49-036 (3) 326 GLENDALE RD BP-2017-1392
• GIS 6: COMMONWEALTH OF MASSACHUSETTS
Map:Block:49-036 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-1392
Project# JS-2017-002320
Est.Cost: $3470.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRYAN HOBBS 83982
Lot Size(sa.ft.): 30012.84 Owner: PRATT AMANDA
Zoning: Applicant: BRYAN HOBBS
AT: 326 GLENDALE RD
Applicant Address: Phone: Insurance:
346 CONWAY ST (413) 775-9006 WC
GREENFIELDMA01301 ISSUED ON:6/1/20170:00:00
TO PERFORM THE FOLLOWING WORK:AIR SEALING AND WEATHERIZATION
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 6/1/2017 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck--Building Commissioner
File#BP-2017-1392
APPLICANT/CONTACT PERSON BRYAN HOBBS
ADDRESS/PHONE 346 CONWAY ST GREENFIELD (413)775-9006
PROPERTY LOCATION 326 GLENDALE RD
MAP 49 PARCEL 036 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �\
Fee Paid
TypeofConstruction: AIR SEALING ATHERIZATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 83982
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
00
Signature o`:'r ciafft I Dale /_/7
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
Department use only
I City of Northampton Status of Permit:
MK( 3 � Building Department Curb Cut/Driveway Permit
I 212 Main Street Sewer/Septic Availability
Room 100 Waterman Availability
Lrt r_ ------ 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
This section to be comp) ted by office
1.1 Properly Address: Map �q Lot Unit
�a lR 19-�4,i1�1�
1 l�Y2YLC ( O I .
Zone weeayDistrict
) C*Q2
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
/4-W& n 4L.o - PY75( \5A(p Gienda ie Roren fie. 1'44 n l l lob
Name(Print) Current M cling Address:
4g /scot-iutri7 4ai-i fiv -r el po i a38 elle
Signature
2.2 Authorized Agent:
6JALU1 Nob193 3N40 Ccnwa NY..vev-ReId ILl4o1.30f
N.--- (Vint) Current Mailing Address
ser / (b/ ±i5 -`1 6 l
• ature ' Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building ✓2 9 -1-D 0? a, (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection 1/
6. Total=(1 +2+3+4+5) 3 , yry1-0 . Oas Check Number Qh 7/7 /Os
This Section For Official Use Only V
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING AR Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage o0
Open Space Footage
(Lot area minus bldg&paved
parking)
ft of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW Sy/ YES O
IF YES, date issued: T�
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW 0 YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 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 0
IF YES, describe size, type and location: .�.,c
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO ry�
IF YES, describe size, type and location: Y�
E Will the construction activity disturb(clearing,grading, x vation, 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 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing n
Or Doors O `
�
Accessory Bldg. ❑ Demolition(1 ❑ New Signs
[0] Decks [p Siding[C] Other(/ml`'
A
Brief Description of Proposed -n r
A `\PQ,�.L.n L� W1'1Ullt-1.7 �
Work:
Alteration of existing bedroom Yes K. No Adding new bedroom Yes x Nis
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa.If New house and or addition to existing housing, complete 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?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. 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 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
kY]L-Q,n Pre ,as Owner of the subject
property p
hereby authorize CLT] 40 b ba
to act on my behalf, in a meters relative to work authorized by this building permit application.
4 rUAst ZflC74,-hl .slatilJO/ 9-
Signature of Owner Date
1111111
I, 4M 41.0 1.0 ,as Owner/Authorized
Agent hereby de re 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.
