35-224 (12) 46 LADYSLIPPER LN BP-2019-1044
GIS x: COMMONWEALTH OF MASSACHUSETTS
Ma : lock:35-224 CITY OF NORTHAMPTON
Lon-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category:Srair BUILDING PERMIT
Permit x BP-2019-1044
Pro ect# JS-2019-001701
Est.Cost: 85500.00
F 65. PERMISSION IS HEREBY GRANTED TO:
Const.Class: Conhaetor: License:
Use Group: ALISHA PHILLIPS 106378
Lot Size(so.R.): 91040.40 OWner. 14ORNOR JOHN W& RONALD E SKINN
Zoning: Annlicant. ALISHA PHILLIPS
AT: 46 LADYSLIPPER LN
Aoaiicant Address: Phone: Insurance:
40 PINE VALLEY RD (413) 586-5986 WC
FLORENCEMA01062 ISSUED ON.3/2212019 0:00:00
TO PERFORM THE FOLL0WING WORK.REPLACE SET OF CONSTRUCTION STAIRS IN
BASEMENT WITH NEW STAIRS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building inspector
Underground: Service: Meter:
Footings:
Rough: Rough: Houses Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department FireplaceiChimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Sienature:
FeeTvoe: Date Paid: Amount:
Building 322/20190:00:00 565.00
212 Main Street,Phone(413)587.1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File N BP-2019-1044
APPLICANT/CONTACT PERSON ALISHA PHILLIPS
ADDRESS/PHONE 40 PINE VALLEY RD FLORENCE (413)586-5986
PROPERTY LOCATION 46 LADYSLIPPER LN
MAP 35 PARCEL 224 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSfD REQUIRED DATE
ZONINGFORM FILLED
Fee Paid
Building Pernnit Filled out 00-17
Fee Paid
Tvveof Construction, REPLACE SET OF C Nff.RUWON STAIRS IN BASEMENT EW TAJRS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 106378
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
_Approved_Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER-.§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plain AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance"
Received&Recorded at Registry of Deeds Proof Enclosed
_Other Permits Required:
_Curb Cut from DPW Water Availability Sewer Availability
_Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
_Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
_ 3-2I- ?019
Sign ire of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
•Variances sre granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
Oepartmem use only
City of Northampton Smws of Pelma:
y.' Building Department Curb CuVOrrvevroy Permit I V D
). 212 Main Street Sower/sepuc Ava�labii�ry
Room 100 Watornveli Avaeabibry
Northampton,MA 01060 T.sem Of structural Put 201
phone 413.587-1240 Fax 413587.1272 Pbusae plans
Ogler Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE Olt FAMILW OF G INSPE ONS
60
SECTION 1•SITE INFORMATION
1.1 p oft
AEereaa: This"~to be complated by office
HV L,d p�" l 144L Map Lot Unit
Fl.'e4f, F(IA a/vol zone O"'layomma
EM SL Dmbkt WDIWbI
SECTION 2-PROPERTY OWNERSHIPIAUTHOMMO AGENT
2.1 Ownar ofRKOIe: 3a^� y` La/yrs�i%r,/yj L4AG
NanN{Prara) lTelaa Madiv Aaharas:
412- Lo-7ye
TabpnuM
ss+Wra I&
t.2AuthodatiO :Acre pff Yv hit ✓ilk GMCI
i Tyke, PFr i F/e inCT. 24 0/1062
Hama
IP cueenl kmarq atervia,
1/3- Sao 96 6 9
Spy Tdargcnar
SECTION'•ESTIMan?O crTNSTRucn15N costs
Haiti Estanalm Coat(OWms)to ba Of/tial Use Orgy
cornpleted by permilt applicant
1. BmMarg ' S' .SOU (a)B.Afap Parrett fa
2. Head (b)Est"had Total Costbf
Corutruam from 6
3, Plumbing Bupeitle Parretti FN
4. McMand(HVAC) (�+
5.Fire Protection
e. Tamia(1.2.3.4.5) Check Nurnbsr
This Sadler Fa Official Usa Only
Data
Building Parrnt ISS.
