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29-357 (7) BP-2022-0735 259 ACREBROOK DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-357-001 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-2022-0735 PERMISSIONISHEREBYGRANTED TO: Project# ADD BATHROOM Contractor: License: Est. Cost: 35000 VK DESIGNS INC 108508 Const.Class: Exp.Date:06/24/2022 Use Group: Owner: MACLEOD SWEENEY HOLLY A&JOHN M Lot Size (sq.ft.) Zoning: WSP Applicant: VK DESIGNS INC Applicant Address Phone: Insurance: 51 Al HOLYOKE ST (413)527-1500 WC231S624125011 EASTHAMPTON, MA 01027 ISSUED ON:06/21/2022 TO PERFORM THE FOLLOWING WORK: CONVERT BEDROOM TO BATHROOM 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimne : Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 4 or , .52 . 49NIT Fees Paid: $228.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner REC 14 The Commonwealth of Massachuse s " tj Board of Building Regulations and Sta I.r•• J Massachusetts State Building Code, 78 i C ' UN 2 1 FO 20 , FOCIP LITY U Building Permit Application To Construct,Repair,R,nova SI. r. .lish a R• ised ar 2611 One-or Two-Family Dwelling NO,RTHAMhr/nry'+NSaE•nply This Section For Official Use Only Mq 01pso s Buildin Permit Number: a i-, ..73� Date Applied: red z.) , � 21--� � � J-ZOL2 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Ma$J&Parcel Numbers 25.9 Acr{6,00k pc aoi7•l..,.7„-/e�n� b /y- O�`� Nod- 63.5 La1 YID l 1.1 a Is this an accepted street?yes 4?.... no! Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: uRA 1309It Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner"of Record: ? /-/ /� Siitw,d� Tl„1 /lticie.,' /Vc -11.. rA, 1t l O/0G Z.- Name(Print) City,State,ZDI /I 25`9 14ct‹ 6.'''L P'' /�eiyt...,,,. di,‘2- If/3 - 2i7- S'C H5 ee.lC1 ®7,""la,fj r?4 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) lit Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed)Work': C on,"c�t Red••a." ) Fv 11 Q wt 1, (di L'A I k- !A S� Nt D .� . RC I DI A it. l,1/!4 .fi J . /No,* f(A JI,,44) /Oor Jo ,6 A ri,•0 0,.v, 6,J,i o v 'do„ 1 3 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 9 S'cry 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ Z.,5-Dv0 Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $4u.� 2. Other Fees: $ 4.Mechanical (HVAC) $ coo List: 5. Mechanical (Fire $ NAi Suppression) Total All Fees: $ Check No.1012 Check Amounn Iw a Cash Amount: 6.Total Project Cost: $ 3 1 0 Paid in Full 0 Outstanding Balance Due: City of Northampton r i� 5� .........,, is , , „:„ Massachusetts �Q?%" ''•s!� t 4 y U.2 :G L DEPARTMENT OF BUILDING INSPECTIONS ,OW .� r 212 Main Street • Municipal Building 1� Northampton, MA 01060 .rf - 00 PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR, ETC. I. 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 and hard copy) 3. Site plan with location of proposed structure(s) and set backs. 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 CS License, HIC Registration and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (new/ replacement windows). 8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable). 9. Note any Conservation and/or special permit requirements (if applicable). 10. Driveway Permit (if applicable). 11. Proof of Water and Sewer entry fees paid (if applicable). 12. Trench Permit - public land by DPW / private land by Building Dept. 13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit application before issuance of permit. 14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-/o$Sa$ G-2V-2on, CPI,ij r,l°ti..� Q. "ea, ut l ( License Number Expiration Date Name of CSL Holder 0J List CSL Type(see below) 3 1.�I i t •�Pe' •c o a .1 No.and Street VV/ Type Description �-(�.r ►, . i4 6!o S o U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,�State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding ,77 SF Solid Fuel Burning Appliances y,3 -S /f`YIP) V(�'fG S III 3 6� 'r' l I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) LT le,Z90L 01 Z0L3 K OeS� f` C Act �� /`� 1 HIC Registration Number Expiration Date C Compaily Name or HIC Registrant Name 57 4Z oit //3- S''012 V kill c ,s ?3 & vi`'a``7. lo". No.and Street Email tiddress I:.se144,70ioV / 444 D/oJ-? y/z..s/ - ec City/Town, State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit 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 121 No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize V w/(07 h�G L /iiE gel/5"J 1 N L to act on my behalf,in all matters relative to work authorized by this building permit application. (-10114 SWc,cv)r7 (-Lo�2a2L Print o er's Name(El ctronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION 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 accurate to the best of my knowledge and understanding. � JJ /47 clitic .i,e ,?)v.-r„H,C ✓ ©lia.✓Z/ G' �U^7.vZZ Print Owne 's or Authoriz 6 Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE • City of Northampton Massachusetts �� � ice. ,c'e; ) .� ); +�'t DEPARTMENT OF BUILDING INSPECTIONS .. a �Y � �- 212 Main Street • Municipal Building J� ca Northampton, MA 01060 'rsdh, 3X-N 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: (/n) / r f t 'y c 1 The debris will be transported by: �a /I�c (('r fGii�,1 N�/q " �� 04j�1C ��^'I/� ]�a.(�c�Name of Hauler: / Signature of Applicant: Date: f - Z u LuZ2 The Commonwealth of Massachusetts n-- ` �i Department of industrial Accidents • tit 1 Congress Street,Suite 100 a it Boston,MA 02114-2017 www mass.go►l/dia -" 1%uskrrs'("ompensation Insurance Af 1davit:Builders/('ontractorstElectririanu'Plumhers. 11►ui 111.E i)N ITH THE PERMITTING AI l I HUkiR. Applicant information Please Print 1.et iltlw Name t uitaancss O r tntzatwn Individud): Vk &e s s n,f z 12 /A//1 i I 1 t c/.._,' - Addrcss:S'/ /1/ //o/y l'.t 5-,.ui City/State/Zip: ,FR Jt6.,o/o•✓, l'1?►9 'IO Phone#: //3. -CZ • 15 tsa Are yea as splayed Cheek the appropriate hu. T�pr of project(required): I a am a employer with cngthryres(MI aeddutport-,Hurt_• 7. D New construction 20 I am a sr*p oproct.n an puonctshtp and hair no rmparyoes*hotting for me.to K. &Remodeling wry capacity.ltit.wsnktrs"komt p.lmurantr ieglmtd.l 30 I am a homaawnet donna all work mysctf.INo*mitts"tomq.rn.,unuur Hawn ld.l 9. 0 Demolition 410 I am a henn WI and ell h►hems ttotaradarrs Io turtdud all work on m)pn.perly. I will ID D Building additionrs�w eneur.lhetaneeeurcenn other have wtnkcts"ttianptmatltnt smarmier or arc%de 110 Electrical repairs or additions pnrprOAoef with ime employees. 12.0 Plumbing repairs airs or additions S�1 am a general tuMra for and 1 but c hind the w h-cuntraciurs hood un itlr atta/illtit sheet_ f Iwx su1•tuatratitn hocenlpkryeta mud love workers.'comp.suits roc.' 31:1�R�lrwf repairs h.j V.e aR a etapOr4lim and as utficcov ha%c on:wo l dice nyhi of cimmp s n perM(aL 14.a v�,er —_ }t 1(4), el and we have e eelpkryers.(Nu warier. clamp..Y required] am! •.ln%srviwaer the Cheehehoc all 011ie ahsbD am*the seol nhekaw shawls theirwmhaa"tr.nsp.n,.atu,m policy i lams tjna. ' h ioas_s,woos who sulatde this affidavit teicatrtis they are thane all wait midis'hive oetsia.t.earatse,.mem submit a New mffidry it indeminy silt 6. o•uua/Koff Sot check do,boo,muvt attached an widower!short%howtnit doer we maw of dtscant s whew mil stilt whath a er ee a thaw aun hastie. as a- t'nthahl.X:Ls.a If the suit-ctnliracalas hole mph.) tt7R)mug rvo% o Altar %arkcni tertsp pellets nuns er. I am an employer that is providing worAers'compensation insurance for my employees_ Below is the policy and job site information. Insurance.Company Name: 4 r De' rt7 /11t roc, S. G. — — -- --- — Paltry#or Self-ins. Lie.#: A)C 2 3 ( S ‘L y I 7-55 01 Z Expiration Date: 3 -Z Y+ Z D Z Z.3 Job Site Address: S e+r /I(Ice,d/o U e O✓. fie• Q fJJ� (�Ity'State%"Lp:I✓d� o�O�a ,vim of 64"L— Attach a copy of the workers'compensation police declar tion page(showing the policy ntonber and espiradstt date). Failure to secure coverage as required under 111(.6L c. 152,*25A is a criminal violation punishable by a fire up to S1,500.00 and or one-year imprisonment,as well as civil penalties in the limn 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()flier of ins estigations of the DIA for instii.ince coverage verification. I do hereby certify under the/grins and penuhies of perjury that the information provided above is true and correct titgnature: f�/ — Date: • _ L U_z eiZ Phone#: yJ3'S/5' 1/4 SD Official use only. Do not write in this area.to be completed by city or town official ('its or Town: Prrmitil.icrnse# Issuing:authority f circle one): I. Board of health 2. Building Department 3.City flow n Clerk 3.Electrical Inspector 5. Plumbing Inspector " 6.Other ( outset Person: Phone*: • City of Northampton / A�?