41-064 (2) 16 RIDGE VIEW RD BP-2019-1144
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Mao,Block:41 -064 CITY OF NORTHAMPTON
Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:New Single Family House BUILDING PERMIT
Permit# BP-2019-1144
Proiect# JS-2019-001853
Est.Cost:$11500.00
Fee:$78.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Gruum TIMOTHY LUCIER 097135
Lot Size(su.ft.): 38332.80 Owner: RIDGE VIEW DEVELOPMENT
Zoning: Applicant. TIMOTHY LUCIER
AT. 16 RIDGE VIEW RD
Applicant Address: Phone: Insurance:
718 PARKER ST (413)883-3573 O
EAST LONGMEADOWMA01028 ISSUED ON:5/30/2079 0:00:00
TO PERFORM THE FOLLOWING WORK.13D SPRINKLER SYSTEM
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 5/30/20190:00:00 $78.00
212 Main Street. Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Filed BP•2019.1 I"
APPLICANT/CONTACT PERSON TIMOTHY LUCIER
ADDRESS/PHONE 718 PARKER ST EAST LONGMEADOW (413)883-3573 0
PROPERTY LOCATION 16 RIDGE VIEW RD
MAP 41 PARCEL 064 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ED REQUIRED DATE
ZONING FORM FILLED
Fee Paid
Building Permit Filled out
Fee Pa
Typeof Construction: 13D SPRINKLER SYST
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 097135
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION RAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
_Approved_Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER:§
Finding Special Permit Variance'
Received&Recorded at Registry of Deeds Proof Enclosed
_Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
5-*30-20�9
Signallific 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.
Versionl.7 Commercial Building Permit May 15,2000
Department use only
City of Northampton Status of Permit:
Building Department Cum Cut/Driveway Permit -
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/She Plans
Other Specify
APPLICATION TO CONSTRUCT,REPAIR,OTHER THAN A CHANGER
CH OGRE TH TWqJFASEEI U QIIWE ISH ANY BUILDING
SECTION I -SITE INFORMATION APR 12 Ll
1.1 Prooerty Address. This section by office
M P oe>r`coa nim, -PECTIONS Unit
NORIHAUPION.IAA oioan
Ridgeview Dr
Zone
Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Ridgeview Development 718 Parker St p
Name(Print) Currenl Mailing Address:
(413)883-3573
Signature Telephone
2.2 Authorized Anent:
William J. Rhodes Y 20A Turnpike Industrial Rd p
Name(Pnnd Current Mailing Address:
(413) 642-3287
Signature TelelNarie
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed!bpermit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from B
3. Plumbing Building Permit FN
4. Mechanical(HVAC) $78.00
5. Fire Protection $11,500.00
6. Total=(1 +2+3+4+5) I Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
5- 30-2019
Building missioner/lnepectarof BulMings Date
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4.CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 36,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition Repairs❑ Mtlitions ❑ Accessory Building 13
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other❑
Brief Description New NFPA 13D sprinkler system
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly13A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
N H' h Hazard ❑ 3A ❑
1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 38 13
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 58 1 ❑
U Utility ❑ Specify.
M Mixed Use ❑ Specify:
S Special Use ❑ Specify
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(s1)
1. iv
2 e 2N
3`° 31,
41, 4m
Total Area(sf) Total Proposed New Construction(sf)
Total Height(R)
Total Height It
7.Water Supply(M.G.L.c.40,9 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑Q Zone Outside Flood Zoned Municipal ❑Q On she disposal system❑
Vergionl.7 Commercial Building Permit May 15,2000
S. NORTHAMPTON 7.ONBYG
Existing Proposed Required by Zoning
'thus Munn w h filld in by
Building DMartmrn[
Lot Size
Frontage
Setbacks Front
Sig L: R: L: R:
Rw
Building Height
Bldg.Square Footage
Open Space Footage
pet mea minus bldg a Wwd
k of Parkin Spaces
Fill: -- _-
wlumealncaoon
A. Has a Special Pennit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW O YES O
IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW 0 YES O
IF YES: enter Bods Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW e 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 Q
IF YES, describe size, type and location:
E. Nil the construction activity disturb(Gearing,grading,excavation, or filling)over 1 acre or is S part of a common plan
that will disturb over 1 acre? YES O NO O
IF YES,men a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9.PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 Cl 118(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE
9.1 Registered Architect:
Not Applicable El
Name(Registrant)'.
Registration Number
"areas
Expiration Date
Signature Telephone
9.2 Registered Professional En inee s
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature T6lephene Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Hampshire Fire Protection LLC Not Applicable ❑
CompaW Name:
William J.Rhodes
Responsible In Charge of Construction
20A Totalke I duatTial R,d p
Address
(413) 642-3287
Signature Telephone
Vcrsionl.7 Commercial Building Pennit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No O
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WNEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I Tim Lucicr as Owner of the subject property
William J Rhodes
hereby auModze to
act on my behalf,in all matters relative to work authorized by this building permit application.