PyYyan 1\ohhs
Print Name
tti it 5 �a
Signature erAent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: 1_ Not Applicablep0
Name of License Holder: V3 vii �obh 3 08'5983,
License Number
311l9 CohwcwSk (rr-o-n-C1_ld N* oi: a I 5 i -t r
AddressExpiration Date
-'1511-ret---)116-6
e� --- / ` l(3) -T1 S-5\0°41 Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
L aIN.bb• at,dian t ‘. `215 (94
Company ame Registration Number
%Lj k Cor.w 3- (9-'c' c-w 4 \, H A 0 3 0 ( ; ) i -
Address r� t� Expirsbon Date
lx ( tobbscay\oAek 3. e9 crw c\.(Lon Telept(48)139
--1 V
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.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 2\ No ❑
11. - 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
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 he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also 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, 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: 3atsi (9-t QhdjXt QA I l r\sttCO- Mfg
The debris will be transported by: Nan Vlnbks rP.nnu k:nc
The debris will be received by: CG . a l! ' , 41W-11 411,a
Building permit number:
Name of Permit Applicant 6c\.c_1 p.ry (-'-D b[ts
� lay �2ol� C D�Sk�
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
r Department of Industrial Accidents
—'?t`Jl=Sl Office of Investigations
tal1= 1 Congress Street, Suite 100
_.'19_ Boston, MA 02114-2017
fi
*o www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Q ` 1 1 1 Please Print Legibly
Name (Business/Organization/Individual): [ J(U OX\y\\fks' .p(yl�e[r0
Address: 3L{(9 C pry W p y 5-4-(1:gei
City/State/Zip: �p"�mc).e\c\ NA 0136. Phone#: 413)QRS-C\bt
re you an employer?Check the appropriate box: Type of project(required):
I am a employer with V p 4. ❑ I am a general contractor and I t have hired the sub-contractors 6. ❑ New construction
mployees(full and/or part-1me)."
2.❑ i am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9 ❑ Building addition
[No workers' comp.insurance comp. insurance.:
required.] 5. ❑ 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 MGL 12.[n Roof repairs
insurance required.] ] c. 152,§1(4),and we have no
employees. [No workers' 13.❑Other
comp. insurance required.]
'Any applicant hat checks box 01 must also fill out the section below showing their workers'compensation policy information.
+Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information
Insurance Company Name: 1tyiJl(OYaV`
SS{ C [1(yU_ _Mt4t
Policy or Self-ins. Lia #: a ,(.j1 >C Expiration _
Date:
\Oat at [t i
Job Site Address: .10-k.9.10-k.9T\e
( fyao\C. V-8a City/State/Zip: Li\, Ql'NSL Heet 00 le
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 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a line
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DR for insurance coverage verification.
I do hereby ce i under the pains and penaltiesaof perjury that the information provided above is true and correct.
Sitmature: ( AA��/lR/1F'� Date: 5 IaIlt I }
Phone#: �ti a) S—Q b 8[p
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
op) 55.."'..s'c
p Massachusetts 3 �- r
la
r DEPARTMENT OF BUILDING INSPECTIONS S :re
\6hi.3$� 212 Main Street • Municipal Building �f'M1'+Y-�f'3'J1^app
Northampton, MA 01060
Property Address: a-(4 (-rlendale ' i-1,ot en0- HA olo(ea
Contractor �p
Name: ASV\SAn AIZAAS } e v\oAekin3
Address: 3y\P ( $ nwA\j 3f J
City, State: 9f.ee41i a ct , Mf} c 1801
Phone: (Lk 13 ) AS-9.Dbh
Property Owner y� (� 1
Name: Prix-�k
Address: 3 01.14 6-t,er\Ac ke_
City, State: C(UYenckt HA 01010e).
I, R vt I n l` _(contractor)attest and affirm that the building I intend to
insulate e�bes not have any open air(knob and tube)wiring in the spaces to be insulated and that I have
provide the property owner with a copy of this affidavit.
liContractor signaturec---lii (4
Date 5) )9
sit Massachusetts Department of Public Safety
1111 Board of Building Regulations and Standards
License: CS-083982
Cons r!r. o'n Gap ;viaor
BRYAN G HOBBS
348 CONWAY STREET
GREENFIELD MA 01301
M-ti, CA_S Expiration:
Commissioner 05/02/2016 •
ys
:9 illi _. \llle Jo7I[7 onwea7tA oln- aJJacAuJef
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 139564
Type: DBA
Expiration: 7/23/2017 Trp 267354
BRYAN G. HOBBS REMODELING
BRYAN HOBBS
346 CONWAY ST
GREENFIELD, MA 01301 — —
Update Address and return card.Mark reason for chug
Address -. Renewal - Employment Lost C
SCA, 0 20410511 - - �-
i
t
Office ofConsumer Affairs&Business Regulation License ar registration valid for individul use only
(10ME IMPROVEMENT CONTRACTORj before the expiration date. If found return to:
Registration: 139564 Type. Office of Consumer Affairs and Business Regulation
`I^ Expiation: 7/23/2017 DBA 10 Park Plaza-Suite 5170
Boston,MA 02116
BRYAN G.HOBBS REMODELING
BRYAN HOBBS
346 CONWAY ST
GREENFIELD, MA 01301 Undersecretary Not valid without signature
A RDW CERTIFICATE OF LIABILITY INSURANCE DADazerzo tt
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: H the certificate holder is an ADDITIONAL INSURED,the policy{les)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 tenter rights to the
certificate holder In Ileu of such endorsemen S).
