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15B-046 (3) 610 SPRING ST BP-2017-0422 GIS u: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 15B-046 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:shed BUILDING PERMIT Permit 4 BP-2017-0422 Project ri JS-2017-000696 Est.Cost: $5400.00 Fee:$48.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: use Group: Homeowner as Contractor Lot Size(s4. ft.): 29664.36 Owner O'BRIEN LESLEY.' Zoning: URA(1001/ Applicant: O'BRIEN LESLEY J AT: 610 SPRING ST Applicant Address: Phone: Insurance: LEEDSMA01053 ISSUED ON:9/30/2016 0:00:00 TO PERFORM THE FOLLOWING WORIG20' X 12' STORAGE SHED - BUILT OFF SITE 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 U 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 9/30/2016 0:00:00 $48.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner 1�p oIC- File N BP-2017-0422 d N I V APPLICANT/CONTACT PERSON O'BRIEN LESLEY I qI"U ADDRESS/PHONE LEEDS Ill '¢Q!/✓�- PROPERTY LOCATION 610 SPRING ST 1J MAP 15B PARCEL 046 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED 0 y Fee Paid LIi7G(/ Building Permit Filled out Fee Paid Tvpeof Construction: 20'X 12'STORAGE SHED-BUILT OFF SITE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION PRESENTED: ' Approved 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: § 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 of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demo ". Delay Sirre of Buil.:g iffrcial 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. Department use only City of Northampton Sous of Permit .._ Building Department Curb Cul/Driveway Penni( i"•."--�) 212 Main Street Sewer/Septic Availability LY- -- Room 100 Waternroelt Availability 2$ r; 1 Northampton, MA 01060 Twos Structural Plans phon 413-587.1240 Fax 413-587-1272 PIOVSite Plans Ogler Specify ICATtbwTO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 property Address: ("/ This section to be completed by office {r ) 117/7/1 1 fir//�/flit /}7///j Map Lot Unit LLt//(�� /r l /` /�`" .C3 Zone ct Elm St Distrix Overlay PDiEI MIS ict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT ���yyy777 ^�1 Owner of O'BrienRecord: �r f /�/4c Lesley rien 610 Spring Street /eerie c' Name(Print) Current Mailing Address. cell: 413 297-6708 �a / �/ X40-te� (�, /gu.,..-, Telephone ,I. /." agile /,r!'aSd�IG Signature r el phone //`M',/ GO > 2.2 Auttwrized Aaent:n Name(Print) / Current Mailing Address: Signature Telephone $ECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $ 5,400,00 (a)Building Permit Fee 2. Electrical n/a (b)Estimated Total Cost of Construction from(6) 3. Plumbing n/a Building Permit Fee 4. Mechanical(HVAC) n/a 5. Fire Protection 6. Total=(1 +2+3+4+5) $ ' )' Check Number /,g/y 9 This Section For Official Use Only Budding Permit Number: Date Issued: Signature: Building Commssronertinspedor of Buildings Date Section 4. ZONING AD Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be flied in by Building Department Lot Size 29,670 SF nla 253,97 feet n/a Frontage Setbacks Front 20' nia Side L: 4 4' nla n/a 4' n/a • Aear Building Height 8' Bldg.Square Footage n/a % 240 Open Space Footage nla (tut Area minus hldg&paved parking) n/a n/a of Parking Spaces Fill: n/a nla (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW O YES O IF YES: enter Book Rage and/or Document ft B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained V , Date Issued: C. Do any signs exist on the property? YES 0 NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO Q IF YES, describe size, type and location: E. Will the construction activity disturb(cl aring,grading, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. • SECTIONS-DESCRIPTION OF PROPOSED WORK(check all anGflcable) New House ❑ Addition ❑ Replacement Windows Alterations? i i Roofing f] Or Doors ❑ Accessory Bldg. 2 Demolition ❑ Neww Signs ICA Decc/kkssss gZI (�j�1Siddiing OM]f/7`/Other]Q ( ./ Brief D- '. .. f-t/ V/ , !/' -%f.1z,C a N JJ/ Jf7t '_ Work ,..r . _ /l /r`./� Alteration of existing bedroom '• Yes Na Adding new bedroom Yes X X Y( f� 4/401P40 Attached Narrative Renovating unfinished basement „Yes _ „ No Plans Attached Roll - Sheet se.If New house and or addition to existing housing.complete the following: a, Use of building :One Family Two Family Other Storage b. Number of rooms in each family unit„ Number of Bathrooms c, Is there a garage attached? d. Proposed Square footage of new construction. j.,, 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. j. Depth of basement or cellar floor below finished grade It Will building conform to the Building and Zoning regulations? Yes_.,, No , I. 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 ,as Owner of the subject Property hereby authorize _ to act on my behalf, in all matters relative to work authorized by this building permit application. Si nature of Owner Date ,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 OwnerlAgent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Cleansed Construction Suoervisoe Not Applicable 0 Name o1 License Holder License Number Address Expiration Date Signature Telephone 0.Renietered Home Improvement Contrsdor•. Not Applicable ❑ Comoanv Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS*COMPENSATION INSURANCE AFFIDAVIT{M.G.L,a.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 0 No 0 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.CMK 780. Sixth Edition Section 108.34,1. 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 i a two-veer 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 he 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 he liable for person(s) you hire to perform work for you under this permit, The undersigned"homeowner"certifies and assumes responsibility fur compliance with the State Building Code.City of Northampton Ordinances,State and Local Zoning I vs and State of Massachusetts General Laws Annotated. iv - Homeowner Signature ri"7. .. .y! _ e S% _� City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 11 , S 150A. Address of the work: 0 �1/IA f fi /l�d"I /4 /I The debris will be transported by: The debris will be received by: f�,24 Building permit number: Name of Permit Applicant l / Date Signature of Permit Applicant (fit a/SCJta ) 9tfjJ /her The Commonwealth of Massachusetts Department of Industrial Accidents I"— — t ='i!N�= Office of Investigations . .. 1= E _ er_= I Congress Street,Suite 100 a ='I=� Boston,MA 02114-2017 ��. www.mass.govldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Lesley O'Brien Name (Business/Organization/Individual): Address:610 Spring Street City/State/Zip: Leeds, MA Phone#:413 297-6708 Are you an employer? Check the appropriate box: Type of project(required): I.® I am a employer with 4. ® I am a general contractor and I employees (full and/or part-time). • have hired the sub-contractors 6. ® New construction listed on the attached sheet. 7. ® Remodeling 2.0 I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ® Demolition working for me in any capacity. employees and have workers' q D Building addition [No workers' comp.insurance comp. insurance.. required.] 