� ` . Massachusetts ' ; DEPARTMENT OF BUILDING INSPECTIONS 7A 212 Main Street • Municipal Building yO a Northampton, MA 01060 j lb.. 1 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born _ (insert month, day, year),hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns 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 home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of ,20 . (Signature) a• -ram t -tl I� 0 a r o L ( --; H �� —3 ..\—F— _ _-\:., I 11-: f I 2'-0 N g2X8DP P UCAM V.LF 2X8 FLOOR FRAMfNG V.I.F. 11' N N �f N� -sl „: , 1 DEMO PLAN A 0,= DOMINIC O'CONNELL V\i 11 V KITCHENS Owner SWEENEY-MCLEOD - BEDROOM RENO • Lst. 2.004 dominic@vkitchens.com SHOWROOM 51-Al Holyoke St. - Easthampton, MA 01027 (413) 527-1500 www.vkitchens.com 7 41111 c `- --0( 0 1 d iy1 pia C'' I 1 _ — �_ I A. 48,E MEI. _ —41 ill 711 169to �� I — / 24I-11 23— __ - ��.g Lr) K 10825.4-CP �" 1\ _� '' 1 I \ 1r41 1 r coId� TOILSTD _ �� 0 CO N i 3 _.......... ! 1 I ‘t.' = _ - CO T (O a • F i CJ co k '1, '1 ! 1 Y 1 Cr, r :.---- ! ..:-v ' L . ..c_vit- 11(`h01. I 11YL / „4 4 / Ilos / 11c` / 1 , nnz 4- -__a_.__ ___1________.1.____-_-._.._______4____.__t_._____i _-_-_1_--_____1_ 4____._ _4_.__ ___.j.__ 1 _ AC`�® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/16/2022 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 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 NAME: Michael Banas BANAS & FICKERT INSURANCE AGENCY (A/c PHONE (A/C, (413)527-2700 FAX No): E-MAIL Coy ADDRESS: so@banasinsurance.com 63 MAIN ST INSURER(S)AFFORDING COVERAGE NAIC# , EASTHAMPTON MA 01027 INSURERA: LIBERTY MUTUAL FIRE INS CO 23035 INSURED INSURER B: VK DESIGNS INC INSURER C: INSURER D: 51 HOLYOKE STREET UNIT Al INSURERS: EASTHAMPTON MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: 785686 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ I POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ I _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED _ AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE PER 1 OT ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? NIA N/A N/A WC231S624125012 03/24/2022 03/24/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Holly Sweeney ACCORDANCE WITH THE POLICY PROVISIONS. 259 Acrebrook Drive AUTHORIZED REPRESENTATIVE 1Florence MA 01062 iel Daniel M.Cr ,, y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ACC1R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/16/22 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 NAME: Michael R.Banas Banas and Fickert PE FAX Extl: 413-527-2700 �a/c No): 413-527-0849 Insurance Agency E-MAIL 63 Main Street ADDRESS: mb@banasinsurance.com Easthampton,MA 01027 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A: Union Mutual Fire Insurance Company INSURED INSURER B: VK Designs,Inc. INSURER C: DBA Valley Kitchens INSURER D 51 Holyoke Street Unit Al Easthampton, MA 01027 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 AUDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO VI/VD POLICY NUMBER MM/DD/YYYY( ) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO REN lED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 5,000 A BOP0195521-01 07/28/21 07/28/22 PERSONAL&ADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 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 LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY Y/N - STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE "�A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Bath&Kitchen Furniture Sales,Installation and Remodeling CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Holly Sweeney ACCORDANCE WITH THE POLICY PROVISIONS. 259 Acrebrook Drive Florence,MA 01062 AUTHORIZED REP -S IVE 15 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 4