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32C-045 (3) BP-2007-0838 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Catigory– BUILDING PERMIT Permit# BP-2007-0838 Project# JS-2007-001377 Est.Cost $3750.00 Fee: $50.0) PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: lJS GronR STEVEN T CZUPRYNA 080726 Lot s-ze(sa ft is 7013,16 Owner: SURER ERIC Z-0-MI—:ClIt Applicant: STEVEN T CZUPRYNA AT: 86 PLEASANT ST - 3R Applicant Address: Phone: Insurance: 178 WHEATLAND AVE (413) 594-5678 WC CHICOPEEMA01020 ISSUED ON:3/13/2007 0:00:00 TO PERFORM THE FOLLOWING WORK REMODEL BATHROOM 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/Chhnney: Rough: Oil: Insulation: Final: Smok : 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 3/13/2007 0:00:00 $50.001013 212 Main Street,Phone(413)587-1240,Fax:(4'13)587-1272 Building Commissioner-Anthony Patillo File#BP-2007 0838 APPLICANT/CONTACT PERSON STEVEN T CZLJPRYNA ADDRESSTHONE 178 WHEATLAND AVE CHICOPEE (413)594-5678 PROPERTY LOCATION 86 PLEASANT ST-3R MAP 32C PARCPL 045 001 ZONE CB THIS SECTION FOR QEFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Pee Paid Buildin Pemti[Filled out Fee Paid L)peof Constmctton: REMOT/,ELBATHROOM New Construction --NODS——c{ural interior renovati s _ Addition to ExisCin* AcCassory Someone Building Plans Included: Owner/Statement or License 080726 3 set's of Plans/Plot Plan THP:EO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF' IATION 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 ANDER: §V„_ Finding✓^ Special Pcrnrit_ _ Variance* Received 8c 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 Boardof Health Permit from Conservation Commission Permit from 413 Architecture Committee _Permit from Elm Street Co scion Signamc of�ii ral ._.—.... __ .... 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. Versionl J Commercial Building Permit May 15,2000 1,. Gty of Northampton M Building Department 212 Main Street _Room'100 Northampton, MA 01060 phone;413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,REPAIR RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING �SEGLIONI-.SREINFORMATION"_:_ . 11-ProgertrAddress- `v Thrs3ectrontgtieeo� jeotFice�. �=5,__'=., WJ t 3k _sa -SECTION 2-PROPERTY ONYI`S- ZS �- 2.1 Owner of Record: Name(Pdnn Current Mailing Address: y7? FiBa-99 7 Signature Telephone 22 Authorized Agent: `- � �'nl �' G.2+%P1139�A 1753 L)f1$ATLA&D Kl-1 ... MA Name(Pnnt) Current Mailing Address: Oha20 Signature Telephone -SEc An TIMATEDCO S- UCTIONCOSTS Item Estimated Cost(Dollars)to be - OlficfaLUse-only completedcompletedby rmita pfcant 1. Building (aTBuilding Pennn Fee - 'I 2. Electrical (b)Estimated Total Cost of ,co I 'Consituctlon Tram 6t 3. Plumbing Building:PiffnffF 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1+2+3+q+5) '7 .CJO :-Check Number Q SM1ns-Section ForDtflicial Use Only Bwldng=PermitNunitiec - - � � 'Hate"`. - -IS-suede Signature: Building CommissionerAmpeclord Buildings .Dale Version 1.7 Commercial Building Permit May I5,2800 SEC7iON6.CE3{i51'RUGIlNSE}.24fCES EO[t'PgOr7k�.$TS�E.?,^�THAN35.004 '-- CUBICFEECOFENCLQS SPAti7E bHerior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs[] Additions AccessoryBeitd3ng❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other Brief Description Far ter a brief description here, Of Proposed Work:{ � �� t -\ �� ''?