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17C-116 (2) ACORDM -CERTIFICATE OF LIABILITY INSURANCE 1 0DATE 6/14/20 6) PRODUCER (413)527-5520 FAX (413)527-5970 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Finck & Perras Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6 Campus Lane HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR p ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton, MA 01027 INSURERS AFFORDING COVERAGE NAIC# INSURED Andre Senecal & Sons, Inc INSURER A: National Grange Mutual Ins. Co 14788 138D Fomer Road INSURERB: Commerce Insurance Company 34754 Southampton, MA 01073 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN 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 DD' TYPE OF INSURANCE POLICY NUMBER EFFECTIVE POLICY EXPIRATION POLICY LIMITS DATE(MMIDDLYYI GENERAL LIABILITY MPI35576 06/14/2005 06/14/2006 EACH OCCURRENCE $ 300,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000 CLAIMS MADE M OCCUR MED EXP(Any one person) $ 51000 A PERSONAL&ADV INJURY $ 300,000 GENERAL AGGREGATE $ 600,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 600,000 POLICY 7 PRO LOC JE& AUTOMOBILE LIABILITY VK9814 05/18/2005 05/18/2006 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ B 100,000 HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) 300,000 PROPERTY DAMAGE $ (Per accident) 50,000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ 1 E ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR a CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WCI35576 06/14/2005 06/14/2006 WC STATU- OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 100,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 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, Elizabeth Kendrew BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 19 Sheffield Lane OF ANY UPON THE INSURER,ITS AGENTS OF REPRESENTATIVES. Florence, MA 01062 AUTHO ESENTA IVE A ACORD 25(2001/08) J ©ACORD CORPORATION 1988 ACORP. .CERTIFICATE OF LIABILITY INSURANCE 1 0DATE MM/DD YY 6/14/20 6) PRODUCER (413)527-5520 FAX (413)527-5970 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Finck & Perras Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 6 Campus Lane ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton, MA 01027 INSURERS AFFORDING COVERAGE NAIC# INSURED Andre Senecal & Sons, Inc INSURERA: National Grange Mutual Ins. Co 14788 138D Fomer Road INSURERB: Commerce Insurance Company 34754 Southampton, MA 01073 INSURERC: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN 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 DD' TYpE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY MPI35576 06/14/2005 06/14/2006 EACH OCCURRENCE $ 300,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000 CLAIMS MADE M OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 300,000 GENERAL AGGREGATE $ 600,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 600,000 POLICY 7 PRO JECT LOC AUTOMOBILE LIABILITY VK9814 05/18/2005 05/18/2006 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY (Per person) $ B X SCHEDULED AUTOS 100,000 HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ 300,000 PROPERTY DAMAGE $ (Per accident) 50,000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ 1 F EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR El CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ TH- WORKERS COMPENSATION AND WCI35576 06/14/2005 06/14/2006 WCSTATU- OR EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ lOO,OO A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 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, Elizabeth Kendrew BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 19 Sheffield Lane OF A UPON THE INSURER,ITS AGENTS R REPRESENTATIVES. Florence, MA 01062 AUT PRESENT TIVE /) J a ACORD 25(2001/08) ©ACORD CORPORATION 1988 fie toanvrno�ufe� ✓�aaa urve� BOARD OF BUILDIN REGULATIONS License: CONSTRUCTION SUPERVISOR i Number. CS 080337 Birtt�ao Ek5109 957 a Ex OSf0 (2097 Tr.-no: 14895 I � ' ANDRE L SENECAi 138D FORMER RD SOUTHAMPTON, M O'f�1&73 Commissioner mis` 1w � r� �✓G Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:_127581 Expiration: 1'I/1;8/2006 .- Type: Private Corporation ANDRE SENEGAL-&SONS`INC_ ANDRE SENECAL 138D FOMER RD SOUTHAMPTON, MA 01073 Administrator SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: 14n CJ e— License Number Address f Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Company Name / Registration Number Address Expiration Date / b vt2�. �Q Tlfn d'�' HZ,� Telephone /3--.jam7 /LAY d. /073 SECTION 10-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......."M No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own 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 homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding[O] Other[b� Brief Desoption of Proposed [ r ° work: / ZI�,h' n .'i� I A /�✓Cr�:EG40'Z Y rAl/tt Nz/l Alteration of existing bedroom Yes No Adding new bedroom Yes �' No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? --Yes No. 1. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING)PERMIT /7 12 as Owner of the subject property hereby authorize ri ��L J �4�r �7 -- to act on my behalf, in all matters relative to work authorized by this building permit 131311i ion. Signature of ner Date I, 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. Print Name Signature of Owner/Agent Date (j Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability hampton, MA 01060 Two Sets of Structural Plans JUN 16 2V ,nef;'t 87-1240 Fax 413-587-1272 Plot/Site Plans Other Specify [r Dc 0ICAIFIQ1'I NST I UCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Proaertv Address: This section to be completed by office ��,.sy�� Q✓/�� Map Lot Unit �/U Kam.n iC G -/ C1 Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT ✓ 2.1 Owner of Record: `J r'-, Name(P(Priinntt). , Current Mailing Address: Telephone Signature 2.2 Authorized Aaent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee 2. Electrical J (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) U 6 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date r BP-2006-1377 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category_ BUILDING PERMIT Permit# BP-2006-1377 Project# JS-2006-2034 Est.Cost: $8825.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor., License: Use Group: ANDRE SENECAL & SONS INC 127581 Lot Size(sq. £t.): 31798.80 Owner: KENDREW JOHN F&ELIZABETH A Zoning_URB Applicant: ANDRE SENEGAL & SONS INC AT: 19 SHEFFIELD LANE Applicant Address: Phone: Insurance: 138D FORMER RD (413) 527-81640 WC SOUTHAMPTONMA01073 ISSUED ON:611912006 0:00:00 TO PERFORM THE FOLLOWING WORK.-REBUILD CHIMNEY TO ROOF 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: 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 Occupancy Signature: FeeTyDe: Date Paid: Amount: Building 6/19/2006 0:00:00 $25.001750 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo