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31A-179 (11) 19 WASHINGTON AVE BP-2019-1406 GIS 0: COMMONWEALTH OF MASSACHUSETTS Map.-Block:31A- 179 CITY OF NORTHAMPTON W.-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category:ADDITION BUILDING PERMIT Permit# BP-2019-1406 Pmiect# JS-2019-002269 Est.Cost:$335000.00 Fee:$2177.00 PERMISSION IS HEREBY GRANTED TO: Coast.Class: Contractor: License: Use Group: THOMAS DADMUN 107919 Lot Size(sp.R.): 11282.04 Owner. SHASHOUA MICHAEL&ZOLL MIRIAM Zoning URB(100)/ Applicant: THOMAS DADMUN AT. 19 WASHINGTON AVE AonlicantAddress: Phone., Insurance: 60 SCHOOL ST (413) 387-7381 HATFIELDMA01038 ISSUED ON.612012019 0:00.00 TO PERFORM THE FOLLOWING WORMADD 20X24 REAR ADDITION, SCREEN PORCH, FRONT PORCH AND PREP FOR FUTURE DETACHED GARAGE 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: Nouse# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: 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 Occuoancv Sienature: FeeType: Date Paid: Amount: Building 620/20190:00:00 $2177.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 2 File% BP-2019-1406 �J ely l APPLICANT/CONTACT PERSON THOMAS DADMUN - f// ADDRESS/PHONE 60 SCHOOL ST HATFIELD (413)387-7381 PROPERTY LOC WASHINGTON AVE MAP 31A PARCELL 179 179 000 (rJla d—S1 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCL D REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid , 119f Typeof Construction: ADD 20X24 REAR AD TI EEN PORCH FRONT PORCH AND PREP FOR FUTURE DETACHED GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 107919 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 Plan 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 Culfrom 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 Dem pion Delay G zo-za9 Sig re 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 are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning& Development for more information. Department use ordy City of North mpt or P It. ..r- Building De rtme t ,-) 20 D vaway Permit �y 212 Main S at pti ayaaalarry Room 10 an A ilabiliry Northampton, M 010 Oilpi"c r" mctural Plans phone 413-587-1240 Fa 413p5 " 7 piO" Plans Other specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: Thissectionto be completed by office p wkbt-haf>top AwC Map Lot /79 Unit Zone Overlay District Elm St District CS District SECTION 2-PROPERTY OVMERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: If MINAS ZeM d r1tGlUcFt St{ {$Ideuk 1� Waswavl., rata NOx* vAPrBa, MA bto(ao Name(Print) Current Mating Address: All „ —4u3'407 6 4"/ Telephone Signature 2.2 Authorized Anent: I'V6Kk5 VA9N+hJ 4vir- St 4ATft"o OA otos Name(pt r ' / Cu a 5 Ad /d1/Wwac /%) 13 3s7 3v Signature T SECTN]N 3-ESTIMATED CONSTRUCTION COST8 Item Estimated Cost(Dollars)to be Official Use Only completed bpermit applicant 1. Building �I.�q Up0 w (e)Building Permit Fee 2. Electrical ; F . (b)Estimated Total Cost of boo 1 Construction from 6 3. Plumbing 11 )q'Doe .