32C-067 (24) 2 CONZ ST BP-2020-0097
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C-067 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category: REPAIR BUILDING PERMIT
Permit# BP-2020-0097
Project# JS-2020-00016
Est.Cost: $86750.00
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOSEPH KENNEDY 055440
Lot Size(sy.ft.): 30666.24 Owner: BERGERON MARYBETH
Zoning: CB(100)/ Applicant: JOSEPH KENNEDY
AT: 2 CONZ ST
Applicant Address: Phone: Insurance:
38 HARKNESS AVE (413) 525-1735 Workers
Compensation
EAST LONGMEADOWMAO 028 ISSUED ON.712512019 0:00:00
TO PERFORM THE Ft OLLOWING WORK.-POINT 400 SF OF BLOCK FOUNDATION -
REPLACE 30 8X16 CONCR TE BLOCKS
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 si nature:
FeeTYpe: Date Paid: Amount:
Building 7/25/2019 0:00:00 $100.00
12 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2020-0097
APPLICANT/CONTACT PERSON JOSEPH KENNEDY
ADDRESS/PHONE 38 HARKN SS AVE EAST LONGMEADOW (413)525-1735 O
PROPERTY LOCATION 2 CONZ ST
MAP 32C PARCEL 067 001 ZONE CB 100 /
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: POINT 400 SF OF BLOCK FOUNDATION-REPLACE 30 8X16 CONCRETE BLOCKS
New Construction
Non Structural interior renovations
Addition to Existing
Accessoa Structure
Building Plans Included:
Owner/Statement or License 055440
3 sets of Plans/Plot Plan
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF99MATION PRESENTED:
Approved Additional ermits required(see below)
PLANNING BOARD P RMIT 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 W Water Availability Sewer Availability
Septic Approval Board of Health Wef l 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
]- 25-ZUI�
Si re of Building Official Date
Note: Issuance of a Zoning per it does not relieve a applicant's burden to comply with all zoning
requirements and obtain all re juired permits from Board of Health,Conservation Commission,Department
of public works and other app icable permit granting authorities.
*Variances are granted only to Ihose applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for m re information.
Versionl.7 Commercial Building Permit May 15,2000
R( Department use only
' L Ci of Northampton Status of Permit:
r Bu I ing Department Curb Cut/Driveway Permit -
I JUL 2019 2 Main Street Sewer/Septic Availability
ROOM 100 Water/Well Availability
ort mpton, MA 01060 Two Sets of Structural Plans
FPT of ru LDIN61��:1:4 -5 7-1240 Fax 413-587-1272 Plot/Site Plans
NORTHAMPTON. A o
Other Specify
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed
, J
by office
Map �C Lot D U' / Unit
U 4 2, e Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name)(Prin) Current Mailing Address:
SignatTelephone
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-KSTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building F 6 W (a) Building Permit Fee
2. Electricalp (b) Estimated Total Cost of
o
IJ" Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) _
5. Fire Protection
6. Total = (1 +2+ 3 +4 + 5) 4 )S Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building ofnmissio er/Inspector of Buildings Date
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs ' Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description Enter a brief description here. �b t 00 rt` o CILt o11
�`
Of Proposed Work: U'(4 0
_ conc��
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
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(sf)
1 St 1 et
2nd 2nd ____..,
3d [ _. 3r ,
4th
th _ 4
Total Area(sf) Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ I Zone Outside Flood Zone❑ Municipal 0 On site disposal system[]
f
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
i
Lot Size
Frontage
Setbacks Front j
Side L: R: L:_ ............ R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW YES 0
IF YES: enter Book : Pageand/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location: C)
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
f
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 CMR 116(CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
d Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
M.., --_-------------- - ..........
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
i
..._._ ... .
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
(�, CiT<<i. CG l,cci�hl �a�l- _ Not Applicable ❑
Company Name: t
Responsible M Charge of Const tion
C, f 0
A ress
Si ature Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Ma it eK as Owner of the subject property
N_
her y authorize to
(act o my behalf, in all rpafters<ela ve to work authorized by this building permit application.
-7
Signature of Owne Date
_._._._ _... ..al .... _..._ _.. as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signedunder the pains and enalties o er ury.
_ o u
Print Nam
L
Signature Owner/A ent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
i�U t1w o
Idss t� (� Expiration Date
�7�_
lureTelephone
SECTION 13-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, §25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes No 0
i
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:
The debris will be transported by:
The debris will be received bY
Building permit number:
Qom-
Name of Permit Applicant
Date Signature of Permit Applica t
v
t
The Commonwealth of Massachusetts
Department of IndustrialAccidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
4 www mass.gov/dia
NA orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): OU
Address: 39 �w t kt-114 lbzSk a 60 eV e?
