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DEPARTMENT OF BUILDING INSPECTIONS `
INSPECTOR 212 Nfain Street ' Municipal Building \�,
Northampton, Mass. 01060
Square Footage Amount
Basement @ .10
1st Floor @ _40 j D 3 6
2nd Floor @ .20
1/2 Floors, Attic, Garage .10
Deck, Porches .10
TOTAL �O
C1 C
Commonwealth of Massachusetts
V
M ( of Building Regulations and Standards
'
I r� i
Manufactured Buildings Program
i LABEL REQUEST FORM
L--- --------------Jrhis Section for State Use Only
Date Rec ived ti '' 1 '`' �' Label Numbers Issued:
Fee Received _ $ Doo .GO W59 &(o � 93 4 8 99399
Check Number S Lt6 Date Issued: 4 p Z 1 Issued by:
This Section to be Completed by Manufacturer-PLEASE PRINT OR TYPE
SECTION 1 - MANUFACTURER INFORMATION BBRS\DPS I.D. # 39 60 9
Manufacturer Name A V I S A M E R I C A/ E X C E L H O M E S I MC# 0 2 7
Street P . O . SOX 420 - HENRY STREET
City/State/Zip A V I S , P A 1 7 7 2 1
Manufacturer Telephone Number: (5 7 0) 7 5 3 - 3 7 0 0 Fax Number: (5 7 0) 7 5 3 - 5 0 0 9
Manufacturer-Plant Inspector 7Ho m R S PAC�C,19/P-Q
Third Party Agency P F S TPIA # 0 2
Number of Labels 4/ Total Amount Attached $ oZ Q O • O
Manufacturer's Serial Q ax,-rE # /D 5 O/ Manufacturer's Model sT 0 R y
Number rl / y(o Q a Designation ���
SECTION 2 - LOCATION OF BUILDING
Street
City/State/Zip ffQkZ14A M P T O W C) ! U
SECTION 3-BUILDER/DEALER/CERTIFIED INSTALLER INFORMATION
Builder/Dealer 7-/-/E H6 M S TQP E
Street 9,3 TA T L jE o a 1) U . L3 Cox- 0 00
City/State/Zip / 1/-J q TLC- Y
Certified Installer U t-LG PEgs
Licensed Construction License Number: J O
Supervisor J l In klA kk I T y
Expiration Date: (a _ a6 - 63
This form shall be completed by the manufacturer when requesting manufactured building labels. All
information shall be clearly indicated_ Incomplete forms will be returned to the manufacturer unprocessed.
This request shall be forwarded to the State Board of Building Regulations and Standards- CERC
Building, Paul A. Dever School-1380 Bay Street,Taunton,MA 02780
Bbrs\Forms2\mf&Labe1Request
June 15,2001
m:Janet Trudeau At: Blair, Cutting&Smith To KATIE I•ax#. (41s)zDlyibv uate: uii/ul iu:DuAm rage i
ACORD CERTIFICATE OF LIABILITY INSURANCE OP HONES-I OA08/01/O1
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Blair, Cutting & Smith Ins. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
7 North Pleasant Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Amherst MA 01002
INSURERS AFFORDING COVERAGE
Phone: 413-256-8541
INSURED INSUREPA Eastern Casualty Insurance Co.
INSUPEP-E Acadia Insurance Company
The Home Store Inc. & INSURER Blue Ridge Insurance Company
Andrew & Janice Gianino
P.O. Box 300 INSUPEP 0
Whately MA 01093-0300
fNSUPEA E
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE MMIDDlYY DATE MMIDDIYV
GENERAL LIABILITY J,CHCCC'JRRENCE s 1000000
A % COMMERC'ALGEIEPALLwEIUT'1 CP00003300 Ce/01/01 I 08/01/02 FIRE^AMAGE(4^io^e Ile) s 300000
c AMS reADE r%I oc-uR I MED E-P(AM Ole ces-) s 5000
`J I PERSONAL&AD\'id1URY S 1000000
GENERALAGGREGATE I S 2000000
GEN'L AGGPEGATE LIMIT APPLES PER. Pz?OD'JCTS-COMPiCP AGG I s 2000000
POL:CY I Eb LCC I Ben' 0
AUTOMOBILE LIABILITY COMENEO SINGLE'-;M^ S 1000000
C A.:APG CA008284900 I 08/01/01 I 08/01/02 [E2 311 11'1; j
ALL OV,4ED AUTOS
(Pe,L�eS IoIL•''
-AUTOS$ SCHEDULE
Iy.HIPED A TOS ECDI!-
NOT? U
RY S
C",,EJ AUTOS
pf�OPFC-/OAVAGE S
I �
GARAGE LIABILITY I —
A3G S
EXCESS LIABILITY sc c_'RP_.acE s2000000
B �7 Occ'_R C'-AMS'AGE CU53419 08/01/01 08/01/02 1 AcGREOA z
I— -
D E er 5000
WORKERS COMPENSATION AND g R� v;s
A EMPLOYERSLUi[ialTY WC00747093 08/01/01 1 08/01/02 __ c'-.Ac-'.DE S100000
_ __ __ �EVP--,_E S100000
3500000
OTHER
I
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONSADDED BY ENOORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER 11 ADDITIONAL:NSURED:INSURER LETTER: CANCELLATION
HOMESTO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL
THE HOME STORE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR
ROUTE 5
WHATELY MA 01093 REPRESENTATIVES.
W ,
ACORD 25-5(7197)
'ACORD CORPORATION 1988
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JaN'c S1S'ir �q[a/s�sN4idlV - 1.�V7
�� t(C i4 Tn 0/l TCI 1'r`UW
Governor e�(_aa•w—ssj-N���sw j w_�crc/, Vice Chairmen
V 210
JAIMES JAIUGA
THOMAS L.ROGERS
Secretary TEL: (617)727-7532 FAX: (617)227.1754 Admrcicrnror
April 29, 2002
Avis America
Henry Street—P. 0, Box 420
Avis, PA. 17721
RE: RE-CERTIFICATION IN THE MASSACHUSETTS 1MAVT_FACTURF;7
R1j11.D1N1 3C PROC D AM Mr:Uh'f'1
To Whom It May Concern:
This letter is to confirm your re-ce-Ttifi.cation in the Massachusetts Manufactured Buildings
Program as a producer of Manufactured Buildings has been approved for the period May 1.2002
through April 30,2003.
This approval is contingent upon compliance with all previously listed conditions of vour
approval and compliance with the provisions of 780 CMR the Massachusetts State Buildinno
Code 6" Edition,the Electrical Conde—and Fuel/Ga-s Code.
SinrerPjv,
CT A TE Pn D Din (1F T11 711 111ATC= D C,'(_T TT ATTn'KTC A ATTI CT A ATT'1 A D nQ
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1 h maS L. K oocr s e
Adrnin istrator
cc: MA. Board of Examiners of Plumbers and Gas Fitters
MA. Board of F.xwniners of Electricians
c nnn l-, A" b"" ircit"d frv.rn the Board of Building Regulations and Standards
a: a t A380 o , Suez r, °0. $az 871, Taunton, .M..a 0 7Rn
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