+'��!S n-vHPoQvy\ SECTION 5•USE GR0UPAND CON$TR,UGTdDA'�'7YPE- USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-d ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ - F-1 ❑ F.2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ I-2 ❑ 1-3 ❑ 38 M Mercantile ❑ d ❑ R Residential 3r R-1 ❑ R-2 ❑ R-3 ❑ SA ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: ., M Mixed Use ❑ Specify- S Special Use ❑ Specify: COIv1BLETETEDSSECTIONIPE'XISINOBUILDINGT9II gGIDf{GRENOVAITONS.'AbDff10NS-ANO)ORGRANCE IN USE Exisdrg Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34); � Proposed Hazard Intlex 780 CMR 341: SEC[I6TT671BUIlDING1iEI4NFYIND;ARW _ BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION FborArea per Floar(sf) e 3b I `30CJ 3rd 4s � c�iCJ('1 � 4 n Total Area(st) II '�;U Total Proposed Now Co_ nsWcWn(sf) -. Total Height(h) Total Height it T.Water Supply(M.G.L.c.4g,§54) 7.1¢Dood one forntation: 7.3 Sewage Oteposal Systerm, Public ❑ Private ❑ Zone Outside Fbodzmecj Municipal❑ On site drsposat system❑ - Veraion1.7 Commercial Building Permit May 15,2000 AM 1-4 L Existing Proposed Required by Zoning This colonm W be filled in by Budding Deparnnmt Lot Size Frontuse Setbacks Front Ci Side G= R-,---' r- Rest -B—.ldmg er Bldg.Square Peerage % r� Open Space Footage (Wtarea mimes bldg #of Parking Spaces I—J Fill: ' w.0 &Iwaeion) A. Has a Special Permit/Variance/Finding er been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Rei of Deeds? NO © DONT KNOW YES Q IF YES: enter Book Page., and/or Document 81 B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW © YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained © , Date Issued: j C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: j (LF�gJ�a4ro� FIC- D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO V — IF YES, describe size, type and location: E. Will the construction activity disturb(cleadrg,grading,re�x�qv�'�en,or filling)over 1 acre or is it part of a common plan rb that will distuover 1 acre? YES O NO V IF YES,then a Northampton Storm Water Management Perna from the DPW is required. Vcrsionl.7 Commercial Budding Permit May 15,2000 SECTION 9-PROFESSIONALDES(GN AND CONSTRUCTION SERVICES-FOR BUILDINGSAND_k RUGTURtMEUECETO CONSTRUCTION COMTROL PURSUANT TO TS0.6NIR 116(CONTAINING MORE TRAN35,600 C.F.OF ENCLOSEDSPACE) 9.1 Registered Architect: Not Applicable Name(Regishant): Registration Number Address Expiatim Dae.. .. Sigmwro Telepbene 9.2 Registered Professional Engineer(s): Name Area of Resp siblity i Address Registration Number Signature Telephorre EViraYon Date Name Area of Responsibility i Address RegistaG Number I Sig.wre Telepl a Emmr n Date Name Area of Responalbildy i Address �^ Registr bon Number I l SigeaNre Telephone E�iadon Date I I Name Area of Resp msibi0ty Add.. Regisbabon Number Signature Telephone 1 Expiation Date 9.3 General Contractor ' L —J-nJ GiJ P2�4 h'1� Not Applicable Cl Company Name: "i,F J�F�r TCWIxi-cN vQ- pLir� rycOEAI�'I tS.E U'l✓! P..P TYe N Charge d Consmrction 174 40 Address sX.rp/ Sigre re Telephone Version 7 Con rnercial Building Permit May 15,2000 f,. SECTION 10-S?RUCTURA4:PEEtREV1EW-(Z6CMR Independent Structural Engineering Structural Peer Review Required Yes Q No SECTION 11-OWNERAWWORIZAT1ON-TO-B&COMPGE[EU;�.'WHEN OWNERS AGENT OR Oft1c6uTRACTURAPPLIEsFLK u(Lbm-PERMIT as Ovmerafthesublectproperty hereby authenze �JZ{`-' L' 2c7Q2�-f!✓ lam` to act on my behalf,in all matters relative to work auli c6zed by this building permit apPlic rtimm Sion re pf�Owner �- � �aCe as Ov ner/Authorized Agent hereby deciare that the statements and information on the foregoing application are tore and accurate,to the best of my knoMedge and belief, Signed nder the pains and Deralfie.of oenum Print o _ Si M of nen/ t —v Gats ' SEC TOR12-CONSTNCkC-flON;SERVlCES 10.1 Licensed Construction$Ups :tgSC Not Applicable ❑ Name of Lkeese Noitler:_I0'?07 a-(` License Number 17C6 CA:,k P_e4 uA, :Q fw..