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38A-029 47 CHAPEL ST BP-2019-0933 GIS a: COMMONWEALTH OF MASSACHUSETTS Msp:Black:38A-029 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv: demolition BUILDING PERMIT Permit a BP-2019-0933 Proiect k JS-2019-001567 Est.Cost:$10000.00 F«:5150.00 PERMISSION IS HEREBY GRANTED TO: Const,Class: Contractor: Lkense: Use Group: NU-WAY HOMES INC 013693 Lot Sim(so.ft.): 4922.28 Owner, HEBERT JOAN Zoning: URBn00u Applicant. NU-WAY HOMES INC AT. 47 CHAPEL ST Applicant Address: Phone: Insurance: 10 WHITE AVE (413) 563-0085 Liability EAST LONGMEADOWMA01028 ISSUED ON.511312019 0:00:00 TO PERFORM THE FOLLOWING WORK RAZE HOUSE TO CONSTRUCT A NEW HOUSE 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 Find: Final: Final: Rough Frame: Gas: Fire Department Firepla"dChimuey: Rough: OJL: Insulation: Final: Smoke: Find: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Si¢nuture: FeeType: Date Paid: Amount: Building 5/1320190:00:00 $150.00 212 Mein Street,Phone(413)597-1240,puts:(413)587.1272 Louis Hasbrouck—Building Commissioner File It BP.2019.0933 X!J' l �""./�nn��. A•,��(- d APPLICANT/CONTACT PERSON NU-WAY HOMES INC ADDRESS/PHONE 10 WHITE AVE EAST LONGMEADOW (413)563-0085 PROPERTY LOCATION 47 CHAPEL ST MAP 38A PARCEL 029 001 ZONE UM IOOV THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST EN REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Builclimx Permit Filled out 1014 7-1, Z91 dvr� F Paid 3G TvmmfC tructi rc RAZE HOUSE TO CONSTRUCTA-NEWTIO S New Construction Non Structural interim renovations Addition Existing Accessory Structure Building Plans Included: Owner/Statement or License 013693 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INWRMATION PRESENTED: isrApproved_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 Head of Health Permit from Conservation Commission Permit from CB Architecture Committee _Permit from Elm Street Commission Permit DPW Storm Water Management _Demolition Delay /W S/IOI 19 Signature of Building Official 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. •Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. aoroop:e.,rv,.w,r auo•: r� „ tyro 1�{(J/,� City of Northampton status or Pem,ir Depertment use only y� Building Department CurbCWDmnway Pernut 212 Main Street Sewerl$eohc Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets f swctural Plans phone 41356711240 Fax 413-587-1272 Plotsde Ppns•, OMr Spafy,__ APPLIG1TpN TO CONBTRUCT,ALTER,REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1•SITE NFORMAT 1.1 Progeds Address: This section to be completed by office y7e1^»M ST MaP Lot Un4 A)L%e 4,, ply., MA 0104 49 zone Overlay District Elm St.Dletrka Ce District SECTION 2-PROPERTY OWNERSHIPIAUTHO; AGENT 2.1 Owner of Record: Joan Hebert 47 Chapel St Northampton MA Namr IPnnl, Coeenl Haling Address g .801-814-5188 A o CDA .2. 1�lu /fl 0 .+. NAwk.(Pnnh Current Malang Address V /O (yj ;) sz 3 �8S 2M I ebpkone SECTION 3-ESTMATED CONSTRUCTION COSTS Item Estim ted Cost(Dollars)to be Olfclal Use Only completed by parmh applicant 1. Building (a)Building Permit Fee 0 2. Electrical (b)Estimated Total Coat of Construction from 8 3. Plumbing Building Permit Fee '\ 4. Mechanical(HVAC) Ov 5, Fire Protection S. Total-(1 ,2+3,4.5) QQ Check Number G] This Section For Official Uss Only Building Permit Number. Date Issued: Signature Building Commbaorerllmpxiar of eWkNga Daw NOVA y/Tk.+es ® C1..«ar-sf . vcf- EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Mi-is nsmtirewrr,mm Section 4. ZONING All Infurmatbn Must Be Canpleted.permit Can ore D led Due To Incomplete Intmnatlm Existing Proposed Required by Zoning n,s v.N.n to be fined,.by Building Depenmrn, Lot Size Fronde Setbacks Front rjp Side LK L:_ .. R:.