+ Building Pori Fee 4. Mechanical(HVAC) 4 5. Fire Protection 6. Total= 1 +2+3+4+5) Yj5 OuryCheck Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissionerfto actor of Buildings Date '�bVA � @ dAdHAUhJC . COMA EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING Alt Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be fille4 in by Building Depanmenl Lot Size _..... Frontage Setbacks Front 3)r - ,v��r Side L: 13�wR: 1511D L:II ti'YI, R-J 1O, Rear —� Building Height Bldg.Square Footage % Open Space Footage % (Lm arca minus bWg&pawl mkin ft of Parking Spaces Fill: volume&Ircvion A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW ® 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 kl B. Does the site contain a brook, body of water or wetlands? NO O DONT 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 O IF YES, describe size, type and location: E. Will this construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5 DESCRIPTION OF PROPOSED WORK(check all applicablel New Nouse Addition ® FReploacement Windows ANeration(s) © Roofing rsAccessory Bldg. © Demolition ® igns [OI Deeks [O Siding [0) Other[EJ Brief Descnption of Proposed rp� �� Work: &NVLat CAM NLt. To Fuu-TWoStvfl AoO 201L4 4*IL Ago, ;*�, SL1LUti Yrrwt+, fnaor P*W AaD .. w FOIL FvWxii, DwAaco 4kMOC. Alteration of e>vating bedroom r Yes_No Adding new bedroom X Yes No Attached Narrative Renovating unfinished basement Yes —_Ia--No Plans Attached Roll -Sheet aa.If New house and or addition to existina housing, complete the following. a. Use of building:One Family )!i Two Family Other b. Number of rooms in each family unit: Number of Bathrooms 3 c. Is there a garage attached? t4 " d. Proposed Square footage of new construction. Dimensions 1oIY1 ' TWJ yrvC�7 e. Number of stones? TWO �Ir yl 4, sr L Method of healing? Fik91AsJT IW � ({wM1 31.A61 Fireplaces or WoodatovesNumber of each_L-JJpD g. Energy Conservation Compliance. Masseheck Energy Compliance form attached? Nu h. Type of construction L Is construction within 100 ft.of wetlands? Yes -_2L-No. Is construction within 100 yr. floodplain_Yes_LNo j. Depth of basement or cellar floor below finished grade it. Will building conform to the Building and Zoning regulations? �_Yes_No. I. Septic Tank City Sewer__X — Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGEN`Tt OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, f`l ILt/CMS UL as Owner of the subject property hereby authorize IIN s'v(J'S 1lrN to act on my behalf,in all matters relative to work authorized by this building permit application. ��u�ir �s�/ 1 rah 1 201 Sig aNre W Ovmer Date ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. �erM nhOsw.� Print Name O-fll� Signature of ownenAgent Data SECTION 8•CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: I Not Applicable ❑1 Name of License Holder: ICWW11'S D ,J LS- (b r G 411 C .I1 Loense Number leo dam` $t. I �}A7(IELDr VLA b1o3E a �L�loIQ F�Iialion Data ;Yk _f. �wAn� hf3 3fl7 �JV1( SigneWre Telephar 9.Raelalerad Home Improvement Contractor: Not Applicable ❑ -r L T)owcia. ow( t-H 6 b), Company Name Registration Number Ido 'if 600ti Sr, bra tLo MA 01038 &12'112022 Atldress QQ // I r Expiration Date Telephone 1 -361-73 SECTION 10•WORKERS'COMPENSATION INSURANCE AFFIDAWT(Ill c.153,f 35C(8)) Workers Compensation Insurance a/fMavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton �l d '( Massachusetts 1•. rr` ` $ » DEPARZKM' OF BUILDING ZNSPFCTrONa 212 Win 8t "t • anniciwl suildinq ♦• 6C� Northeton, M 01060 -- + 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 must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction,alteration, renovation,repair,modernization,conversion, improvement,removal,demolition,orconshuction of an addition to any pre-exishhg owneroccupied building containing at least one but not more than tour dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:!f the homeowner r has contracted with corporation or LLC,that entity must he registered Type of Work: ryWe4ftoNS � Awitloo Est. Cosk i3m,bbor Address of Work: 1q WI5*jrIvPt AA - Date of Permit Application: +yVE I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): —Job under$1,000.00 _Owner obtaining own permit(explain): _Building not owncroccupied Other(specify): 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.