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38B-012 (3) BP-2022-0049 131 TEXAS RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-012-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-0049 PERMISSIONISHEREBYGRANTED TO: Project# JS-2022-000125 Contractor: License: Est. Cost: 1500 AQUADRO &CERRUTI INC 062358 Const.Class: Exp.Date:02/10/2024 Use Group: Owner: Lot Size (sq.ft.) Zoning: GI Applicant: AQUADRO & CERRUTI INC Applicant Address Phone: Insurance: P O BOX 656 413-626-5698 6S62UB-7H83464-9-19 NORTHAMPTON, MA 01061 ISSUED ON:01/18/2022 TO PERFORM THE FOLLOWING WORK: portion of 2nd floor office space being outfitted as a hydroponic grow facility 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: House # Foundation: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: IMAiL TAIT �J Fees Paid: $105.00 • 212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts / Office of Public Safety and Inspections 4 J 4 /O Massachusetts State Building Code(780 CMR) UBui rding Permit Application for any Building other than a One-or Two-Family Dwelling 6, `' --_ -1 (This Section For Official Use Only) Building Permit Number:2XX3 y% Date Applied: Building Official: SECTION 1:LOCATION /31 Teica5 7oace e/66 v ,40u4 DRa b ceRR 0 Fr s.✓C, o. d Street ? 3 q6 T„r wrn/ Zip Code Name of Building(if applicable) r �oK/o(yl, Tie Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used 1 — If New Construction check here 0 or check all that apply in the two rows below Existing Building Repair 0 Alteration k Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes A No 0 Is an Independent Structural Engineerin Peer Review req ' d? 4QO Yes 0 No, Brief Description of Pro Wor • Ov(.. 02 /002 ?(e Q C - p sad � D/`7'�i bel it, p v-h i tft� !,C A. �c C�/` 'po t G �C Neff Ci I ?c pptoX , -.0ooSIG V SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Z 3596 5 rA'` e rt Total Area(sq.ft.)and Total Height(ft.) 6 / ? 3 5- f 4.4.e SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business ilk E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2 0 I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2❑ U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB 0 IIA 0 IIB 0 IIIA, IIIB 0 IV 0 VA 0 VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Su p y: Flood Zone Information: Sewage Disposal Trench Permit Debris Removal: Public Check if outside Flood Zone 0 Indicate municipal A trencli Nyill not be Licensed Dis sal Site 0 Private 0 or indentify Zone: or on site system 0 required )or trench or specify: C!/P2 permit is enclosed 0 5//e„., Railroad right-of-w y: Hazards to Air Navigation: CommissionMA Historic Review Process: Not Applicable Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed CIYes 0 or No Of, NA./ Yes 0 No 0 ( SECTION 8:CO TENT OF CERTIFICATE OF OCCUPANCY Edition of Code: CO, Use Group(s): ' Type of Construction Does the building contain an Sprinkler System?: 'v Special Stipulations: Design Occupant Load per Floor and Assembly space: City of Northampton t Massachusetts `.' ' ri_ << d . DEPARTMENT OF BUILDING INSPECTIONS D•. r •.,t 212 Main Street • Municipal Building y4.)% a` —- Northampton, MA 01060 '5'.." :0 PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL & MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS 1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work (Digital & Hard copy). 3. Site Plan with location of proposed structure(s) and setbacks. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CSL and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (if applicable). 8. Note any Conservation and/or Special Permit requirements (if applicable). 9. Driveway Permit (if applicable). 10. Proof of Water and Sewer entry fees paid (if applicable). 11. Trench Permit (if applicable). 12. Initial Construction Control Documents filled out and signed by the Registered Design Professional in responsible charge. 13. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton SECTION 9: PROPERTY OWNER AUTHORIZATION N e and Address of Property Owner — / C-TPOLT,WC /3/ ie1051Z 6' 1, /`'U °ere Name(Print) c C k tam No.and Street City/Town Zip Property Owner Contact Information _ it e 2 cgi� 67o _ _ rtfcq.( i c /o Title Telephone No.(bus' ) Telephone . (cell) e-mail address ylppliFable,the propertyC �d �� 5�e %l f ,i-(4 Qfa Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O. Otherwise provide construction control forms(see section 107 in the code)as required. _ 10.1 Registered Professional Responsible for Construction Control(the ro¢fasienat coordinating document submittals) Name(Registrant) Telep o. e-mail address Registration er Street Address City/Town State Zip ' pline Expiration Date 10.2 General Contractor /40a/W,io C�7ZRV/1 )/r/C ZP74aln4a4f (5 --0(9 ,2 3$ 3 Name of Perso on%'e for Construction License No. and Type if Applicable 3�f��` 95 ti` /1� o/ tx Street Address City/lbwn State Zip y(3/0y 5-6Q0 iA d,,Gtgala d,, Gam( Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of tsuance of the building permit. Is a signed Affidavit submitted with this application? Yes No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ /J Da 1.Building $ /5-00 Building Permit Fee=Total Construction Cos (Insert here 2.Electrical $ —reeS appropriate municipal factor) 3.Plumbing $ TP-K- 4.Mechanical (HVAC) $ %€�G Note:Minimum fee=$ lex (contact municipality) 5.Mechanical (Other) $ /4i,--t-a--w71 4t cj� da Enclose check payable to ‘��0�/f//0 /Ka'�p 6.Total Cost $ IS (contact municipality)and write check number here 8 a t SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and ate to the best of m knowledge and understanding. Please-gt..Ciittal) ce/V;RD/Ifraa& oote&/6C 30 prin�ari/\.O eye t° � MA Ol&6O Tel [�C(fe No. a,Date 41 Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: ( r d� Name D e CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-062358 Expires:02/10/2024 RICHARD D AQUADRO 30 FORBES AVE NORTHAMPTON MA 01060 Cu issiune =A K. Y muuv, The configuration of the second floor of the existing building,which FCC Holdings LLC is occupying,does not require any structural changes.The scope of the renovations to support the proposed cultivation facility are as follows: 1)Reconfigure existing electrical service to support horticultural lighting. 2)Install ductless split air conditioning units into each cultivation room. 3)Install dehumidifiers into each cultivation room. 4)Cover existing walls with moisture resistant Polywall 5)Install washable PVC Vinyl ceiling panels into existing ceiling grid system 6)Install sink and drain 7)Install exhaust and odor control system. 8)Install security cameras,motion detectors,alarms,locks and other equipment in support of 935 CMR 500.110 compliance. 2 FCC Holdings LLC has contracted Hesnor Engineering Associates to lead the design of the renovations to the facility and ensure all work is done to specification and code. Hesnor has provided stamped drawings and construction control affidavits to support the permitting process.All contractors involved in the project are licensed.Hesnor Engineering Associates will also visit the site to observe construction progress,as required for 780 CMR construction control purposes. Upon completion of the work,a Certificate of Occupancy will be obtained from the City of Northampton following an on-site inspection to certify all codes have been followed. In addition,the Center for EcoTechnology has been engaged and inspected the building to ensure insulation and the selected ceiling panels were compliant with building and safety codes. 3 FCC Holdings LLC will implement available strategies to reduce electrical demand,including load management and lighting schedule. LED lighting is used for both veg and flower, lowering the amount of heat generated,which lowers the demand on the HVAC systems. The main room,which is used for vegetation and propagation,has three skylights that provide natural light to the canopy as well as the work areas. FCC Holdings LLC has engaged the Center for EcoTechnology to identify energy efficiencies on an ongoing basis. A Building Envelope evaluation was conducted to ensure compliance. Valley Solar of Northampton was consulted for a general strategy and estimate.Solar will be re-evaluated after the first year of being operational when there is electrical usage data available. 4 Emma,Stars -; 1 roof (t`)—_ ___ Cromtc, ®i .ids _.._. �h"stdM� L2`—� �� C -'' Cam? C Lanwidow DC ,y (Covered) Entrance (Covered) ! E�mdaa ' " (Covered t Leoenci W indowA (Covered) (Covered) Bloom 1 �J Ltnitied Access Window :� Bloom 2 Vault ault (Covered ' ' e Dry Cure Room r" PB Blcsm 3 frEerrenx o © _� fl — t,_________te,7\ ..._.,,,,. ..... .:. _,,,,,•\DC ,, �` t:asxial' s Product �`� and mr.aste El, ca t:P -Key Pad A 0.:..� Window ' �1 Cu"dL8$oSl Area T"r� DC-Door Contact (Covered) SkYliebt S S ik011 1 PB saD 1 Palk l,, a . .t..., Witte: n 0 Bloom 4 01 Access '' (Covered) - Control Window'Pnlraguicia 'So Cannabis A !. Motion Beyond This Door _ (Covered; Detector 0174;asb and k igstaan Suites! �'' J JCanesa ,`o C'autt it)P.... ,. ,'c . No Cannabis 3nnabis Na('aunabis Entrance Li I�`.