PRODUCER •NTAC Trac
.omeE:. ._.Tracey Kukieartz
A H RIST INSURANCE AGENCY INC rRDnE e,. LTJ 683-4373 —FAXE. �___
it (rsce,..'�^ehriSt.[Oln
P O BOX 391 _ _ iNSVRgei)esPORmga'COVERAGE _ l NAIL R
TURNER FALLS MA 01376 tSURER A_; AMGUARD INSURANCE CO 42390_
INSURED
HOBBS BRYAN G otSURERS: _.. __—.—_—�.— _._._.._ iI
TA BRYAN G HOBBS REMODELING CONTRACTOR Menefee: —r
348 CONWAY STREET ITnliRiag_,_,_.
GREENFIELD MA 01301 INS R F.
COVERAGES CERTIFICATE NUMBER: 148323 REVISION NUMBER:
THIS in TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERNOO
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT IMTH RESPECT TO WHICH THIS
CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
IN9GAINSO Uel' PODCYEFF POLICYexP
or i„ TYPE OF INSURANCE
1N60 "nPOLICY NUMBER mrl'•N4 ML, nren'Y LIMITS
I
COMMfliCIPLGBNBR0.L L1A91L1tt EACHOCCURRENCE IS
I—+— — 3AMAGE tcY ENTEG"—" j--.
WMGMAOE ,_,_,I RIGOUR FfESSealg oce Leo E
I MEO EXP rnyrro2e,ee� S_
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(PoL IEtT LOC ROgK15_COMPARE AGO 1 5__
1iDEE'. __ 5 �.�..
PUTOM(1BILELIABILITY • _�-- .CDMBINEEI SINGLE,LIMIT IS
GEA a ieeley _ ,.
ANA AJTO ,. BODILY INJURY(per penal) I S
-"- 1 ALL OWNED • _'1.SACHEDULED ._..� _. ..._.._._.-,-.__._..-_._.
L_:AUTOS ( tATOS NIA BODILY INJURY(par wvueny,S
NON.SVMEO PIiLP£PTY DAMAGE •,y
�_.,,, A RIDGE __„; lay{— Pl—.._
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UMSRELLAUUAB •
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1— 'EXCESS Lae CLAM&uACEE I N/A ,AGGREGATE __ '15
DEO I RETENTIO E ---_ _._--__.— •S
woakERe COMPENSATION 'P TX.
AND EMPLOVENW'Ua4TY ux•SIgty —_-'Cmsµ
9YPROPWETORfPARTNER:E%ECUrrvC yI" EL.EACH ACCIDENT �'s 500,000
A OFFIOERoMEMBER EXCLUbeot NIA Wm S, R2WC768203 10/20/2016. 10/20/2017'
'Narrator/In NH) EL.DISEASE,EA EMPLOYED). 6U0,0uu
Ipnflon unaur
rs RiPitirdEERAT'ONSulow , _.— EL prase.aoucr LIMIT '$ 500,000
•
NIA
DESCRIPTION OF OP4RATIONS/LOCAMNSI VEHICLES(AGGR0101.AetlINOMI Remirks Sdndula.may be.M1eahed Il more space Is roguV Wl
Workers'Compensation benefits coil De paid to MassaGhueeltS employees only.Pursuant to Endorsement WC 20 0306 B.no authorization Is given to pry Claims-RR IMnefts tO
employees In states other bran Massaohusatts if the insured hires,or has rowed those employees outside of Massachusetts,
This Lert lioate of insurance Shows the poury In force on the date that this°emmirate W89"sued(unless the err/vier date on the above pokily precedes the issue dale of this
ce,tfOate of insurance, The status of this coverage can be monrored daily by accessing the Proof of Coverage-Coverage Verlllcation Search tool at
wow.mass.govnwdlworkersmompensatronnvestigalionsi.