04/11/2019
Signature of Owner Dale
William J Rhodes
,as Omer/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.
Print Name
/ /J 04/11/2019
Signature or er/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable E
Name of License Tim LucieI
License Numher
O q7/ 3y�
Address Fvirelion Date
(413) 883-3573
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.182,J 2SC(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 Me building permit.
Signed Affidavit Attached Yes Q No
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: 60T / l DlaCUlGCI� 17L.
The debris will be transported by: YJ a (9. C
The debris will be received by:
Building permit number:
Name of Permit Applicant p
Date Signature of Permit Applicant
Hampshire
Fire Protection LLC Getter of Transmittal
Hampshire Fire Protection LLC Date- a 11 19
20A Turnpike Industrial Rd
Westfield,MA 01085
Tele: (413)642-3287
Fax: (413)642-3792
Job Number: 0310CMA
Job Name: Lot 1-Ridgeview,Dr.
Send to: Northampton Building; Dept
Attention: Building Inspector
Transmitted via: ❑US Mail ❑UPS ❑FedEx ❑Next Day ®Hand ❑Via separate cover
❑Electronic:
The following items:
❑Shop drawings ❑Prints ❑Calculations []Change Order❑Samples ❑Specifications
❑Copy of letter ❑Eq.Submittal❑
Ouantitv Date D seri tion
1 4/8/19 Permit Drawings-FPI
1 4/9/19 Hydraulic Calculation
1 Copy of Contractors License
1 WC Insurance Affidavit
1 4/11/19 Permit Application
1 4/11/19 Pernit Fee Check-$78.00
Transmitted for.
®Approval ❑Your use ❑As requested
❑Review&comment ®Permit ❑Record
❑Coordination ❑Quotation
Notes:
Thank you!
Copy to:
lh idtam j. Rhodes
President
IfeMlosura
..,a u noted,kindly totity us as once.
I
The Commonwealth of Massfachusetis
Department of IndustrialAccidenis
Office of investigations
uffi 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers
_Applicant Information f I (^ Please Print Legibly - -
Name(Business/OrganizatioMndividual): ]' 9 r/� 0TC-Citorl LLC _
Address: 507 5QuTFIN'WTOn3 eo
City/State/Zip:----Q6:-ST IELD Phone#: (3 • 2 . - Z7
67
Are you an employer?Check the appropriate box: Type of project(required):
1. , 1 am a employer with Ito 4. E] I am a general contractor and I
employees(full and/or part-time).• have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity. employees end have workers' 9 ❑Building addition
[No workers' comp. insurance comp.insurance.t
required.] 5. ❑ We ere a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' _ 13.0 Other
comp.insurance required.]
eMy applicant that checks box#1 moat also fill our the section below showing their workers'compensation policy information.
t Homwwners who submit this affidavit indicating the,art doing ell work and then hire aurae eomannors most submit new affidavit indkming such.
tCantractors that check this boa must attached en additional sheet showing the nerve of the sub-contractors and state whether or not those entities have
employees. Ifthe sub-contmclum have employees,they must provide their worker comp policy number.
1 am an employer that is providing workers'compensation insurance far my employees. Below is the policy and jab site
information. v,
Insurance Company Name: A-1- M, MU'r0AI. T43-&
-
Policy#or Self-ins.Lic.#: 66 D6ffAC.8 E() C-0.1- Expini ion Date:-119 � ,,n
Job Site Address:�T' / IIIP(e� tJ/PGt) Do City/SteWZip: J gk l- �6j//„A
Attach L copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certt&u the he pains and en ties oirperjury that rise information provided above is true and correct.
Pico a# 113 - (PL/2- • 328'7
Official use only. Do not write in this area,to be completed by city or town offeciat
City or Town: Permit/License#
Issuing Authority: Building Department
Contact Person: Phone#: (413)499-9440
ti � -
Co .weakb of Massackuaeffs
Dwlson of Professional Lwensure
Sprinkler Cbntramor
SC-105360 EApirm 05/10/2020
WILLIAM J RHODES
QI
ST NORTHRIDGE ROAD
WMA ESTFIELD MA O/W6
Commicaioner L
I - . .