� JLi: De C Limited Access ��L� Access `e Na Cannabis Nat Used � � (` nityTT Locked I rr ,ram...,:- 1 l� mi a�,l Lowest Lq , Cannabis Area BUSintliS Retards Net Usti" i PessmoOdYiaued'is 1 [l 1 t f CM Window(coverr d) HVAC Compliance Letter: H ESNOR August 2.2021 'MASSACHUSErrS 2A Riser Street Mcssachusens Cannabis Control Conmrission Adams.MA 01220 (Pt 413.743.9500 Re:FCC holdings.LLC NEW YORK Ala Florence Cannabis Company 22 Compute;Drive West 131 Texas Road.Northampton.MA Allan}'.NY Vies[ 05 -HVAC Compliance fetter (1')51/L689 2030 www.hesnor coin Dear Cannabis Control Commission Represematise. Ilesnor Engineering Associates is under contract as the engineer of record for the renovation of the Florence Cannabis Company facility at 131 Texas Road in Northampton.MA.The partial building rennation is currently in the permitting and construction phase. I lesnor Engineering Associates has reviewed the specified mechanical equipment fur this project and ate s:ts that the equipment is compliant with 935 CMR 500.120(1 l Ncl and the Massachusens State Building Code.The project utilizes both packaged and split-type DX air-cooled air conditioning units as well as supplemental dehumidifiers.Ventilation air is supplied to the space by an existing packaged DX rooftop unit-This unit utilizes natural gas for heating.Cultivation rooms have precise temperature and humidity tequirements and are served by a conthinaiiun of split-type uir-cooled DX heat pump units and permanent stand-alone dehumidifiers. The split-type head pumps servitor these spaces lease efficiencies which meet or exceed the minimum m ettetgy requirements of IECC Section C.403. Included at the end of this letter is a sutnntary table of anticipated IIVAC equipment including total no ntinal tons of refrigeration (TRL thousands of British thermal units per hour(MBIll.ntininuun required efficiencies.actual efficiencies,and total nominal tons of dehumidification(TDI,where applicable. All equipment was evaluated and sized fur the anticipated loads of the facility. The dehumidifiers and heat pump units serving cultivation spaces were specifically sized to produce a combined cooling capac- ity sensible heat ratio that closely matches the room operating conditions.Gnus facilities require significant dehumidification due to high latent loads produced by plant transpiration.The high penenrage of latent load as compared to total cooling load often requires IIVAC units to be significantly uversized to meet the teen t Wad_Compounding this issue.using oversized IIVAC units to provide dehumidification requires a supplemental heating soune to re-Meat air once it has been dehumidified.because the unit provides excess.sensible cooling to the space.This results in increased overall energy usage.By using HVAC units sized in chorus with supplemental dehumidifiers.the excess latent load in the space can be convened to sensible load through the stand-alone dehuntidifnr dehumidification process.This utmersion from latent load to sensible load atlas the room sensible (eat ratio to closely match what the IIVAC unit can provide.This eliminates both the necessity to oversize the err conditioning units and the need to provide supplemental heating for re-heat,significantly reducing overall energy usage. To prevent odor from marijuana or its pnrcessiug being detected by a person at the exterior of the facility.the facility design includes the following treasures. Potentially aka-laden areas are maintained at a negative pressure relative to the adjacent spaces and the exterior of the building.This controls air mtwcmcnl,and consequently,odor movement through the building.A negative pressure at the interior side of the exterior walls forces air to infiltrate duough these walls.elinitnating odor exfiltration at the esierior of the building.Potentially odor-laden air ultimately exhausted front the building first passes through activated carbon litters to remote odors.Activated carbon removes odors by a process called adsorption where odor causing molecules in the air stream are trapped at the surface of the activated carbon.removing them front the air stream downste.un of the tiller _. Table f:H'4tC Equipment Specified to be/nsatRed in the Florence Cannabis Company Facility: .. TAG ( TR MBH MINIMUM EPECtENCv ACTUAL EFFICIENCY I TD AC-1/CU-I 2 24 14.0 SEER/8.2 IISPF 20.0 SEER/10.0 IISPF - AC-?1CU-2 2 24 14.0 SEER/8.2 IISPF 20A SEER/10.0 IISPF - AC-3/CU-3 2 24 14.0 SEER/8.211SPF 20-0 SEER/10.0 IISPF - AC-4ACU-4 2 24 14.0 SEER/E211SPF MA SEER/10.0 liSPF - AC-5/CU-5 2 24 14.0 SEER/8.2 IISPF 20.0 SEER/10.0 IISPF - AC-6 CU-6 3 36 14.0 SEER/8.2 IISPF 16.0 SEER/8S IISPF - AC-7/CU-7 3 36 14.0 SEER/8.2 IISPF 16.0 SEER/BS IISPF - DIlL-I - - - - 0.60 DIIU-2 - - - - 0.81 DI11.7-3 - - - - 0.61 DilLrl.l - - - - 0.40 DHU-4.2 - - - - 0.40 DI11.1-S.I - - - - 0.40 DIIU-52 - - - - 0.40 DI112-6 - - - - ?73 TOTAL I 16.0 I 192.0 1 -I All Comply 633 Thank you for taking ilia time to rer kw this leucr. Sincereh. Tyler Scarboruueh.PE Massachusetts Mechanical PE License a 5521I HQPL Letter: 11 H ESNOR September 20.2021 MASSACHUSETTs 2A River Street Massachusetts Cannabis Control Commission Adams.MA 01220 IP)413.743.9500 Re:FCC Holdings.LLC NEW YORK d/b/a Florence Cannabis Company 22 Computer Dove West 131 Texas Road.Northampton.MA Alban,NY 12205 -HQPL Energy Compliance Letter (P)518.689.2030 www•.heanor.com Dear Cannabis Control Commission Representative. Hcsnor Engineering Associates is the engineer of record for the current renovations of the FCC cannabis facility at 131 Texas Road in Northampton,MA.The horticultural lighting used at this facility is in compliance with 935 CMR 500.120.I I.