= I7 Address Expiration Gate SignaWre � �� Telephone _ .SECTION 13-WOR$EWC;OMPENSAMN.INSURANCE}yFFIOATZk (1 G.Lc,� ,6C6 )� Workers Compensation Insurance affidavit must be completed and subotitted with this application. Failure to provitle this affidavit vnll result in the denial of the issuance of the bu' ' g pemvt Signed Affidavit Attached Yes No The Commonwealth ofMassaehusetis Department of Industrial Accidents U01 Office of Investigations 600 Washington Street Boston, MA 03111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aonlicant Information Please Print Legibly Name(Business/Organizatioc/Individual): Address: City/State/Zip: Phone#: Are you sm employer?Check the appropriate box: 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 hued the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have nn employe^s These Sub-conhactors have g. ❑Demolition workingfor me m an capacity. employees and have workers' Y P tY 9. ❑Building addition req workers' comp.insurance comp. a ormost corporal required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised thea 1L Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t n 152, §1(4),and we have no employees. [No workers' 13.[1 Other comp.insurance required.] 'My applicant Nat 6® box NIrntabofin outNasmdonbalow atwwing tlwlr workari co,np�ou policy io£orvmdon. t Homeowners who submit Nis affidavit indicating tt,err doing ad work avd Nm hire w:tside contractors must wbrmt a vew a davit mdiarmg such. rCono-actors Nat check Nis box must aneched an addidotul sheet showingNe.area of Ne subionttacmrs andmt,wlnh ce not Nose cctts have employees. If the sub<mtrecxns wave era 1,=,they mutt provide Nair workers'comp.policy numbs. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site m/ormation. 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 crimnai penalties of a fine up to$1,500.00 and/or one-year imprisonment m well as civil penalties in the form of a STOP WORK ORDER and Eine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded in the Office of investigations of the DIA for instnance coverage verification. I do hereby certify under the painsand penalties ofperjury that the information provided above is nue and correct Signature: Date. Phone#: 7=ther only. Do not write in/his area,to be completed by city or town offuiaL n: P,ermit/Licenss# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: The Commonwealth of Massachusetts Department of Industrial Accidents Office Wzs Investigations Street 600 Washington Street Boston,2VIA 02111 www.mass.gov/dia Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le¢ibI Name(Badncss/orgmimtion/Individual): ��J F� T czoP P4 N c-� Address: t `74 f (� ✓aA O f�JP [jkC P F d 4. OtGz� City/3tatelZip: l�.c-sT�PF ,,np ChoxPnoneft: `-113-2�fG—�s�' O Are you an employer"Check the appropriate bo Type of project(required): I.❑ I am a employer with 4.appropriate a general contractor and I 6. ❑Ne consiructron �-yp,s�p.loyees(Cull and/oxport-time)." have hired the sub-contractors I uP a am a sole proprietor or partner- listed on the attached sbeet 7. Remodeling ship and have no employees These sub-contracrus have g, ❑Demolition working for me many capacity. employees and have workers' y ❑Building addition [No workers' comp.tre name comp.insurance.' required-] 5. ❑ We a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 LE]Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12-E]Roof repairs insurance required]t c. 152, §1(4),and we have no - employees.No workers' 13.❑Other comp.insurance required-) •My,,heant that clicks box#1 rmtst also fill our N<sstiw belawshowm%dsv workers'compwsadw pohry infomadw- tHOmeowneswhosubrtut Nis affidavit mdinmtg trev we doing ail work and then h wtside wnmcmrs eaoi sumrdtaacw affidavit mdiadng such. iConaumrsd t check this box mustamched an a Edaal sheet shooing the nun of Ne,u aaoacmrs and state wheNe or nor those moue have cmploYeeS. If the stio-canlrs[iws have enmlavee;,Ney mus[provide dncir'workcrs'cortW.po5eynumber. lam an employer that is providing workers'compensation insurance for my employees Below is the policy aunt jobsite information. Insurance Company Name: -=N`•,jZ4rjCP Policy#or Self-ins.Lic.R: Ur— g7'`l fJ 1 7 Expiration Date:- 1 1 Job Site Address: �/ 1'4�tof9f2t I 51 A,09 t-)rAn AP D13 r Ciry/State/Zip: /Ni 1,4— 0 Attach a copy of the workers' compensation policy declarafion page(showing the policy number and expiration date). Failure to secure coverage.w required order Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a