38A-008 (5) 39 CHAPEL ST BP-2018-1361
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:38A-008 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv: ROOF BUILDING PERMIT
Permit# BP-2018-1361
Proiect# JS-2018-002420
Est.Cost: $8550.00
Fee:$80.0 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MARTIN ROOFING LLC 152743
Lot Size(sp.ft.): 22476.96 Owner: RAY DONNA
zoning: URB(104)/ Applicant. MARTIN ROOFING LLC
AT: 39 CHAPEL ST
Applicant Address: Phone: Insurance:
85 LEE ST (413) 525-0671 WC
EAST LONGMEADOWMA01028 ISSUED ON.6/20/2018 0:00:00
TO PERFORM THE FOLLOWING WORKSTRIP & SHINGLE ROOF FOR 2 HOUSES ON
LOT
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 Occumancv signature:
FeeTvpe: Date Paid: Amount:
Building 6/20/2018 0:00:00 580.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Do pankrasid
City of Northampton "Operrrdt
Building Department :ZWOrhissway Perodit
212 Main Street SewerlSeptib Availbiky. I 1 1,
Room 100 WaterafkNel A
1Pill"
Northampton, MA 01060 1 1 41 ?1,if
phone 413-587-1240 Faxii P
d
A
APPLICATION TO CONSTRUCT, ALTER, RE AIR, ENq Qf 9&%DU+A li OR TWO FAMILY DWELLING
SECTION I -SITE INFORMATION
1.1 P,operbi,Address: NORTHAMPTON.
MAotgLMa se to be wmpktepd by offlea
39 CHOU. STREET Map Lot 6 Unit
II rH-Impru," Gd Zone O"rlay Diddrick_
W.Sit Dislact_ CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORtZED AGENT
2.1 Owner of Record:
b0fiNA Ptry 39 CHAIVI STRGCT, JtbgTij*o" Af r3rjo
N Pring iAdcd,;VBtoi �.
Si not
2.2 Authorized Ai
Awii r7AeT-."3 441-w kvvl,,6 LLC
9-k /_ff ST'ACCr- ii 0/029
Name(P t Cument Mailing Address,
(1i Sas-0671
-ti nature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS I
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Binding (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
6, Total=(1 .2-3+4 5) $ R, SSO. 00 Check Number "5
This Section For Official Use Only
Date
Building Permit Number Issued.
Sfqgimnars:
BuldM
Commis
aga Date
Martin , r-o b hofMa I . co
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
e
Section 4. ZONING All 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 Depa enwt
Lot Size
Frontage
Setbacks Front
Side L R:'...... L: ..... R
Rear _.
Building Height
Bldg. Square Footage ""' % ' -- —
Open Space Footage % .....
(Lot area means bldg&paved,ar .........
k:n ..._ _.. ._..
#ofParking Spaces -- -
volume&Locm,on ____
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES Q
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 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 O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size, type and location:
E. Wil 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 O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 6 DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteratlonls) E:1Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[oj Other[ED]
Brief Deggcription of Pmpose C�
Work. VZrv7 P d A PCA S qy SH u(L[c A e Aeccromcs — I o--'1NR�'S
Alteration of existing bedroom_Yes No Adding new bedroom Yes No
Attached Narrate Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ga.If New house and oradel tion to existing housing.complete the folioWina�
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?
dill. 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 Complianceform 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 Pnvate well_ City water Supply_
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT/O��RCONTRACTOR APPLIES FOR BUILDING PERMIT
I, &"VA 1Z;y as Owner of the subject
property ,t
hereby authorize 1�,{AQ-rr.y Roof w G LLC
to act on my behalf, in all matters relafive to work authorized by this building permit application.
Signature o er Date
1, RO$C2T /"�A2i b✓ . 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.
figi 14ARTIN
Print N me
nature of Owner/Ag Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Nam.&Lic.ne.Hold., Reaea �,1l / IARTIAl LS-o1336H
License Number
85 Lcc STffci &.9 LoAa;ncaopw. PfA o1o.TCi IdIli
Addre s Expiration Date
(�1'}� SSS•Of.7 I
ignature '�rt ' 'Telephone
S.Registered Home Imorowmsrd Con@aetor. Not Applicable ❑
Co�an Name Registration Number
N�41N .fIA4 R-C `11161/8
Address Expiration Date
8S LCC STRCCT bili, 4+ oiox? Telephone C'Y$3)S]5-0071
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.,.. .. ❑ No...... ❑
City of Northampton
Massachusetts '��-
{ D212 Min'NS " Ba auni i INSPECTIONS
312 nein 6Tiaa[ Hunicipal Building
NozNampWn, !p 01060 h':yrl(6aC
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 structures 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
_Owner 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 aasem the agent of the owner:
I<000CTrN2TrN /f *ATI- f OWjIV& SLG (S.)7y3
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:
Date Owner Name and Signature
City of Northampton
i
Massachusetts
�jI c
V s
DEPAETlIC'NT OF BUILDING INSPECTIONS
212 Mein rtr a lNn 010 auildillg
Northampton, MA 01060
Massachusetts Residential Building Code
Section I I 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 I I O 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 110.R5, provided that if a homeowner engages a person(s)
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
6 — ,
Massachusetts
{ DEPARTNENT OF BUILDING INSPECTIONS ,t
1 232 LLin .te •Municipal eui1E4ng pb
Novthampton, IA 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:
39 CfFAKL Safe F
(Please print house number and street name)
Is to be disposed of at:
ABL UA STE rs ciy,4l,TVC
(Please print name and location of facility)
Or will be disposed Doff in a dumpster onsite rented or leased from:
&L LJRSTL �no "9(- 7vC l!a E l ou6�t400a 9og0, NAr+pino, 44 O fo3C
(C/oOMPLy Name and A dress)
Signature of Permit Applicant 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
•0��y Department of Industrial Accidents
I Congress Street,Suite 100
Boston, MA 02174-20177
wH'w.mass gov/dia
\Porkers'Compensation Insurance Affidavit:Builders/Contraemrs/Electriflan9/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/OrgmrizatiDWIndividua): tlgQ{tnl QooPwG LLC
Address: 8S LfL STQCC—t
City/State/Zip:(ASTLoaarnddov 14A OIoaA' Phone#: C413) S1$•6fe71
Are you m employer?Check the appropriate bax:
Type of project(required):
I. amaemployerwas ..�empkvom fall and/or par-tore).^ 7. ❑New construction
2,,MII asole prrprie[arormarersh,-it mvenoumployecs working macro r g, C]Remodeling
any capacity.[No workers'camp.imcuranee mermaid]
3.DI not a homeowner doing at work myself[No workers'con, insurance required 1 9. El Demolition
4,F1 I am a homeowner and will be h'vine coMa¢ors to,coddua all wank No my pmpeny. I will 10❑Building addition
arc chat all enamors either have workerscompensation uncommon or are sole 11.❑Electrical repairs or additions
pmpr cmrs with no employees. 12.❑Plumbing repairs or additions
5❑I am a Woman connector and l have hued the sub-comometors listed on the ans the l mon 13.�ROof repairs
Thesesub tm
-emare e have employee,and have workerscome insurance.: t�I
h.❑ me ,u
We oumR
tron and its ocers have eacersea their right of exemption per Mor.c. 14.J6JOther Qr Q�r F
152,gr[q),and we have no employees.[No worker'comp.resonance requend.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation Wh,mroccomm..
s Homeowners who submit Ws afchrot indicating dory are doing all work and thea hoe maid, xnameas must submit a new affidavit indicating such.
lCoacanam dem check dos box maid mounted an additional sone showing the came of the sub-mnaarma s and some whether or not drown=fares have
employees. If the sub-conmrcmrs have employees,they must provide their workers comp.policy number.
1 am an employer that u providing workers'compensation insurance for my employees. Below is the policy andjob site
information. /� n
Insurance CompanyName: ASE raOFy(RT�
Policy#or Self-ins.Lia#: 6 5G.1 uLA S Q 74 S`I a Expiration Dater ] j 9 /fe
Job Site Address: 39 CHAPEL STRCLT- City/State/Zip: rN 140 ;;0
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 51,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
[do hereby carti&under thepains andpenaldes ofperjury that the information provided above is true and eorrech
Signature: / Date Cn �/a /(g
Phone#' 4Cwrf=ne9t
Offwial 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):
L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
x
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
of the foregoing engaged in ajoint 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 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 s 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 of public work until acceptable evidence of compliance with the insurance
requirements of this 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 sub-conmactor(s)morels),address(es)and phone number(s)along with their certificate(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 retained 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
ofthe 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 pennitilicense number which will be used as a reference number. In addition,an applicant
that must submit multiple perntit/hcense 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 proof that a valid affidavit is on file for fuwre 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, 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.mss.gov/dia
e
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant o 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
of the foregoing engaged in ajoint 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 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 commonwealth 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 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 permiulicense number which will be used as a reference number.In addition,an applicant that
must submit multiple perroviicense 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 he 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 Commonweahh of Massachusetts
Department of Industrial Accidents
1 Congress Street
Boston, MA 02114-2017
Tel. #617-72711900 ext.7406 or 1-877-MASSAFE
Fax#617-727-7749
www.mass.gov/dia
Fmm Rc—,si W-23-15
06/19/2016 11,01 (FAX) P.001
A� CERTIFICATE OF LIABILITY INSURANCE GAaeneno e
THI6 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONPERS 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 INUING IMSURER(9j, AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: If the caRlBcate holder Is an ADDITIONAL INSURED,the pollcy(aa)must hew ADDITIONAL INSURED prevlalons or be andomed.
If SUBROGATION IS WAIVED,subject to the Yana and conditions of the pollry,urYln policies may nbuhe an andomemenU A statement on
this cartltieate does not confer rl hY to the eertlReste holder In lieu of such endorsement s.
PRODUCER Neill&Neill lnsummoe Agency Eno Devi.RLrry
662 RHardale Street 413-732197 , 613.791 dB29
West Springfield,MA 01009 llandnelll.com
IoperyB asual COVWeAmi HAS:0
ACE
xw ena: APropeRcasualty eelry AGE
Slum Martin Roopn9,LLC
85 Lee Street Ix R
East Longmeadow,MA 0102E aRo
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IuwIMR a:
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COVERAGES CERTIFICATE NUMBER: REA81QN NUMBER:
THIS 19 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTLMTHSTANDING 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 SHOWAMMAY ILIO£BEEN REDUCED BY PAID CLAIMS.
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Fixed to! 413.587-1272
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED P041CIES BE CANCRLUID BEFORE
TOWn of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL 06 DELIVERED IN
212 Mein Strut ACCORDANCE TH TIE POLICY PROVISIONS,
Northampton,MA 01080
AumCNmo Riv a Trve s
Its
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