Sole proprietor has not elected coverage.
3ERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE.DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN
Bryan Hobbs dba Bryan G Hobbs Remodeling Contractor ACCORDANCE WITH THE POLICY PROVISIONS.
146 Conway Street AUTNOWZEO REPRUS/MTaNE
4r
;reenfleld MA 01301 Denier Al'. CPCU,Vice President—Residual Market—WCRIBMA
091488-2014 ACORD CORPORATION. All rights reserved.
:ORD 26(2014/01) The ACORD name and logo are registered marks of ACORD
ACORD CERTIFICATE OF LIABILITY INSURANCE AAZs �;Y)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy{lest 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).
PROOUCSR c.NAME;
Tracey ttuklewicz
A.H. Rist Insurance Agency, Inc. Q (4131863-4373 - - iuc No]:.00:853-9651
159 Avenue A AIL @y
b '
R TOMER
P.O. Box 391 1cuBTGMeR to aDO DOTOBB
Turners Palls MA 01376i, IxsuRER{ll prronmxa COVERAGE SAIDA
INSURED IINSURE0.p_Llberty GYOuQ _ I
Bryan Hobbs dba INsuR4n _ _ _
Bryan G. Hobbs Remodeling IrvsuRsa
346 Conway Street 1' c�
I INSURMRE:
Greenfield MA 01301 INSURER F. t
COVERAGES CERTIFICATENUMSER2017 CERT 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 EY PAID CLAIMS
I lex TYPE GFINb NSW
ADDi Uea-' —�-0 1 DE ttiSV ExP —. .... _ .. .
4INSURANCE R Y? , .. Q ICY NUMSFA SAW °reYYY) IMXIDDE. WYI _ LIMITS
'GENERAL LIABILITY EACH OCCURRENCE IS 1,00,000
pENT€n
imaaET6 _.-T._ _—.
X LCO_MMERCJAL GENERAL LIAB;Uri PRNAICFA(Ea pmnentel 8„ 300,000
rn
A CLAIMS-MADE ;3CC OCCUR BIC 356084898 08104f2a Is 06/041 Eon.2FDEXP(Aq oneyeo IS 15,000
PERSONAL AGV INJURY la 10000:000
. . ._._. GENERAL AGGREGATE iS._.._2,000,000
GENF AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG I s 2,000,00.0_
) i POLICY Il,;PCT LOG _.._. —.. IS
AUTOMOBILE LIABILnY COMBINED SINGLE LIMIT IE 1,000,000-
;Ea ac en0
ANY AUTO sooty INIU Y;Per person) IS
A TALIOWNED AUTOS A102013a 01/02/2011 01/92/2018—
•
EOOILY INJURY(FMacflCPnl)I S
X 1 SCHEDULED AUTOS PROPERTY 6NAHF
1 XI HIRED AUTOS (Per accident
' X NCN.OWNEO AUTOS IS
X I M 9 Policy Form _____ S
A XI UMBRELLA0AB X I OCCUR , EACH OCCURRENCE S 1,000,000
EXCESS LAB
• CLAI0,09440E., • 12505608488E 06/01/201601$/01/2017 AGGREGATE __ S 1,000,000
-,OEMICTIELE _.�.___..._.. _y}_.._.—.._.._
X RETENIION $ _,. 10 000. _._.._.—.._.�_.._.._.._.�.._._._.—.. 3
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'ANY EMPLOYERS'4 TNITY _..
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OFFICER/MEMBER E%C LOEO? L —� OYER$ —"'— -"�-
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PoWION OF OPERATIONS below EL.DISEASE-POLICY LIMIT{3 __
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OESCRVTICN OF OPERATIONS I LOCATIOkS R'EXICLES (Attach ACORD 101,Aa Ilona)Remarks Schedule,If more space is r60u1re91
Classification: Carpentry & insulation
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Bryan G. Hobbs ACCORDANCE WITH THE POLICY PROVISIONS.
dba Bryan G Hobbs Remodeling Contractor ---
346 Conway Street AUtwQAI;EO REPRESENTATIVE
Greenfield, MA 01301
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LCORD 26(2009/09) G19894009 ACORD CORPORATION. All rights reserved.
49025(2009R The ACORD name end loge are registered marks of ACORD
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