____ Rear Building Height Bldg Square Foulage _. % Open Space Foulage Iia.Iw m,.bIq a pared 34 19 #of Puking Spaces 2 fill: l.mume a t.,ca,w, A. Has a Special Permit/Variance/Finding ever been issued forion the site? NO O DONT KNOW- ® YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? ' NO O 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 0 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 O . Date Issued: C. Do any Signs exist on the property? YES O NO 1P 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 IF YES, describe size, type and location: Y E. Win the c instmCtian activity disturb(cleating,grading.excavation,or Bang)over 1 acre or is it part of a common plan that will disturb over/ acre? YES O NO J& IF YES,then a Northampton Storm Water Management Permit from the DPW Is required. aawop:.moveurmunon: SECTION 5,DESCRIPTION OF PROPOSED WO check all applicable Now Nouse ❑ Addition ❑ Replacement Windows ARarstlonls) ❑ Roo/ing ❑ or Doors O Accessory Sidg. ❑ Demolition �, Now Signs 101 Decks ID Siding 101 Other ILII Brief Description of Propo I Work: Tp Rl•t zr ons To Gn,a7t0ret A /Vt tet' 14ou.1e Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet as.If New house and or addition to adfistino housing.Cotnolete the following a, Use of building :One Family Two Family Other_ ___ b. Number of rooms m each family unit: Number of Bathrooms c. Is there a garage attached? J, Proposed Square footage of new construction. Dimensions e. Number of stories? L Method of heating? Fireplaces or Woodstoves Number of each g, Energy Conservation Compliance, Masscheck Energy Compliance form anached? h. Type of construction I. Is construction within 100 it of wetlands?_Yes _No. Is construction within 100 yr. floodplain_Yes_No 1. Depth of basement or cellar floor below finished grade k, Will building conform to the Building and Zoning regulations? Yes No 1, Septic Tank City Sewer Private well City water Supply SECTION?a-OWNER AUTHORIZATION-TO BE COMPLETED= OMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMR I. Ao;Hirw o u Zu t as Owner of Me subject property ) hereby authorize SD k' � � / r wnxt�ZX./1 /A/V'—U/1 li' o qi. U:;,"' to act on my behalf in all matters relative to work authorixetl y this building permit application, Signature of Oaiw / /J Date as Owner/Authorized Agent hereby declare that the sUtements 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 �..1[Ji+r.✓ r Hb NP Tri' ��rl , � A Pent Name Signature of OwnenAgent A74 scamp sasumre.eracsuo�: SECTION 9-CONSTRUCTION SERVICES 9.1 Licensed Construction --11Supervisor: Not Apphcable ❑ /' O 7 Nems ALignas Kogsr JOti� stHs N � � —0/21(n / J License Number /0 yh.is A✓c 6.[nra+ret9�a.� .Np • ole7s 7/ao/f! AEdmss Expk Ipn D iB T lrbone G3 ooPS 9.Reeisbmd Nome 9norpyme9nt Canwetor: Not Applicable ❑ Company Name Registration Number Address Expimoon Date —Telephone SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,S 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 Me issuance of the building permit. Signed Affidavit Attached Yee....... No.__ ❑ �\ The Commonwealth ofMassachusefts Department of/ndustrial Accidents 1 Congress Street,Suite 100 Boston,MA 01114-2017 spww.massgov/dia Wil.rkers'Compensation Insurance Affidavit:Builders/Contractors/Elech iciaaa/Plumbers. TO BE FILED WITH THE PERMrI1TNG AUTHORITY. Applicant Information Please Print Legibly Name(Busi one/OrganuanoNlndividual): N H Address: /D Cdh,'Te— 'Que E.. t—a n.t eaerW- ma. ao City/State/Zip: O/d �-8 Phone#: ( y/3 S-LL j —00,FS Are yea an employer. Cheat We approprime hoz: Type of project(required): I.[]lama.ploym with eacloyeer(M av pmt-time).' 7. []New construction x.�lamamle pmprieuvmptmenhip am havemmployees wml've fmmem 8. []Remodeling my .capm ey.Mo workers'comp.asoma a mquae1l 9. demolition y.Q ecmall I am a homwr&mg work myself[No wotken'taw.mearamenqu red.l t 4.Q 1 am a twee nm and wAl Ix swats convectors to conduct work on my property. 1 wdl 10❑Building addition ame dut all comnators etW have workers'compensation wamr coram sole 11.❑Electrical repays or additions pmpnemrs wiW nn employee'' 12.[]Plumbing repairs or additions 5C]l am aeevom convacataad l have lamed the tub-covvacmrs lasnd on the amdid Aemc 13.�R00f repairs rhes,orb'.'.n have employtts ad knw lave woeco .at'.. 6.[p7.ILWe mea capontam and its otficros have exercised thea right ofmcmptiov per MGL c. 14.[:]Gther ISx.frl(a),avd w<hevnm employzs.Mo wohas'comp.insmavice mgwrd.l *Any applicant that checks box#1 most elan fin out the section below showing they workers'compcvsatiov policy udo mmi m. 'Homeoxmrn who submit this affidavit wdicativg Wry me doing at work and Wev hue ouuWe consomme most submit a new affidavit mdiwring such. 1C....out check suss box must asmrid an aMbonil sheet Amwmg We name of We s lbtmta cmrs and nee whemer mnot thou entities have employes. I(ihe sub-canvactors have wployss.tory must provide Weu wmio—'comp.policy namber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M 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 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. 1 do hereby u r the pains airier o pert m the information provided above is true and correct Sign Date: -3 Ll -2O Phone 4- G Official use only. Do not write in this area,to be completed by city or town offrial. City or Town: Permit/Liomse# Issuing Authority(circle one): L Board of Health 2.Building Department 3.Cityrfown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,m 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 mother who employs persons to do maintenance,construction or repair work m 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 my of its political subdivisions shall enter into my 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-contrmtor(s)camels),addresses)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 LCC 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 resumed 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 my 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 mrc 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 permit4immie number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license 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 than 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 my business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required m 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.#617-7274900 ext. 7406 or 1-877-NlASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 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: y 7 C la(�c.0 ST The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant At/V-Jin&I , 5oti� M. Date Signature of Permit Appli nt Commonwealth of Massachusetts CNision of Professional Licensure Board of Building Regulations and Standards ConstrydlRS�i$ilpgrvisor I CS-013693 Upires:07120/2019 i n M ENAN �JOWITAE n5 ,AEQa GM Commissioner ACOROY CERTIFICATE OF LIABILITY INSURANCE _ATE" °°'""" am0IM19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATWELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTRUTEACONTRACT BETWEEN THE ISSUING INSURER(Sj,AUTHOR= REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. N the certificate holder Is an ADDITIONAL INSURED,Me pollcy(lea)muat hexa ADDITIONAL INSURED pmylelons or be efidoresl. H SUBROGATION IS WAI)PED,Subject to Ms terms and conditions Of MB policy,carlaln policies may require an er domement. A statement on this certificate does not confer rights to the coriMcats holder In lieu of such endorsement(s). nooucEa xAUE, Sara SCMner,CIC CommaWG2xaline lnsleance Awnc,,Inc. vxoXe p137283-03]5 (413)2882568 1352 MMn 51. /,pOREa6' SSalvneL�P]Ipe6n1 P 0 Bm 905 IxauNE AFFpgNp WVPAApE MAC• Pat. MA 01069 NINA A: James River In..Co. NNIIIIO IMEURER B: NUWay Hanes Inc IxauRER c: 10 Wnae Avenue INSURERD IN W RER E East LMgmaderr MA 01020 INaressi COVERAGES CERTIFICATE NUMBER: 201$GL RIVISION NUMBER: THIS IS TO CERTIFYTHATTHE POLM.IES OF INSURANOE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAN EDIBOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDINGANY REQUIREMENT,TERM OR CONDITION OF ARYCONTPACTOROTHER DOCUMENT WITH RESPECT TO WINCH THIS CERTIFICATEI YBEISSUEDORF YPERTAIN,THEINSURANCEAFFgiOEDBYTHEPOLICIESOEBCRBEDHEREINMS MECTTOOLL ETERMS, EXCLUSNHISAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN!MAY HAVE BEEN REDUCED BY RAID CLAIMS. LTR TYPE OF INSURANCE Fo110YXUYYR Yq 11YrE CWYMIICML0E11EIIKMNNY Fb10tdINiENCE s 1.000.000 CWL4YADE ®OCGR a 50.000 MEDEsp f EGGS A DDaeeoeao wv=1e ItN2'm ig vERSDNusAov NRWr s 1.M.DDD LIDNLAWIEBATE LARTAN1F8 Pei OENENALAOONFGATF p 2,DOO,IXp Po11CY❑ LOC %mOUI coNPmPA00 It 1,000•WO p $ ALROYOSR[LNaSIRY FDamam LF uu f AHvwro BODILYINAR"( . parem1 f AUTOSSOND, NSCI�I� BDORrwAnY R'a eaMaR i Dures HIRED reIMNANIlL f AUTDS MRd ONLY f uYeRWULMBOOQR EACH ocwRYBIrE f DttlON"N p.SWX. AMREOME f ceo I iIikTEMIIt _ L1MRImlarekLYeRwlgx PDE A1DlROYSf LIASERY BT" - YIM NIYNmM WREXCMRED''ECYINE ❑ M/A EL F/LNICCDDIT f MKERMFMBER EXCLUDED? OYWwFMMM E.L.pIEFAX-FAEYROYEE f YSsA aYpp u,y pEECRV11pI pFgBIMAY6[Ms ELdSFME-PoIX:1'lYT s DESCRIPTION OF OPEFUTIONS I LOCATONt IYNtlH MCOMIH,AYYweIRwNacMEun,mcy a�cXacNtl Ilmw�apNa4X4iNt CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN city Of NOINamgOn ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main SDeet AUTIal00R ...NTATNE NOrmamDton MA 01060 019882015 ACORD CORPORATION. All rights ressmed. ACORD 25(2016103) The ACORD name and lops are registered marks of ACORD o�J T �VFA, UISTING DRNE F, •v/� �e C/ 1A 20, F / LOT 1 / \ 4933.0 SO.FT. 0.11 ACRES 224n / 12.0 4* sow + / yu 9k/ PROPOSED PATIO(PAVERS) G�Pe 12'x 15'WITH STAIRS F � yG EL D. m $ SMITH No.48742 �aVAL tA88S OWNER: MICHAEL J. HEBERT PLAN OF LAND AT: SAME ADDRESS: 47 CHAPEL STREET DATE: 2/25/2019 SCALE. 1" = 20' HAMPSHIRE COUNTY BOOK OF PLANS: 186 PAGE NO.: 162 LOT NO.: 1 SMITH ASSOCIATES DEED BOOK: 5895 SURVEYORS, INC. AGE NO.: 189 �wwwameer.usrw+m<,mxw-aim P+s>a.oi File#MP-2019-0049 APPLICANT/CONTACT PERSON NU-WAY HOMES INC ADDRESS/PHONE 10 WHITE AVE (413)563-0085 PROPERTY LOCATION 47 CHAPEL ST MAP 38A PARCEL 029 001 ZONE URB(100U THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee a Building Permit Filled out Fee Paid Tvveof Construction: ZPA-RAZE EXISTING HOUSE AND BUILD NEW SINGLE FAMILY HOUSE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plan Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION PRESENTED: Je�LApproved _Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER: § Intermediate Project:_Site Plan AND/ORSpecial 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 Bond of Health Permit from Conservation Commission Permit from CB Architecture:Committee _Permit from Elm Street Commission Permit DPW Storm Water Management l � 3z � Signature of Building Official 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,Depanment of public works and other applicable permit granting authorities. w Variances are granted only to ihne applicants who meet the strict standards of MGL 40A.Contact the Office of Planning&Development for more information. File No. f1,7 /�-l9 c(? ZONING PERMITAPPLICATION 01o.2) Please type or print all information and return this form to the Building Inspector's Office with the$30/iling fee (check or money order)payable to the city a N��orth0pampton 1. Name of Applicant �d�.1/ N` r /'rkhNGt�P/I Ny —,ff /7(/A'!p2 � Address: %0 ut)"f- age E Lrrr9ofr4 leeppn e: r�/i�,) e7-Z 2. Owner of Property: SO Vi+V df6e,47- Address: V7 CtiwOAS Sr. lVon&ggarN Telephone: (So 1) If/y S� 88 3. Status of Applicant:: Owner r � p—Contract Purchaser Lessee Other(explain) 4. Job Location: ~ 7 `- �A r 'r t/o'n7t7,,44p7x fr1p Parcel Id: Zoning Map# Parcel# District(s): In Elm Street District In Central Business District (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property: Si 61 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): Ta 9g1e P.bzJ.8>>7',A7 ('CN. e-^wMej Nouse t (I"'l Q. A Ve `rr�1 w� f�flYs�e 7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plansy 8. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page � / and/or Document# 9.Does the site contain a brook, body of water or wetlands? NOy DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , date issued: (Form Continues On Other Side) W &4nO 6 YJuwa�hanPS Q GQ/�ar �_ ,.� 10. Do any signs exist on the property? YES NO IF YES, describe size, type and location: Are there any proposed changes to or additions of signs intended for the property? YES NO IF YES, describe size, type and location: 11. Will the construction activity disturb (clearing, grading, excavation, or filling er 1 acre or is it part of a common plan of development that will disturb over 1 acre? YES_ NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION This column reserved for use by the Building Department .EXISTING PROPOSED REQUIRED BY ZONPiG Lot size y 3 3 Frontage Setbacks Front Side L: R: L: R: L: R: Rear Building Height Building Square Footage %Open Space: (lot area minus building B paved parking N of Parking Spaces M of Loading Docks Fill: (volume It location) 13. Certification: I hereby certify that the information contained herein is true and ac urate to the best of my knowledge. qq,,,, f Date: "' Applicant's Signature NOTE:Issuance of a zoning permit does not relieve applicant's burden to comply with all zoning requirements and obtain all required permits from the Board of Health,Conservation Commission, Historic and Architectural Boards,Department of Public Works and other applicable permit granting authorities. W 8/4/2004 r " Department use only City of No that pion us f Permit s Building D pa 81Y 1 urb C t/Dnveway Permit 212 Mai Str et AA1l 0 2019 wen 5eptic Availability- Roon 100 atefP Vell Availability .ra Northam t0 , M o S of Stmctural Plans P - URDINnTI - phone 413-587-124 .LNAm Ae nmosoPlousiPlans Other Specify APPLICATION TO CONSTRUCT,ALTER REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Properrty AddTdress'. This section to be completed ffice by o L/ /ty ` k qff&/ 577 Map Lot Unit /tJoyt71.H+1PT0'M OyoGO zone Owriay District Elm SL District CS DI$Vkt SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: 1111)-wr4 (� msec L.ec, /D wkl :ra flue. Ne I Cu Mail Add a: 0�d 7 �/i3 .S.3 oo�S— Telephone Sign u 2.2 Authorized Anent: �: li, T I4l/P SHP�W} LN Name(Pring ` / Current Mailing Address: O/ �4i�� G-3 re �e SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed try Permit applicant 1. Building (a)Building Penn t Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. MechanicalHVAC) �� 5.Fire Protection 6. Total=(1 +2+3+4+5) Cheek Number This Section For Official Use Only Building Permit Number Date Issued: Signature: Building Commisslonerimspector of Buildings Dale NU�u{4&Ohlfs � C ) re.( . .y 0' EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) $eCti0f1 4. ZONING All Information Must Be Completed. permit Can Be Denied Due To Incomplete Information Existing Propbked Required by Zoning This column.be filled in by Building Depm4nrns Lot Size Frontage Setbacks Front Side L R U R: Rear Building Height Bldg.Square Footage % Open Space Footage % ltd. in.bldg&Weed parkall) F N ofParking Spaces Fill: wlume&-.1 i A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW (2. 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 M B. Does the site contain a brook, body of water or wetlands? NO V J DONT KNOW Q 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 t7y� 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 IF YES, describe size, type and location: E. WIII the construction activity disturb(clearing,grading[exgAvaaon,or filling)over 1 acre or is it part of a common plan that will disturb over i acre? YES O NO /'KDk IF YES,then a NoMani Storm Water Management Paring from the DPW is required. SECTION S DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing -r,. Or Doors O Accessory Bldg. ❑ Demolition I� New Signs [0] Decks [q Siding[0] Other[C:3] Brief Descd tion}Q�f Propose `h` nn t Work: fJ C'HbgTG 'f Alteration of existing bedroom_Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Be. 