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES 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: �uDL L bg14 ltek41t6 VXINAJ'.) 1196bz 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 T S< Massachusetts DEPATMENT OF 8 : IIS min Street OWanii l Ruilang aortn.mpt ' WER �C<< �n 01060 .v1� 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: to wGN.) ASE. (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: "Y,ii TtWGIGIJL . (Company Ngameean Ad cess) xtl�_.l_ I/r t 1�>f. ( 2a[9 Signature of Permit Applicant or Owner Date 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. IV Cornernowealih of Massachusetts Onlslon of Professional Licensure Board of Building �Regulations and Standards COfI{`rpurp��rvl5or /r CS-107919 �tres 0121l12019 THOMAS DADMDN 80 SCHOOL ST HATFIELD MA 01008 Commissioner 4 cT/ woov Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home improvement Contractor Registration Type: LLC THE TUCKER GROUP LLC. Registration: 179682 Expiration: oe/zT/zozo CO SCHOOL HATFIELD,MAA 01038 Update Addraw and Return Card. office of consumer mads a awa.»g.aWaticn HOMEIMPROVEMEMTCOMr$I=TOR Registration valid for Individual use only TYPE:LLC before the expiration data. If round return to: Raoistratlon EMAEN&D Office of Consumer A.deba and auMness Regulation 179602 0e/2T/2020 f 000 Weshimwrt Street-Suit.71 THE TUCKER GROUP LLC. Bostom MA 02119 THOMAS DADMUN WSCHOOL Si HATFIELD.MA 01039 Underoecrefary Not valid without signature Mit A MOM 7142e2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURI IS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the cerUfkele holder is an ADDITIONAL INSURED,the policyfies)must have ADDITIONAL INSURED prwislon{or be endorsed. If SUBROGATION 13 WAIVED,subject to the terms and conditlonf o/the policy,certain Policies may require an endorsement A atelement on this a1rUlIDMe does not confer rights to the certificate holder In lieu of such endoneemem(s). PaOwcER CONTACT NAME. Susan Fleury,010.DISK, King B Cushman Inc. Px�wu dal, (413)584-5610 Na (4191504-9332 P.O.BOX 447 AapREEe. id, @kl,c,XhPMP.rn 176 King Sbael NSUMNS)AFFprgMOCOYER NAK. NOMempinn MA 01061 RLfhNi Main Street Amerim Assumllm Do. 28939 ONSION D NSVRExa: DADMUN DESIGNSCONSIRUCTON NwRmc: W SCHOOL ST MwRa O: MICE: HATFIELD MA 01036-9747 NwM91 F: COVERAGES CRFIIR WNUMBER: CLI01IM2970 REVISION NUMBER: THIS IS TOCERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT NTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MY HAVE BEEN REDUCED BY PAID CLAMS. mm LTR IYPEOFINEURAHtE I011CYMMlp1 IJWTf X COMMEROALaENEMLllA9LITY EACH nCC11RRENCE a t'ottgo O .MSWOE OLCIR PRERACE$ a a Botoolf MECEv a tOPW A AIPTN910 11/13n016 11/1an019 REABdMLaAW IxuRY f t.ocal'cato OENINXREDATE LIMITAPXLIG PF0. DEXEMLAD(VIEGR' 3 2.0011'000 POLICY ❑JECT ❑Lbc PROWCTS-COMP.aP K.B f 2.0110.000 OTNE fl. Identity Recovery f 25.000 AUTOMOBILE WBIUry ZOO E. L f B] pNandiderm YAUTO OILV INRYNIPm m Pon { ALTOS Y AUTO