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42-060 (3) 840 WESTHAMPTON RD BP-2020-0396 GIS#: COMMONWEALTH OF.MASSACHUSETTS Map:Block:42-060 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTYI FUND (MGL c.142A) Category: INSULATION BUILDINrG PERMIT Permit# BP-2020-0396 Project# JS-2020-000675 Est.Cost: $3741.00 Fee: $65.00 PERMISSIONIS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sq. ft.): Owner. RIVERA CINDY Zoning. Applicant. VALLEY HOME IMPROVEMENT INC AT. 840 WESTHAMPTON RD Applicant Address: Phone: Insurance: P O BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON.9/2 7/201 9 0:00:00 TO PERFORM THE FOLLOWING WORK.-ATTIC INSULATION 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 9/27/2019 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner go -a.O -�qCv Depda City of Northam n vtu Building Dep artm nt SEP 212 Main Stre t 419 / ULATION Room 100 +4r' � Northampton, MA�106>�?r OFRij)i�iNc iN PFCTIpNS phone 413-587-1240 Fax 413= Fro" r 01060 ONLY APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT 1.1 Property Address: This section to be completed by office l '84v J 'v j 1 at 1 J Map �� Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: z L. t.1 'eL i. I el —,I L.-NA 4.4 t-1 ktt, Name(Print) rrent qqu�ailing Address: 131 �j 2 9012, xIeph no e Signature 2.2 Authorized Anent: Name(Print) J Current Mailing Address: Signature Te ephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: lu *f 9 Building Commissioner/inspector of Buildings Date a@ V� I ►�U . Cot, EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: '�l 1i eP_ A n-4-3- License Number ori � LA :L,- Z-2-1 Z 2,0 2-0 Address Ex iration Da e AA / AR/ 5 8 4 - "22 Sig t r Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ f K2 Company N m Registration Number J1 Address Expiration Date Telephone( 2 . SECTION 5-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....... 4�( No...... ❑ Brief Description of Proposed Work LQ>-1- , L as Owner/Authorized Agent hereby declare that the statements and i ormation on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. C-,' r t �{ Print Name Signature of Owner/Agent Date PI, kf'V as Owner of the subject property hereby authorize to act on my behalf,in all matters rele#ve to work authorized by this builring permit application. Signature of Owner Date ' SECTION 5 DESCRIPTION OF PROPOSED WORK(check all apl New House ❑ Addition ❑ Replacement Windows Alteration(s) � Roofing ❑ Or Doors l� Accessory Bldg. ❑ Demolition ❑ New Signs [CI] Decks Siding[tom] Other* Brief Description Proposep� d Work: UJ e Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet da. if[Vew Nouse and or addition to 6A''n housin com" lete the'followiti : 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 1. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION T0-8E--'COMPLETED WHEN OWNI:R8 AGENT.OR"'CONTRACTOR APPLIIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize cli on my behalf,' II mAtters relative to work authorized by this buildingiparmit applicatio .ag Sigti�Wre.of.Owne Date �infor asOwner/Authorized Agent hereby declare that the statementon the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the sins and penalties of perjury. Print Name Signature.of OWnerlAgent Date ACOIR& CERTIFICATES OF LIABILITY INSURANCE r/ATE(MRUODI"TY) THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE I0812019 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 the certificate holder Is an ADDITIONAL