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32C-104 (23)
50 CONZ ST-WWII CLUB BP-2017-0766 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C- 104 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: WATER DAMAGE BUILDING PERMIT Permit# BP-2017-0766 Project# JS-2017-001278 Est. Cost: $54908.00 Fee: $385.00 PERMISSION IS HEREBY GRANTED TO: Const,Class: Contractor: License: Use Group: BAYSTATE RESTORATION GROUP 056785 Lot Size(sq. ft.): 25047.00 Owner: WORLD WAR II VETERANS ASSOC OF HAMPSHIRE COUNTY INC Zoning: NB(100)/ Applicant: BAYSTATE RESTORATION GROUP AT: 50 CONZ ST -WWII CLUB Applicant Address: Phone: Insurance: 69 GAGNE ST (413) 532-3473 WC C H I C O P E E M A 01013 ISSUED ON:12/28/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:WATER DAMAGE - REPAIR WIRING DAMAGE, RE-INSULATE, DRYWALL, RESET APPLIANCES 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 12/28/2016 0:00:00 $385.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0766 APPLICANT/CONTACT PERSON BAYSTATE RESTORATION GROUP ADDRESS/PHONE 69 GAGNE ST CHICOPEE (413)532-3473 PROPERTY LOCATION 50 CONZ ST-WWII CLUB MAP 32C PARCEL 104 001 ZONE NB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 3 g6"."Building Permit Filled out Fee Paid Typeof Construction: WAT ' _ , _ • 'AIR WIRING DAMAGE,RE-INSULATE,DRYWALL, RESET APPLIANCES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 056785 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INEOprIATION 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 /, Signature of Building (ficial Date / 6 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. �\ Departmentuse.only .. City of Northampton :Status of Permit. ._ Building Department Curb Cut/Driveway Permit 212 Main Street Sewer4Sepac.Avaitablity _Room 100 WaterfkleflAvaicabifity `L Northampton, MA 01060 Two Sets of Structural'Plans. phone 413-587-1240 Fax 413-587-1272 PiteIItSite 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:OThis section to be completed by office 60 �VZ � �� Map Lot Unit �-/2,.wn/wA/j N44 O/OCC`) Zone Overlay District ,,'"'^^,,��-'' Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2A Owner of Record: 41.ibE oLb -5r— Name rName(Pdni) / Current Mailing Address: ai (_ b. C . :. Telepnone Signature #_ /-- OP 44 2.2 Authorized Agent: ___Aou fuwd 8A6 ‘9 (/J�Jve �- c, ' i o Name flareCurrent Mailing A98ress: i _ .. 'f/3 — 53a---311? Signature Telephone i SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be - Official Use Only corn•feted b *emit a•recant 1. Building c$ 3 i I qa-: yr (a)Building Permit Fee 2 Electricalsit f 0 CO (b)Estimated Total Cost of Constniction from 16) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Are Protection r 6. Total=(1 +2+3+4 .5) Yi T qD Check Number r34/•ii This Section For Official Use Only Bung Permit Number: Date aed: Signature: BWid4,g Commissionerfnspectorof Hu9Wings Date Section 4. ZONING All Information Vuot De Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This seitimo to be nided n by Budding Deparopert Lor Size Frontage ... _.. Setbacks Front Side Rea;. Building Height Bldg. Square Footage Open Space Footage _.. ._ _.. .. (Lot area minus bide,&paved we're) t of Parking Spaces -- !volume&Location> A. Has a Special Permit/Variance/Finding ever been issued far/on the site? NO O DONT KNOW YES O IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW YES O IF YES: enter Book Page. and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained O , Date Issued O. Do any signs exist on the property? YES y.k? NO 0 IF YES, describe size, type and location: (.,f w 0( 4 D. Are there any proposed changes to or additions of signs intended for the property? YES O NO a 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 a NO Q( IF YES,then a Northampton Storrn Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows 1 Alteration(s) n Roofing n Or Doors C Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [ID Siding IQ Other/. Brief De}c,ri tan