City/State/Zip: O �0 Phone#:
Are you an employer?Check the appropriate box:
Type of project(required):
Iram a employer with J_Q_ ployees(full and/or part-time).' 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3.❑I am a homeowner doing all work yself.[No workers'comp.insurance required.]f
10 ❑Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employ es and have workers'comp.insurance.
14ther 6 0 tk ��
6.r-1Weare a corporation and its officer n have exercised theright of exemption per MGL c.
-'Olr
152,§1(4),and we have no employees.[No workers'comp.insurance required.] n0 6'
•Any applicant that checks box#1 must als fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit ini licating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attact ed an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have eral loyees,they must provide their workers'comp.policy number.
I am an employer that is providin workers'compensation insurance for my employees. Below is the policy and job site
information. � ��
Insurance Company Name: -4, w"
Policy#or Self-ins.Lic.#: a S'3 Expiration Date: 0
Job Site Address: ���� 7�T' City/State/Zip: 0 nk 4G
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 ciertift under the p and perjury that the information provided above is true and correct"7
7
Si nature: Date:
Phone#: L �'
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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
V
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 a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. 'Also be sure to sign and date the affidavit. The affidavit should
be 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 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 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 burn leaves etc.)said person is NOT required to complete this affidavit.
The Department's address;telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 02-23-15 www.mass.gov/dia
a
FRAWLEY ENGINEERING
MS-01-19
June 14, 2019
Ms. Marybeth Bergeron
Maplewood shops
P.O. Box 706
East Longmeadow, MA 01028
Re: Concrete Block Foundation Wall Structural Condition Evaluation for
Hempest Basement
Maplewood shops
2 Conz Street
Northampton, MA 01060
Dear Ms. Bergeron:
Frawley Engineering evaluated the structural condition of the existing concrete block
foundation walls of the Hempest basement at the Maplewood shops in Northampton,
Massachusetts.
Background
It is our understanding that you purchased the Maplewood shops around 1983 and that
the front building and all of its additions/wings were completed before that time. Hempest
is the tenant located on the right side in the front building. Angelo's Barbershop was the
prior tenant located on the left side in the front building. According to the oral history you
have been given, the front building was originally just a small one story building where
Angelo's Barber shop was located. Over time there were multiple additions that added
the Hempest wing, yellow building wing, and a second floor over Angelo's and Hempest.
The foundations for each wing are different construction types. Angelo's has a shallow
crawl space. The yellgw building first floor is a slab-on-grade. Hempest is the only part of
the front building that has a basement. The basement has concrete block foundation
walls and a dirt floor.
The first floor above the basement has one original metal lally column support on a
concrete pad footing. Angelo's first floor had termite damage and the first floor framing
and double sill plate were repaired/replaced. There are three pressure treated wood
posts on concrete pavers that appear to have been added during the framing repairs to
Angelo's. In addition)) there is a new stair that was constructed along the wall between
Angelo's and Hempest.
There was an account of water seepage through the exterior side wall. The downspout
was altered to drain away from the building and the water seepage has stopped.
Evaluation
Frawley Engineering evaluated the structural condition of the Hempest basement
foundation walls. The foundation walls are constructed with plain masonry walls. The
masonry is 8 inch �ollow, rock face concrete block. The foundation walls are
approximately 6'-6" high above the basement floor/ground level. The maximum height of
unbalanced fill is approximately 4'-8". The side walls have 18"x32" rough window
140 Christopher Lane• Feeding Hills MA 01030
Tel.413.786.6334•Fax.413.786.6512
AL FRAWLU ENGINEERING
openings. The window opening on the exterior side wall has been boarded up. The
window opening on the interior side wall is open to the crawl space under Angelo's.
The exterior side wall has suffered from significant water seepage. The water has
damaged the mortar joints and disintegrated a few blocks. The water has stained the
inside of the block wall with efflorescence. The water infiltration problem has been
corrected. The basement should be monitored for any additional water infiltration or any
condensation. The efflorescence should be cleaned from the wall. This will help in
monitoring the wall foi any new water leaks. The few blocks that have disintegration
should be removed and replaced. The mortar joints have gaps and some disintegration
to mortar. All the joints should be completely repointed/filled in. This wall did not show
signs of overstress and structurally appears to be performing satisfactorily.
The interior side wall adjacent to Angelo's has suffered a couple localized areas of
bulging. This is a structural sign of overstress that could be from surcharge loading. The
greater bulge is to the left of the window opening, right where the new stair was installed
in Angelo's. This bulged area of wall has also cracked. It is possible that the construction
of the new stair might have overloaded the wall. The lesser bulge is to the right of the
window opening. These two bulged areas of wall should be reconstructed plumb. Any
existing concrete blocks that are not damaged can be reused when reconstructing the
wall plumb. Care mush be taken to avoid undermining the adjacent footing for Angelo's.