BJOILY INIURY IPxxAiM S HIRED NONIOMNIED AUIOSONLV AUTC6p6Y Rmiw f f W9BlALWOCLTM EACH OCCURREXI'E f FXCE&9LW CIAEI — A3KNN<NE S DED RETEMKMS a nO0fER4 COMgNeATpM N .LOYERMLMW1Y VIM AT Am'PROPRIETg4PMmelMEXECUIM ❑ MIA EL.FILXACGM.M s ONFICERMEMBEREXCLUYW IMxWory M NIM ELM E.MEWLDYEE a nw<B✓/Ir. . DESCNI"T NC£OPOATIONSaFHn ELDISE EL CYLIMIT a OeaW1M)XDF OITM1KMalLMAlg1M/VEWYEI IACOtDtH.MINsxI MxsEr atlwiY.mYNaesMXnlwpruY IpuMl CERTIFICATE HOLDER CANCELLATION SHOIJ D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTnORIiEO REPRE9ENTATM _yl'-t>.XtA_ 1L-A. 11JJ ©1988-2015 ACORO CORPORATION. All rights rsserved. ACORD 25(2016/03) The ACORD name and logo are mgistered marks of ACORD The Commonweakh of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Willarkers'Comperessation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Informationfr. � � Please Print Legibly NaDte (Business Org//aniz tionandividwl): ijh- Tuf"it. ITT U-re Address: V O &k W L St, City/State/Zip: F1"It R btvPho,,#: +3-bol-lbbj Areyaa v empbyer'¢saes the appropriate 6az: Type of project(required): I.E]I am a employer with isnipimses(full and/or pan-time).' 7. 4 New construction 2.Fjr amssole pntaimoror partnership and lave no employees working for me re S. Remodeling any capacity.[No workers'comp.insurance nquind.] 9. Demolition`L�.J., 3.1[am a homeowner doing all work myself.[No workeri comp.irem."ined.]s 4.[]I am a homeowner and will be Ening contractors to conduct all work on nsy property. Iwill 10 Building addition ¢more Natall conaacmrs aides have workers'compemadon ins..'are so to 11.1 Electrical repairs or additions proprietors with rm employ«s. l2. Plumbing repairs or additions 510coI an a general connowtor and I have hued the sub coneractan listed on the reached sheet. Thesesub- mumors have ampleyees and have workericonat.ins..: 13. Roof repairs h.[]We ere is cospotwom snd is officers have mercisN their right ofexempdoa per MGL c. 14.❑Other 152,§1(4).a we nave no employees.Mo worker'comp.inswetae raluired.l *Any replicant Nat checks box#1 most also fill out to section below showing their workers compensation policy info ation. I Homeowners who submit this affidavit indicating they are doing all work and Nen hire ouaide connectors must submit a new affidavit indicating such. :Connacmrs that check this box must atached an additional sheet showing the name of the sub- mtmcars and state whether or not Nose amities have employees. If thaw conmwlms have employees,they must provide their wmkeri'eamp.policy number. 1 am an employer than is providing workers'rompensatios insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date:, I ,� Job Site Address: 11 umihtlOtw M& City/State/Zip:2.lt ren Dow Attach a copy of the workers'compensation policy declaration page(showing the policy number end,spine on date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the turns 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 thepains,a����l pe rs ofperjary that the information provided above is use and correct Sionature. -1 AL. - 1 `UMAvw-- Date dSNE (al 2oLAl Phone#' '113- bV-11lM Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector b.Other Contact Person: Phone#: r DADMUN Design +Construction Project Address: SubContractor List 19 Washington Ave 6-Jun-19 Northampton, MA 01060 Subcontractor: Has Employees: Yes No Hampshire Concrete X R. H.Adair&Co. x Domian Masonry x Wallace