IF
siDnewra: 3-21-2019
a."caaatlseimsnmpeaar d aw" caro
EMAIL ADDRESS (REQUIRED;I EITHER HOMEOWNER OR CONTRACTOR)
�,;y ,_..
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to W tillcd in by
Building Detainment
Lot Size
Frontage
Setbacks Front
Side L: R: ,. L —_ R. _..
Rear i...
Building Height
Bldg.Square Footage
Open Space Footage
(Lot am minus Dldg&peed
Pact
#of Parking Spaces
Fill:
volume&Location
A. Has a Spec' ermit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW O YES O
IF YES, date issued:.
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? N NT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O Date Issued:
C. Do any signs exist on the property? YES O NO /
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO��
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,gradin ,exca n,or filing)over 1 acre or is R pan of a common plan
that will disturb over t acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
DESCRIPTION OF PROPOSED WORKk
HIM Houw ❑ Ade8lon ❑ Rapladmant Wloduwa Albrstlon(a) Roofing ❑
Or Door D
Accessory Mg.
fD D.molleen ❑ Ww Signa (o) Dews IO SldMg WI O/lRiwi
wwk.'�P/A CHi. p3tf PF cpnsrM c/,r•N S1h;it !e b<finrrf 4.f�f� Vi✓ SN'oT n%cf� Sh%i ,
Alterabon of aysbng MMourn_Yea No Addug,.bedroom_Yoe _No
Alti Namfive Renovating unhNSM lumnent _Yea _No
Hays Afla Roll -Sheet
ea.if Now house and or addition to yxistling housing.complete the f II 1 a,
a. Use of ouldioq Ona Family Two Family Omer
b. Number of rooms in each famdyuM: Numberof Ballroom.
c is agarage atunnie?
J. Proposed Square lootege of rww oonawctkn. Dimensions
e. Number of stabs'+
f. Method of healing? Finplacim,&Woadatoves Number of each_
g. Energy Contuunu bon Camplienw. Ma nidn,d Energy Canpliance from eMched?
K Type of const u kmn
L Is oonsbucbon M.100 ft,of wetland.? Y. _No. I. larudion w vo l W yr. eoodplain_Y._No
j. Depth of basement or m1lar floor below Mlslled grade
It. Wit balding mnrorm to"Building anM Zoning regNrtions? Yes_No.
I. Sepik Tenk_ City Sewer_ Private""_ Dllywater Supply_
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONATR'ACTOR`APPLIES FOR BUILDING PERMIT
I --5- ,V W QI� NO ,as Owner of Ne subject
propero I Ptl lli
Mreby auNorrse
M aG on my Ce11N1 n M wafk aWldizad Mia Medrg pemR
sgreNn olonner� DaH -
AJ's6. TyL. OL-/lros tee. AaMgd.�
Agent MrebY depare Ma[Me atemeMe and mlorma on an Meforegpinp apWMHon are gua end alFluaM,btlN Mal of my kmwletlga
and bpllef.
Sgned upM Me pars and penaloob a perjury.
,Aga, Tvb. Ply/legs
vnnt Noma
3i
BiOUWro
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SECTION 8•CONSTRUCTION SERVICES
8.1 Licensed Construction Suoervisor: NotApplicable ❑
Name of License Holder ALL Ty / Pi1�oLp�— /Q(1 3?p
.T License Number
0 (76 z/z4 12-0Address Espimtion Date
`/13 - 3.2u - 9GG
na - telephone
9.Realstered Home Improvement Contractor: Not Applicable ❑
A-A .I1T Lgn�SaA, d Ilodae �gGyaun/+t I71IL1116
Company Name Registration Number
10 P,,1L 1/4PAJ Fl mct. ,N.F 0/&162 Address Address / Exp1 'onoG/
Telephoire //3-320—f1
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.n 152,1 28g8((
Workers Compensation Insurance affidavit must be completed and submitted Win this application.Failure to provide this affidavit will result
in the denial of the issuance of Iha buil g permit.
