Loading...
31B-004 (26) 47 ROUND HILL RD-GAW ITH HALL BP-2017-0265 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31B-004 CITY OF NORTHAMPTON Lot:-OW PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: demolition BUILDING PERMIT Permit# BP-2017-0265 Project It JS-2016-002048 Est,Cost; 5{)000.00 Fee: $350.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: COMPLETE RESTORATION SOLUTIONS 103014 Lot Size(sq.ft.): 311018,40 Owner: CLARKE SCHOOL FOR THE DEAF Zoning: URC(IQI,/ Applicant: COMPLETE RESTORATION SOLUTIONS AT: 47 ROUND HILL RD -GAWITH HALL Applicant Address: Phone: Insurance: 30 HAYES CIRC (413) 592-2772 WC C H I C O P E E M A01020 ISSUED ON.:9/1/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMO WORK from water damage 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/4 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: FeeType: Date Paid: Amount: Building $350.00 212 Main Street, Phone(413)587-1240, Fax:(413)5874272 Louis Hasbrouck—Building Commissioner File bBP-2017-0255 WIC TO MAK ,l$Ltel APPLICANT/CONTACT PERSON COMPLETE RESTORATION SOLUTIONS ADDRESS/PHONE 30 HAYES CIRC CHICOPEE (413)592-2772 �}} PROPERTY LOCATION 47 ROUND HILL RD-Ciab$ t ttL \anL \ t 4uBAAR l MAP 3IB PARCEL 004001 ZONE URC(10C0/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT ', df��� Fee Paid re-*? LIQVI// 'S' BuildJi g Permit Filled out Fee Paid Ul4tb PAHA Tvpeof Constmctign: DEMO WORK R-• -: (- : � ';-` • g•i, - ' ,. - ::' •� • - '. CiE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 103014 3 sets of Plans/Plot Plan THE FOLLOWING.ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Lid7Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:* Intermediate Project: Site Plan AND/OR_ Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: l Finding Special Permit Variance* Received& Recorded at Registry of Deeds Proof Enclosed_ Other Permits Required: Curb Cut from DPW Water Availability - Sewer Availability Septic Approval Board o'fHealth Well Water Potability Board of!lealth Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay / 6 Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. i aalMOS Version1.7 Commercial Buildin± Permit May 15,2000 t Department use only r- g City of Northampton Status of Permit: 'i i$ Building Department Curb Cut/Driveway Permit _ _ 6 212 Main Street Sewer/Septic Availability (,!:� c `9f Room 100 Water/Well Availability C.� en Northampton, MA 07060 Two Sets of Structural Plans LJ j E phone 413-587-1240 Fax 413-587.1272 Plot/Site Plana_ Other Specify_„ .,_ APPLICATI TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION V1.1 Property Adtices : This section to be completed by office Historic Round Hill Summit, LLC Map 318-006 Lot Unit - 47 Round Hill Road Northampton, MA 01060 Zone URA Overlay District wet Elm St.District CB District —woe SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT _ 2.1 Owner of Record: Historic Round Hill Summit,LLC Name(Print) Current Mailing Address: (413)296-4328 Signature Telephone 21 Authorized Meoy Name(Print) Current Mailing Address: Signature .` Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS _ Item Estimated Cost(Dollars)to be Official Use Only _ completed by permit applicant 1. Building Cpry Wo, cc (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of -.' Construction from(6) ++em .r 3. Plumbing Building Permit Fee alai. 4. Mechanical(HVAC) 5.Fire Protection 6. Total={1 +2+3+4+5) Check Number 179h/ 03SY) This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date e-mitr' l .' Thm bar^rt�( in ticrs; c.. . Co m L erg. Versionl.i Commercial Building Permit May I5,2000 1 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations 0 Existing Wall Signs 0 Demolition Repairs 0 Additions 0 Accessory Building 0 Exterior Alteration ❑ Existing Ground Sign 0 New Signs 0 Roofing Change of Use❑ Other❑ Brief Description Demo work required from structure tire, Excess water Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-i 0 A-2 0 A3 0 IA 0 A-4 ❑ A-5 0 iBI ❑ is B Business 0 2A 0 E Educational ❑ 2(3 I 0 `e- F Factory 0 F-1 0 ..... F-2 ❑ 2C I 0 It. H High Hazard 0 3A ❑ I Institutions! ❑ i-t 0 F2 0 1-3 0 38 I 0 M Mercantile 0 4 ❑ aaa. R Residential 0 R-1 ❑ R-2 0 R-3 0 5A I 0 . S Storage 0 S-1 0 S-2 0 5B ` ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group'. Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) I- ivt 2`a 2nd 3m Imo-- 3'° h- 4m 4^' Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.4 Flood Zone Information: 7.3 Sewage Disposal System: Public 0 Private 0 Zone Outside Flood Zone❑ Municipal 0 On site disposal system❑ - ae Versionl7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be tilted in by nodding Depannuat Lot Size • .a woe Frontage Setbacks front Side L: R: L: R: sear Building Height Bldg.Square Footage °6 Open Space Footage '... / I .�...... (lot rrea minus bldg R pared parkins) #of Parking Spaces .._.._ ._ Fill; (volume Lutetium •._ ._ A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW Q YES Q ..� IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? '.� NO 0 DONT KNOW 0 YES O IF YES: enter Book Page and/or Document N B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Heeds to be obtained 0 Obtained © , Date Issued: C. Do any signs exist on the property? YES 0 NO Q IF YES,describe size,type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES U NO \S IF YES, describe size, type and Location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over I acre or is it part of a common plan that will disturb over 1 acre? YES O NO O .+i —am IF YES,then a Northampton Storm Water Management Permit from the DPW is required. �"'� Versionl.7 Commercial Building Permit May I5.2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant) _ Registration Number Address Mn...- Expiration Date Mess Signature Telephone Ss.— 9.2 Registered Professional Engineer(s): Nam¢ Area of Responsibilly Address Registration Number SignatureTelephone Expiration Date ,_`__ Name Area of Responsibility Address Registration Number t- Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number loish- 40. Signature Telephone Expiration Date Name .... Area of Responsib lity • Address Registration Number SgnaNre Telephone Expiration Date 9.3 General Contractor Complete Restoration Solutions (Completing Emergency Services) Not Applicable 0 Company Name. Responsible In Charge of Construction oi— 30 Haynes Circle, Chicopee,MA 01020 t: Add:es ilia— __ (413) 592-2772 a 1`��� Signature Telephone !M� _,il As Version! 7 Commercial Building Permit May 15.2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes © No O 11 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Historic Round Hill Summit LLC i as Owner of the subject property Hereby authorize to Restoration Solutions for Emergency Services ut act on my behalf,in all matters relative to work authorized by this building permit application. 08/30/2016 Signature of Owner Date veva ve -.me ,y^�r'�/ /y tJA .-,rte I, `•�,}Jj.uv/th ilwtic.--- ,as Owner/Authorized "10 Agent hereby declare that the statements and informs on the foregoing application are true and accurate,to the best of my knowledge and belief. _ Signed under the pains and penaltiespf syskury, Alit �"T-",4 /r7 C, le AS Print Name gr. �s/�- et . 8���/G Signature Qr,e i ,y '''$$$�f Date SECTIO / 2-CONSTR! TION SERVICES 10.1 Licensed Constl'uo•nSuperylsor: Not Applicable 0 Joseph Gillette.... CS-103014 License Number 6 Shady Line,West my,CT 04/30/2017 Address Expiration Date I. iffia (413)592-2772 - Signature Iiir Telephone SECTION 3-WOR' --S r OMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Ins ranee 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 No 0 it The Commonwealth of Massachusetts 7.- Department of Industrial Accidents E='- = Office of Investigations •�: . ' 1 Congress Street, Suite 100 dam Boston, MA 02 114-2 01 7 " °�- www.mass.govfdia - Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly -+i i Complete Restoration Solutions, Inc. Name(Business/Organization/Individual): .+tw Address:30 Haynes Circle City/State/Zip:Chicopee, MA 01020 Phone#:413-592-2772 . Are you an employer? Check the appropriate box: Type of project(required): I.BE I am a employer with 15 4. 0 I am a general contractor and I • 6. 0 New construction employees (MI and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 9. ® Demolition workingfor me in anycapacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp. insurance,, required] 5. 0 We arca corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] ' c. 152, §1(4),and we have no 13.0 Other employees. No workers' - comp. insurance required.] _ *Any applicant that checks box bl must also fill out the section below showing their workers'compensation policy information. -. t Homeowners who submit this affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such. a "Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not hose entities have -� arra employees lithe srh-contraetors have employees,they must prorde their workers'comp.policy number. sa at I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site inf rmation. - Insurance Company Name:Ace Group Policy#or Self-ins. Lie. #:6S62UB-oG12610-0-15 Expiration Date:09.01-2017 Job Site Address: 47 Round Hill Rd City/State/Zip:Northampton, MA 01060 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct Stgttumre: Pate: 06/30/2016 - Phone#: 413-592-2772 • .. Official use only. Do not write in this area,to be completed by city or town official -+at0 was ..r ' City or Town: Permit/License #_ Issuing Authority(circle one): - 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other_...—...—.... Contact Person: Phone#: . t �Wt't'' .. 4�1�� � , �k =r 4 _ . dtec s SIZOOE$STL}�PTLRIEOATTNEISON ,, , frx WORK AUTHORIZATION AND DIRECT PAYMENT REQUEST r 30 Haynes Circle, Chicopee,MA 01020 -as —es (413) 592-CRS2 • FAX (413) 592-2775 -"T {2772} FID9 80-0453943 MA RIC#103014 CT#556236 reit leisured Mame&Billing Address: nq (1:1 �0 } Property Address: (/ /' �J mi mi rel S10/GlC eau tifil 11 : ( 1 SU rLt(y f f Lt e., "7'7 in �. /CGI 333 Q RI SE . ,itto ,, - # — AL S ca Vr1 . 0.1(}Si Jn1 I/w ate r/" 5t- `/F/G,_ res n raseraara Acme ds ofd '71 o-l< 1-ofJc,�In-kms The general of work and a Centra. 's set forth in the Estimate of Comp ate Rest tion Solutions, Inc, which is incorporated into this Agreement. Work will commence on and the estimated completion date is VAD .which may be extended for delays beyond the controltrot oof f Complete Restoration Solutions,C C . In consideration of the agreement of Complete . :don Solutions,Inc to provide services required to preserve and protect the personal and/or real property,which I own,control,or lease: I, I/We hemby assign to Complete Restoration Solutions,Inc all of my right,title,and interest in and to a portion of all insurance benefits or proceeds to which Uwe may be entitled, and assign any and all claims which Uwe may have against any insurer, to the extent of the amount of the bill for professional services rendered to me and/or my property referenced above;and I/we hereby grant a hen to Complete Restoration Solutions,Inc on any insolence benefits or proceeds that may be due me. f/we Rather acknowledge and agree that said assignment may not be revoked retroactively,and may only be revokedby giving a written notice by Certified Mail or handdelivered to Complete Restoration Solutions,Inc,effective after the date of receipt may;; of said written notice by Complete Restoration Solutions,Inc. ., SS 2. I/We hereby authorize and direct the payment of such insurance benefits or proceeds directly to Complete Restoration.Solutions,Inc and direct the above referenced insurance company to pay to Complete Restoration Solutions,Inc such sums as may be due upon receipt of a statement for services rendered 3. UWe understand that I am primarily responsible for the payment of all charges related to professional services rendered by Complete Restoration . Solutions,Inc to me and/or my property referenced above and the authorization contained herein in no way releases me from personal responsibility to ---vmAi pay for such charges. "!, 4. I/We hereby request and authorize my insurance company to furnish Complete Restoration Solutions, Inc with any and all information, including without limitation,payment information and estimates with regard to work required to preserve and protect the personal and/or real property which Uwe own,control or lease, S. Any individual or entity shall be entitled to rely on the original or any photocopy of this document as if it were an original. 6. It is understood that the estimate is subject to theoval of the adjuster or a representative of the insurance carrier. 7. I/We acknowledge that all moveable items of s'p fiprnt value have been removed from the premises or destroyed except as follows: 8. 1/We further understand that any and all deducti es and/or betterment from our insurance carrier shalt be due and payable by us at the completion of services semhsrd. If payment is not received thin 30 days of invoice,a delinquent payment penalty will be charged at 18%annual rate. 9. In the event this account is referred to an attorney for collection,I/we agree to pay reasonable attorneys fees to Complete Restoration Solutions,Inc's attorney,and court costs,in the event a suit is filed. 10. All contractors and subcontractors must be registered by the State and any inquiries relating to a registration should be directed to the State.Owner's rights am set forth in M.G.I..e.142A. Do not sign this Agreement if there are any blank spaces. You may cancel this Agreement provided you notify Complete Restoration Solutions,Inc in writing at its office or by mail posted not later than midnight of t,e third business day following the signing of this Ag - meat Se,Notice of Cancellation. -ndin, to be /gaily bound,l/we sign this „day of -a acro,_. I � 7 /t r?«4e ,er s Sit.T.tore SS# Date .art a 0 �.ie : r` SS# Date . ill .art ep a e F i 8/ G /!� 100.1D'Nt 80-0453943 Da ot rat CRS R sanative vot I/We hereby ize my deductible and any other sums due under this agreement to be charged to the following account: Visa or MasterCardrar number Expiration Date Cardholder Signature „_„ .MM ARO} CERTIFICATE OF LIABILITY INSURANCE bBJSOlz0361 -ROMP " 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 la an ADDITIONAL INSURED,the policypes)must be endorsed. If SUBROGATION Is WAIVED,subject to the terms and conditions et 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 endorsementls). PRODUCERIWet"Gail Crooke — Borowski ZnduranCa PHONE (413)586-5011 IFAS A EnI. et__<iu1586-'7871 89 King Street, Suite B RDDONESS:gOrOakeebOrawekiinanranCa.COM amPjxsureERACa 7201 Specialty Ins 1NAcs _ INSIMENSIAFFORONO COVERAGE Northampton MA 01060-3257 —._ P CorpesP 10328 INSURED DXsuREae:Zucictl Insurance Services _ ' ZGR001 _ Complete Restoration Solutions Inc. INSURER c Ranover 22292 30 Haynes Circle INS KERD: - -INSURER E.: _-. Chicopee MA 01020 INSURER F: COVERAGES CERTIFICATE NUMBER:16-17 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. alai CONDITIONS CIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _E%CXW CCMMERCMLOE SURANCABI Y UCH FDL B � .�....... roIICY EFF POLICY}' A CMSMAOEw J(X OCCUR 7A � PouGV NUMBeR IMMIeOM'YVI NNW LIMITS LTR VSD EAC CCCDRRE E 5 1.000,000 I OAMM4 300,000 yROMIxE3_L neper� $ .� FXI Professional Liability ' 'EV201E052E-02 8/28/2016 8/28/2014 I MEC E%P( y neperaoZ S 5,000 aSi i„ PERSONAL 6 AW INJURY 5 1,000 000 GEN'L AGGREGATE LIMIT APPLIES PER' GENIRAL AGGREGATE 5 2,000 000 _ _Pa4X il.78f _1 LOC PROEBL s 2 PAT' (S 2,000,000 I OTRBa. '',memorial UPIAB, $ 1,000,000 AUTONO9ILE LIABILITY I IrCOMBINeeD3dHaat N S ANY AUTO sonny bauRY(Rr aerial) i S AI..IOWNED r (AUTOS LFO I N BOONJUfl (Per accident) S - �AUt06 -NON-OWNEDD PROPERTY DAMAGE - S HIREDAUTOS _Th AUTOS _ 1$ XaUMBRELLALMB IYXIOCCUR I EACXI�URRENCE 11 A ., ,AAAA5 4Opp,000 EXCESStua I CVJMS-MADE AGGREGATE IS 5_000,000 040 :X RETENTIONS 1.0,000 10E00015119-02 8/20/2016 8/20/2017 $ COMPENSATIONWORKERCOMPENSATION11 ROEMPLOS'ERS'We111TV _L$TRATTF..�.. ER VrN ANY PROPR ETONPARTNER/ExECuiIVC E L EACH ACCIDENT $ 1 000 000 OFFICER/MEMBER EXCLUDED* B (M �:NIA anNtaXM)y In IR0G2639 8-fi-16 9/1/201€ ! 9/if2017 E L DISEASE EA EMPLOYEE$ 2 000,000 IKESCW EVMw�r DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 5 1,000,000 C Sailpent Coverage 1 M0;955954 02 B@0/2016 8/25/2014 z S3E0.00 Mtl Si W] A CPL i .ZV20150528-02 0/28/2016 ' it/28/2017 151%0.500 Es OW -.eel 1 I I "m: DESCRIPTION OF OPERAna4S,LOCATICHS4 VEHICLES fACORO101,MMPlensaeierlateda reay be=ached n mos apace N raqinfell aM _a 1111111g Y+ CERTIFICATE HOLDER CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE Mm THE POLICY PROVISIONS, 212 Main Street, Room 100 Northampton, MA 01060 AUTHORIZED REPRESENT/ONE �P R Borawski/BORGC1 Y --aeras,..-,..01C ®1888-2014 ACORD CORPORATION. All rights reserved, ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025,num1 ACLI O CERTIFICATE OF LIABILITY INSURANCE DATLMWtDrfYYVI Se.-8--"- 8/26/2015 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 g�m+saasir� BELOW. THIS CERTIFICATE OF INSURANCE DOES EDT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED Bey REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER IMPORTANT: tt the cartificate holder i an ADDITIONAL INSURED,Bre polis)cyfemint be endorsed. If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,ceRabl policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsementls). FROMCER mug._Gall. Croaks Liorawaki Insurance IFAS eW,Rnr (413{556-5021 (Ns Rte(4131506-1913 B6 King Street, Suite )2 EMAIL gcroake@borawskii surance.cola ArRAHLAIC AEC MWPERAcialty COVERAGE 1!28 NOcihaaptOn MA 01060-325] wsuxea A Capitol Specialty Ins Group 30328 - �.. P__ INSURER INSEAM BAce Group 22667.__... Complete Restoration Solutions Inc. eHHanover __. 1,22292 30 Haynes Circle IIS RD: ngWER E: .. __.. _. ChiC.!'- r MA 01020 INSURER E: COVERAGES CERTIFICATE NUMBER:15/16 REVISION NUMBER: iTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTE IHS'ARCING ANY REQUIREMENT,TERM OR OONOIT.ON OF ANY CONTRACT OR OTHER DOCUMENT v:'in RESFEO I i.. DES,-I HIS 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. TADDLIEVRA _.. _.... _.._.... OH Thai TYPE INSURANCE 14V . FOUCTMONIER I ItWtavren AiryAVp ARD41„. UNITS -. X.COMMERCIALGENERAL UASIUIY 1 EACH occuRRerich 5 1,000.000 A '.. U M-MADE X OCCURE.v£ ff m.REZf' S 300,000 EV201502528-01 8@8/2015 6/20/201fi MERATED _ $ 5,000 TONS _ PE55aRSON AL a Uv INERT `i ] 000,000 'v9 GEKLIAG f -?EpDgMP CM PAAGGREGATE rES POENE9 2,000,000 X RODD I.7: T LW PRODUCTS COMP/OP AOC a 2,000,000 O'1£R. Taos 4 $ 1,000(000 "^y AUTOMOBILE IU®LITY I L�Bpi I$ G LIMITT ANY AUTO 1800111 NTRRY F I ) ,S -.. 1 ALL.mYMD a)REOUIRT i'. BWLY ADETY(Fn READS.t I I NODS AUTOS. HIREDAUTOS .NONDONEO - PROPERTYp DAMAGE 's Rums .E?Er_=s9M1_ _ X UMBRELLA LIAR 1 OCCUR 1'. EACHOCCURRENCP 5 5,000,000 A I.EXCESS LINN o,Los4NFOE I .AGGREGATE S 5,000,.000. T X CO : RETENTIONS 10,000 I 6J0001511Tp; A/29/2(315 B/20/2016 AN!WORKERS YAKS' LABIUT I I PER CTs. AND pWLR RSUABWn rrx I j LSCRAT'6 a ANT Mra E Ex L Etw[cu7vC ..t SCR CbE $ ] 000,000 R .nMtu , NEA ExCLVDEM NlII1 .._ IWVLIay- NH -- I'6662U8-OGI2610-0-15 19/1/IDIy 9/1/2016 I E1DISEASE EMPLOYEES 1 COO,000 devote AIR 'EL DISEASE-POISE'UV T 1.000 000 C I Bar Inent Coverage I IAmI96S9542 B/28/2015 B/213/2016 DSO OD ORI 51000 A CPL. I ECY200612213 IB/28/2015 8/15/2016 .S1.HaGOV Ea 0c I DESCRIPTION OF OPERATIONS I LOCAndler VEHICLES IACCpw 101.AWIM1uul Pomona SCMMO,may IR attached Il men WEN Viral/AVER •ort CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF'DP ABOVE DESCRIBED POLICIES 8ECANCELLEDBEFORE ~o( THE EXPIRATION DATE THEREOF, NOTICE VRLL RE DELIVERED IN v,Y ACCORDANCE WITH11*POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE `� q ���y � R Rol awsi_i/AOBGC:: d •.. - @ 1988.2914 ACORD CORPORATION. All rights reserved. ACORD 25 12014101) The ACORD name and logo are registered marks of ACORO INS08m:.as IPMassachusetts-Department of Public Safety Board of Building Regulations and Standards Centru.tin n SulkFt h..i LiIGIL.144E m3014 f JOSEPH M6 SHADY AJ(E WESTSIM ctV � -4 tib/ Jt ..S�6rjo. ""'I. Expiration Commissioner 04/30/2017 "t -.mei -..••••1i irk .1 "1 v c. tet. Cr Ae 'Coin »a>zuea/fA at C��:47.;.x{cA%e.:eh Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 .a Boston, Massachusetts 02116 Home Improvement Contractor Registration -.e Registration: 164927 Type: Private Corporation COMPLETE RESTORATION SOLUTIONS, I Expiration: 122/2017 Tr* 273106 JOSEPH GILLETTE 30 HAYNES CIRCLE CHICOPEE, MA 01020 ------ Update Address and return card.Mark reason for change. , T- `+ ' Iasn -� Address II. Renewal Employment _ Lost Lost Card -72,t i,,,,,,,,,,,ti/n,rr /..r de.:rirG -2 Office of Consumer.Affairs&Business Regulation License or registration valid for individul use only 'd4 Y IMPROVEMENT CONTRACTORae,ore the expiration date. If found return to: Registration: 164927 Type: Office of Consumer Affairs and Business Regulation Expiration: 12/2/2017 Private Corporation10 Park Plaza Suite 5170 COMPLETE RESTORATION SOLUTIONS,INC Roston,MA 0 • JOSEPH GILLETTE /✓///,(j�� 30 HAYNES CIRCLE /11411647— -•• •••101 CH COPES.MA 01020wfwatiat { _ Undersecretary ‘llNot valid without si nature "14 "5 •�4 -mi 1