of Pra•osed 4 Work: 6,/0Y /AOS CC G✓/hW9 //Yt�1 8 /u /i v - Adik, art',/u / / iare41. Alteration of existing bedroom Yes )C No / Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet Ga. If New house and or addition toexisting housing, complete the following: a. Use of building One Family Two Family Other 71-._ b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? IVU d. Proposed Square footage of new construction. Dimensions { e. Number or stories? / /4h C I Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation.Compliance. / ��/, Masscheck Energy Compliance form attached? h. Type of construction Alofa/ b'nla6ip i. Is construction within 100 ft.of wetlands? Yes K., Na Is construction within 100 yr. floodplain Yes K No j. Depth of basement or cellar floor below finished grade Ni/.} k. Will building conform to the Building and Zoning regulations? / , Yes No I. Septic Tank City Sewer N Private well City water Supply J( SECTION 7a -OWNER AUTHORIZATION•TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner of the subject property \ hereby authorize `Y' to act on my behalf, in all matters relative to work authorized by this building permit application. A * Signatur e of Owner Date iniiimi I f(JU Q/q I Q�'jAd , as Owner/Authorized Agent ereafy 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. —i- t-L— ,OavtyliJ /Li' Print Name /a'-6 —dQ/G Signature of Owner/ ent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable / Name of License Holder lark LJQW a ` S 0 C(0 723-- License Number 73.-- -14)9i Gl (AA'AGorky) //0 q —q — DO/7 Address "0/o73 Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable l ie)Ski.r fR05/ffiffin6fa.t/ 62ty I go N 7S' Company ame Registration Number 0 -�f e /l—/1—)0/1 Morass 1 Expiration Date jJCC�EC /04- ©/O/3 Te!ephene4R-33.)3473 SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(mos.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 Attache Yes`.. . No 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780. Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner'shall submit to the Building Official,on a form acceptable to the Building Official that belshe shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature • City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 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: J 6Z 5/-: m+>>ytla�p�e ✓� ,+i O/0 6.0 The debris will be transported by: //x1447,7 y4fra' ef///Lt!] The debris will be received by: 2/0 � ll J 7T wiy Y ` ,4f-Favi Building permit number: nn Name of Permit Applicant /5ouy 14 J /Jowai Date Signature of Permit Applicant %�F � ni cy„t,ea711 cJ(ass«cX�elPil Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement.Contractor Registration Type: LLC Registration: 180478 Baystate Restoration Group Expiration: 11/18/2018 69 Gagne ST = - Chicopee, MA 01013 Update Address and return card. Mark reason for change. .. zmn-on ACO' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYY” 1/4..../ 10/19/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 00ES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES 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). PRODUCER NAMECT Marson Lentos 3erkshire Insurance Group, Inc. III iaic2N10 SRI. (413) 935-1200 LAIC Nul. (41-4)67-v00 138 Longmeadow T3Y. EA'MAIL tes@berkshirei_-asurance CoA - ADORNS.mien group. INSU RER(S1 AFFORDING COVERAGE NAIc4 I Longmeadow MA 01106 INSURER A'Phiiadelohia Insurance INSURED INSURERS Tokio Marine Soealali, Ins. V ate Restoration Group LLC INSURERC. 59Gagne St INSURERD-. INSURER E: 1 Chicopee ;A 01013 INSURERF COVERAGES CERTIFICATE NUMBERSL16101346016 REVISION NUMBER: THIS IS TC CERTIFY THAT THE POLICIES OF.NSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NCH 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. INVEFF . POLICY EXP I CEOI TYPE OF INSURANCE Imono ] O!con ISWVVRI POLICY NUMBER I IMMIDCNYYYYI I IMMICOMYf I UMITS X I COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE 1 1,000,000 • DAMAGE-0 RENTED A l I CLAIM6NADE I X ' OCCUR .=REMISES IN occurrence 5 100,000 _ Pffi56284] 10/7/2016 10/7/201] I MEDEW{Any one person) S 5,000 I PERSONAL&TONINJURY Is 1,000,000 GENE AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE S 2,000,000 X PGcY 'I 'IC: ,ECT LOC PRcvvcs-comaroP AGcs 2,000,000 OTHER. 1 5 AUTOMOBILE LABILITY • COMBINED SINGLE LIME 5 Ib acodenil_ NY AUTO BODILY INJURY(Per personi I $ ALL OWNED SCHEDCLED BODILY INJURY P racodenr) S HIRE]AUTOS AUTOS ED Pp OPEcTY DAMAGE 5 H I XII UMBRELLA LIAR OCCUR ' EACH OCCURRENCE I $ 1.000,000 R I acEss LIAR C:AIM$MAOE AGGREGATE 3 OED RETEN ONS ?13B559655 . 10/2/2016 10/7/2011 5 WORKERS COMPENSATION 1 PER➢TE I 1NH- :ANDSTAI hi ANY PROPRIETOR/PARTNER/EXECUTIVE y r,, N E.L.EACH ACC':DENT 15 'OFFICER/MEMBER EXCLUDED, ;(Mandatory in NH I—A. I , EL DISEASE-EA EMPLOYERS I If yes describe under I DESCRIPTION OF OPERAT ONS oelow EL DISEASE-POLICY LIMIT, E B 1 Pollntlan/ 5 2rof essconal : PBPIG562864 10/7/20161 10/7/2017 •Lim! 1,000,000 Dedumme oar clam 5,000 DESCRIPTION OF OPERAPONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarts Schedule,may be attacIWd if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE - THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE // )) llam�// �� Marion Lentes/MLENTE %"/�2Zei-,. L�7� @1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014,01) The ACORD name and logo are registered marls of ACORD INSau much Cit 'fl is /fl i„aene srn—\ Office of Consumer Affairs&Business Regulation A L1 (BIOME IMPROVEMENT CONTRACTOR _ _ egistration 180478 Type Expiration. 1111$/'2046 LLC BAYSTATE RESTORATION GROUP.LLC. MARK DAVIAU 69 GAGNE ST CHICOPEE, MA 01013 Undersecretary , Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-056785 Construction Supervisor MARK R DAVIAU 75 GILBERT RD M SOUTHAMPTON MA/ CA— (�--n ! Expiration Commissioner 09/09/2017 • The Commonwealth of Massachusetts _ Department oflndustrialAccidents 1 Congress Street,Suite 100 - `FT= Boston,MA 02114-2017 www.mass.govldia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aoolicant Information '' Please Print Legibly (� Name(Bussiness/organiration/Individual): - l 3aL/:.54/ t- &S-}WA1Gn 61/62/p Address:__4 _� glike ✓ City/State/Zip: u/r�Q�'...//I/j-1'I/WJ_-Phone#. 4/3_-_ 3 .--'�y23------- Are you an employer?Check the appropriate box: Type of project(required): 1.0 am a employer with ) >employees(full and/orpart-time)." 7. ❑New construction 2.❑Iamasole proprietor arpartnership and have toemployees working forme in 8. ❑Remodeling any capacity.[Na worktn'comp.insurance required.] 9. Demolition 3.0 lama homeowner doing all wodcmyselt[No workers'comp.insurance required.] 4.❑Iamahomeowner and will behiring contactorstoconduct all work onmyproperty. IwiL 10❑Bu ding addition ensue that all contactors either have workers'compensation msmaoceorare sole 11gEleotrical repairs or additions pmpdeton with no employees. 12.❑Plumbing repairs or additions 5 E lam a general amhaztnr and l have hired the submutretlon listed on the attached sheet These subcontractors have employees and have wars'comp insurance" 13.❑Roof repairs g.❑We am a=paragon and its officers have exerasedtheirrightofexemptionperMGL c. 14.N Other_A/e'"--4/h yqt_ 152,§1(47,andwhere no employees.[Notaken'camp pssvrnec rguired (y�,/ri ] - *Any apphcantthat checks'box#1 must also fill om the section below showing then workers'compensation policy mumadoa tHomeovmerswhosubmitthisaffidavit indicating they are doing all work and then bice outside contactors must submit a new affidavit mdiadug suck tContacton that check ibis box most attached an addmon]sleet showing the name of the sol-amhacbn and state whether or not those entities have employees Iftheaub-eentatnbave®pinyees,theyn ht rovidetlun workrn'mmP policy u ee. ... .. :. _ Ism an employer thefts providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: II,l4/4/`Vh'tt,,,,r�f(y1 fie Policy#or Self-ins:Lic.