23A-123 (6) 20 MIDDLE ST BP-2017-0508
GIS#: COMMONWEALTH OF MASSACHUSETTS
Man:Block:23A- 123 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: KITCHEN RENO BUILDING PERMIT
Permit# BP-2017-0508
Project# JS-2017-000830
Est. Cost: $58472.48
Fee: $380.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group THOMAS MALONE 167595
Lot Size(sq. ft.): 13503.60 Owner: WYMAN GINA
Zoning: URB(100)/ Applicant: THOMAS MALONE
AT: 20 MIDDLE ST
Applicant Address: Phone: Insurance:
128 RYAN RD (413) 885-9038 WC
FLORENCEMA01062 ISSUED ON:10/18/2016 0:00:00
TO PERFORM THE FOLLOWING WORK RENOVATE KITCHEN & DINING ROOM
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:
FeeTvpe: Date Paid: Amount:
Building 10/18/20160,00:00 $380.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0508
APPLICANT/CONTACT PERSON THOMAS MALONE
ADDRESS/PHONE 128 RYAN RD FLORENCE (413)885-9038
PROPERTY LOCATION 20 MIDDLE ST
MAP 23A PARCEL 123 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid /,//��
Building Permit Filled out T ��
Fee Paid
Typeof Construction: RENOVATE KITCHEN&DINING ROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 167595
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOIIBjMMATION 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
Sig e o it ng tial 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.
.s!, . Department isa only
Cyz
City of Northampton Stabw orPermit:Building Department Curb CutlDrireway Permit
% 212 Main Street Sewer/Septic Avayebilly
' Room 100 Water/Wee Availabity
Northampton, MA 01060 Two Sets of structural Plans
`- phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION 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
10 PCI �\e. S u e. Map Lot Unit
?'\,C$x^`"•c- m*1 OvOb .2- Zone Overlay District
Elm St.Disinct CB District
SECTION 2•PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: -.
6kY s. es-- , "N) ? ' - - QC t71Vt bz
Setae(Print) (' "1
XI.
S.nature V
Z,2
Authorized
Agent: U
Mame (l cItnC rJ��Sttl 5:otob
kX
Signature
SECTION 3-ESTIMATED CONSTRUCTION COSTS
09)
Item Estimated Cost(Dollars)to be ,
completed by permit applicant
I21. Building LI b -17 NI-
2.
. Electrical CA 0 O. ad Cot.(b)E.
r
3. Plumbing 06Building t
O.4. Mechanical(HVAC)
S.Are Protection
6. Total=(1 +2+3+4+5) 5z ki-iz ,4i" Check Number .325/3 3a0
This Section For Official Use Only
Building Permit Mainstay:__ IssIsso
Dat e ed'
Signature:
Bing CommissioneMnspector of Buildings Date
Section 4. ZONING AU Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be fined in by
aui ding Department
Lot Size
Frontage
Setbacks Front
Side L: L: It
Rear
Building Height
Bldg.Square Footage °lo
Open Space Footage
(Wt area minus bldg&paved
parking)
N of Parking Spaces
Fill:
(vommc a r.raion)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW (Ti YES O
IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document N
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 O , Date Issued:
C. Do any signs exist on the property? YES O 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 O
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over t acre oris it part of a common plan
that will disturb over t acre? YES O NO 0
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 0 Addition 0 Replacement Windows Aiterationis) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs (CJ Decks (p Siding(p] Other
Brief Description of Proposed
Work: l CnvJ'S . Kcr^,L A. r.W
nkr\sn \
/
Alteration of existing bedroom Yes V No Adding new bedroom Yes V No
Attached Narrative Renovating unfinished basement Yes y No
Plans Attached Rofl -Sheet
Pa.If New house and or addition to existing housing. comolete 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?
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
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 la-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, h ..(a 4 as Owner of the subject
hereby authorize S)rrJ_.) (NC's/AVAC--
t• act on m behalf, in all matters relative to work authorized by this building permit application.
�,.. s ... /eV/Oflli
gnature;. Owner Date
I. 4 . a t,_,1 .r asg 1.4.-e<LA—- ,as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing appli tion are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
h r�.tYl4) mr.lG(V/C-
Prim Name
\U—kd -1b
gnature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor Not Applicable 0
Name of License Holder: --diem > (Tl4.04.42-•- ( S— OS-123 C.