Eme 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 DLA for insurance coverage verification. I do hereby c(ero)Y,y/nde, ' an res ofperjary, the the information provided above is true and correa Si®ature: Dart- Phone ate Phone f - Of zciat 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 s: Information and Instructions Massachusetts'General Laws chapter 152 requites all employers to provide workcrs'compensation for their employees. Pursuant to this statute,an emplgr'ee is defined as"._everypeeaon m the service of another under any cermet ofhire, express or implied, oral or written." m employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in 2joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house laving not more than three apartments and who resides therein,or the Occupant of the dwelling house of another who employs persons to do m>amax ince,construction or repair work on such dwelling house ser on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business Or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 15% §25C(7)states"Neither the commonwealth nor any of its political subdivisions siuilf eater into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill our the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiacmr(s)vame(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Parmerships(LLP)with on employees other than the members or partners,ate not required to carry workers'compensation instance. If an LLC or LLP does have employees,a policy is required He advised that this affidavitmty be summered to the Depanmose of Industrial Accidents for confirmation of msureace coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Deparrernem of Industrial Accidents. Should you have any questions regarding the law or ifyou are required to obtain a workers' - compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-msmanee license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete=it printed Iegibly. The Department has provided a space at the bottom ofthe affidavit for you or fill out in the event the Office of Investigations has to contact yon regarding the applicant Please be sure to fill in the penuitlicense number which will be used as a reference number. In addition,an applicant that most submit multiple pemvtrlicense applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)and under`Job Site Address"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or awn may be provided W the applicant as proof that a valid affidavit is on file for fume permits or licenses. A new affrdava must be fined om each year.Where a home owner or citizen is'obtaining a license orpermit not related to any business or commercial venture (Le,a dog license or permit to born leaves etc.)said parsec is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate in give us a call. The Department's address,telephoneandfax member: The Commonwealth of Massachusetts Department of Industrial Accidents' Office of Investigations 600 Washington Street Boston,MA 02111 Tel. n 617-7274900 ext 406 or 1-877-MASS.AFF itevised 11-22-06 Fax 4 617-727-7749 www.mass.gov/dia BOARD OF IBUiLDiNO REGULATIONS License: CONSTRUCTION SUPERVISOR Number CS 080726 Birthrate: 11129/1964 Expires: 1112W2007 Ta no: 19561 Restricted 00 STEVEN T CZUPRYNA 178 WHEATLAND AVE CHICOPEE, MA 01020 c•^•^ Commission DRfVER'S YLiCENS6 , HJMxEP w— fA,p4 PEs XFIOM � oEErr*Pwxx D �' M STEVENT V 1}g WNEATIA 0 AVE OEE.NN _ 010xi61 1 0102M Aaam CERTIFICATE OF LIABILITY INSURANCE GPID DWTE(YWOMYYYYI XCZUPRY d 01/10/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE First Aaerican Insurance Agy., HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 510 Front Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Ch?c MA 01013 Phone:413-594-8118 Fami413-594-0995 INSURERS AFFORDING COVERAGE NAIC# WBDREG INSURER A. AtO¢lla Pavfac4cn inv INSURER B: m Steven T. Csupryandow dba Aldenville Wi INSURER C: opeet0020nue INSURER