Signed Affidavit Attached Yes....... No...... ❑
City of Northampton
Massachusetts 3 y-
c
` D&PAP� OF surwi1C zmspl zws
113 Min 9ezaet0 010 Mwiclauildlnq
Ml1 0102
6ovNwpWn, 60
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor most be registered as a Home Improvement Contractor("HIC").
M.C.L.Chapter 142A requires that the"reconstruction,alteration, renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction Oran addition to anypm-existing owneroccttpmd building containing
at least one but Trot more than four dwelling units....or to structures which are adjacont to such residence or building"be
done by registered contractors.
Note.if the homeowner has contracted with o corporation or LLC,thin d
entity mast be registered.
Type of Wmk: k 6;ld •C Citsh C *t Est.cost: C�
Address of Work: Nb ��e1 r /fL /r CC a G2
Date of Permit Application: nj
I hereby certify that:
Registration is not required for the following mason(s):
_Work excluded by law(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
Building not owner-occupied
Other
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.C.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITIES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
Aw.,t) IlNNI-f
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Massachusetts
i
i\ DEPARTMENT OF BOZLDZM ZNSPECTZMS .0
212 Main St " Nun BNilainq C
NOr[hWpion, W 010 01060
Massachusetts Residential Building Code
Section 110.R5.1.2
Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,
on which there is, or is intended to be,a one or two family dwelling,attached or detached
structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner.
Section 110.115.1.3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5,provided that if a homeowner engages a person(s)
for hire to do such work,then such homeowner shall act as supervisor.
Such homeowner shall submit to the Building Official, on a form acceptable to the Building
Official,that he/she shall be responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to
time,during and upon completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153
(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts
General Laws Annotated, you may be liable for person(s) you hire to perform work for you
under this permit.
I
City of Northampton
Tdrr -_
Massachusetts
r M x
(� ospwar¢Nz OF eorrorac rxspscrroxs �
y, 213 Nein street .Municipal Building
North- toa, M 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
(Please print h Vas nurp r and street name)
Is to be disposed of at: // (J / / ,y�
VlJe cI d, Z3 1 9$ l,11an �r/ A'4- /'/� 0/066
(P ase print me and cation of facility) /
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address) r
3 J
Signature fl"Olegll
or Owner Dal
If,for any reason,the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
WiWcarkers'Comperossition Insurance Affidavit:Builders/Contm&ors/Electricions/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Le ibl
Name(Business/OrganivtioNlndividml): Ayliarlta, Lesibuthcf G I
Address: vy Asiavw11 d
City/State/Zip: 11- D Phone#:
Are
youu se'byerr Chink the aPrimprlid,hos: Type of project(required):
1. employer with--�--employoes(full monm urt-tim )'. 7. ❑New construction
❑lamawlc rromiswwpamcrshiP and love mcmployaes watiog fwmein 8. ❑Remodeling
any entrain,Mo workars'comp.immeme "mrod.l
i❑Iamahonk wnetdoing all woh myoma.iNo wakns'cmop.imumac mauireal' 9. ❑Demoli0on
4.[]1 am a bromewneraM will be hiring common to conduct all work on my property. I will IB❑Building addition
e (Mianconmct either ww�erscomlK dminw cwvewle II.❑Electrical repairs or additions
pr row.with no employees. 12.❑Plumbing repairs or additions
SQ I am a larval uomamw and I have hired the sub<onmewrs listed on the amched ares.
new mhcnnvruu,hive employ.end have workerscomp.iosunoee.t 13.E]R frepairs 1
6.❑We arc arotpaation and in omcers eveasoiaed tear right ofeaempdon perhol.c l er SAV p(ev
152.§1(4).and we love no employees.(No workers'cintention mop.inteion notiond.] 01SL myt
*Ary applicant that chinks bon a1 must dw fill out the motion below showing their workers'compenmtion policy infomation.
I Homeowners who submit this affidavit indurating they ire doing all work and two hate outside eomtasors must submit u new affdevit indicating arch.