License Number
gag eel (L)-
Ad. ' . / { Expiration Date
•
•
Si•nature Talep • n
8.Rwhrtsred'�r"Home Imwovennnt Contractor Not Applicable ❑
CyorZditsn
) w- 7 0-4r\amo t (17-1 5-95-
Company Name Registration Number
19, , Lc t . r - # t UUL ib —?—k to
Address �t Expiration Date
Telephone'l) -"a`4tiO)I
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(S))
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
21. -Home 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
$¢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-vear period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that hetsbe shall be
responsible for aft such workperformed 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 persons)
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
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 111, S 150A.
Address of the work: 7-6 M,? 'Apo 2sca PA-C)06
The debris will be transported by: \ rA\,th‘R__
The debris will be received by: \I 4*t ae Ey
Building permit number:
Name of Permit Applicant
„IP 1U'\h
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Vis.= Department of IndustrialAccidentss
b=€11 Office of Investigations
_ Ml. 1 Congress Street, Suite 100
Ez v-
Boston,MA 02114-2017
'+..a www.massgov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):
Address:
City/State/Zip: Phone#:
•
Are you an employer? Check the appropriate b : Type of project(required):
1,❑ 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
2.❑ Tam a sole proprietor or partner- listed on the attached sheet. 7. 9 Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp.insurance.: 9, 0 Building addition
required] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 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 MCiL
12.❑ Roof repairs
insurance required] r c, 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp.insurance required]
`Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Hrmreowneis 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 slate whether or not those entities have
employees. If the sub-contranms 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 DIA for insurance coverage verification.
I do hereby cerafy under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date: _....
Phone#:
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):
I.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
' Contact Person: Phone#:
Estimate
of nbru.. 128 Ryan Road
Florence,MA 01062 Date Estimate#
8232016 1564
Name/Address
Gina and Joe Wyman
20 Middle Street
Florence,MA 01062
Terms Project
On receipt Wyman Kitchen I
Description
Remove existing plumbing fixtures
3 E
Removal of existing countertops
8 LF ;Thi\
Cabinets removal,rule of thumb Wall cabinets
II LF HOZ\
Cabinets removal,rule of thumb Base cabinets 8 LF `,
Removal of interior wall assemblies O
255 SF
Removal of ceiling
215 SF
Removal of linoleum
24 SY
Removal of nailed hardwood
17 SY
Shores for beams and girders
12 Ea
LVL beams(laminated veneer lumber) 1.75 in.x 16 in.
28 LF
Laminated glue beams(Glu-lam beams)Install beams with connections attached
56 LF
Window opening framing,2 in.x 4 in.Over 3'to 4'wide(4 in.x 6 in.header)
I Ea
Wall stud framing,2 in.x 4 in. 16 in.centers
15 SF
Install siding
24 SF
Fiberglass batt insulation 5-12 in.Kraft faced,R-21,between studs
24 SF
Paradigm All vinyl Double-hung low E Argon insulating glass window
1 Ea
Total
Phone# E-mail
Signature
(413)341-3838 tom aUl ainhome.net
Page 1
Estimate
Rainicw 128 Ryan Road
�f�O�l{I/I1�Y. Florence,MA 01062 Date Estimate it
- 'rsw
8/23/2016 1564
Name/Address
Gina and Joe Wyman
20 Middle Street
Florence,MA 01062
Terms Project
On receipt Wyman Kitchen I
Description
Sprayfoarn insulation for around windows
16 SF
Gypsum wallboard nailed or screwed 1/2 in.