Plumbing and Heating x James Elkins Electrician x All Seasons Heating x Brian Polan x Alexander Leonardi X SDL Home Improvement x Right Way Drywall X Cortina Tile x Dion Flooring x Executive Painting X AC=' CERTIFICATE OF LIABILITY INSURANCE D e/10161 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND 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 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certifica ,holder Is an ADDITIONAL INSURED,the pofryllal must be endorsed. H SUBROGATION IS WANED,subject to the terms and conditions of the oollcy,Certain Policies may require an endorsement A statement on this certificate dose not confer rights to the cedifuu,holder in lieu of such en lorsemen sl. PROWOEa CONTACT Nes, Christina Barrett Aquadro 6 Aaaoccates PNONc EDI, (413)586 7373 Arc xec Uulet6-6.s 355 Bridge St. , P. 0. Bore 357 _r�L Mal $ AFFO CW Iti.... IYta Northampton wh 01061 IAauReRA:Tre 3 re Imuran" CpqNEnX INSURED - INSURER a:Ra Grounars bel InaseCa 1,11711111 All 8eaaons Heating 6 Air Conditioning Inc. eaUReRc: 93 RINA St eftuallo. INSURER a: Batlield 2A 01038 1 I.UReR F: COVERAGES CERTIFICATE NUMBER:CL1652607678 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WN RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHORN MAY HAVE BEEN REDUCED BY PND CLAIMS. ILot N TYPEOFINSURANC6 yN FpLICY!)F 4XP Jamr, % OOINIYutuL OH1eRALwWM4Y EACH OCGIRPF2,CE if 1,000,000 A _J CLAMSAPDE ' X�OCCUR a 3001000 (FF 60010.5056. 1/10/2016 7/10/2017 NEP W ANmN psm, 4 6,000 I,_� PEA60MMaAWOWIY a 1,000,000 GBn KgaE0A1EMryWgprt.IfRiJRBt OEN014aLA00RMA7e 0 3,000,000 % PULICv ,RPT ❑La PnOWCTO-CDVAP AOO 4 2,000,000 IDI 0 AUTOYpOIa LUaalfY ."visai Lear a 1,000,000 B MIY AUTO OWLV MMLY 1Pe p,Fall a 61Lon D = 8C1®IA2D MT65295 7/10/2016 7/10/2017 aOOava (fts ) a AVm8 X .,.ED TCS Z /1RD6 a EFUJIN 8 ' u1HREW LYa -C- EACH ODD4NIENCE a ' ERCEea LY9 _ L CLANeyeac l M01{dR1E a R YA)PI(6RI WIIPENM110N AND LYPLOYERV YAMNTY YIN Ks p O ,ETOR,PARTNER XECUTILE RIA SL EACH ACCDENF a 1 000,000 AIMUN IN�sr Nm EXCLVOED+ _ NCT61111 W10/2016 ii 34/20 -1 .000,009 M .Cewb,nN, RIFT lYr OEaGInR110P OPMAl10YEl LPCAlp1101Y6iY0 MCORD 101,A6atlpulwins) CERTIFICATE HOLDER CANCELLATION TOMD@DADMUNDC.COM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DADMUN DESIGN 6 CONSTRUCTION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 60 SCHOOL ST ACCORDANCE WITH THE POLICY PROVISIONS. HATFIELD, MA 01038 AUTWO bREPReeENTATNE C S1)111van/CMS -Cli - 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014,01) lin ACO#EI,l and ki a registered marks of ALONG INS026I:c1a1I AC R& CERTIFICATE OF LIABILITY INSURANCE m)aazpt9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND 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 CERTIFICATE OF INSURANCE DOES NOT CONSTRUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT If the urMkRe holder IS an ADDITIONAL INSURED.Me policylHs)must have ADDITIONAL INSURED provbions or ha andonW. It SUBROGATION IS WAIVED...bill to the W..End CondHbn.of Mo PRO,,..I.poli errs may hR SIre an andOner enL A abbr.nt 9R Mb La1iHKEN doe. of COOfar dphb t0 Me.rdNCab hada,le loo of...h..d.o emant(il oHDDDCIRENE. Cynme Henderson CISR.CPIA V.aoon a Goonri oHoxE IH3)S86g11t Xal la6)6668Eet 6 NOM A.,JIR¢I NppRFn: chordWpn RAvbbw kVeYFA.2 N AMOIOM.L�IA9C NN.