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38B-097 (4) 36 MUNROE ST BP-2019-1222 GIS 0: COMMONWEALTH OF MASSACHUSETTS Map:Block:39B.097 CITY OF NORTHAMPTON Wim:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category*renovation BUILDING PERMIT Permit# BP-2019-1222 Protect# JSP-2019-001977 Est.Cost:8105060.00 Fee:,$683.00 PERMISSIONM HEREBY GRANTED TO: Const,Class: Contractor: License: Until Grono: ROBERT WALKER 034783 Lot Siu(so.ft.): 6664.68 Owner: RHODES AMYL&ERIK S zoning;URB(100)/ Applicant: ROBERT WALKER AT: 36 MUNROE ST ApalicantAddress: Phone. Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:Jg417019 0:00:00 TO PERFORM THE FOLLOWING WORK.3RD FLOOR BATH REMODEL, KITCHEN RENO, PORCH WINDOW REPLACEMENT"SEE PLAN NOTES SMIOKEfCO ALARMS 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: lire Department Fireplace/Chimney: Rough: 91 Insulation: Phial: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of OccumnCV Signature: FeeTvpe; Date Paid: Amount: Building 5/14i20190:00:00 $683.00 212 Main Street,Phone(413)587.1240,Fax:(413)587.1272 Louis Hasbrouck—Building Commissioner File N BP•2019-1222 APPLICANT/CONTACT PERSON ROBERT WALKER ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)5841224 PROPERTY LOCATION 36 MUNROE ST MAP 38B PARCEL 097 001 ZONE URB(I OOV THIS SECTION FOR OFFICIAL USE ONLY: P T L ED REQUIRED DATE ONIN ORM IL EDOUT Fee Paid BuFldina Permit Filled u Fee P ' TypecifConstruction, 3RDFLOOR BATH REIVICIDEle.0KITCHEN RENO,PORCH WINDOW REPLA EMENT SLE PLAN NOTES 5aw1" t r o AL1Rr`+ 5 New Construction Non Structural interior renovations Addition to Existing Accesso Structum Building Plans Included: Owner/Statement or License 034783 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION PRESENTED: ✓Approved_Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance• Received&Recorded at Registry of Deeds Proof Enclosed _Other Permits Required: _Curb Cut from DPW Water Availability Sewer Availability _Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee _Permit from Elm Street Commission Permit DPW Storm Water Management _JDemolition Delay Signature of Building Official Date Note: Issuance of 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 thou applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 2 IV' Sewer/Septic Availability R Water/Well Availability Nortam on, MA 01060 Two Sets of Structural Plans phone 413-5 7-1 40c q13-5�y127 P[oUSite Plans Other Speciry APPLICATION TO CONSTRI CT,1/dRM F]IMM//f ARINJJI111111IME O 1 DEMOLISH A ONE OR TWO FAMILY DWELLING 448 SECTION 1 -SITE INFORMATION `�--C/1.LU 1.1 Property Address: This section to be cooam�pljelaull by office3 6 ��n�rzo� ' Map J ise Lot l 7)p / Unit Zone Overlay District Elm St DlsWet CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: A WW� Avs� KMV Q WddlS 6 4'Vl J N QUQ $T4 N o 7nrJ Name(Prim) Current Melling Address: Telephone Signatu e 2.2 Authorized Agent: 2 Z tr['TLS O K4L(Z .J� S$.2 1rIcc CV-NTf C Name(Prim) Ounent Mailing Address: 4I-'; - S 34 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bpermit applicant 1. Building q o/ 06 (a)Building Permit Fee 2. Electrical Z L S (b)Estimated Total Cost of Construction from fi 3. Plumbing C1 fA S Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection IIIJJJ S. Total=(1 +2+3+4+5) 0(p 0- Check Number This Section For Official Use Only Building Permit Number: IIsssued: Signature: Building Commissioneninspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Ir Yn � � I Section 4. ZONING All Inforrnenon Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This rnlumn to be fi11N Building Department Lot Sim Frontage Setbacks Front Side L:= RL L: Rear e V IN Building Height O Bldg.Square Footage % Open Space Footage 1zN. /1 (Lot am minus bids&paved m #of Parkin S s Fill' ume @ Location A. Has aS'pyec)al Permit/Variance/Finding ever been issued for/on the site? � NO t! 