Final Calculations : Hazen-Williams
Hampshire Fire Protection LLC Page 5
Ridgeview Drive Lot 1 Date 4-9-19
Nodel Elev1 K Oa Nom Fitting Pipe CFact Pt
to or Ftngs Pe •""" Notes
Ncde2 Elev2 Fact Ot Act Eqiv Len Total PflFt Pf
'REMOTE HEAD TO SUPPLY
S7 18 4.90 13.00 1 N 7.0 6.000 150 7.039
to O 5.0 12.000 -0.217
T1 18.500 13.0 1.101 0.0 18.000 0.0307 0.552 Vel= 4.38
T1 18.500 13.27 1 2N 14.0 35.000 150 7.374
to O 5.0 21.000 0.0
T2 18.500 26.27 1.101 2R 2.0 56.000 0.1127 6.311 Vel= 8.85
T2 18.500 0.0 1 O 5.0 23.000 150 13.685
to N 7.0 16.000 0.0
T3 18.500 26.27 1.101 4R 4.0 39.000 0.1127 4.395 Vel= 8.85
T3 18.500 0.0 1 O 5.0 14.000 150 18.080
to 0.0 5.000 4.475
T4 8.167 26.27 1.101 0.0 19.000 0.1127 2.141 Vel= 8.85
T4 8.167 0.0 1 3E 6.0 22.000 120 24.696
to 0.0 6.000 0.433
T5 7.167 26.27 1.049 0.0 28.000 0.2156 6.036 Vel= 9.75
T5 7.167 0.0 1 Ball 2.25 7.000 120 31.165
to E 2.0 4.250 6.104 ••Fixed Loss=3
FPD 0 26.27 1.049 Fsp 0.0 11250 0.2155 2.424 Vel= 9.75
0.0
FPD 26.27 39.693 K Factor= 4.17
*PATH 1
S2 18 4.90 13.27 1 O 5.0 2.000 150 7.336
to R 1.0 6.000 -0.217
T1 18.500 13.27 1.101 0.0 8.000 0.0319 0.255 Vel= 4.47
0.0
T1 13.27 7.374 KFactor= 4.89
Computer Programs by Hydratec Inc. Revision: 50.53.5
Pressure / Flow Summary- STANDARD
Hampshire Fire Protection LLC Page 4
Ridgeview Dnve Lot 1 Date 4-9-19
Node Elevatlon K-Fad Pt Pn Fbw Densly Area Press
No. AcdaI Ad.W Rea.
S1 18.0 4.9 7.04 na 13.0 0.05 280 7.0
T1 18.5 7.37 na
T2 18.5 13.68 na
T3 18.5 18.08 m
T4 8.167 24.7 na
T5 7.167 31.16 no
FPD 0.0 39.69 na
$2 18.0 4.9 7.34 na 13.27 0.05 260 7.0
The maximum velocity is 9.75 and It occurs in the pipe between nodes T4 and T5
Computer Programs by Hydretec Inc. Revision: 50.53.5
I - -
Fittings Usad Summary
Hampshire Fire Proteclen LLC Page 3
Ricigeview Dnve Lot 1 Dale 49-19
Faun,lageq
Attmr. W. N % 1 tb 1% 2 2% 3 3% I 5 0 0 10 12 to 10 1e 20 M
Ball Sas,Mh ncSc100 225 2 2.5 230 10
E NWA 13 W SlwnaN Eltw, 1 2 2 3 • 5 0 7 a 10 12 N 10 22 27 35 0 Le 00 fit
Fsp Flow SwtN.v3R Fpdq 9anaralna FUM Lea asset on now,
NCP/C 90£A HerW-Seers 7 T 0 9 11 12 13 0 0 0 0 0 0 0 0 0 0 0 0
0' CPJC TM-bto
an 3 3 5 0 0 10 12 15 0 0 0 0 0 0 0 0 0 0 0 0
R' CWC Couping Tee-Run 1 1 1 1 1 1 2 2 0 0 0 0 0 0 0 0 0 0 0 0
Units Summary
Demeter Unite Inches
Length Units Feel
Flow Units US Gallons per Minute
Pressure Units Pounds Per Square Inch
We Filling Legend pmviales equivalent Pipa lengths far fittings types of various diameters.
Equivalent lengths shown are standaM for actual diameters of Schaal a0 pipe and CFactem
of 120 except as noted with'. The fiWngs marked with a-shay equivalent lengths values
suppled by manufacturers based on specfiq pipe diameters and CFaotors and they require no
adjustment. All values for alUogs not marked with a-will ae adjusted in the calculation
for CFactors of other than 120 and diameters other than SCWd 4 per NFPA.