500 SF
Plywood sheathing
324 SF
Install Cabinets,rule of thumb Base and wall cabinets and hardware(Allowance$7500.00)
50 LF
Granite countertops Most 1-1/4 in.(3cm)granite tops(Allowance$2800.00)
56 SF
Wood snip flooring to match as close as possible
324 SF
Sanding and finishing wood floor
324 SF
Equipment rental
Softwood molding,base(all patterns)
35 LF
Softwood molding,casing
36 LF
Priming and painting plaster or drywall,latex
948 SF
Install new hood vent supplied by owner and duct work to outside
1Ea
Electrical(Pendant lighting,standard outlets,standard switches,GFCI.recessed and under counter)
1
Plumbing
1
Recycle fees
4 Ea
Building permit fees
1LS
Total
Phone# E-mail
Signature
(413)341-3838 tom@rainhome.net
Page 2
am/minus Estimate
128 Ryan Road
Florence,MA 01062 Date Estimate#
8/23/2016 1564
Name/Address
Gina and Joe Wyman
20 Middle Street
Florence,MA 01062
Terms Project
On receipt Wyman Kitchen I
Description
Removal of interior wall assemblies First floor bathroom
32 SF
Wall stud framing,2 in.x 4 in. 16 in.centers
96 SF
Fiberglass three-piece shower stall(renovation).Shower stall,trim and valves(add rough-in)(Allowance$800.00 shower and faucet)
1 Ea
Gypsum wallboard nailed or screwed 1/2 in.
114 SF
Plumber
1
Remove existing plumbing fixtures Second floor bathroom
1Ea
Acrylic three-piece tub and shower enclosure(renovation).Enclosure,trim and valves(add rough-in)(Allowance$1000.00 tub and faucet)
1Ea
Stud walls 2 in,x 4 in.for on right side next to toilet
1 SF
Gypsum wallboard nailed or screwed 1/2 in.on walls
32 SF
Installation of tile in thin set mortar,walls
30 SF
Ceramic tiles subway to match existing
30 SF
Tile backer board Walls
30 SF
Plumber
Installation of tile in thin set mortar,walls backsplash
72 SF
Ceramic tile
72 SF
Total 0
Phone# E-mail
Signature
(413)341-3838 tom@rainhome.net
Page 3
Estimate
Rainh ... 128 Ryan Road
11�Y WLlYl
Florence,MA OI062 Date Estimate#
8/23/2016 1564
Name/Address
Gina and Joe Wyman
20 Middle Street
Florence,MA 01062
Terms Project
On receipt Wyman Kitchen I
Description
Project material,labor,equipment,subcontract
Material,per job
Labor,per job
Equipment,per job
Subcontract,per job
"Project Subtotal
'Project Total
Total $58,472.48
We propose to hereby to furnish material and labor-complete in accordance with the above specifications,for the sum total.Payments to be made
as follows:half of full total upon acceptance,one quarter of full total upon the start of the project and the full balance due upon completion.All
material is guaranteed to be as specified.All work to be completed in a manner according to standard practices.Any alterations or deviations from
above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.
All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado,and other necessary insurance.
Acceptance of Proposal will commence with the home owners signature.Prices,specifications and conditions are satisfactory and are hereby
accepted upon signature.Rainbow Home Improvement is authorized to do the work as specified and to be paid as specified.
Phone It E-mail _7e-=
Signature
(413)341-3838 tom@rainhome.net
Page 4
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City of Northampton
Building Department
Plan Review
212 Main Street
Northampton, MA 01060
CS Beam 23165014 20 Middle St
mB.mF�.'L116202 10.11-I6
MaaoWDaee.e 1555 Northampton 7:12am
l oft
Member Data
Description: 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 Criteria: 11360 live, (1240 total
Dead Load: 10 PLF Deck Connection: Nailed Member Weight: 7.3 PLF
Filename: 13 ft 3 in B
Other Loads
T/Pe Tr@. Other Dead
(Description) Side Begin End Width Start End Start End
Repacement Uniform(PSF) Top 0' 0.00' 13' 3.00' 2' 0.00' 30 10 Live
I`
1330
1330
Bearings and Reactions
Location hype Material enggtth Required Reaction Mn Uplift
1 0' 0.000" Wail SPF Plate(425psi) WA 1.500' 585# --
2 13' 3.000' Wall SPF PIate(425psi) WA 1.500" 585# --
Maximum Iced Case Reactions
uist1braPP0mg Porn baa prime lae4b=anyin9 mine..