• NpM.mp1. kN D1o6D Nwa:RN: SaklrAvE Mc9as CENINM ,ns9 W611rEp NholeageLp, SeMCUw Ne cdasatuMr 3W26 SDLHhhe ImpR,,A, ant C.FEAM .,Inc. R6u9Fnd. 21 C..Sheel MSIIRFR O: MWRER F: Ha ulld MA 01038 RF! COVERAGES CERTIFICATE NUMBER: M Evp2020 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED BELOW FIVE SEEN ISSUED TO THE INSURED HANIMABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANONGANYREQUIREMENTTERMORCONOTIONDFANYCORRACTMOIHFADOCUMEMWITHRE9PECTTOMMOITHM CERTIFICATE MAY BE IS6UED Ot MAT PERTAN,THE INSURANCEAFFORDEDBTTIEPOLICIESDESCRIBEDIEREWISSUB.ECTTOAUTI TERMS, EXCLUSIONSAta CONDITIONS Cf SACH POLICIES.LIMITS 3ItOWN WT INV.BFFNFEpUCFDBY PADClAMS. Lm TYPEDF Al Palcrxueeat Bal COtWIKIALOBFIrAL DABEITY EACH h0hata ICE 1. I.a9o.DpD CLANNADE ®occuR . . � rMp ExP s t5,00D A 82291600 olorvaItB 0ImIn020 PER.fNKaA,INNRY f 1,OOD000 G 1A0DIEGATSOVETASBOR. ER: 6F1rERALAGGPEWTE 1 3,000,000 —Y�I�EC6T OtCt MOWCi6.D}1PiOPAW I J.N0.000 O'ER s AUTOMO9eY W WITY 1 1.000.000 vAOTO .Cd.Y iNJUW IPa.prruq 1 A OWNED 6CHEWIED A9106120 O1/01I20,0 O1I0fY1020 BVON,VB'IO"Pe EVIwNr f SUTOG ..BE..1NON4ANED A1TOS EAL, AVTDHONY 1 UMMlreurM magm181 1 100.000 UWREMAYN o"Be EE OCCURRENCE f 1.000.000 A ER(Ias OAe CINNr.MAa 53391508 O,m112019 O1g1ItD30 ACOREWIE 1 1.000,000 I. I I RETEMKK/. s AW ErIPImE 'Boeal B S DNEoN,A 80992456 D2RJlb ONYd202 ELEACHA VDEBT s � IaxWWeNH) EL Deal IS5N'" .SCNPTgry CF CPERAigN6 rwLwr E.LMSEASE.M Y. IS 6W.OW -.. .ECRIPTION CfOPERATIWe1LOL.ITIOrI61VMICLE81ACdID 101,MNWmYl4mrb hnMY.myb Wwbd Eelepw Nnp.M1 The Vbrkerfi Comper mt.yollcy does But odude CCveOP W PM Schmd.K.Tek, k Dempsoy and DaGM Salnvd[ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POL CIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.HOME BALL BE DELIVERED IN DADMUN Deeipn.Comtruor l ACCORDANCE WITH THE POLICY PROVISIONS. fl0 S,I Street nu umR¢to utrwr.a+rrurvt A ) Hetfirld MA O'OJR D 19884015 ACORD CORPORATION. All rl9hte reserved ACORD 2612016MJ) Tho ACORD name and logo are ra,Roared mark.of ACORD Client#:41801 CORTII ACORD- CERTIFICATE OF LIABILITY INSURANCE °"/'"�Omm 04/16/2019 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND 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 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:Nthe certificate holier IS an ADDITIONAL INSURED,the pollcy(Ies)must have ADDITIONAL INSURED provisions or be arMoraed. N SUBROGATION IS WANED,subject W the farms and conditions of the Policy,certain policies may ra tuire an endorsement.A statement on this cenlfican does not writer any dome to the LedifiCe holder in lieu of such endorsemends). PRODUCER Mary A.Henderson People's United Ins.Agency MATE En;413781871 AIC xR:846805.1990 One Monarch Place,10th Floor .am. Mary.Hendereon@peoples.com PO Box 4950 sMU 3 AFFORDING COVERAGE NAC' Springfield,MA 01144 NWM A:Merchant Mutual Insurance Cc 23329 INBVREa MW.B: Cortina Tile of West Springfield w 1645 Riverdale Street NW .OUM G: West Springfield,MA 01089 MOVREA E: MXORER F: COVERAGES CERTIFICATE NUMBER: REWSION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POMCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID Cl-AIMS. NSIR DC EOFWMPLYXYA ET MILT EMP LIMITS A X COMYEIILIALABIERLLWMIRY BOPM71B49 3/30/201903/301202 EACH aCCURRENCE $1,000,000 pENTFD cwMsnuDE X occuR Eaov,nmx $500,000 X BIM AI Per Prior naso ElPc m ma,l $5000 Wd ton Contract PEWPONK0AOVMJURY E GEN-LAGGREWTELIMRAPPUESFER GENERPL AGGREGATE s2000000 POLICYOJr LOC PROCUCTB-CIXace AGG s2000000 OT ER' f AVFONOEIIELIABIUIY COASkert)SIWLE LIMIT ANY-TO WIDILYINJURY(Remmn) f 27 EEDONLVAUTOSNLED BOmLY INJURY1Pw®Jeslll f HIRED 1gNOWNEO PROPERTY DAMWE s AUTOS ONLY AUTOS ONLY amEXll f AXUN ELw X OCCUR CUP9146566 3130/201903130/2 EACHoccURRENce, $1000000 FJI .UAB CIAIMSIIME AGGREGATE $100001K), OEGI X1 RETEMICef1D000 s A WORIQAe COMPENSATION WCA1033448 3/30/2019 09130/202 X PER mH' ANG nPLOmW UAMLm TE MY PROPRIEICRPARTNERFXECUTNE YIN EL.FACXACCIGENi $500000 OFFICERiMEMBER EXCLUDED? O X/A nesues In NM EL.DISEASE-EA EMPLOYEE $SOD000 ryas esscroe u. , DESCRIPTION OF OPERATHMS.. EL.DGASE-PoIJ UlfflT 1$5011,000 OESCN IONOFOPERAM /LOG S[VEHICLES(ALORD101,AaeNp,MRamFxuacnaauX,mayaaaftcn Xmmmasp ls"uY I Blanket Additional Insured per Merchants form MUS277(1111); Blanket Additional Insured-Completed Operations per Merchants form MUS530(1111). Proof of Insurance CERTIFICATE HOLDER CANCELLATION DADMUN Design+Construction SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Tom Dadmun ACCORDANCE WITH THE POLICY PROVISIONS. 60 School Street Hadfield,MA 01038 AUTT,H��O""RME°D REPRE9 AME ®1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1081057/M1081053 MADCT A41 1 oR& CERTIFICATE OF LIABILITY INSURANCE p7i2;/2027 ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND 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 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certHlCate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. H SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endoreeme e. PRODUCER XEAOi Barbara Grynkievelcr Nebber 4 Grinnell WE. . (419)586-0111 F'� (ilalfei-Nei S North King Street Ems;bgryaklwiCafwebberaedgrionell.ea IFFMOMO WYLSE,9nC IWCI Northanpten IDL 01060 MMMERA:Pat MI1tua1 Ina. Co. of CZ _ INSURED ...B:Stab Auto Preopearty E Caurnialty tae. A. Dion L Sort Floor Contractors, LLC INSURES C: Attn: Donald 6 Caren Dion INSURER D: P.O. BON INSURER E: Hadley NA 01035 1 INSURER F: COVERAGES CERTIFICATE NUMBER: 1/1/18 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING MY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CI-AIMS. Raw.SURRI II'M TYPEOFIM&PAMCE MBE. mm�PoIJCYEFF 1 PMEXP Wrs Y COI/ERCMLOBJEMLLNBYIY EICN OCCONIFNCE f 9,000,000 A 6rWMSM.OE ]OCClllt sEeamnsu i 900,000 BOP2906663 03 7/1/2017 1/1/20111 LEn EID(MyoreLwO f 5,000 PFRsonuirnvewm S 2,000,000 OEN'LAGGREWTELIMITFFREaF OFNFAKPGGIaiGATE f 4,000,000 X PoLILY X 1ELTRYE Lac vRCDIICTs-CO.NCP AGO f 4,000,000 OTHER f AMMOMLE UA61U1v nl N L L f 1,000,1100 A ANY-TO SOOILYINJURY(Per,K) i AALL UTOS ED Y �U11]) W2606132 09 l/1/201] A7/2/20LS Y INJURY(PAY ANAMO) i X XIREO M1T08 Y AIlTEO ERTY DP1MXIs Nc f 8,000 ' X UMBRELLALWOCGNema Z 000 000 AEIKEB6 WB OVygMN)E EGF,TE f RETENTION .2125771 03 77/1/2017 a ERS COMPENSATIONAND EMPLOYERS'UAnLnYOHPRTHERIEIECUINE YO MIA GNFfACO1r a 1 000 000 BOV,iCXNLn NEU ERCLUOEO? WP2227689 03 T/1/2011 ARE-EAEWL f 1 000 000 m LIPDESCRPTIONOFOPERALONSMNN M'A9E-PgN:Y 11MR i 1,000,000 DESCRIPTIMNOF OPEMnONSILOC NSIWMCLM(ACORD 101,...ntl RemerFs Sd1e4u1e,may Oe aXecMJ II moM1eWc6 IF EMUNNE CERTIFICATE HOLDER CANCELLATION tomd@dadmundO.coN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TON Dad.= THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 60 School Street ACCORDANCE WITH THE POLICY PROVISIONS. Hatfield, MA 01038 AUTHORIZED REPRESENTATIVE H Huron, CIC, CISR/BK ®1988.2014 ACORD CORPORATION. All righb ra"med. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025¢m4L11