Computer Programs by Hydmtec Inc. Rension: 50.53.5
Water Supply Curve C
Hempetiire Fre P mwtb LLC Page 2
Ridgeview Drive Lot l Dete 4419
City water Supgv'. Dement:
C1-Static Pressure : 60 Dt-ENveibn 7.296
C2-Residual Pressure: 55 D2-System RM :26.272
C2-Resqual Flow 40 D2-System Pressure : 39.693
Hose(DemeM)
D3-SystemD &m :M-271—
Safety Margin 16.009
150
140
130
p 120
R 110
E 100
S9D
SSO
D 20
C1
RM
E 50
2
b
30
20
10
D1
10 20 30 4 50 60 20 60 90
PLOW(N"185)
C PN Pm M Sy Hycft c lm. Rev : 50.9.5
Hampshire Fire Protection LLC Page 1
Ridgeview Drive Lot 1 Dale 4-9-19
HYDRAULIC CALCULATIONS
for
Project name: Ridgeview Lot 1
Location: Northampton, MA
Drawingno: FP1
Date: 4-9-19
Design
Remote area number: Area#1
Remote area location: Breakfast/Living Room
Occupancy classification: Light Hazard Residential
Density: .05-Gpm/SgFt
Area ofapplication: 2 Head-SgFt
Coverage per sprinkler: 260-SgFt
Type of sprinklers calculated: Reliable Residential Pendent
No. of sprinklers calculated: 2
In-rack demand: -GPM
Hose streams: NIA-GPM
Total water required(including hose streams): 26.272-GPM @ 39.693- Psi
Type of system: Wet
Volume of dry or preaction system: -Gal
Water supply information
Date:
Location: Basement
Source: Pump&Tank
Name of contractor: Hampshire Fire Protection
Address: 507 Southampton Rd Westfield, MA 01085
Phone number: 413-642-3287
Name of designer: NR
Authority having jurisdiction: Northampton Bldg & Fire Dept
Notes:(Include peaking information or gridded systems here.)
Computer Programs by Hydratec Inc. Revision: 50.53.5
OPA 9k
Hydraulic cablA9ns Hang HydraCkC
Hampshire Fire Protection LLC
507 Southampton Rd
Westfield, MA
413 642-3287
Job Name Ridgeview Drive Lot 1
Drawing FP1
Location Northampton, MA
Remote Area Area#1
Contract 0409CMA
Data File Ridgeview Dr-Lot 1.WXF
Computer Programs by Hydratec Inc. Revision: 50.53.5
1E I!7 CERTIFICATE OF LIABILITY INSURANCE oATE1MMODY.Yn
12/17/2018
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(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: N be comments holder Is an ADDITIONAL INSURED,the policyges)must be endorsed. If SUBROGATION IS WAIVED,subject to
the bans and corWltlons M the policy,chain pollcNa may require an andorsemant. A sutement on this CeMflmte rices not confer rights to the
cerOaceEr holder In Ilan Of such endorserrNm(s).
PRODUCER RANI
M Rena. Ski1119ga
TBS ROMIRY AGENCY INC. PHONE (603)224-2562 IV
ma, 141.1112 1-
45 Constitution Avenue e L rekillingearoalryagancy.ees
P.O. BOn 511 PRAINERISI APPO MO COVERAGE XYL A
Concord NN 03302-0511 IXSURERA:Watford specinilty Ino CO
momman a9URERa:Allearica Financial Benefits 41840
..,.hire Fir. Pr.teot10n, LLC IXRURERC:Berklen, Assurance CO.
507 Southampton Rd. INWRERO:A.I.H.
MUNDEAE:BanoVlr Inmeranne CO. 22292
Westfield NA 01085 MURER F,
COVERAGES CERTIFICATE NUMBER:19-20 all line. REVISION NUMBER:
THIS ISM CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICTED. NOTWITHSTANDINGANY REQUIREMENT,TERM OR CONDITION OFANVCONTRACT MOTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUEUECTTOALLTHE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Nµ TYIEOFNNMANCEL 0 ILY MLWBER POLICYOF POLICY Eup LYT6
Z CaY1ERCMLOEIERAL L.LNY EACH OCCURRENCE 6 1.000.000
A CLAIMSMAOE 5-1 OCOU0. PREMISES Ma OCWWCOI 6 100,000
Z Contracteal per CG0001 sententoulamt 1/1/3019 1/1/3020 OLEO ECP M f 5,000
Z IPsee...tonal InNionanumal iwtu FERSO AAO,INJURY f 1.000,000
GEM AOOREGATE LIMIT APPLIES PER F1.000.000/i].... Do. GENEFULAGGREGATE 2 21000,000
P^LICV O PRP El LW retutLOo, 41 PRODUCTS-CdNrUPAGG f 2,000,000
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L, EXESE..a CWAg,MALE AGGREWTE 5 5,000,000
DEC I I RETENTION I 1/1/]." 1/1/]0]0 f
Wormas CCMPENEATION Z
AM EM0.0YER5LABILITY Y/X
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installation Floater L.1 50,000
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AUTNpaB:D REPRESEMATNE
C Holman, CPEO, CIC/R &&'I
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