(b).2.All horticultural lighting used in the facility is listed on the current Design Lights Consortium Solid-State Horticultural Lighting Qualified Products List.and the lighting Photosynthetic Photon Efficacy t PPE)is at least 15'1 above the minimum Horticultural QPL threshold.The following tables summarize the compliance data for all lighting fixtures used for cultivation in this facility. Table I: Lighting Fixtures used for Cultivation Intended to he Installed in the FCC Facility. MODEL NAME DLC PRODUCTID I MINIMUM PPE FOR COMPLIANCE I LISTED PPE I COMPLIANT Phlizon PH-FD8-I H-CW3NMBA 2-1(unol/3 2.6/tmol/1 Yes Grower's Choice ROI-E420 I H-041NKQV 2.1 pool/1 12.4 pmol/3 I Yes Table 1: Horriculriral Lighting Power Density in the FCC Facility. SPACE TYPE I HLSF f&l I LIGHT FIXTURE TYPE I FIXTURE WATTAGE I QUANTITY I HLE l WATTS] Cultivation Space ( 9bl I Phlizon PH-FDS-1 1 640 I 40 I Growerss 25.600 ' Choice ROI-E420 j 420 10 4.200 TOTAL I 961 I I i 29.800 HLPD 31.0IW/FT1 Both light fixtures are LED type fixtures designed specifically for cultivation.The facility will utilize forty(401 of the Phlizon light fixtures which are 640W each.The facility will utihre ten(10)of the Grower's Choice fixtures which are 420W each.The total square footage of canopy at the facility will be 961 square feet.Flower rooms will use a 12 hours on/12 hours off light schedule.The Vegetative mom will use a I8 hours on/6 hours off light schedule Thank you for taking the time to review this letter. Sincerely. tN OF 4r, Oc"7 , N Tyler Scarborough,PE 4' 4.755281 ' Massachusetts PE License it 55281 p�,9FOlST p6. Eve Safety Plan: a) Anyone entering grow areas are required to wear protective glasses. b) Eye safety protocols are in the Standard Operating Procedures and is part of new employee onboarding. c) Employees are provided with protective glasses and required to wear them in all growing spaces,or any area with horticulture lighting. a. Visitors are given protective glasses before entering grow areas b. Visitor glasses are disinfected after each use d) The following signage will be used to remind workers of eye safety: a. 10"x 14"OSHA Safety Signs will be displayed at the entrances to the grow area. b. Slip Safe Floor Stickers with the text"Safety Glasses Required"will be displayed in individual rooms. e) Safety protocols and equipment will be reviewed and updated annually. Third Party Certifications: tnterteEC AUTHORIZATION TO MARK Thls mummies ow appacabon of the COrt,rr• too:i maws;5•:u..,i t„tt;a to t±w .,Li.,is dku:i.t..d n the Product's) Covered section Wain made in eccnrnance oath the unyvtwn set total er the Codification Agreement and Dstbt0 Rop,rt This aulhOrtyal,on also apphn trultipte Estrin ox.dr.l(at identified on the rorntalon gage or the Luting Report This document rs the Property oI Inlettelt Testiro Services and is nu II Stefanie The cadge-alien matklol may be ,seokod orgy at the location of the Party Autttarzr3d To Apply Mark Apphrant Shenthtn Phkton Tectrnngy Court Manufacturer- Shenthen Phktoo Technology Co.-Ltd. Bldg 2-4,TrrrlgFuYe Industual Park, Bldg 2-4.TongFuYu indusaint Park. Address: AtGun Road.Sthyan Torn.Bao'an Address: Argun Road.Shiyan Town.Bao'an Drstrict,Shenznen.Guangdong Drstrtct,Stlenuh n,Guangdong Country: China Country: China Contact: Xu Hong COMMact: Xu Hong Phone, 96.13B26560077 Phone: @6-13926500p77 FAX. .88 755-23722708 FAH[: a888 755-23722796 Email: salesC.OlhzCn net ErnaUt saleudgphkzdn.net Party Authorized To Apply Mark: Sarno as Manutacruror Report Issuing Office: tnlw.tat Testing St:wirxrs Shanghai Limited Control Number 5014185 Authorised try, •I Ir 1 - for LLGUS Matthew Snyder.Cerefrc tbn ktattaQrn C �� lts Intertek Intertek This document supersedes all previous Auttro.zatvnn to Mark for the noted Repot Nettling. ,.ear..z.n........e .-.-...csn.a•p>.•som T.':.-s,+.•a...T.r SS.... �.v...s .y .ant, ...... +.T i..,rh.yM l.r..;Nib• • '.....t..M...tw wnT•wrLer.m:w.e.wriH • w'.ws+Y+�-.r..,a.r.••. aNwMT.h/4...l e�yryr•MHa.nn4rm.*.S.o wa M.4..4fln..tl eq-W t Jr..$m.- •..a„-..r.♦ n It*v n.l.a.II*al..tm ad n6...t a$♦ufdad ory b 4N a.u1...n.'fl' Ors-N..M.....M oN .�.Ww.x..n i.W to Wr�T..wt.a♦-.e0 IL ta..+l .. 0._.M.W...ua....a+v+..r11.+Nwra •w.>k..Tt.rwn arysawer q.ry'M M.•.•••• .T ry..rrl.,xy.r..new T.o-r Inbrta.Testing SttnnOeS NA tie 5.15 East Auknotn Road Arington Heights L 60306 Ttaulmne 800.345-3851 tw 847a30-5687 Fa■312-283-18f2 Pr.wlrte FSecrc Lienruees ILA 1532014 Ed 13•C27A420t81 Standeolts): Port ere L emanes tR20I9)1CSA C22 2450 4.2014 Ed 11 _— Product LED Lurnsrave Brand Name: PHLIZON PH•GA-600,PH-De.PH-GA-900.PH-09.PH-GA-I200.PH-DI2,PH•GB-1200,PH-W 12,PH-GB-1509. PH-WIS,PH-GB-1800,PH-W18,PH-GB-2000.PH-W20 PH-GC-1200.PHS12.PH-GC-1600,PH-Sit. Models: PH-GC-2200,PH-S22.PH-GO.100O.PH•8-L2 PH-GO-I500.PH-B-t.3.PH-GD-2000.PH4814,PH-GD- 2500.PH-B-LS.PH-GO.3000,PH-B-L6,PH-GE-400.PH•B-Rd.PH•GF480.PH-65.PH-GF-640.PH-B8. PH•GF•800 PH-B10.PH•GG•300 PH•L53•PH-GG-450.PH4,124..PH-GG-600,PH•L 126 Ar mor Report 190101263SHA•001 Page 1 oft ATM Issuers 27-Apr-2020 City of Northampton Massachusetts r + �' � � ?'� DEPARTMENT OF BUILDING INSPECTIONS •' 212 Main Street • Municipal Building 2i Ii.--�_ Northampton, MA 01060 Jst`�y, 3 l\\ CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: ikVii0V5 ` // // ec f / & cb w The debris will be transported by: Name of Hauler: 0' fe' /4/00,fre-wt-- Signature of Applicant: .) ,G(i�� Date: / f1 02"Z The Commonwealth of Massachusetts 1=? •`:('0,. Department of Industrial Accidents Wi P., I Congress Street,Suite 100 _-r Boston,MA 02114-2017 1741 , www mass go►�/dim 'S1 uikers'Compensation Insurance Affidavit:Builders/('on$ractorstElectriciansiPlumbers, fO BE FILED H.LI H THE PERMH°ITI (:Al THORIT1'. Applicant Information Please Print l.eiilds Name illusinessiOrpinizationilndividusly /119t&A0 l?0 C1 k.i? A7t ..4-4/G. Address: 1�. D. Pox ,6,56 i 13 11eXd 5 a , City/State/Zip:/�Wt't1M/4 0 /06 / Phone#: /}/3 6p26 -St�9 fg (ce// t'c 4 Are yno as empianee?('heck the appropriate hut: Type of project(required): i.o I am a employ 1.7 with employees dull and or pas time).* 7. o New construction 2 I am a sok proprietor or pui nenhip and Isaac no enployccs wurkmtg tot me in K. 0 Remodeling am capacity.(:`o workers"wimp.insurance rcyuuaal.1 9. ❑Demolition 1_0 I am a hormowner Joint)all work myself.Ism workaTs"comp.ntaunutoc required.)` 4.0 I am a homeowner and will be hiving contr"aiora to conduct all Noel on my property. I will I0D Building addition .mum that all contr-.ators either leoe worker;cumpenwwo nuurance or arc sole 110 Electrical repairs or additions propnelora with no employees. I e LZ . _ _ 1 /. lit.e r C2�t�1 S !�( (�( 12.0 Plumbing repairs or additions A I am a ponesl contractor and.r6ic hared the sub—contracton listed en the t.111�dthem 13 Roof repairs Thex aub-eontracturs hoar employees and hate 14oikers"comp.Insurance.• r 6.0 We an:a c-owpuratr n and officers has c c im:li d then ogle of rxcmptrun per.5K c. 14. Ohba / 0 l `` 152.Q 144l.anti we hate no employees.(t.0 w ctrken'wrap.msuraae mowed_I , a e e l /1 i ydr^a (C a 'Arts applicant that cheeks box PI mint also fill cat thesoxtiurt below%huw trip worers"g thek contptensatios police information. 9 v Iknmcuwnrrs who submit dn.Antl.It m.laatulg they arc doing all work and then hoc rubric cunireoUtrs now subunit a new atfslat m nalio hw ouch. :('ontractors that cheek this box Inuit attached an additional shot slummy the name of the sub-cu tracMxa and stale*hillier or not those emirties hase euipk,yces. If the sub-eoaeraetun base eirpkyovs.they moil pruatdc their workers"comp.policy norther, I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: .rilvii( 14&r! `-./vim //i �'t'CCe /14 G� — Policy tt or Self-ins.Lie,.#:fQ y o 0 a - 7118 3,y-,/ (Y Expiration Date: /7 7/7 �'Z Job Site Address: /?/ /"x a 5 Rea G( City/State.`Zip: /v r02/-/-(4.-010( 2 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coserage as required under MGL c. 152.*25A is a criminal violation punishable by a tine up to$1.500.00 and or one-year imprisonment,as well as cis al penalties in the form ola STOP WORK ORDER and a tine of up to S250.00 a day against the s ioiator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. time I do hereby certify"under the pains and penalties of perjury that the information provided� above is true and correct. Signature: . - Phone�: l � Date l/ ///r� l//3- T �G 77 ., - / . ( - - .I ac //) / Official use only: Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.('ityfl'own('lerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: (7/1"//o20 Zeit7 ik r 5 (0 mfict. (7`("vL-- ;c;i5c/inar,vie CC- Ittcw-dM ctr Ccvv, oft. 1-1/t.c 5601CtB 7 /f839‘ q-3 -fq' / - 3r_a ( ? -Etc c. Ca _ 1.