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18-003 (3)
426 HATFIELD ST BP-2017-0429 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 18-003 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2017-0429 Project# JS-2017-000722 Est.Cost: $175239.00 Fee: $1139.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Grouo: BARRON & JACOBS 60475 Lot Size(sq.ft.): Owner: SKIBISKI MARY A Zon ne: Applicant: BARRON & JACOBS AT: 426 HATFIELD ST Applicant Address: Phone: Insurance: 70 OLD SOUTH ST (413) 586-8998 Workers Compensation N O RT HAM PTO N MA01060 ISSUED ON:10/24/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:NEW SERVICE, UPDATE PLUMBING, INSULATE, DRYWALL, TRIM, NEW KITCHEN, FLOORING 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: FeeType: Date Paid: Amount: Building 10/24/2016 0:00:00 $1139.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0429 APPLICANT/CONTACT PERSON BARRON&JACOBS ADDRESS/PHONE 70 OLD SOUTH ST NORTHAMPTON (413)586-8998 PROPERTY LOCATION 426 HATFIELD ST MAP 18 PARCEL 003 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid rp p / t31A t Building Permit Filled out _/ Fee Paid Tvoeof Construction: NEW SERVICE,UPDATE PLUMBING, INSULATE.DRYWALL,TRIM,NEW KITCHEN,FLOORING New Construction Non Structural interior renovations Addition to Existine Accessory Structure Building Plans Included: Owner/Statement or License 60475 3 sets of Plans/Plot Plan THE FO ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 Demolition Delay rde P -// K Siraure of foiling O'rc al 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. \\ Daparenwd we ally City of Northampton S6eluadPaDSY. : ilding Department +6 P t - - - '12 Main Street S AI' Lr`ows Room 100 rPa1d/IINitAwLYiar �ero+t' 'orthampton, MA 01060 ,TrSs�eE9Meduwl Plus . .°p�,• . ne 413 587-1240 Fax 413-587-1272 elN 'pkf�pq,Plr- "marspo , •PPLICATION TO 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 Ott haiflt16 31 Map Lot Unit Northamptoo MR Clot:( Zone Overlay District Elm St DIstriet CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: TNinn Sliihcki 56 140eFirr Neighh F/orerfe , /NA 010(02- Name(Print) Current Mailing Addrehs 413- sScd - 4a1 Telephone Signature 2.2 Authorized Agent: I� (�UQm .5tLlba RQ Gid SO6�� Si , �etf aI' pk An Gaon Name(P Current Mailing Address. N13 -S - A6 899A Sig ure Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 4 /31 talk CO (a)Building Permit Fee 2. Electrical '� -I } O (b)Estimated Total Cost of T l Construction from(6) 3. Plumbing a ds)111', DO Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 0 6. Total=(1 +2+3+4+5) $ 145439 Check Number /V.&576 731 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissionerllnspector of Buildings Date Section 4. ZONING AR Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Par column m be filled in by N;) Chnnyel PXIChrj Floor p/C(y Building Department Lot Size – Frontage Setbacks Front -- - Side L:— R: L:_; R: Rear Building Height Bldg.Square Footage eo -- -- Open Space Footage(Lot area minus bldg&paved _ _— parking) — - — — of Parking Spaces -- — Fill: - [— (volume&Location( ------- _ A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ®I DONT KNOW O YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document X B. Does the site contain a brook, body of water or wetlands? NO 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 O , Date Issued: C. Do any signs exist on the property? YES O NO 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 IF YES, describe size, type and Location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing n Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs [CO Decks ED Siding[ 1] Other(0] Brief Description of Proposed Work: NMI S1rydR VI ring ItlinJe pum1rr lfSu[(IIE, p'r� lrsa(( , in\ new Y If6nOh heu1 IlccfIgc Alteration of existing bedroom Yes X No (Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet 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 R.