5. ® We are a corporation and its 10.0 Electrical repairs or additions 3.III 1 am a homeowner cleissailia. officers have exercised their 11.0 Plumbing repairs or additions a. [No workers' cora right of exemption per MGL P 12.® Roof!links insurance qui d.] c. 152, §1(4),and we have no Storage shed employees. [No workers' 13.11 Other _ krark/airal. comp. insurance required.] *Any applicant that checks box III must also fill out the section below showing their workers'compensation policy information. 'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees.they must provide their workers-comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: _ Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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 fine 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 DR for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 9-26-16 Signature:'a..pn t q 4-u .nn Date: Phone#: 413 291-6708 Official use only. Do not write in this area,to be completed by city or town official. 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#: atassachusetts �, > <rc �t j#�T!� P DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street . Municipal Building Northampton, MA 01060 soh 3d%,d INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to act as his/her construction supervisor. The state defines"Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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," The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages,which include • • •• • •.; ••• r•; •r • r .• • • 1 •.- • � ore pourL a.rough building inspection (before work is concealed). insulation..inspeetion..(if repoirnd) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure r • - •- '•.• , • - ; • t= • • • ; r.a.certificate of occupancy until the work can be tnspected- If the homeowner hires other trades to perform work (electrical, plumbing & gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, YLA.,./.14 understand the above. (Home oWnbr/resident's signature requesting exemption) i will call to schedule an re fired building inspections necessary for the building permit issued to me. Date % c;.27 f7)/(7, T/iii fJ Address of work location /B`// f/)/ t / /y�J • ra MOTEL _ 2`he boundary lines shown hereon A are based upon found survey Stakes % and occupation hoes. An update of d� � the legal description is recommend- �. ed in U orer to more closely reflect the linos shown. ip IPE' DENOTES: Iron pin found NA?. Z is 2 � s r., t { GG " `�. 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BM \ !MIL 1 2x4 PRESSURE ern ���a�yn II,I1/',I1,�� 2X4 RAFTF,0.5 TREAJOISTTED IFLOOR er YNi fi"OC 2%4 KILN DRIED SPRUCE = 72' STUD WALLS @Ifi"OC. 44 DOUBLE 2X4 4x4 PRESSURE TREATED Wilt DURATEMP TI-11 SIDING LI TOP PLATE FOUNDATION BEAM 10'WIDE V2X4 KILN DRIED 4 S DJ X SPRUCE 7 7. –_ O Q1111111 STUD WALLS �22-J/4" s a 4 (d ifi"OC' I17-1/2" +f i b_ as 2x4 PT 3/4"HOOVER EXTERIOR J 2X4 BOTTOM RIM JOIST 12'WIDE FIRE-X PRESSURE TREATED PLATE FIRE-RETARDANT PLYWOOD imili �� PRESSURE TREATED CNON-COMBUSTIBLE) GRADE ". a- ' 4X4 FOUNDATION J3" 34-1/4" ML 2 _-_ \ryl2 BEAMS 138-0" — 8'L•-14'-O" < L4" " HOOVER EXTERIOR w"^ 2X4 PRESSURE TREATED 14'WIDE SIDE ELEVATION O FIRE-X PRESSURE TREATED CROSS SECTION FLOOR JOISTS @ 12"0.C. FIRE-RETARDANT PLYWOOD I 30-YEAR TAMKO (NON-COMBUSTIBLE) 22-12'' 23" 34-1AV 34-1/4" 23" �22-12" ARCHITECTURAL WINDOW SIZE, fff!!f ' SHINGLES STYLE VARIES 1/E"CDX PLYWOOD 163-0" 1 ROOF SHEATHING (3ABLC VENTS 12 30-YEAR TAMKO ,( i ON BOTH ENDS 4 �Qe ARCHITECTURAL FOUNDATION BEAM CONSTRUCTION II r'16"0 RAFTERS II HINGLLS —=IBNRACCO DANCE WI HMETHLOCATION 612 PITCH 2 16'O-C. ���ALUMINUM ACCORDANCE WITH METHOOCSWSP URIP EDGE SECTION R652.109 NOTL NOT CODE irI 2%4 KILN DRIED PRFBCRIITVEOLCTOIL WALL HEIGHT 2 �Y SPRUCE STUD FINISBED SOFFITS BUILDING LODES&pESIGN pATA: J O _ 1,1111111011 FORWEATHER WALLS @ 16'0.C. 'EW9INTERNATIONAL RESIDENTIAL CODE. TIGHTNESS j a� \K 201JCONNECTICUf ADMENDMENT3 'TIIC MASSACHUSETTS RESIDENTIAL BUILDING CODE l80CMR EIGHTHEDITION E L8"DURATEMP 'M PSF SNOW LOAD(ROOF)q IIIIIIIII"ns ' I II,,I T-II SIDING II' VINYL PFRMq 45ECOND GUSi0F 115 MPN 11 TRIM '3-SEGO SECTION STOF FL1115 ORMP SYSTEM WILL 3TONEBASED SUPPORT 2000 LB LOAD APPLIED . ! GRADE GRADE STONE BASE OVER A 20 SQUARE INCH AREA 'THIS STORAGE BUILDING IS DESIGNED TO LACKS&HEADERS Be0"-4A-0" NOTE; 8'q�'-v1 -0" BEPLACEDON 6'DEEP 3/4'CRUSHED REINFORCED DOUBLE DOORS ' PRESSURE TREATED STONE BASE ABOVE DOORS& SIDE ELEVATION PAINTED ON BOTH SIDES FRONT ELEVATION 444 FOUNDATION 'FROST PROTECTION NOT REQUIREDUP TO WINDOWS PER CODE SIZE&STYLE VARIES BEAMS (M SQUARE FEET PER SECTION R403.14.I .�nm".L°�-°'Bow..""...,."m,T m..�..,.0.,t OP616.:E",,.,.,CY e1.�,.,.�w"..,n..,"a,co..„, CONNECTICUT MASSACHUSETTS STANDARD FEATURES: n91LK Ym 610 YAM 6 R6MT rce. .:w•v 10.4 `LENSES xeux \01\11 II I IIIbp/ _ BASE: 4X4 PRESSURE-TREATED BEAMS CAPE STYLE CT SIC.LICENSE .23101 p0ONNF1/4313A OP FLOOR FRAMING:2X4 PRESSURE-TREATED JOISTS,12'0.C. Rt xIC.LICENSE pZ11E5 x50 Q rci .'gyp. rySf FLOORING: W HOOVER EXTERIOR FIRE-X PRESSURE STORAGE BUILDING MA I' (LICENSE 127550 ° 'N-S r MA CS.LICENSE 495915 ��`� � 4'rc' / 'AC TREATED FIRE-RETARDANT PLYWOOD NY WGx6515x1f mel r TO'," INONNMBIISTIRIP) NY ecalx = • :1 L � if ' 84 4 ; „E 1 4 WALL&RODE DARN RD FRAMING PREMIUM 2X4 KILN DRIED THEBARN YARD = I , 1� " *�', 11w�L P ren SPRUCELUMBERWIG'OC- ______a SHOWCASE IOCAYON 1b3]2=4 Q T NO.SOOA1 SIDING S/r DURATEMPTI-II OR VINYL EL"A3QuAc Bl. ftriS Boo SHOWCASE CT LOCA IQN,3 EcorTN. R. 'r,Of•'tKCF SE�• ,o• NN.5VQ34O`<W RCOFINU: 30-YEAR TAMKO ARCHITE.CTURALSHRNiLES B60-e5/.- OS 860-696-006 p F .1.V. G4 ' 4'J' \� DOORS: HEAVY-DUTY,REINFORCED AND PAINTED www.GFEATCIpNTRYGARAGES ce ���n;SSiONAIENso d/ONAL ETA ON BOTH SIDES q/1/0 u, P\ SIZES 8'XA TO I4'%IB' %/, 1/ Oil?i)/(,i/weft/7/ 177.;.;(ef/iL;(1/; Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 I lone Improvement Contractor Registration Registration 127550 Type'. Private Corporation Expiration 11/16/2016 Trp 258847 THE BARNYARD ENT. INC EVERETT SKINNER P.O. BOX 89 ELLINGTON, CT 06029 pdate Address and return card. )lark reason for change. Address Renewal Employment Lost Card Rusin _ Office of Ces mAffairs ff on er ARa lrs& Rusin ess Regulation License or registration valid for lad laid ul use only `. HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration. 127550 Type: Office of Consumer AAffairs and Business Regulation NIZ•CI Expiration: 11116/2016 Private Corporation 10 Park Plaza-Suite 5170 Boston.MA 02116 THE BARNYARD ENT. INC EVERETT SKINNER 120 WEST ROAD , .ysoce ELLINGTON.CT 06029 I'nderserretary Not valid w ithout signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards C . iSir LicenseCS-098915 EVERETT W SKINNEgjain POBOX89 9P Ellington C1 06D29 06/26/2017 499111 CORPORATION STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION I6i (' apitol A ‘ critic ♦ Hartlord Connecticut 061 (16 Attached is your Home Improvement Contractor Registration. This registration is not transferable. The Department of Consumer Protection must be notified of any changes to your registration within thirty(3o)days of such change. Questions regarding this registration can be directed to the License Services Division at(860)713-6000 or email dcp lironceservices@ctgo'. Visit our web site at www.et.gov/(Icp to verify registrations,download applications and the booklet for The Connecticut Contractor for Home Improvement and New Home Construction. STATE OF CONNECTICUT DI PIR 1 at%I 01 (0 L,C( 1ILR PRO/i.