If the footing for Anelo's is higher than the basement ground level, it could be
surcharging the block,foundation wall. If this is the case, then Angelo's footing would
need to be underpinned or the reconstructed wall might be overstressed and bulge and
crack again. The underpinning can be accomplished by pouring a solid concrete footing
for the unbalanced footing height. The interior side wall adjacent to Angelo's has also
suffered efflorescence and water staining which should be cleaned. The mortar joints
have gaps and some disintegration to mortar. The mortar joints of this wall need to be
repointed/filled in.
The front and back Walls have also suffered efflorescence and water staining which
should be cleaned. The mortar joints of these walls have gaps and some disintegration to
mortar. The mortar joints of these walls need to be repointed/filled in. This wall did not
show signs of overstress and structurally appears to be performing satisfactorily.
The lally column and Wood posts do not appear to be mechanically attached to the first
floor framing or the concrete footing/paver. These supports need to be mechanically
fastened to the first floor framing and the footing. The pavers should be replaced by
concrete footings.
Recommendation
It is Frawley Engineering's professional opinion that the existing concrete block foundation
wall is in need of some repairs to return the walls into good condition.
All four basement walls, need the following repairs:
• Clean all efflorescence and water staining.
140 Christopher Lane• Feeding Hills MA 01030
Tel.413.786.6334•Fax.413.786.6512
FRAWLEY ENGINEERING
• Monitor walls for any water seepage or condensation. If any seepage or
condensation is encountered it must be addressed.
• Repoint all conitpromised mortar joints and fill in all gaps. Remove any foam
insulation in thel joints and replace with mortar.
The exterior side wall additionally needs the following repairs:
• Remove and replace the disintegrated blocks.
Three of the basement walls did not show signs of structural overstress and damage.
However, the interior side wall adjacent to Angelo's did have signs of overstress and
needs the following additional repairs:
• Reconstruct the bulged areas of wall. The wall should be plumb. Do not
undermine the adjacent footing for Angelo's. If there is any footing higher than the
Hempest basement ground level, it must be underpinned. The underpinning can
be accomplished by pouring a solid concrete footing for the unbalanced footing
height.
The lally column and wood posts need to be mechanically fastened to the first floor
framing and the footing. The pavers should be replaced by concrete footings.
If you have any questions, please do not hesitate to contact us.
M or r+J'
Sincerely,
o FPAWL s
N. 4 y FRAWLEY ENGINEERING, P.C.
s',t���t
Christine B. Frawley, P.E.
President
Copy: FILE
140 Christopher Lane• Feeding Hilts MA 01030
Tel.413.786.6334• Fax. 413.786.6512
j '`� V® C RTIFICATE OF LIABILITY INSURANCE =04'/MIL2
(MWD 3"
�r7R*,S CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND CON 9
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: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER NAME: Frances L.Leahy
Leahy&Brown Insurance+Realty,Inc. PHONE (413)788-8393
AIC No
AIC No Ext): : (413)788$492
535 Alien Sheet,Suite,,
ADDRESS: fleahY@leah andbrown com
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INSURERI:S)AFFORDING COVERAGE NAa
Springfield MA 01118-2009 ATLANTIC CASUALTY
INSURED INSURER A: 21792
INSURER B: ARBELLA PROTECTION
Charista Construction Seances
INSURER C:
38 Harkness Avenue INSURER D:
INSURER E.,
East Longmeadow MA 01028 INSURER F:
COVERAGES CERTIFICATE NUMBER: Master Certificate(2019) REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI
INDICATED. NOTWTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISOD
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1W xmx 313911 ---
LTR TYPE OF INSURANCE D POLICY NUMBER ylYY1,Y �,1,1,,,
COMMERCIAL GENERAL LIABILITY UMrTs
EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE OCCUR
PREMISES Ea ocwrrerke j 50,000
A L281002308 MED EXP(Any one person) j 10,000
04/01/2019 04/01/2020 S 1,000,000
- •- PERSONAL b ADV INJURY
GENL AGGREGATE LIMIT APPLIES PER'.
POLICY
❑PRO- F]JECTL� GENERALAGGREGATE j 2,000,000
OTHER.
PRODUCTS•COMP/OPAGG j 2,000,000 AUTOMOBILE LIABILITY Employee Benefits j
ANYAUTO s7 0 Ea accidentLEL MIT •j
B A
BODILY INJURY(per person) s 250,000
ATOD �D SONLY AUTOS 1020072227 05/03/2019 05/03/2020 BOD{LY INJURY(Per accident) $ 500,000
X HIRED NON-OWNED
AUTOS ONLY AUTOS ONLY PROPERTY OAMA E j
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UMBRELLALJAB PIP-Basic $ 8,000
OCCUR
EXCESS LIAB CLAIMS-MADE EACH OCCURRENCE _
DED RETENTION j AGGREGATE j
WORKERS COMPENSATION j
AND EMPLOYERS,LIABILITY YIN PER OTH-
ANY PROPRIETOR/PARTNER/EXECUTIVESTATUTE ER
OFHCER/MEMBEREXCLUDED�
I ❑ NIA E.LEACHACgDEN7 j
Mandatory in NH)
If yes, e OFLindE L.DISEASE-EA EMPLOYEE S
DESCRIPTIOIPTIOOF N OPERATIONS bebw
E.L.DISEASE•POLICY LIMIT j
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addrdonal Remarks Schodu*may be attached H mon space Is mMr*d)
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEWERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHOR=REPRESEM 1A IWE
/--77—
ACORD 25(2016103) The ACORD nae and logo are registered marks of ACORD1988- f 6 ACORD CORPORATION. All rights reserved.
m
commonwealth of Massachusetts.
®! Division of Professional 1_icensure
Board of Building Regulations and Standards
Qonstru(`tion Supervisor
0 Expires: 07/22/2020
JOSEPH A KENNEDY
18 FOREST ST
PO BOX 1356
BONDSVILLE MA 01009
Commissioner
DATE(MWDD/YYYY)
ACOROD CERTIFICATE OF LIABILITY INSURANCE 06/14,2019
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 INSURANdE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or stat
on
endorsed.
if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A stat
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
ONA7 Joseph Leahy,Jr.
PRODUCER I NAME:
PHONE (413)788-8393 FAX No: (413)788-6492
(AicLeahy&Brown Insurance+Realty,Inc, , AIC.No,
o Ext):
E-MAIL leak leah andbrown.com
5C,5 Allen Street..Suite 1 ADDRESS: I y@ y
I
NSURER(S) RDING COVERAGE NAIC#
S ^,ngfieid MA 01118-2009 ESTAR
21792
INSURER A
INSURED O 18023
INSURER B
Charista Construction Services INSURER C 38 Harkness Avenue INSURER D
INSURER E
East Longmeadow MA 01026 INSURER F:
COVERAGES CERTIFICATE NUMBER: CL1961301226 REVISION NUMBER:
`HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
NDICATED. 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,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
N RADIK P LICY EFF P LI EXP LIMITS
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MWDD1'YYY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1.000,000
CLAIMS-MADE OCCUR
PREMISES Eaoccurrencei S 50,000
MED EXP(Any one person) S 10.000
L261002306 04/01/2019 04!0112020 pERSONALSADVIWURY S 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER.
GENERALAGGREGATE S 2,000.000
POLICY PRO- SOC PRODUCTS-COMP/OP AGG S 2,000,000
JECT 7
Employee Benefits s
OTHER
AUTOMOBILE LIABILITY Ea SMBINED INGLE LIMIT S
accident
ANY AUTO BODILY INJURY(Per person) s
OWNED SCHEDULED BODILY INJURY(Per acadenr) S
AUTOS ONLY AUTOS PROPERTY DAMAGE
HIRED NON-OWNED Per acadentl S
AUTOS ONLY AUTOS ONLY
S
UMBRELLA LAB OCCUR EACH OCCURRENCE s
EXCESS UAB HCLAIMS-MADE AGGREGATE S
S
DEC) RETENTION S
PER OTH-
WO COMAP04ATfON STATUTE ER
uvtreRS'LIABILITY 1 Y r NE.L.EACH ACCIDENT 5 1.000,000
R TJC PROPRIETOR/PARTNERIEXECUTIVE �I N i A WC0002537 06f0812019 06108/2020 1,000,000
CERIMEMBER EXCLUDED?
OFFI
IMandatory In NH) E.L.DISEASE-EA EMPLOYEE 5 __
If yes.descnbe underE.L-DISEASE-POLICY LIMIT S 1,000,000
DESCRIPTION OF OPERATIONS below
I
C=SCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD i0l,Addltional Remarks Schedule.may be attached if more space Is required)
,ERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
CITY OF SPRINGFIELD ACCORDANCE WITH THE POLICY PROVISIONS.
36 COURT STREET
AUTHOS4D N,JMIVE
SPRINGFIELD MA 01103 -.
J 1988-2015 ACORD CORPORATION. All rights reserved.
CORD 25(2016103) The ACORD name and I o are registered marks of ACORD