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 I. Septic Tank City Sewer Private well_..._ City water Supply SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT john S' his .as Owner of the subject property hereby authorize 3QrfO(1 JQCOVi to act on my behalf, in all matters relative to work authorized by this building permit application. S¢e A4RCV1Pri ► Cluasc ay! meni- Signature of Owner Date I, 3(],YrCA 8 )PCOhS ,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. Adam SLiha , Pfint Na Si Nre ofget Date SECTION 8•CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisof: Not7 � Applicable 1 Name of License Holder- T{ . -. ( i Cs " 0(00‘475- License o(0oq-cLicense Number O___OLt S/aLlt��, ft Ma ()KatoX1101;o18 Atltlre/" )(.s ! iy ?(M' Expiration Gate Signature Telephone S.wed lame lastovagnent Cosactorr Not AppiicaWe G &Wet $ JO( Jt5 tIsmwink3 /Pic _ I00$Ug Company Name Registration Number 70 aid .SiattiiC� Nefthampho MA OtOGo (p 1;3,3 j)6i3 Address Expiration Date Telephone 4)3— 1kG-3998 SECTION 10•WORKERS'COMPENSATION INSURANCE AFFIDAVIT(NLG,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 t No....,. O 11.—Rome Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 7Mb Sixth Edition Section 108.4.5.1. 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 ail such work performed under the buiidine 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 Coda City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SIGNATURES By signing below,you agree to items A.B and C. JO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. A. Alternative Dispute Settlement(Arbitration Clause):The Seller and the Buyer hereby mutually agree,in advance,that in the event of a dispute concerning this Agreement,the parties shall submit such dispute to a professional.state-approved arbitration service(costif any,to be paid by the submitter)prior to either party proceeding to legal action in the courts. B. By signing this agreement,you,as the owner of record,are hereby authorizing Barron&Jacobs Associates Inc.to act as your authorized agent in all matters pertaining to the building permit application. C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and supersedes all conversations,statements and agreements,expressed or implied,between the parties,their agents or representatives. 0472 � 2E -/� You.the Buyer.may cancel this transaction avec Date at any time prior to midnight of the third business day after the date of this transaction See the attached notice of cancellation form Buyer _ Date for an explanation of this right Seller retains an equal right to cancel. i.... .�sa// i ae ) anon& 'Representative Dat ******....ast.........................******.s..........+.x...******........................ Jesigner/Salespersons Registration Numbers 0 Cecil R.Jacobs MA HIC 100809 0 Christopher R.Jacobs MA HIC 100809 CT HIC 0518617 CT HIS 0554397 El Adam Skiba MA HIC 100809 Barron and Jacobs-Key Personnel Contact Information: Office Cell Home Office Manager:Sandy Scavotto 413.586.8998,x100 Vice President and General Manager: 413.586.8998,x103 413 150.6677 413.6659113 Chris Jacobs President:Cecil R.Jacobs(Jake) 413.586.8998,x101 413.250.2327 f Purchase Agreement Page 31 of 31 cam tIc© wawa is Skihiskt 9-3026 awsmm re2#4.54. t: m Mange Database:55.5 p ton 1:34pm I of Member Data Description:living roomhdr Member Type: Beam Application: Floor Top Lateral Bracing: Continuous Bottom lateral Bracing: 0.00 Standard Load: Moisture Condition: Dry Building Code: IBC/IRC Live Load: 40 PLF Deflection Critena: L/360 live, 0240 total Dead Load. 10 PLF Deck Connection: Nailed Member Weight: 9.4 PLF Filename: 9 ft 5 in ii Other Loads 'type Trib. Other Dead (Description) Side Begin End Width Mad End Start End Category Replacement Uniform(PSF) Top 0' 0.00" 9' 4.75' 5' 6.00' 30 10 Live Additional Uniform(PSF) Top 0' 0.00" 9'4.75" 12 OW 35 15 Snow 9 4 12 9 DO 9 412 Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 0' 0.000' Wall SPE Plate(425psi) N/A 2.191" 3259# -- 2 99 4.750' Wall SPF Plate(425osi) WA 2.191" 32594 — Maximum Load ease Reactions ,.mlmama., wmh,aIa,an.a Live now Dead 1 787# 2IX44 TfiW 2 7874 20044 11664 Design spans 9 6.5(10" Product: 1-3/4x9-1/4 VERSA-LAM 2.0 3100 SP 2 ply PASSES DESIGN CHECKS Connect members with 2 rows of/6d common nails at 12.0"oc Minimum 217'bearing required at bearing#1 Mnimum 2.17'beating required at beaming#2 Design assumes continuous lateral bracing along the top chard. Design assumes maximum unbraced length of 0.00'along the bottom chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 7775.4( 1526331 50% 4.7 Total Load0+0.75(L+S) Shear 2733.# 7074.# 38% -0.06' Total Load D40.75(LLS) TL Deflection 0.2760" 0.4771" 1/414 4.7 Total Load D+0.75(L+SI Ll.Deflection 0.1772" 0.3181" L/645 4.7 Total Load a75(L+S) OMITS IL DetkwiTto Dots. LNstas% smx_n5 o Room=las: wva.lm e ` An peeac,em.e a.:ndemana o:u.Aw.ae"e o.na, Doug Nodgl ns ar;g4n�easr..pmaM,n1i Cmwmeau 4#442 4E224440 fktAuesinc- -gaw!e 424244 a#422 a.,,on 44444 eeTawo.moue.a,=.:..eIv..ad..."edp ea„d::�"dz and wa„sImed on t.,,mow The o,aim be.e.:a.e by a qw ee de,a,er or oe.0 pwe® :is ito,Dprevai de.00 caw a.nwmo accord te sae.:, 0i Ti Calltsm Cs ammvoeasal4 Ski@Saki 9-30-16 1 aenm + se OD Nonhem on I aft Member Data Description:living roars hdr Member Type: Beam Application: Floor Top Lateral Bracing: Continuous Batton, Lateral Bracing: 0.00 Standard Load: Moisture Condition Dry Building Code: IBC/IRC Live Load: 40 PLF Deflection Criteria: L/360 live, L/240 total Dead Load' 10 PLF Deck Connection: Nailed Member Weight: 9.4 PLF Filename: 9 ft 5 in li Other Loads I‘/Pe Trib. Other Dead (Description) Side Begin End Width Stan End Start End Category Replacement Uniform(PSF) Tap 0 0.00" 9' 4.75" 5 6.00" 30 10 Live Additional Uniform(PSF) Tap 0' 0,00" 9' 475" 12' 0.00" 35 IS Snow .. 9 412 9 412 Bearings and Reactions .. _ Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 0' 0.000" Wall SPF Plate(425psi) N/A 2.191" 3259# — 2 24750" Wall SPF Plate(425psi) N/A 2.191" 3259# -- Maximum Load Case Reactions "'I.'l°'1pal;, Pom.1a,dd.a �787$ro U'ToeSnow Dead 1 787$ N) # 04# 1166 2 187k74 1004# 11660i Design spans 565)" Product: 1-3/4x9-1/4 VERSA-LAM 2.0 3100 SP 2 ply PASSES DESIGN CHECKS Connect members with 2 rows of/6d common nails at 720"oc Minimum 215'bearing required at bearing 41 Minimum 24r bearing required at bearing 4/2 Design assumes continuous lateral bracing along the top chord. Design assumes maximum unbraced length of 0.00'along the bottom chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 7775.'# 15263.'# 50% 4.7' Total Load D+0.75(L+S) Shear 2733.# 7074.# 38% -0.06' Total Load D+0.75(LLS) IL Deflection 0.2760" 0.4771" L/414 4.7' Total Load D+075(L+S) LL Deflection 0.1772" 0.3181" 1./646 Am Total Load 0.75(L+S) Cfly Tr_Detecon DOLS: Lye=IWO Snoo=115Y RWt"125% Win@ W% All Pdddn,emm am iadem.n:or nsoomIeoo a„ea Doug Hodgins se�nStfiaa.