( 110\ HO I1 NIPR• - r T 0 S . if • ' THE BARN YARD ENTERPRISES INC THE BARN YARD ENTERPRISES INC 120 West Road 120 West Road PO Bos 89I PO Boz 89 Ellington,CT 06029 Ellington,CT 06029 LIC 0REG 5589 EFFECTIVE / 0/2 111C0558916 12/01/2015 11/30/2016 SIGNED ' ° 1 5 3 4 1, S 1 t 3 5 S �S F f. ➢ 5�� ) 7 �" 1 STATE. OF CONNECTICUT + DEPAR'ITIENT OF CONSUMER PROTECTION I ,- d lie it known that 1 !"..-II THE BARN YARD ENTERPRISES INC , 120 West Road 4I t l PO Box 89 0 Ellington, Cf 06029 - Is mitt:,d Lc Ihr U, *Hunt nl i a (' nut m(I Pn Con c.t I>crd at-j HOME IMPROVEMENT CONTRACTOR k��,,ttt` f Registration # HIC.0558916 � •t ' Effective: 12/01/2015 wA � ! I Expiration: 11/30/2016 Q s it L _ — _ e< .. .' . 1 t d :7:,--,5,,,,, .(4,;,-,. 1T'...j -----� rpfi ;LCT,i:'" 3. a Z 'IT.. v4 a, > vn� is a P 1 :.y ea a O ;"Z , .3 . ACO CERTIFICATE OF LIABILITY INSURANCE DATE ) 6/27/2016 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). PRODUCE0. NAME CT The WS Irish Ins Agency The WS Irish Insurance Agency PHONE (860)646-1232 FAX INC-Na Fill'._. . 55 280 Main Street EMAIL WC,No):(860)6<3-<0 ADDRESS: P.O. Box 360 _ INSDRER(S)AFFORDING COVERAGE _ NAICoi Manchester _ CT 06045 INSURER A£MO Insurance Companies 21415 INSURED INSURER B:THE BARN YARD ENTERPRISES INC. INSURER C: PO BOX 89 INSURER D: INSURER E'. ELLINGTON CT 06029-0089 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1662004941 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 AODL SUB0. --POLICY EFF POLICY EXP IND'WVD POLICY NUMBER IMMNDIYYYYI IMMIDDNYYY) LIMITS X COMMERCIAL GENERAL LIABILITY ' EACH OCCURRENCE S 1,000,000 - A _ CLAIMS-MADE X I OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ 15D49214 6/27/2016 6/27/2017 MED EXP(Any one person) ' $ 5,000 PERSONAL P.ADV INJURY $ 1,000,000 ' GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X . POLICY PRO- ' LOC PRODUCTS-COMP/OP AGG $ 2,000,000 j I OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea aceidenn A ��I ANY AUTO BODILY INJURY(Per person) $ I ,ALL OWNED I K SCHEDULED 5E49214 6/27/2016 • 6/27/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS L- '. i NON-OWNED PROPERTY DAMAGE HIRED AUTOS X AUTOS Per accident/ __$ ' Medical payments b 5,000 IX UMBRELLA LIAR '`_ OCCUR EACH OCCURRENCE $ 5,000,000 A • EXCESS LIAR CLAIMS-MADE __ __ AGGREGATE $ 5,000,000 DED RETENTIONS , 5J49214 6/27/2016 6/27/2017 -- $ 'WORKERS COMPENSATION PER DTH. AND EMPLOYERS'LIABILITY .//N .STATUTE ER_ _ ANY PROPRIETORIPARTNERIEXECUTIVE -- EL EACH ACCIDENT $ 500,000 A MendMWry in NH)FICERMEMBER ExCLVDEO? NIA', 51149214 6/27/2016 6/27/2017 ( ' EL.DISEASE-EA EMPLOYEE $ 500,000 If Yes describe under _ - DESCRIPTIONOFOPERATIONSbelow ' EL.DISEASE-POLICY LIMIT 3 500,000 • DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached N more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Barn Yard Enterprises THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 Village Street ACCORDANCE WITH THE POLICY PROVISIONS. Ellington, CT 06029 AUTHORIZED REPRESENTATIVE {,� A Par1ante/AP (j., / ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025rPntenn