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 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 0 , Date Issued: C. Do any signs exist on the property? YES O NO 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. Will the construction activity disturb(clearing,grading,ex tion,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Stoml Water Management Permit from the DPW is required. SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Altaration(s) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0) Decks [❑ Siding[0) Other[❑) Brief Descriptign of Proposed Work: r FUOM C.i n GVF4. vof2Z4 t... i✓or. RTc>7LfK Mf Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrativji, Renovating unfinished basement Yes o Plans Attachec"o— -Sheet ea.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. ensio e. Number of stories? I. Method of heating? t.J� laces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction L Is construction within 100 fl. etlands? Yes No. Is construction within 100 yr. floodplain_Yes No j. Depth of baseme cellar floor below finished grade L. Will b ' g conform to the Building and Zoning regulations? Yes No. spike Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, '-40 V) as Owner of the subject property hereby authorize 1`tlft Fr ftp `A'C.ILIE.R to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner n Date I, 17LAXCN— �l.J�'0-K.G!( ,as Owner/Aumaized 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. �Z-�i1rr.27C' V.rJ�t.LL Print Name Signature ofOwner/Agent Date i SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: I ,.,,n. I.,,, Not Applicable El Name of License Holder: `2cf,5nfW v'r^'�- .� CS License Number SRlZYicr 6irr-N1tr..0. AAA oto(.' lu Ib rase Expireli n Dale S7 113 12z4 Signature Telephone 9.Reolatered Home Improvement Contractor: Not Applicable ❑ ��rj ff w'f -j wit-k-�n zb \ (v Company Name RegistW Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.L.C. 152.g 25C(8)) 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 perl Signed Affidavit Attached Yes....... ❑ No...... ❑ City of Northampton Massachusetts l fF DEPARTMENT OF BUILDXNG INSFECIrIONS IS- 212 Nein Street BYS1 NozNampconon, M Nr Gi OlOfiO 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: 21 G VN1 v r+ 2u K SY, (Please print house number and street name) ' Is to be disposed of at: V A-( 1." C+-cycQ. LT,y No czCHA ba ST, NaYu��- (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of 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 Department of IndustrialAccidents I Congress Street Suite 100 Ir Boston,MA 02114-2017 www massgov/dia 1\twkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/OrganizatioMM �nividml): -06<-(br— V `�Y-V,a Address: db, '�J Ee-g k[Xc f YrnJTPitti City/State/zip: N otiC4wvworevy A a o tbyc Phone#: l3 5--154- — J2-74- Are yot n xe,k,er?Check the appropriate bea: Type of project(required): 1. I am a employer withcmployeca(full and/or part-timet• 7, ❑Ne construction 2.C]I a ma sole proprietor or partnership and have no employees working formein g, emodeling any capacity.[No workers'comp.insurance required] 3.❑(aurmowner do a hoeing ell wok rmyself[No wodscrs'comp.insurance required.]' 9. Demolition 4.❑I am a hmncowner and will be hiring conmecbrs m cortducr ell wodc an my property. 1 will 10❑Building addition ensu¢that all contractors either have workces compensation insureace or are sole 1 I.