(11515- . �i`o F(ec.f/ c4. ( (2'^v-64_04,043 :1-i/tickra.vt.ce WC 1b35313 ot( -ol - ar --7o41-01- 2A Aeeitca c Clti 5QA„,,i e. /1iw . 1u. C -- -- - - 4550Ctra. i-ed - Ge(.e S rii o-� / �95adt-u Se flLej tO 3oo -502M$ 3t - 2 opt( : Aar-ov /ri A Skeet rh 51-eteel-74'Nit20t 1G4 �rt5u.ivA4Ce jvc7/aYOD 03 ( 0,3?)- � Z 1 /d C(`i_ ? hik- mac. (4.0/1- 5 to f-/fivterica 5cr/C��C /' 367?x cow -dam /D-og -� '3) 4,(tted- "6.ter* XeckuLie,t I_1 NeetAhl 0,44461 , CMractr,r5 FCc cal - -5 Liz- ``�: 4drc7 AC D® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDmYY) 01/07/2022 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If 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 endorsement(s). PRODUCER CONTACT Hollie Kochapski Aquadro&Associates PHONE (413)586-7373 lac,No): (413)584-0859 355 Bridge St.,P.O.Box 357 A DRESS: hoilie@aquadroinsurance.com INSURER(S)AFFORDING COVERAGE NAIL# Northampton MA 01061 INSURERA: TRAVELERS INSURANCE COMPANY INSURED INSURER B: ACE AMERICAN INSURANCE COMPANY Aquadro&Cerruti,Inc. INSURER C: Texas Road INSURER D P.O Box 656 INSURER E: Northampton MA 01061 INSURER F: COVERAGES CERTIFICATE NUMBER: CL19122610205 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 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 CLAIMS. INSR ADDL SUBR POUCY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO D CLAIMS-MADE XI OCCUR PREMISES(EaENTE occurrence) $ 300,000 MED EXP(Any one person) $ 5,000 A BIP2R505200 08/25/2021 08/25/2022 PERSONAL&ADV INJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY - AUTOS ONLY (Per accident) _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N ..".I STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBEREXCLUDED? N N/A 6S62UB-7H83464-3-19 12/31/2021 12/31/2022 (Mandatory to NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) PROJECT:TEXAS RD,2ND FLOOR RENOVATIONS FOR FTC HOLDINGS LLC CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN CITY OF NORTHAMTPON ACCORDANCE WITH THE POUCY PROVISIONS. 210 MAIN ST AUTHORIZED REPRESENTATIVE NORTHAMPTON MA 01060 OtAt*ITAJAAA 4'' (� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD - Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) I`,..----- 01/11/2022 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If 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 endorsement(s). PRODUCER CONTACT Tina Beaulieu NAME: Borawski Insurance PHONE (413)586-5011 FAX (413)586-7973 (A/C.No.Ext): (A/c,No): 88 King Street,Suite B E-MAIL SS: tbeaulieu@borawskiinsurance.com ADDRE INSURERS)AFFORDING COVERAGE NAIC# Northampton MA 01060-3257 INSURER A: Merchants Insurance Group INSURED INSURER B: Winston H.Bancroft Electric Contractor INSURER C: P.O.Box 156 INSURER D: INSURER E: Chesterfield MA 01012 INSURER F: COVERAGES CERTIFICATE NUMBER: 21/22 GL;AL;WC;UMB 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 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 CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 A BOPI089640 04/01/2021 04/01/2022 PERSONAL&ADV INJURY $ Included GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PO- POLICY JET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Cyber Liab $ 100,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A - OWNED X SCHEDULED MCA1002222 04/01/2021 04/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY XHIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) Underinsured motorist BI $ 50,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A - EXCESS LIAB CLAIMS MADE CUPI000636 04/01/2021 04/01/2022 AGGREGATE $ DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N -_ -STATUTE ER - A ANY PROPRIETOR/PARTNER/EXECUTIVE E. EACH ACCIDENT $ ,500000 OFFICER/MEMBER EXCLUDED? ri L.N/A WCA1035363 04/01/2021 04/01/2022 - - - -- - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Aquadro&Cerruti Inc Rick Aquadro ACCORDANCE WITH THE POLICY PROVISIONS. 131 Texas Road AUTHORIZED REPRESENTATIVE Northampton MA 01061 L/ 'L I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD A� DATE(MM/DD/YYYY) .�.. CERTIFICATE OF LIABILITY INSURANCE 12/20/21 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If 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 endorsement(s). PRODUCER CONTACT Katelyn Marshall PHOMirick Insurance Agency (NC,No.Ext): 413-625-9437 (Atc No): 413-625-9473 POB 375 E-MAIL 28 Bridge Street ADDRESS: kmarshall@mirickins.com Shelburne Falls,MA 01370 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Concord Group INSURED INSURER B: Associated Industries of Massachusetts Sam the Man,Inc. INSURER C: Climates by Pomeroy 188 Ed Clark Road INSURER D Colrain,MA 01340 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 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 CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A 20007010 12/15/21 12/15/22 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 B WCC-500-5024531-2021A 03/10/21 03/10/22 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Aaron Morin ACCORDANCE WITH THE POLICY PROVISIONS. 