>.Camera a ax.rs aesErvEo. r k Miles inc. ::mrevde_+.t.,ftorraa tum r dea °marv,e.ede,da„ eadeaenrmdw4^CMessialee,pm , °'mISdSn el .cm.,Hnnnh edbeto,hehWw��„�.a,mane. J ( Pk04 3'e 4 e,{1. FE _crdas iuh ese a ov,s ons bt MGL c 40 4E4 1 — S recnibtion of the Stticiirci p runt, =_i o brs re ? (tom ettlest-tc,ton eesebesy med by ThisS�Ildini ' rr ,ftshcl b d: poSo0n:2': Dctse G b, bib("NJ j rY�oOF Chub TOF DF322).1::iti_t art - -- D 1- h (i Sf , _LVlbiyl afflolan P111_ 0(00 a —_ , cii/e 0-nin oirtoear/7l o <�'/l4t iacAaie76 Office of Consumer Affairs and Business Regulation T 10 Park Plaza - Suite 5170 ,, Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100809 Type: Private Corporation Expiration: 6/23/2018 Td 419291 BARRON & JACOBS ASSOCIATES, INC. Cecil Jacobs 70 OLD SOUTH STREET NORTHAMPTON, MA 01060 -- — Update Address and return card.Mark reason for change. sca• C zom. -,i Address Renewal Employment Lost Card Office of Consumer Affairs&Business Regulation License or registration valid for individual use only v HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 100809 Type: Office of Consumer Affairs and Business Regulation Expiration: 6/2312018 Private Corporation 10 Park Plaza-Suite 5170 Boston.NLA 02116 BARRON 8 JACOBS ASSOCIATES, INC. Cecil Jacobs 70 OLD SOUTH STREET NORTHAMPTON,MA 01060 - - d without Not valid signature AsMassachusetts Department of Public Safety Board at Building Regulations and Standards License: C84604.16 Construction Supervisor CHRISTOPHER R NFOBS TO OLD SOTS ST NORTHAMPTON MA Nit,"x CA__-- Expiration: Commissioner TRAUMA )S ' tea 41694 t $ y� The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations c" T•rra g I Congress Street, Suite 100 %cam c' Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizationilndividual): Barron & Jacobs Associates, Inc. Address: 70 Old South Street City/State/Zip: Northampton, MA 01060 Phone 4: (413) 586-8998 Are you an employer?Check the appropriate box: Type of project(required): .I . I am a employer with II 4. ❑ I am a general contractor and I employees(full and/or part-time).' have hired the sub-contractors 6. El New construction :.❑ I am a sole proprietor or partner- Listed on the attached sheet. 7. /2 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P Y 9. ❑ Building addition [No workers' comp. insurance comp. insurance.[ required.] 5. ❑ We are a corporation and its t0.❑ Electrical repairs or additions officers have exercised their l 1.❑ Plumbing repairs or additions ❑ I am a homeowner doing all work myself. [No workers' comp. right of exemption per MOL 12 ❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' BD Other comp. insurance required.] thy applicant that checks box#1 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. :ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have nployees. If the sub-contractors have employees,they must/amide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site [formation. tsurance Company Name: Webber & Grinnell Insurance Agency, Inc. olicy#or Self-ins. Lic. #: `" ff MZ 800-8006365-2016h Expiration Date: 3/1/201} ab Site Address: `Lar Ha)hffli Si City/State/Zip: N Ci 11ant ipn My} 01000 ,[tach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DIA for insurance coverage verification. do hereb certifyy under t ains and penalties of pedury that the information pro�vi�deed/aaboovve/i/s true�and correct i¢nature:CL/l/ Date1 /t n vt t o —� hone#: � �.Z- �B/a - geAet y � 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#: AR ne CERTIFICATE OF LIABILITY INSURANCE DAT (MWD Dom s) 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 pollcy(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). PRODUCER CONTACT Laura Cannon x Webber & Grinnell PHONE (413)586-0111 FAX INC No):(aL3)se6-6de1 Ig O: D xs EE 8 North King Street - AR :Kennon@Nebberandgrinnell.COO INSURERIB)AFFORDING COVERAGE ACA E CO — NN Northampton MA 01060 _ INSURER A Main_Street America/MSA _ 2.9939 INSURED INSURER B NLZS/MS_A _ Barron S Jacobs Assoc. Inc. INSURER CA.LM. Mutual/A.LM, Attn: Cecil R. Jacobs mSURERD: _ 70 Old South Street INSURER E: _ Northampton MA 01060-3833 INSURER F: • COVERAGES CERTIFICATENUMBERMaster Exp 2017 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: !ADOLSUBR'I -- --- - POLICY EFF POLICY EXP --- LTR TYPE OF INSURANCE I INW I WWI' POLJCY NUMBER IMWDONYTY1 IMMNDIYYYY) LIMITS R COMMERCIAL GENERAL LIABILITY I ___ EACH OCCURRENCE 5 1,000,000 DAMAGE TO RENTED A CLAIMS-MADE ' R OCCUR PREMISES(Ea occurrence) 5 500,000 _ I9'reO49D 3/9/2016 13/9/2017 MED EXP(Any one Person) S 10,000 _.. PERSONAL 8ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 PRO- X POLICY -_ IECT LOC PRODUCTS--COMP/OP AGO 5 3,000,000 OTHER EPL $ 10,000 AUTOMOBILEWBILITY 'COMBINED SINGLE LIMIT $ '(Ea accideng. B _ ANY AUTO • BODILY INJURY(Per Bperson)caden $ 1,000,000 ALL OWNED —IscHE0ULE0 MIT80a90 3/9/2016 3/9/2017 BODILY INJURY(Per acadenI) 5 AUTOS 'AUTOS X 'AUTOS ED -PROPERTY DAMAGE HIRED AUTOS IR AALTS (Per accident) $ -_ I M d,cal payments S 5,000 UMBRELLA LIAB _ _ OCCUR EACH OCCURRENCE 5 _ B EXCESS LIAB CLAIMS-MADE' AGGREGATE 5 DED I X RETENTION5 10,000 CUTB049D 3/9/2016 • 3/9/2017 S WORKERS COMPENSATION - '. PER cHH- AND EMPLOYERS'LimaaiTY NHN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEEXCLUDEI EACH ACCIDENT S__ 500,000 OFFICER/MEMBERandaton NH)EXCLUDED I NIA •I .. C (Mandatory In NH) 'dI280063652016A 3/1/2016 3/1/2017 IEC DISEASE EA EMPLOYEES 500,000 If yes desaON under DESCRIPTIONOFOPERATIONS below I ' EL DISEASE-POLICY LIMIT $ 500,000 • DESCRIPTION OF OPERATORS I LOCATION51 VEHICLES(ACORO101,Additional Remark.Schedule,may be attached Rmmre space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Horan, MR/LAURA L - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025nnlenn "kit Cr,td,4414,o4 426 Hatilel Go.,9 e Maps /or rte: �.n •n,0,004w4°' 000 DI 00'0000 .,110. .000 „,0.0 ax 'N,W4" wa r."."un+... e 00 Google m"4"‘"!' "w, . Map data @2016 6000 2K Barron & Jacobs DESIGN . BUIL[) . REMODEL Dear Code Official. Enclosed please find an application and related documents and information for a requested building permit. Our client will be out of town. lam enclosing a self-addressed. stamped envelope for your convenience. Please mail the building permit to our office. Thank you. Sincerely. Cecil Jacobs President t;rnte . 3Snun Vora. ,cn. 11A :. 414 ;yngt) N • z 4.' ..aw.barronandjacobs.rem . , . • \ v. ..,.......et; .eflir a , Air . •4000..... •.4.*P'-' I S .....1.'10 io ••• i ..., • _ * ...- . „..0* ' - _ - i''. X1 No. , ..., .. ...... .._....---- ,..‘,..., , . e•A" 1--- --*C11 '....... --", . Iii'. \ . 1.-, 4 •4:-.% . _....,.....- -.All* .' • '.` ,, '''' .. .i,. ..' . . ifilki_.• 4rif._ - ••10.- ,,, ‘'.2••': — Wig ."'.! „ : ." ." . 0 1..%^.!! 5.'', ‘,- ' • , ;' .-"SW4 ' , . . . , '41; .., \ , 11 . . } . I _---- , ,. r • , . . f •-•... f ,.z.::. ' . ;:s;\ '-..,,..- 11 ' ..t t, . , . — . ..,.43 I 1 v't . t 1111.1111111111111 \ ••,. * 4,044*4.1' ..4,4 _ 4A-A,4.1•71P ' \1110 , A 1-10,„, e .... %? 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