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36-206 (11) 59 WINTERBERRY LN BP-2018-1272 GIs s: COMMONWEALTH OF MASSACHUSETTS Ma%Block:36-206 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category'Inground Pool BUILDING PERMIT Permits BP-2018-1272 Projects JS-2018-002271 Est Cost $69000.00 Fee:$75.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use croup: Homeowner as Contractor_ Lot Size(sp.ft.): 45738.00 Owner: CARLAN MARGARET A&JOVAN JAMES Zoning, Applicant: CARLAN MARGARET A & JOVAN JAMES AT. 59 WINTERBERRY LN ApplicantAddress: Phone: Insurance: 59 WINTERBERRY LANE FLORENCEMA01062 ISSUED ON:611&2018 0.00:00 TO PERFORM THE FOLLOWING WORK 1 BX36 IN GROU ND POOL 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: FeeTvne: Date Paid: Amount: Building 6/18/20180:00:00 $75.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2018-1272 APPLICANT/CONTACT PERSON CARLAN MARGARET A&JOVAN JAMES ADDRESS/PHONE 22 MAPLE ST FLORENCE PROPERTY LOCATION 59 WINTERBERRY LN MAP 36 PARCEL 206 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST SED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: 18X36 M GROUND POOL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: Approved_Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed _Other Permits Required: ^Cub 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 Der ition Delay ature of Build ng Of] 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. i Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. • F Department use only City of Northam p StakasofPermlb, �1Idin�Iy/��n��yrtm Curb Cul/Driveway Permit fJ18R1 Sire Sewer7Septic Availability t Room 100 Water/Well Availabdtty Qgp1 6 Two Sets of Structural Pians nn^ AN01 7-1272 PloV$b Plans r Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 6jq- 11' 27� 1.1 Property Address: This section to be completed by office 51 I.J'r`ieAerrl LAre Map 3 Let Z-OIC/ unit ��Drer1C¢ 1 MA DIO6L Zone Overlay District Elm SL District CS District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: ZoJt 5ares $9 tJrnk/�7rry Lane fflu tie�fmP CtOI Name(Print) Current Mailing Address' �n ,It S-Z.t4 ,L Telephone Signaturlel 2.2 Authorized Agent: Name(Prop Current Melling Address: Signature Telephone SECTION 3.ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only cum feted hy permit applicant 1. Building bS (a)Building Permit Fee OG J 2. Electrical (b)Estimated Total Cost of poo Construction from 6 3. Plumbing 1 000 Building Permit Fee $76�/ 4. Mechanical(HVAC) "' /v 5. Fire Protection 6. Total=(1 +2+3+4+5) 1 61 OOO Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signat Date Building Co oner/Inspector of Buildings si cwVc' Jartts @ C�rnq t 1 r rg.y EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) ( Section 4. ZONING Alt Information Must Be Completed PermlE Cpn Be Dented Due To Incomplete'Information Existing P2ephsed Required by Zoning; j This column to beFlled i by building DepatlmFnt w 1111 Lot Size .-• -.-:'[' Frontage Setbacks Front Side L R:. U l Rear Building Height Bldg, Square Footage "" % Open Space Footage _ % _. (Lot arra minus bldgdpmod arka,p 4 o Parking Spaces -- ----- Fill: (.olumc&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# 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 Q , Date Issued ,... C. Do any signs exist on the property? YES © NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing grading,excavation,or filling)over 1 acre or is It pan of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(chi all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) Q Roofing O Or Doors D AccessoryBldg. ❑ Demolition ❑ New Signs [D] Decks [O Siding[O] Other[f7) Brief Description of Proposed Work: We wo.flct (rkc 6 1p_..\ct G.n IB r36 In X.+�4 I+ or;r �cck yank Alteration of existing bedroom_Yes`No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Rall -Sheet III 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 farm 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 Privatewell_ City water Supply 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 to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Data i as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Jov c. �4.K<S Print Name Signature of Owner nl 9 Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ _Name of License Holder: License Number Address Expiration Data Signature Telephone 9.Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(i 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 penult. Signed Affidavit Attached Yes....... ❑ No...... ❑ City of Northampton 5 Massachusetts Fs�s .p`' DEPARTMENT OF BUILDING Municipal INSPECTIONS 2 111))) 213 Nam Street � Nwicipal Building i ® `cam Nortie,ton, NT 01060 IO ti.. AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owneroccupied building containing at least one but not more than four dwelling units....or to stmctures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered. Type of Work: Est. Cost: Address of Work: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): Job under$1,000.00 v1 obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: I.11( IIK Jov.:n Ssr < /w Date Owner Name and Signin r City of Northampton 5 -H'-' Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 210 Main Street a Municipal Building vi Cm Northampton, MA 01060 Massachusetts Residential Building Code Section 1I O.R5.1.2 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. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 11 O.R5, provided that if a homeowner engages a persons) for hire to do such work, then such homeowner shall act as supervisor. 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. City of Northampton •� "" Massachusetts `moi DEPARTMENT OF BUILDING INSPECTIONS 2 ® e m 212 Main Street Municipal Building Noctha,gton, MA 01060 Debris 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. The debris from construction work being performed at: SI 6err!. L, , e- (Please print house number and street name) Is to be disposed of at: (Please print name an location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 'A 11kt kW Signature of a mit pplicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of Industrial Accidents f $ I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia H-orkers' Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization lndividluai): 'SOy"a � ciM e� Address: Swir4er9errs� Lyr) c ( ( City/State/Zip: rlorLncL ' h O D6L Ph... #: Are you an employer?Check the appropriate box: Type of project(required): I 1 am a employer with employees(Poll and/or paraime).• 7. ❑New construction 2.❑I am a sole pmpricmr or partnership and hove no employees working for mein 8. ❑ Remodeling any rapacity_pe.wod:ers comp.insurance required.] 3 E l am a homeowner doing all work myself [No workers'somp ,- surancc rrgmred] 9. Demolition 4,}�lam n homeoer wnand will be hiringtractors to conduct all work on my prove, Iwill 10❑Building addition J—'4rs con ore that nn contractors either workers comvsm=efinn insurance or arc sole 7IF]Electrical repairs or additions proprietors,re wemployers_ 12.[]Plumbing repairs or additions 5 I am a genual contractor and 1 have hired the sub-contraemrs listed on the attached sheet Thesesub-convectors have employees insurance: 13. Roofre airs p gees and have workers comp.ire _ P 6.❑We are a corporation and its officers have exercised their right of exemption per MGL e 14.❑Other 152,kl(4),and we have no employees.[No workers'romp_insurance required-J *Any appliwnuhat check box 41 most also fill out the section below showing their workers compensation policy information. t Homeownvs who submit this affidavit indicating they are doing all work and their hire outside contractors must submit a new affidavit accenting such. :Convectors that check this box must anuched an additional sheet showing the name of the sub-contraemrs and star whether or not those entities have employeeslithe sub-conraanrs have employees,they must provide their workers comp,policy number. I am an employer that kt providing workers'compensation insurance for my employees Below is the policy anQjob site information. Insurance Company Name: Policy#or Self ins. Lie.#: 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the from 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, I do hereby certify under Ihepains and penanfes ofperjuy that the information provided above is true and correct. Sdmature�� Date: b Phone# 41',- 5$6 -0382- Oficial 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 ti.Other Contact Person: Phone#: ti Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract Df hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more ofthe foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee ofan individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an 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 152, §25C(7)states"Neither the comnronwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authoriry." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),addresses)and phone numbers)along with their cernficate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance 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 Department of Indusnial 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-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pennitflicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/liecnse applications in any given year,need only submit one affidavit indicating current policy information(if necessary)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 town may be provided to the applicant as proofthat a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (te-a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax #617-727-7749 Revised 02-23-15 www.mass.gov/dia Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more ofthe foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or tmstee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwcl Ii ng house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an 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 152,§25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements ofthis chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply your insurance company's name, address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance 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 Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which rill be used as a reference number.In addition,an applicant that must submit multiple peruit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e, a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia Form Revised 02-23-15 5:3 NEWBERRY ROAD EAST WINDSOR, CT 06088 U� (860) 623.8374 jok FAX (860) 292-103 �Ii ul. fnl. ,i uri x.,<i Date 05/25/18 TO WHOM IT MAY CONCERN: Jovan James. 59 Winterberry Ln. Florence MA. 01062 Are acting as Agent of Aqua Pool &Patio, Inc. concerning any matters in order to obtain a Permit for the construction of a swimming pool at: 59 Winterberry Ln. Florence, MA. 01062 Thank you, s/l Aq Pool ati , Inc. Date lkpgp BioGuard meA.,cdanon of Authorized Pool aooles v fn-ionafsCT Rvi;_ vHIC ;0318 — tiIA Roy. Seal — VP(. 03000-1193 PC b`1) &Spa Care Center AQUAP-1 OP ID: MI .a`oirv° CERTIFICATE OF LIABILITY INSURANCE amzazol9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATNELY 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 ttrtilfeHe holder is an ADDITIONAL INSURED, the polhcy(ies) must be endorsed. If SUBROGATION IS WANED, subject to the terms and condRlons of the policy,certain policies may require an endorsement. A stalenlent on this certificate does not confer rights to the certiODate holder in lieu of such endorsement(s). PRIDDI i cOXTACT MNE" Marnie_Evans 121 RonentsS Leonard PHONE .880-289-8818 IF4k xe: B80-291,0848 121 Roberts Street BAZA E East Hartford,CT 08108 g00RE55:mevansiftevans-InsuranlXf.com Evans Piens A,Leonard _-- INSURERS AFFORDING COVERAGE NNCA _ INSURER A:HarMord Casualty Inc. _ 29424 INauam Aqua Pool&Patio,Inc. INSURER B:Trum bull Ins.Co. 27120 _ S3 Newberry Road INSURERC:WeSCO Insurance Company 25011 East Windsor,CT 06088 - - INSIIRERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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 MY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IXSR TypE OFINSUMNCE A U PoLICTNUMBER PoLILW EFF P0.1CYE%P LM11T5 TR GENERAL LIABILITYEACH OCCURRENCE $ 1,000,00 A X COMMERCIALGENERALL�IADI UUNOZ8129 021011018 02/01/2018 PREMISES �oe;o,rsnee $ 300,00 C IMSM � ADE A OXUR MED EXP(Anyone person) s _ 10,0 00 PERSONAL S ADy INJURY $ 1,000,00 GENERAL AGGREGATE _ E 2,000,0010 -ENL AGGREGATE LIMn APPLIES PER: P_ROOUCLS-COMPIW AGG S 2,000,0 00 POLICY x PR6 LCC E COMUNED SINGLE LIMB 100egg AUroMOBILE LIABILITY EaamEeo f_ B X ANYAUTO UUNOZ8128 02101/2018 02Min018 BODILY INJURY(Per person) E _ . ALLOWNE) AUTOS SCHEDULED BODILYIWURYTeraakmtl S ANTOS NON-0 NED PROPE A E --- 'HIRED AVIOS ALTOS E GMBRELIA LIAR OpCUP EACH OCCURRENCE, $ _ _ EXCESS LMB CIAIMSMADE AGGREGATE _ $ _. OEp RETENTION E s 1YGnNE ISCOMPENSaTWN x WORM AN- OTK AND EMPLOTERS'LM&Lltt TORY LIMDS_ ER _ YIN 259988 021011018 02/011019 EL FwcH gccloEm E 1,000,000 C PNY PROPRIETORNARTNEXIEREC.TVE ® HIAA OFFILAAeIs ER E%CLVCEDi EL DISEASE-EP EMPLOYE E 1,000,00 (MenCFWy1n XX) _. -. H�w sones Uneer 1,000,00 pE5CRIPRON Ci OPERATIONS holo- EL DISEASE-ROJCYLIMR $ DESCRIPnON OF OPERATIONS DOC.S11DH3I VEHICLES(AhCe ACORD IDI.AEaMonel RemeM Schedule,Hmwe NXI Is,pUlred) B8: Jovan Jamea 59 a otarberry L., BID..., IIA 01062 CERTIFICATE HOLDER CANCELLATION SHOULD MY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Florence MA,Northampton MA Building Department AUTHORIIE➢REPaESEmATIVE Puchalski Municipal Building 212 Main Street NorthannDton-MAOIOSO ®1898-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Vp Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home improvement Contractor Registration Typo. Corpomum AQUA POOL&PATIO,INC. Regfehatlon. 113881 63NEWBERRYRD _ Expimdw: 97/22/2019 E WINDSOR,CT 08088 - Update Addrw and Mum card. Yare ration fm dmn9�. scnl 4 2antoLll _❑AddTroS O P.eaewel r7I EmCMyment O itis[C•ra1 HOME IMPROAMIE8a ON17 Raqulamn W _ N9NE IN TYPE: ENr CONTRACTOR Raf Yb ,n valM M lndNIOUY use oNy TYPE:Caod MI O"IN Ne s>gti mw A eb. I and Bu Mum le: 9 11"i19p E7mIrMI08 10 P of Corlsumw 5170 end ewinw Re9ulatlon 113881 0]/22/1019 10 Pad[Plaze- 51]0 AQUA POOL&PATIO,INC.. a n,MA o MICHAEL A OIANNAMORE 53 NEW BERRY RD E W INDSOR,CT 05058 UndWESCIEEq; N t vend wMhout Signature