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 fl.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. Sepbc Tank CitySewer Private well City water Supply SECTION Ta-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 -t-urree M Owner Data I, _ AO�.0 ,�K4/iY2P. � IAIU—40,i*j ge✓ z e . �s . , as Owner/Authorized Agent hereby declare that t statements and si or ation on the foreVng application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. n r/ ti Print Name Signature r/ ant Date SECTION 8•CONSTRUCTION SERVICES 8.1 Licensed Construction Suosrvlsor:se M,r N(ott`Applicable ❑ 9 Name of LicenHolder: T01,.., Qi/ S- D/3 (.913 License Number O 4v4, 7C. 09 '71a0�19 Atl ® Expirelfbn Date sign 'telephone 9.Realatered Home improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Data Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152,§2808)) Workers Compensation Insurance affidav,#must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildofg permit. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS �* 212 Mian Sfi t • w nieipal Building >i Baatluspton, ! 01060 V� 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 preexisting owneroccupied building containing at least one but not more than later 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 owneroccupied 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 RESPONSIBH,ITES 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 0the ve property: S� / JbI,� lam, /q vLiLr Dad Owner Name and Signature City of Northampton Massachusetts L i 4= DBFARTNBNT OF BUILDING INSFSCTIONS 212 l x. et[.t • xunicil.l Bvildin00 z'• Ts xoxtha ton, N 01060 Massachusetts Residential Building Code Section 110.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 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 "P Massachusetts DEPANTN&NT OF BUILDING INSPECTIONS 212 Main Straat *Municipal Building North C ampton, 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: L/7 C' �,�� S7-, (P ase print house number and street name) Is to be disposed of at:QQSi �y� T h-o-�1 / r FvC�K S7i9O,I r (/ (Please pont name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) S 9 Sig a re of Permit A nt oeXliTr 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 1 Congress Street,Suite 100 Boston, MA 02114-1017 www.mass.gov/dia UV Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Pleage last Lenabli, Name(Business/OrganizatioMndividual): wti Address: /0 4A"rn /qve Mp&i IJ (Vi3J City/State/Zip: _ d)+r Phone#: Meyaumemployer?Oak rhe app, rare boa: Type of project(required): I.01amaamployawim empksyees(fml mdhicen-ohne(- 7. ❑New construction z.❑fam axle pmpnpor or partnership wdhavc vu employees woddng formai 8. Remodeling my calmcity.[No worker'comp,announce required] 1.❑lamahammwoerdoing all work mywlf lNo waheri comp.imwmCe requiad.]' 9. Demolition 4.❑I am a homawner and will be hiring contractors w conduit all work on my property. I will 10❑Building addition ure theta((conuaciors eine have workers compevssswm wmme,or am sok 11.❑Electrical repairs or additions po,onserr with m employes. 12.[]Plumbing repairs or additions 5r]1 am a genml wnvactor act 1 have hired the subcontractors listed on the mmched shat. �, P wb-cma acmr have employees and have worker'comp.io_ 13.�Roof repairs ' h.�we are a corpnraoon mdits oflkers have exemised meh.ight ofeximpom M HGt.c 14.❑Other 152,91141.act we haven,employees.[No wwkas'emq_haurame required.] eMy applicant that checks hox a1 must also fill out the see ion below showing weir workers'con scnmtion policy infon isomm. I Homeowners who submit osis aefdavi,indicating they are doing all work and men one outside conmetors most submit a new affidavit antennas such. :Conmemrs that check this box moss,attached an additioml sheet showing the varve of the sub-mmocmr and state whether moot Nose amities have employees. If du'subconmcmrs have mnpluYtts,racy must provide theb workerswrap.policy number. I am an employer that is providing workers'compensotion insurance for my employees. Below is the policy and job site information. 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 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 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. I do hereby certify under the pains and naides of perjury that the information provided above is Was and correct Si nature: 74gLe awl Phone#: 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): 1.Board of Health 2.Building Department 3.Cityrfown Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone#: 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 mcgivef or trust=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 sub-commemr(s)tunnels),addresses)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,arc 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 will be used as a reference number. In addition,an applicant that must submit multiple permib'liceme,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 future permits or licenses. A new affidavit mus[be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to my 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 Cornnhonwealth 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 of Nort4am}irton massarhuseus c DEPARTMENT OF BUILDINC INSPECTIONS '''.` 212 Main Street • Municipal Building Northampton, MA 01060 Fee Calculator for Residential Properties Location : L-17 L m fcl Si, Square Footage Amount Basement @ .20 111 Floor @ .50 2nd Floor @ .50 '/2 Floors, Finish Attic, Garage @ .20 Deck / Porches @ .20 Total : Columbia Gas of Massachusetts A NiSo rm Company 995 Belmont Street Brockton,MA 02301 Date: May 8, 2019 To Whom It May Concern: The address listed below has had the gas service(s) disconnected and is now ready for demolition. ADDRESS : 47 Chapel St TOWN : Northampton STATE : Massachusetts Sincerely, Justine McKinney Integration Center Columbia Gas of Massachusetts 508-580-0100 x 1404 I nationalgrid 40 Sylvan Rd Waltham MA 02451 April 11, 2019 RE: Service Removal for Building Demolition 47 CHAPEL ST NORTHAMPTON, MA To Whom It May Concern, This letter is to confirm that,per your request,National Grid has confirmed electric meter #72010119 and service line have been removed from 47 CHAPEL ST NORTHAMPTON,MA. The work request number for this job is 28142146. If you have any questions or need further assistance,please feel free to contact me at (508) 357 4658. Sincerely, AL- Ross Coghlan Customer Order Fulfillment nationalgrid as 06.Moto AI Spectrum Services 0 �o- 43 Eight Lots Road,Sultan,MAO 1590 ay 69 Wentworth Road,Revere,MA 0215 14155 G� Phone:508-8654525•Fax:508-865-5525 71-4-0 Aloo Email:alsPec®charter.nel May 7, 2019 Report For: Top- Notch Abatement, LLC Attn.: Russ Box 115 Thomdike, MA 01079 Project: Residence 47 Chapel Street Northampton, MA Date of Inspection: May 6, 2019 Scope: It was requested that a visual inspection be performed to verify the removal of asbestos containing materials - roofing at the above entitled structure. The inspection was performed by Robert F Gravallese, an AHERA accredited and Massachusetts licensed project monitor. Comment: A complete and thorough removal was performed and no suspect materials were observed at time of the inspection. Project photos are available upon request. r Obert . Gravallese AM # 061537 AA# 000152 otos,`"wa Al Spectrum Services 43 Eight Lots Rastl,$uUOn,MA 01$90 D4 Gs Wentworth Road,Revere,MA 02151-2155 h Phone:508-865-0525•Fat:508.865-5525 , Email:nls0¢cachnrter.net May 7, 2019 Report For: Top- Notch Abatement, LLC Attn.: Russ Box 115 Thorndike, MA 01079 Project: Residence 47 Chapel Street Northampton, MA Date of Sampling: April 18, 2019 Date of Analysis: April 18, 2019 Scope: It was requested that a visual inspection be performed and final air samples be collected and analyzed for fiber content. The inspection and air sampling were performed by Robert Gravallese, an AHERA accredited and Massachusetts licensed project monitor. Methodology: The air samples were collected in accordance with 453 CMR 6.00. The samples were analyzed by the NIOSH 7400 method for Phase Contrast Microscopy. The samples were collected with high volume pumps with flow rates pre and post recorded. The rotometer used to measure the flow rate was calibrated to a primary standard within the past 6 months. Samples collected inside containment were performed by aggressive sampling method. RESULTS Sample ID LOation Start Stop Type Result LOD Flee 04.18.19.47ch Living Room 11:40 12:50 PM Final F0.004 <0.003 a Comment: The containment was visually inspected and found to be free of suspect material. The project involved the removal of asbestos containing glue daubs by the full containment method and window glazing. Roofing removal is pending. The current clearance standard in the State of Massachusetts is 0.01 fibers/cc of air. The airborne fiber level in these areas were below this level. Obert F. Gravallese AM #061537 AA#000152 c: file C Commonwealth of Massachusetts }1�,( Division of Prolessional Licensure Board of Building Regulations and Standards ConstrµCd6A tDpFrvisor C"13693120 US Peres: 07/2JOHN M HANDZEL 38 WHITE IW6-ELONOMEAUGVA.M , Commissioner AC RORO OB CERTIFICATE OF LIABILITY INSURANCE DATE IMNoomrvl 0310112019 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 INSURERISI,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. H the certificate holder Is an ADDITIONAL INSURED,Me policy(les)must bras ADDITIONAL INSURED provisions or be endorsed. H SUBROGATION IS WAIVED,aubj.t to the tents and condhbns of Me policy,certain policies may require an endorsement A statement on this certificate does not confer rights to UW certificate holder In Ilau of such andonamends). PRODUCER NONTACT AME. SBR BCTYJe1 GID CNmminsOmmeline Insurance Agency Inc. PRONE (413)28M370 ly (413)2BS2880 1382 Main St �DME3S secrn er®o]ins. PO BW 905 INW B AFFORNIM CO"FAAGE NAC• Pehner MA 01089 INSMMA: Jxmaa Fur Insurance Co. .wm MPMER B' Nu-Way Homm Inc soness Rc: 10 W ift Avenue INSURER D: INSURER E: Easl Lolgmeadoe MA 01028 nISUREA F: COVERAGES CERTIFICATE NUMBER: 2018 GL 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 INDURATED. NOTNIMSTANDINGANY REQUIREMENT.TERM OR CONDITION OF ANYCONTRACT OR OTHER DODUMEMWITH 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES LIMITS S1pWN IMY RAVE BEEN REDUCED W PAID CLAIMS. L1R ME CF INSURANCE PW(.Y NIIYBFA YYTOIVWY Y Liters LOMMEIIDBLOEXEJUL WBIIItt EACH OCCURRENCE 1 1,00,000 CUMBYAm ®OCCUR PREMISE LN.—ri a so'0oo MED,P —PNsml a Sp00 A 000840840 W27MO18 =012019 PERSDNALFAovdUUR, s 1,000,000 GEN'LAGGREGATEUNT AFPLIEb1ER'. GENERALAOOREGATE a 2,000,000 POLICY❑JE, R El. PROOUS-CONP00.COAa 1.000'000 OTTER a AUTOMOBILE LABIIJTY C BIH U a Raicneem ANY AUTO BODILY INJURY(Per mi i ONNEDSCNE➢IAID BOBLYINJURYIPw N:ricem a W AMOSONV AUI HIRED NCNOBNED Amos ONLY UTOSONLv s F UMaRE1lA Wa OCCUR EACH OCCURRENCE a .MeCIAIMSAUOE AIX#EGI S CED I I RETENTION{ e M'gU(FAa COMPENSATION YIN AIOFYROYEASLIABLIT' STAN FA OANY F �A F1TOAW.E&rECUTIYE ❑ MIA E.L FAGIPCCIOENT { MSEA IWnisi In Niel EL LYS E-EA EMPLOYEE a Ilya&.IRN.' CEELRI .cP CPE.Tim$bNeA ELBEEASE-FOUCYLIMn s MWMPro MOPER MSILOCATCNSIxwIueB olmwTw,A4erIwlR.,I.n.s.wal,I...+r S..rc.crreSnmw.surdIs rRRMM CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIMMH DATE THEREOF NOTICE WILL BE DELIVERED IN City of Noirim en ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main SbeM AUTHOLLson RFARESENTATIVE Northampton MA 010150 O/( ®188B4015ACORD CORPORATION. All rights rammed. ACORD 26 J201643) The ACORD name and logo am registered mart M ACORD