DChicopKA1 : INSURERS COVERAGES THE POLUCRE OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NGTWRMSTAHDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,IXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMBS SHOWN L HAYS BEEN REDUCED BY PAID CLAWS. LTR TYPEOFMWflY10E PDUC,..Be DATB WTF ZMAN LMITS OENEMLlNB1IlT( F CURRENCE $1000000 A X COMMERCIALGENERALUABBITY 8500030850 05/03/06 05/03/07 S IS.oar ) s 100000 CLAIMS MADE ❑X OLLUR (Mry—l) f SDDO PERSONAL ADV INJURY $ 1000000 L AGGREGATE f$OODODD GEML AGGREATEpUNIT APPLIES PER: TS-COLRIOP AGO $4000000 POLICYT& LOCADIOMDBILELIAMLMYD SINGLE LIMIT f ANY AUTOnBALL OWNED AUTOSNJURY f SCHEDULED ADIOS 1Per PN%�RT HIRED AUTOS BODILYA) $ NON-0WNED AUTOS (Pa xoMnO PROPERTYOAMAGE $ (Pm acJOmt) GARAGE UASSU Y AUTO ONLY-EAACCIDENT E ANY AUTO OTHER THAN EAACC f AUTO ONLY: AGE $ ERCEE8NMMIIE UAM.MY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE f E OPoUCTIBLE S REUFIJTdI E f W ORRFAS CpIPEN&LTgM N1D EWLOYERSLMMMN TORY LIMITS I I ER ANY PROPRIETDRNARTNER/FXECUTNE EL EACH ACCIDENT $ OFFICERAEMBER EXCLUDED] E L DISEASE m EA EMPLOYE f BYe¢ SPECNl-L PRORONSIOIONS plow El DISEASE POLICY LIMB E DINER W YC W PION OF OPERilgx4/LOCATIONS I V ENLCLEE U IXC W BIONS ADDED BY EH DORSe$ENT/SPECIAL%LDV gKME CERTIRCATE HOLDER CANCELLATION 0000000 SHWI➢ANY W THE ABOVE DESCRIBED POLICIES BE CoUCEum BEFORE THE EUFyATOx WTE TIEREDP,TxE 498U1ND IXBURFRwBL BxOEAvoRroIWL 30 DAYSWRLTEx NDTMETDTECERTFlCATEW$LDERN EDTOTELEFT.BUTFMLURETOWWSRALL - - IMPOSE XDOBLbATON OR LNMVTY OF AHY xINDUPON TXE INSURER T19 AGEM90R REPRESENTATNES 1 ORPJBJ REPRE9 ATrvE 11 ACORD 25(2001/08) 0 ACORD CORPORATION 1988 ACORD_ CERTIFICATE OF LIABILITY INSURANCE Xr1$ce°D Baa wYYY 10,107 PBDDUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE First American Insurance Agy., HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 510 Front Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Chicopee MA 01013 Phone:413-592-8118 FaR::413-592-0995 INSURERS AFFORDING COVERAGE NAIL• MBIIRm NWRERA: De��ib Sta4 Ln w to. Timothy McDonald and Charles INSVRERa Capellaa &Ta The Edge Remodelin INSURER C. 9pringaannnn4tieldSMA 01104 InwRER D INSURERS COVERAGES THE POLICIES OF INSURANCE LISTED BELOW XNV£SEEN SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INWGTm.NOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY COM T OR OTHER DOCUMENT WrtX RESPECT TO WXIOH TRIS CERTIFICATE MY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED IHREIN IS SUSIECT TO ALL THE TERMS.IXCLUSIONS.0 CONDfNONS OF SULX POLICIES.AGGREGATE LIMIT$S MN MAY NAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPEOFE011. POLIDYMUYaFII WTE MTE I1Y18 GENEIGL WMLITY EACH OCCURRENCE f J--IAL GEHER.LL LMBILfTY PREMISES 2 CLAIM.MADE ❑OCCUR MED IXP INry mw Rws j f FER.ONP1 flaOV IH.X1gY S GENERAL AGGREGATE S GWL AGGREGATE LIMIT APPLIES PER: PROWCTS-COMPIOPAGG i POULY JPEP LM AV,OMOMRE LIOwLIIY C00aL�INE05wGLE LIMB ANYALTO f w ALL OWNED AUTOS BODILY INJURY S SCHUR LED AUTOS (PMPB¢n) HIRWAUTOS BODILY INAIRY S NON-0MED AUTOS (PN...Q PROPERTY OMMGE $ IPwaraaeMl GAPI'GE WBERY AUTOONLY- EAACCIOEM f ANY AUTO THAN EA ACC S AWOON AUTO ONLY ADD f 7�10N EACH OCCURRENCECLAIMS WDE AGGREGATEi f wwwsss COIIPEMBAT ION AND ��. TORYLIMRS ER A ANYOFFICERYMEETONNARTNDEIE%ECUTIVE NC BT451T8 0$�11�D4 05�11�0T E.LEAEASE-1DENL $100000 IT,- RARFMBFR IXLLVOEG9 ELDISEASE-E4 EMPLOYE 5100000 nT..,BeB�IMunBr E.L.DISEASE-POLICY LIMIT 1500000 SPECML PROVwg11$pelOw OTXER DFBCPoPMIN W OFERATMNISI LOCATIONS/1RUPOLESR IXCLUBIONS ADDED BY ENODRHdES1i/SPECIAL PROARRINS CERTIFICATE HOLDER CANCELLATION 0000000 9NWLDAXYKTXEABP/E DESDRBIm POLICIES BE CIN"LLAD BEFORE THE ERPIRATNIN WTE TREREOP.TNEIBSIRXB IM9111RER WILL ENIIFAVORro MAR 30 DAY8 W111TTF11 NDTCE TO THE CERTMILATE xoLDER xAYm To THfi LEFT,BIrt FARURE ro 0080 sILLLL rroeE m osuoaTR»R oR uAwLm of Axr Rwo urox TRE wwRwL ce aGERT9 oR RF➢RE.9RTaTVEx olaosa a ACORD 25(2001/08) O ACORD CORPORATION 1988