#: Ys/�tl(�( c- ial[ / Expiration Date: . h 114-)017 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 MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.09 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 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 ofperjury that the information provided above istrue and correct Signature: a!/ Date: 7,r,1^ (p —,(:).6/L Phone#: 3 L/7 Official use only. Do not write in this area,to be completed by city or town offciiaL City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Bmldmg Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - Contact Person: Phone#: • ©uCERTIFICATE OF LIABILITY INSURANCE °Po 29i6 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 DOS NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERT/AGATE HOLDER. IMPORTANT: It the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. it SUBROGATION IS WAIVED, subject to the terms and conditions at the policy,certain policies may require an engorgement. A statement an this certificate does not confer rights to the ¢r0ncate holder in lieu at such endorsement(s). -ore" �N SH 00501 -001 NAME:C Lebel/Lavigne a Deady Insurance Agency, no M E is (413)532-3291 �/� Na., (41 Cj6J4]982 PC Box 52 A�o�lEss: Chicopee,MA 01021 - INSURERSI A"m09OWG COVERAGE ryu Cy_. Irvsu9B A Atlantic Charter Insurance Company MAC 29211 INSURED Eat/state Restoration Group, LLC URs.E B INSURER C'. 59 Gagne Street INSURED Chicopee, MA 91012 MEURER'c. INNRFR c- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE PCL CIES CF INSURANCE 'LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE °OR THE POLICY PERIOD NDICATED. ,NOTWITHSTANDING ANY RECUIREMENT, TERM OR CONDITION CF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CEPT RCATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREM 'S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS GF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIR CLAIMS LER TYPE OF INSURANCE �GGLSUe FPLC.NUMBER ucvF� 11 �/p G NeR WVGI TAMlDMW11Y) MGMMON9NM LWRs SENEFALLNRILJiY EACH CCCURRENCS IS COMMERCIAL GENERAL_ABUT! DAMAGE TO SEATED ',.p5ENI6Eo_Eaapad e CLAIMfA SADE CCC'JR MED EYP(Any ane persrson) PERSONAL&AD)/INJURY •. _ GENERAL AGGREGATE IS GENSAGGRE AT IMIT APFUES PEE PRCDUOTC-COMPIOP AGG S 9cuey DEFT Cc COMBINED SINGLE LIMIT AUTOMOBIL DA6ILT/ - S ANY ALTC. scoff IWURY(Ptr pump IS AV_LWNED SCHEDULED 3COILY INJURY(FacSGml) AUTOS AUTOS HIRED AUTOS NEN-OWNED PROPN,Y DAMAGE UMBRELLA LIAB OCC•A - EACH OCCURRENCE -1a —....-3OFRR JAB I CLAIMS MADE PCa'.RESATE 5 GED I REcvf0N (Ax�v `gqpipovFETt�sFIPSpAqTTI�N.°FNF�E X :o�v ilriA s: 03 s C.^�CFR,ME�MBE E%CLIIDE]^tECJP/EYN rt. WCVD1200B01 1/14/2015 1/14/2037 EL EACHACCOFM 500,000.00 NLnti mry)n Mr) EL DISEASE-EA EvIPLOYEE:'-.S 500,000.00 e m n Ve, Policy Coverage State: MA ' gg!aP 9GN e2:PRRATIONs below EL DISEASE-POLICY'uMIT I t 500,000.00 No Member is covered by the workers compensation policy. DESCRIPTION OF APER ATONS/LOCATI N /VE � LI S(Attecn CORD 101,AccItlionalRemub Schedule,if mote spasm is resusred) IIIc I — . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFI I FD BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR. TO MAIL NONCE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. . AUTHOR=REPRFSBiiANVE ©1988-2014 ACORD CORPORATION_Allrights reserved. - ACORD 25(2014/01) The ACORD name and logo are registered marks at ACORD - Mi estate Restoration Group December 28, 2016 I request that you grant a modification to waive the requirement for control construction for the WWII Club at 50 Conz ST Northampton,MA 01060 because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. Thank you for your consideration. "Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project" /Respectfully. ' c eiA Melissa Rivera Office Manager Baystate Restoration Group, LLC 413-335-7068 - Cell 413-532-FIRE I 855-532-FIRE- Office 413-532-3472 - Fax Melissa.Rivera@BaystateRG.com 1 Baystate Restoration Group,LLC ( 69 Gagne ST I Chicopee, MA 01013 I ph.413-532-3473