140 West Street West Hatfield,MA 01088 AUTHORIZED REPRESENTATIVE r I f I /r% f, I ,� / AlCo/ CERTIFICATE OF LIABILITY INSURANCE DATE(""'D°"""') Y 01/10/2022 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the poilcy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If 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 endorsement(s). PRODUCER COACT Manna Aquadro Aquadro&Associates PHONE (413)586-7373 FAX 355 Bridge St.,P.O.Box 357 E �ananna uadroinsurance.co ( NO)' (413)584-0859 o.ADDRESS: �� m INSURER(S)AFFORDING COVERAGE NAIC e Northampton MA 01061 INSURERA: Main Street America Insurance 29939 INSURED INSURER B: Quincy Mutual Insurance Co 15067 Aaron Morin Sheet Metal INSURER c: 14788 140 West St INSURER D: INSURER S: West Hatfield MA 01088-9500 INSURER F: •_._.._ . COVERAGES CERTIFICATE-NUMBER:- CL2142310342 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE UFEb BELOW HAVEBEEN ISSUED TO THE INSUitED NAMED ABOVE FOR THE POLICY PERIOD INDICATED: NOTIII�THSTANDINOANY UIREMENT, OR CONDITION OF/1NY CONTRACT OR O.t DOCUMENT VNii,i!ES TO wooltiTis$;,. , ' E }1FICATE>'Ii1►V I$SOE OR MA I EI TAIN,THE INSUI' NCE AFFORDED BY THE,POUCIES DESCRIBED HEREIN IS SUIL6OT TO AU.THE TERMS 'EXCLUSIONS ANC)CON171TIOt.l OF SI)+y?IpOLICIES.LIMITS WON*MAY HAVE BE ,14REDUCED BY PAID-CLAIMS. leg- AOOL811rt a: POUCY EFF POUCll up _. :r ai. •••• TR• . ' TY !of visuRAticx ! L , 1NSD mu fit: _ .,.PAI&Y NUMBER ("MIDDIWYY) (NMIDDIYYYYI UNITS . X CD$$$Mr1'OEDNERALtM IN,U P:nr.: :, EACIiOCCURRENCE :1;000;000 PPAA"A� ctAMSMA :, �OCXgoc. PREMISES(Ea occurrence) 4-.. • •CIDD Eay'.. a 10,000 .. MED EXP(Any s person) _3 A MPT1090D 01/19/2021 01/19/2022 PERSONAL&ADVINJURY $ 1,000,000 GENLAGOREGATE UNIT APPLIESPER: GENERAL AGGREGATE S 2,000,000 Fi PRO-POLICY JECT n LOC PRODUCTS-COMPIOP AGG S 2,000,000 OlT1ER: S CO SINGLE UNIT $AUTOMOBILE LABIUTY (Es MCdenU. _ ANY AUTO • BODILY INJURY(Per person) S 250,000 B OWNED SCHEDULED AFV207622 07/25/2021 07/25/2022 BODILY INJURY(Per accident) S 500,000 HIR D ONLY vX ANON-OWNED • Per accident) Y DAMAGE X AUTOS ONLY X AUTOS ONLY (Per accident) $ 200,000 S _r UMBRELLAUAB EACH OCCURRENCE �__. . • EXCESS LJAE I,;;;.!,... CLAMA 3�Ai!DE =tyAGGREGATE • 1 $ WORKERS DED j MINSAT10NTIOM: :` Y X!SETA UTE I I ERA S AND EMPLOYERS'UABIUTY Y/N :-... A ANY PROPRIETORIPARTNER/EXECUTWE 1:1 N/A •WCT'1090D 03/22/2021 03/22/2022 "EACH ACCIDENT S , 500000 OFFICERAIEMBER EXCLUDED? L J Mandatory In NH) . , . . .. •. _ . E.L.DISEASE-EA EMPLOYEE S S tM DD,DDO If yes,describe under ' EL.DISEASE-POLICY LIMIT S SD0, DESCRIPTION OF OPERATIONS below 000 • ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N more space is required) ERT1FICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN FCT Holdings LLC ACCORDANCE WITH THE POLICY PROVISIONS. 131 Texas Rd A 0 REPRESENTATIVE aet Northampton MA 01060 • ACORD 0//10120YYYY) CERTIFICATE OF LIABILITY INSURANCE DATE(1012022 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If 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 endorsement(s). PRODUCER CONTACT Ann Harrington NAME Aquadro&Associates PHONE (413)586-7373 FAX (413)584-0859 (A///C INo,Extl: (NC,No): 355 Bridge St.,P 0 Box 357 ADDRESS: ann@aquadroinsurance.com INSURER(S)AFFORDING COVERAGE NAIC N Northampton MA 01061 INSURERA: Main Street America Insurance 29939 INSURED INSURER B: HODGE CITY PLUMBING INC INSURER C: 60 N MAPLE ST INSURER D: INSURER E: FLORENCE MA 01062-1323 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1911509748 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 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 CLAIMS. INSR ADDLSUER' POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) ,/MMIDD/YYYV) UMITS X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 DAMACLAIMS-MADE LX�OCCUR PREMISESO(Ea ocRENTEcurrence) E 500,000 MED EXP(Any one person) S 10,000 A MPK3772X 10/08/2021 10/08/2022 PERSONAL BADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE S 2,000,000 X POLICY PRO- 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000.000 (Ea accident) ANY AUTO BODILY INJURY(Per person) S A OWNED V SCHEDULED M1 K3682X 10/08/2021 10/08/2022 BODILY INJURY(Per accident) S AUTOS ONLY /� AUTOS X HIRED X AUTOS ONLY NON-OWNED PROPERTY(Per acadentDAMAGE AUTOS ONLY S X UMBRELLA UAB OCCUR EACH OCCURRENCE E 2,000,000 A EXCESS LIAR CLAIMS-MADE CUK3772X 10/08/2021 10/08/2022 AGGREGATE $ 2,000,000 DED XI RETENTION S 10,000 $ WORKERS COMPENSATION XJPER OTH PEATUTE ER AND EMPLOYERS'LIABIUTY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 500,000 A OFFICER/MEMBER EXCLUDED? NIA WCK3679X 10/08/2021 10/08/2022 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 500,000 It yes descnbe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN FLORENCE CANNABIS COMPANY ACCORDANCE WITH THE POLICY PROVISIONS. 