Live Dead
1 402* 1834
2 402* 1834
Design spans
13' 4.750'
Product: 1-3/4x7-1/4 VERSA-LAM 2.0 3100 SP 2 ply PASSES DESIGN CHECKS
Connect members with 2 rows of Irl convnon nails at 12.0"oc
Minimum 1.50"bearing required at beating#1
Minium 1.50"baring requIred at bearing#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 1958.'W 8377.4t 23% 6.63' Total Load D+L
Sher 532.# 4821.# 11% -0.06' Total Load D+L
TL Deflection 0.2845 0.6698" L1564 6.63' Total Load D+L
Il Deflection 0.1956" 0.4465" L/821 6.63' Total Lord L
C0r404 U.Deflection
DOLS: 1-1213•100% Snow-115% Ro01-125% WIn116He
All roay.namaarwwaMaamecrepe dVeMSS Dam Hodgins
wimmIC)2Olbq Sln[a.Std .Yie Company Inc Au RIGHTSRESERvee r k Miles Inc.
-Peeing " ne' o �cseBwaaeapplicable `m`ii°°°' °°� t ' esOceaugbenwiienad by a the mortar ion.i esr oa. adeigwarms oert i..o�: ea otha mnulammtmepatn The
ACcwo CERTIFICATE OF LIABILITY INSURANCE DATE Na MIDDin YI
ki.../ 10/14/2016
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 DR PRODUCER,AND THE CERTIFICATE HOLDER.
. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polis hes)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 House
4ME:
King 6 Cushman Inc. fox NNo ut (413)584-5610 FAXfar Nny 14131594-9322
P.O. Box 447 EMAIL
ADDRESS:
176 Ring Street INSURER(S)AFFORDING COVERAGE NAIC
Northampton MA 01061 INSURERA:Peerless Insurance 24198
INSURED
INSURER B:NorGOARD Insurance Company 131470
Rbi Construction Inc INSURER 0:
128 Ryan Rd INSURFR o:
INSURER E:
Florence MA 01062 INSURER;:
COVERAGES CERTIFICATE NUMBER:C1.16101401727 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 SE 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•, TypEOFIN3URN1cE ADSL SUER I POLICY EFF POUCY EXP
11450 NND POLICY NUMBER IMMtDITIVY) MMIDONIYYI LIMITS
1 X COMMERCLAL GENERAL LIABILITY 000,000
EACH MAGETORENTE $ 3.
A CLAIMS-MADE I X I OCCUR
PREDAMAGE Ea arr
MED EXP
cab a,ral $
CCPa 196830 10/3/2016 10/3/2017 :MED (AnyE%Pone moon) 3
_ PERSONALS ADV INJURY 5 1,000,000
GENL AGGREGATE LIMRAPPLIES PER: i GENERAL AGGREGATE S 2,000,000
K POLICY . JE LOC PRODUCTS-COMPIOP AGG $ 2,000,000
OTHER $
AUTOMOBILE UABIUTY I E MBlINNLD11SINGLE LIMB ,$
ANY AUTO I BODILY INJURY!Per person) S
ALL
AUTOS OWNED I'. SCHEDULED BODILY INJURY(Peracocna $
r NONOV.dEO PROPERTY DAMAGE
HIRED AUTOS AUTOS (Panatodent1 I$
UMBRELLALAB OCCUR 1,EACH OCCURRENCE 9
EXCESS LAB I
CLAIMS-MADE AGGREGATE LS
DED ! I RETENTION:5 "'WORHERS COMPENSATION $TgnITE 10R
AND EMPLOYERS'LIABILITY YINANY PROPRIETOR/PAWNERRXECUPVE NIAIE.L EACH ACCIDENT 000
•B DEWMata In NH)E%CWOEOi RENp777974 10/5/2016 10/5/20171 a 1 EL 018EA5E-FA EMPLOYE ,000
If yes, under
OFO POLICY LIMIT 13 500,000
DESCRIPTION OF OPERATIONS below ELOISEMSE-
•
I
DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES IACOR0101,Additional Remarks Saludae,may he attacked lr more span la required)
Job - 11 Barfield Place
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
212 Main St. ACCORDANCE WITH THE POLICY PROVISIONS.
Northampton, MA 01060
AUIilOR6ED REPRE3EXTATNEG N
• SCI cttrl,�'
®1988-2014ASORD e . All rights eserve
ACORD 25(2014/01) The ACORD name and logo are registeredmarks of ACOR9. - , LLL
INS025/201 40E
Boston, I
Home Improve
ZE
Rhi Construction Inc. f'
128 Ryan Rd
Florence, MA 01062
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