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.01 am a general convector and I have hired be sub-cnnhamore listed on the am seh d sheet. 13.�Roof repairs These subch onacters have employees and have workers'comp.insurers 6.❑We area corporation sod m officers have extremes their right ofexe as new per MGL c. 14.❑Othm 153,§I(4),and we have no conal s.[No workers'comp.assurance requicd.] *Any applicant that checks box a man also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they one doing all work and then hire outside contractors most submit a new affidavit indicating such. lContreams that check this box must attxchM an additional sheet showing the name of the sub-contractors and stale whether or not those entities have employees. Ifthe subconmetors have employee,they most provide their workers'wmp.policy number. I am an employer that is providing workers'compensadon insurance for my employees Below is the polity and job site information. SE-� yxCOsaa4w✓J 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-yew 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 thepains and penalties ofperjmy that the information provided above is true and correct S'enatum cu--t- Q Date: YU 19 Phone#: ACi - 581- J ILLd— Ojfaeial use only. Do nm write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I 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 mora 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 you situation and,if necessary,supply sub-contratc r(s)murals),address(es)and phone number(s)along with thein 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. Alm 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 arc required in 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 most 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 my 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, Suite 100 Boston, MA 02114-2017 Tel. #617-7274900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia I A roc o® CERTIFICATE OF LIABILITY INSURANCE .ATs'""°°"" 06 222010 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES _BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SI.AUTHORIZED EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. APORTANT: "the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statementon this rerDficate does not confer rights to the Certificate holder in Was of such endorsement(s). ooucER "Me Barbara Grynktewi. Webber l3 Grinnell (a13)SBfi 0111 e, U13)S88A181 8 North King Street ADDREss. bgrynki 'w" dlvlebbemndgnnnetl.com wau a AFFORDErDcw Mal Northampton MA 01060 IvkuRERA. WeztAmencaMbsry 14493 INSURED INSURER.: A M.MUN.1 Robed Walker WSU.mc AM:Klm Clairemom ImseffR o: 36 SBNKe Center Road W REM E: NonM1ampton MA 011)00 I.MMERF: COVERAGES CERTIFICATE NUMBER: El REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW Mart BEEN ISSUED TO THE INSURED NAMEDAROVE FOR THE POLICY PERIOD INDICATED. NOTVIRHSTANDING MY REQUIREMENT.TERM OR CONDITION OF ANYCONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CEROFICC E MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCL RRIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY M NIE BEEN REDUCED BY PND CLAIMS. 