228 CARDINAL WAY AUTH D REP ATIVE NORTHAMPTON MA 01060 Initial Construction Control Document j t To be submitted with the building permit application by a C.„1\ yis Registered Design Professional for work per the ninth edition of the r f4 Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Date: � `( bo c 1� �Property Address: ✓ " ` �� Project: Check(x)one or both as applicable: New construction Existing Construction Project description: I MA Registration Number: Expiration date: ,am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning=: Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable_ 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code_ Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107_ Whenrequired by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a'Final Construction Control Document'. Enter in the space to the right a"wet" or electronic signature and seal: Phone number: Email: Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with art'x'project design plans,computations and specifications that you prepared or duectly supervised.If'other'is chosen,provide a description. Version 01 Ol 2013 Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 107.The checklist below is a compilation of the documents that may be required. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) 10 Surveyed Site Plan(Utilities,Wetland,etc.) 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report !� 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) ///4 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation A/4 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction. Registered Professional Contact Information 7 k/1-/U 5car- rou,1-1 -546-6 ao 3c T5c4,Wapuotte, 5-5-62 game(Registrant) Telephone No. e-mail address(f EJ/fJLQ. C. Street Address City/Town Discip( e Expiration Date CItr►"s Pb c`n 5-6-hgf a03 c bak2)@ hesnauoric 5o29g Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Please follow this link for construction control forms to be used by Registered Design Professionals. Final Construction Control Document ): �t To be submitted at completion of construction by a • J Registered Design Professional r for work per the ninth edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title:k�c�4. �� Date:izjt,1LI Permit No. Le` Property Address: /3{ (P.xa c ifoeL4.0 Vo r�� ^'!P4o PJ P1/I Project: Check(x) one or both as applicable: New construction Ming Construci�• Project description: ?q.�,z�Atr 'g.Eao Jpfcw� o(= Aa �x�sT��h 3uu.1i (1 Chris Bat:n I J MA Registration Number:Ears Expiration date:6(3tinfam a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: Architectural Structural Mechanical Fire Protection prtrica Other:Describe for the above named project. I, or my designee, have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge,information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. ✓y.u.ti4. Enter in the space to the right a"wet" or :,SZH Myss� o y electronic signature and seal: � � i T (C o 0.50798 2- ` �FS/FGISTEVL cs ,: , s NA EN Phone number: 5)��‘c R-2.614 Email: C h ab;,I c !j e.rno r. corn •'• L :`` Building Official Use Only Building Official Name: Permit No.: Date: �r - Final Construction Control Document • To be submitted at completion of construction by a tis )fl Registered Design Professional a" for work per the ninth edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title:4 r-, ` Date:(Zia" Permit No. Property Address: is' -rEX,gs fz,oivb, Nof.-T,A him?/ , NA Project: Check(x)one or both as applicable: New construction xisting Construction Project description: -.ia,. , e�o��-c�o�•� ,o ey.t ►ac, 1,014-`011.)E1. 1 E1 Sck'Mauc6.1 I " MA Registration Number:55Za1 Expiration date:1p 130/n.,am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: Architectural Structural Fire Protection Electrical 4=4 P escribe Nh for the above named project. I, or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis.To the best of my knowledge,information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet" or �P\t�OF M�ssq electronic signature and seal: o�� TILE' N. ct • • -OUGH .. 281 90 g /s7EQ��``Q Phone number: Si b-0 S9-zo3o Email: -rst itaeoZc ! (a r1 S �SS��NAL ECG Building Official Use Only Building Official Name: Permit No.: Date: