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Board rd' Building Regulation% And Standards
''/ Cnrstructlon Supervisor Licensor
License: Cs 98991
Restricted to: 00
JIHAD 8 MOUS8A I f - • .'
025 TRADEWIND ST
NEW BEDFORD, MA 02740 .
Expirelbrt: 3130/2O11
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CERTIFiCAT'E OF INSURANCE
(3ENEFtAt.At3ENr ISSUE TAW t;MM
A.I. T
A.I.T. Insurance Brokerage of MA, Inc. (�!'Vl QE3joy fat}g
183 Davis Street This certificate is issued as a matter of information only and confers
]vast Douglass, .14A 01516 no rights upon the certificate holder. This certificate doss not
AGENCY .21102 — 00 amend, extend or alter the coverage afforded by the policies below,
INSUMED COMPANY AFFORDING GOVERAoE
JBM Etiterpriees Sa .tilue Insurance Company
925 Tradewind Street
New Bedf d1A 02745
Cf7VER4GES _
This Is to certify that the policies of Ins=urance listed below have been issued to the lns:cred named above for the policy period inrt+cated, not
withstanding any requirement, term or condition al 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 (rand(dons of such policies.
Limits shown may have oeal1 reduced by paid claims.
ere Inv yllgoLiqf
TYPE OF INSURANCE POLICY NUMBER EFF. DATE Ex?. DATE UMFtO
(MyNtOf ) ,iM.MJ OD 1 `nllrYi
ii.
Commercial �L wraiial 07/13/2008,07,/:.3/2o0.9 ut.wh1�Atoommeo r'E $ 10C,000 .000
irt1A'tercuss
Ei Oeeurrerres PRQOUCT64OMP /ops AGtREQATE $ .. V 4 , U vc
❑ Claims Made PeresCHAl. i><A0VERPeW1A ILunY
General Ago Limit Applies Per Wry Gm person w arssnitMlion) $ 1 QC , 00 0
Racy EACHOCCUStse $ 100, 000
Project
$ To PPI314IEES Ii1W ro yot;
LouatlUtt not omelleaq $ 11)0,000
[.I Other ME[7iwALEM (Anynna 5,000
pessanl 5
EXO ESS/UMBRE1.LA LiABILITY a ACH or.lou ; ifiN .S AGGRacm - rF
0 Excess t sbtaty $ 5
Umbrella Liability
❑ Oct urrence
❑ Claims Made
❑ Oeduci Die a
❑ Retention $
- -
OTHER
$ $
DESORPTION OF OPeRAT1ONS /LOCAT1ONS/PESTt;IOTIONS /SP ECIAL rTEMS
Sewer Main Conatruction
Policy includes =LT coverage
CERTIFICATE HOLDER __ GANCEUATltlw
Should any of the above described policies be cancelled
twfewe the expiration date thereof, the isauing compenY will
endeavor to mail IQ days written ncxtce to the sass urinate
holder named to the left, but failure to rrtiall such notice shall
Impose no obligation or liability of arty kind upon the
company, its agents or representatives,
AUTHORIZED RE
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THIS CERTIFICATE. IS ISSUED AS A MATTER OF INFOIRMA'TION ONLY ANN
Braokiswn lnouraItCe Agency Inc CONFERS NO RIGHTS CPON THE CERTIFICATE HOLLER, THIS CERTIFICATE
556 Ashley Blvd DOS NOT AMEND, EXTEND OR ALTER THEC:OVERACE AFFORDED BY THE
POLICIES BELOW,
New Bedford, MA 02745 — •...°..
COMPANIUS AFFORDING COVERAGE
JBM Enterpriaclae
925 Tradewind Street COMPANY A A,I.M. Mutual Insurance Co
New Bedard, MA 02740 I.EDFER
LL I '..__ u ? $c ` l 1 , :Y i t C k. i *, � � � ' l' + c,,' t ' , '
This IS TO CERTIFY THAT T - POLICIES OF RV • ' E LISTED BELOW HAVE BEEN ISSUED TO TEE INSO$(BD N '• iv. tt r rOr4Cs1
PERIOD INDICATED. NOTWITHSTANDING ANY REQIJLREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCt1MENT WITH I ESPEC.'T
TO WHICH TIUS CERTIFICATE MAY BE 19SURD OI.MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SI ALIECT
TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS 4NOWN Y FIAVB BMW REDUCED SY PAW CLAIMS.
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CHOUBAH ENGINEERING GROUP, P.C.
CONSULTING PROFESSIONAL ENGINEERS
112 State Road (Rte. 6) / N. Dartmouth MA 02747
Tel: (508) 858 -5040 / Fax: (508) 858 -5041 / www.choubahgruup vuui
July 1, 2009
Mr. Anthony Patillo, Building Commissioner
Puchaiski Municipal Building
212 Main Street
Northampton, MA 01060
Re: Proposed Filling Station & C -store
54 Easthampton Road
Northampton, MA
CEG# 07.208
Dear Mr, Patillo:
Please be informed that CAP Development, Inc. is no longer an authorized Agent/Contractor for
Track Reality as of June 23 2009 and his Contract has been terminated by reason of
abandonment. A new Contractor (Jt$M rnnterprise, Inc.) has been authuricca w nut us Auxin
on behalf of the Owner to complete the construction of the project per the approved plans drawn
by Choubah Engineering Group. As per your request we are forwarding proof of insurance and
copies of the Construction Supervion License.
This office will continue to conduct periodic field inspections at the various critical stages during
construction and will submit copies of final inspection reports to your Department prior to
occupancy in compliance with the Massachusetts Building Codes requirements.
Please let us know when you are available to conduct a site inspection of the completed work per
our previous discussions.
Sin iy, ,f
/
Hakim Choubah, P,f
t •rof essivnai crrginccr
Massachusetts License No. 38736
Co: Pile, Attorney Henry Cropsey, IBM Enterprise, Trek Petroleum LLC
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tEM:a
CHOUHAH ENGINEERING GROUP, P.C.
Consulting Professional Engineers
112 State Road (Rte. 6) JUL 2 - 2009
N, Dartmouth, MA 02747
Tel. 508 858-5040 / Fax 508. 858 -5041
FACSIMILE
TO: Anthony Pati11o, Building Commissioner
FROM: Hal Choubah, P.E.
DATE: 07/01/09
FAX NUMBER: (413) 587 -1272
NUMBER OF PAGES INCLUDING COVER: 5"
RE: 54 Easthampton, Road
CEG# 07 -208
Dear Mr. Patillo,
As requested faxed are copies of proof of insurance and construction supervisor license of new
authorized Contractor at the above referenced location.
Please feel free to call this office if you have any questions.
Thank you
CONFIDENTIALITY NOTICE. The documents accompanying ing this facsimile transmission contain privileged confidential
Lnfbrntation. Thu Infinnuaiun LY intcudod wily Lb dm use of the ici.ipicnt uaxlad arc. If you two Aot on intended rouipiont, you ore
hereby notified that any disclosure, oopying, distribution or exploitation of, or taking of any action in reliance on, the contents of this
facsimile is strictly prohibited. If you received this facsimile in error, please notify us immediately by telephone to arrange for return
of the documents.
T 0 ' d 1 trOS 8S8 BOG ON I d33N I ON3 HtlgflOH3 Wd 8 GO 6002-TO
See �.
I 0 II flijJU I II
J U ( 1 0 2 009 2009
Bk: 9852Pg: 100 Page: 1 of 1
Recorded: 06/16/2009 10:27 AM
NOTICE OF CONTRACT
M.G.L. c. 254, § 4
Notice is hereby given that by virtue of a written contract, dated March 20, 2009,
between CAP Development Inc., P.O. Box 727, Holderness, NH 03245 ( "Contractor ")
and M & R Concrete, P.O. Box 688, Easthampton, MA 01027 ( "Supplier ") has furnished
materials and labor for the erection, alteration, repair or removal of a building, structure
r-- or other improvement of real property by Contractor for M & A Realty Associates, LLC,
C
owner, on a lot of land or other interest in real property described as follows:
- • • '''SieNorthampton, MA 01060
M & R Concrete
By:
Kenneth Lieber - m 4 iN
Its: Attorney and authorized agent
COMMONWEALTH OF MASSACHUSETTS
Hampshire, ss.
Then personally appeared the above named Kenneth Lieberman, as attorney for
11.1 M & R Concrete and acknowledged the foregoing instrument to be his free act and deed
and the free act and deed of M & R Concrete, before is
� Notary Pu i 1ic
( My Commission Expires:
RAYMOND E. DINSMORE, III
NOTARY PUBLIC
I COMMONWEALTH OF MASSACHUSETTS
- My Expires Mar, 21 , 2014
LT TEAT : HAMPSHIRE, PSHIRE,L' wu.cptra£ a uiF �REGIcUl.ii1
MARIANNE L. DONOHUE