:Consort that cheek this bon must attached an additional sheet showing de name aide lubcammson and stain whether or not Ihow entities have
emplo}ecs. If the subcantacmrs have employ.,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
informadon. _
Insurance Company Name: L -1 H N,9+
Policy#mSelf-ins.Li..#: wlCs- 3IS ��ZSZ3o/tea Expiration Date:
Job Site Address: I�r �ies�NS ltO.�l� �Mt City/State/Zip: F/�K0et"" � C06 r2
Attach a copy of the worke nom nation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to 51,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penafties of perjury that the information provided above is true and correct.
Situ aturc Data
Phone#'
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Perstrumcense#
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.Chy/fown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
1
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under my contract of hire,
express or implied,oral or writtrn."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or mare
of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-oontractor(s)name(s),addrem(m)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required in tarty workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to rhe Department of industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accideuts. Should you have my questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you in fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in my given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licroses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to my business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel.If 617-7274900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
o
.ac ' CERTIFICATE OF LIABILITY INSURANCE
An8001e
THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIMATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If tM ceHlNcale holder IF an ADDITIONAL INSURED.the wOcy(les)muM hew ADDITIONAL INSURED provislons or De en0orsoE,
H SUBROGATION IS WANED,subject W Sn terms arM conditions of IM Polley.certain pollebs may rMUNe an ewarcemem. A statement on
dlie cedllNMe dace col confer d hb to Ne wdlflcale holder in IMu W ewh andorean enNsl.
PRooucLn FINCK 8 PERRAS INSURANCE AGENCY INC _
8 CAMPUS LANE NAE,„ __IIP"rA'.N,x
6 CAMPUS
N.MA 01027 - -- - -
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NNM[NNMIpYpLMaPR ... _ -.IwCa
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"AXIOM LANDSCAPE&HOME IMPROVEMENT LLC P"'F"L. -- -
40 PINE VALLEY ROAD
FLORENCE MA 01002
NausmA
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COVERAGES CERTIFICATE MINIM 4 ] REVISION NUMBER!
THIS IS TO CERTIFY I ME THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE Ecocy PERIOD
I ATED, NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION Of ANY COMPACT OR OTHER DOCUMENT WIIH RESPECT TO NAICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTMN, THE INSURANCE AFFORDED BY THE POMCES CESCRDEO HEREIN 15 SUINELT TO ALL THE TERAS.
FECLU IONS ANOCORN➢ONS OF SUCH PoLCIF.S LIMirs SHONNMAYHAVEB_E_ENRF[HICEDBYPNDCIANIB.
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WORKERS 01]MPENSATN]N INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STAI E OF MA
Ihis mnlfeate calKel9OM 9LPNwdee aY PeNwlsly issl,ed Ce N4fates,oMy ea Mey IlIeN to viarMxrs rgmpensallpn coverage.
CERTIFICATE HOLDER CANCELLATION
CITY OF NORTHAMPTON SHOULD ANYOF TME ABOVE DESCRIBED POLICIES PE CANCELLED BEFORE
212 MAIN STREET MTHE µED" tDAT THEREOF. NOTICE WILL BE OEUVE� W
NORTHAMPTON MA 01080
Au+xo""oRErueerRArlw
Jon 6mllh
010M.2015ACOROCORPORATHM. AIId"nat Ennd.
ACORD 25 12 013/113) The ACORD name and low Me registorad marls of ACORD
..».e-e I L+.nve I :[ u n I :Am.,n I v.x.uu ._.u._, .R ..::. I r•a- -a I
LISA M.rBrM<COTWellan
VBuw.W1 54402
Liberty_Mutual.
INSURANCE
CITY OF NORTHAMPTON Sender n0271703
212 MAIN STREET Phone: (800)1953-7893
NORTHAMPTON MA 01080
Subjeq: N
UDSCAPE&HOMEeM RPRP OVEWNT�CIOM
CITY OF NORTHAMPTON
Date: 8128/2018
No. of Pager: 2
URL:
The attached document contains certificetion of insurance coverage for the insured named in U:e
wbiecl line above. Your company,is listed as the organization requesting receipt of this document.
If au have any questions regarding the content of this communication,you may contact us at(8f10)
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