1. UTN TYFEOFMIMMAY6 Pol1CY MUI�MI IYrs COYYERCWLGR�MLLMBMJIY Ewcn CCCURREHCF f 1.BW.000 CLAM.. ®cccJR AEMI its scvvven S 19D'BD3 ME .1A, NDII n' I S 15.000 A BNWS83T22S3 OMIMIS MIW20 FERsoNMaAw tluLnv S 1.010.000 DENLAGGRECI LMMTNNJE.PER: GENER9LAGGREGATE S 2'000'030 Paucr® ❑Loc van DLCTS.COMProPAW a 2.000.000 G XER: $ AmarOaEMAWO• C06WEDSNCIE LMn $ AVYAUTO BCOILYIWURY(ss.) f OWNEDNIf09 piLY AUDI LED BCOILYIWURY(Heaccerp) f HIEDfC11LWNFG PROPERTY GVWC£ S MIT09 call AlgIY Pa f UMBRE4A LIY CCWR EMM OCCURRENCE s EYCESS WB .AGGREGATE s 9E° RETENTIW S S VgCRNER8 C0MPBleaTMN1 � OTM EM PLOYERS'YLaILT' YIN E 500.000n OFF CENMEMaEn PARTMMIA WN2800BOOB54=IM 07,,,Q0182018 3TN1NIBLFCXACFvUTIVE f IMaMa ".NNl EL°EFABE-EAEM0.DVEE S .I— 4ex,Ire.rAcr OESCRIiTON OF OPE. Iolct M ElL .EASE-HOL In S 500.000 CEYAETIDN OF OPERATNNID I UOCATNINS I VENKLR (ACORD 101.GEENrewl pmlMe SeMW,m/Y ANeM tl WnAPA[�N rpulreSl CERTIFICATE HOLDER CANCELLATION MCI ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ..For Insurance Info Only-' ACCORDANCE WITH THE POLICY PROVISIONS. AUTNDRMED REPRESEMAME ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(201W03( The ACORD name and IDgo are registered marks ofACORD 1 DATEIMWepMYYYI A� CERTIFICATE OF LIABILITY INSURANCE 07/06aole THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY MEN D,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSU RER(S),AUTHORIZED SPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. .APORTANT. It the certificate holder is an ADDITIONAL INSURED,the Policy)ksl must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of Me Policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endomementtsl. PRoouceR orn— novas. Ban.Grynkiewia Webber B GrinnellPxoxE (413)55&0111 ACxo (413)WI-6,181(413)WI-6,18181 . S NOM KingSvaet AODRsss: O6rynkiawkzGnaabberandgrinnNl.mn Ixa WG covERAGE XMca N]IIIWmPbn MA D1010(30IXSIIIIERR: U/aslAmplcaNAerbaric p 46993 INSURED INSURER B: Amenctn F"C®Wtyliiwrry COnatNlf AMaGMa{.IM. Be.C.. Can Caaudy"Jbtdy 24074 Ann:Him ClRiremont sau"a O: UOWhy MutuM In. 24168 3B Simace CMbr Road INSURER E: Northampton MA DING .HEARER F: COVERAGES CERTIRCATEMUMIER: EAp711119 REVISION NUMBER: THIS IS TO CERRFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSANO CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CI-AIMS. LIR 1YPEOFYNMR4ICE PpLKYMYli61 r1B1a CNIMFACMLGMMNLUaYaJrY 1,000.000 EACH OCCURRENCE S LL/uMBAIADE ®0.VIR mFMI 5 Ee f 100,000 MEDE%PIA m f 15'000 A 8"5836`l577 03ro1rzD1e 03101x020 PEri60N4LSADVIIUURY f I'm.= GENLAGGREGATEUMITARRUESPER: GENERALAGGREG4TE 2'001100D PDucv® ❑LOC ON... caroPAGG f 2.m0.00n OMER: f .m..w eyAyyly COMBINED SINGLE t 1,01DO,0000 MIVAIRO BCOILys"a"IFa.) f B ONNFD SCHEWLED BAA58364571 03101,2016 D310IMM suo's,owavr YYtlMp t ANOSOMY ANUS mRm Ovif OWNED R1v DAMAGE t ANDS ONLY NfIUS ONLY Pa 1 Medical peymenfa t 5.000 IIMBB.I. ICU pL•0UR EACH OCWRRENCE f 1'Dm'mD c E.cEaa CIA. .A„pE US058384577 03104=10 09113140M sO,,Ga, f 1'limi'm DED aETENTION f 10 ON wmmltcaremAnox P� onH Al IBlILYlM'LW4NY YIN MIYCE=EETORFAmNEILEXECNNE .1-E CHACCIDEM f 500' 000 D CfFICEWMEMBER EXCLUDED) ❑ XIA XW558360.5T) 07/l11/N18 07A112D18 IMLnXr4urYIN NRI EI.DISFA6E IS BOO•ON DESLRIFl1ary OF OPEMTIONaMW EL DISEASEY LIMn f 5m•0m gaQPMN OFOPEMTIONa I LL%1MINS I VENICLE9 IACORD 1a1.AWXMM Remar4e ScaeEule,maY ae atlacNea a imn epxe bApWM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXMRATXIN DATE THEREOF,NOTICE WILL BE DELIvERED IN -ol insurance Purposes" ACCORDANCE WITH THE POLICY PROVISIONS. AUTNOmaso B.P.M. f ©1868-2018ACORDCORPORATION. All nghtsreserved. ACORD 25(0D16103) The ACORD name and l090 are registered marks of ACORD NOTE:ADJUST EXSTING WINDOW TRIM AND/OR REPLACEMENT WINDOWS TO BE LEVEL ON SHORT SIDES.REMOVE AND REPLACE EXISTING REPLACE. WINDOWS W NEW CLAD WOOD DOUBLE HUNG WINDOWS.INSULATED REMOVE&RE4NSTAU-EXISTING WOOD GLAZING.LOWS,ARGON FLOORING.SHIM FLOOR TO BE LEVEL. - i FILLED.VERIFY SIZE IN FIELD. 1 PARTIAL 2ND FLOOR PLAN AT PORCH Scale: 1/4"= 1I-V 0 5 10 FT NEW WINDOWS: MARVIN CLAD ULTIMATE DOUBLE HUNG-NEXT GENERATION 2.0 CN 2824 R.O.: 34 1/4"X 56- OUANTITY:8 RHODES RESIDENCE 36 MUNROE STREET 114"= 1'-0' NORTHAMPTON MA 01060 5.1-19