INSURED,the popcy(too)must have ADDITIONAL INSURED provisions- 9 be endorsed. ff SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsemeirlt; A statement on this certificate does not confer rights to the certificate holder in Neu of such endorsement(s). PRODUCER NAtdE: Barham Grynkiewlcz Webber&Grinnell PHONE (4 3)586.0111 S North King Street �Ex : (413)586-8481 aoDRkiewlczQwebberandgrinneil.com Northampton INSURER APFORDINS COVERAGE MAIC p MA 01060 NSURERA: ArbeNa Protection 41360 INSURED INSURER 13: ArbeGa Indemnity 10017 Valley Home improvement,Inc. Attn:Steven Silverman INSURER C: P 0 Box 60627 INSURER 0: _ Florence MA 01062 INSURER 8; COVERAGES CERTIFICATE NUMBERURER P: : Exp 211120 REVISION NUMBER: THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACTOR 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. LTR TYPE OF WOURANCE POLICY NUMBER MM/D0 M1Sf5ad LIMITS COMMERCIAL GENERAL LIAad.rry EACH OCCURRENCE $ 1,000,000 CLAWS-MADE �OCCUR M=RM NTED PR h11 Eno t rr nce $ 100,000 A MED EXP(Any one rson) 5,000 8500063755 02/01/2019 02/01/2020 PERSONALBADV INJURY $ 1,000,000 CiENLAGGREGATE LIMIT PROAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 POLICY ®,E� F LOC PRODUCTS-COMP/OP AGO g 2,D00,000 OTHER: AUTOMOBILE LIABILITY $ ANY AUTO Ea aoCi ED ING L $ 1,000,000 BODILY INJURY(Per Man) $ A AUTOS ONLY SCHEDULED 1020037691 02/0112018 02/0112020 BODILY INJURY(per aLTJdent) $ HIRED NON-0YJNED Ep AUT09 ONLY AUTOS ONLY GE $ Peracddem Uninsured motorist BI $ 100,000 UMBRELLA LIA9 OCCUR r A EXCESS Lb1B EACt1 OCCURRENCE $ 5,000,000 CLAIMS-MADE 4600083758 02/01/2019 02/01/2020 AGGREGATE $ 5,000,000 DED RETENTION S 10.000 WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Y 1 N STATUTE R B ANY pROPR1E70R/PARTNER/EXECUTIVE 1,000.000 OFFICER/MEMBER EXCLUDED? NIA 4220051237 02/01/2019 02101!2020 E.L.EACH ACCIDENT $ (Mandatory In t4FI) It m,descnba under E.L.DISEASE-EAEMPLOYEE $ 1+000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,AddlOonal Ramairhs Schodulo,may be attached N more apace Is required) —CERTIFICATE"QLQER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Greenfield ACCORDANCE WITH THE POLICY PROVISIONS, 14 Court Square AUTHORQED REPRESENTATIVE Greenfield MA 01301 ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD dame and logo are registered marks of ACORD Commonwealth of PAassachusetts Division of Professional Licensure Board of Building Regulations and Standards Const. 16'n CS-077279 J E Aires: 06/21/2020 STEVEN A S&ERM 4' 268 FOMER ROAD SOUTHAMPTOk M_A Gio" *� Commissioner CIL 3% lv7?xp2C} G`A'Y%h/0l/iCC ��ICfli!lr� l Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration- - - _ Type: Corporation VALLEY HOME IMPROVEMENT INC Registration: 105543 P.O.BOX 00627 -_- Expiration: 07/1612020 FLORENCE,MA 01062 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE.,Corporation before the expiration date. It found return to: Rggiaf ration irari rl Office of Consumer Affairs and raUSIneSS Regulation P5543#--, 07ii6/2WO One Ashburton Place-Suite 1301 VALLEY HOME tMP.RC111Et3T INC. Boston,MA 02108 rSVEN A.ss,ILvtiPMA ta'. 340 RIVERSIDEDIT' NORTHAMPTON,MA 01062 Undereeoretary Not valid without signature The Commonwealth of Massachusetts Depurtttrc ut o f inditsNal Accidents (N.�.�1l rte.•---•.r � � 7` lCongress Street,,wife 100 `.r Boston,.AM 02114-2017 RIM41.mass.g0v/dia Workers' COmPensation lusurance Affidavit: Builders/Cutnti-actors/Electricians•ri'rrtn2bers, TO 13.E FILED WITH THE PER-MiTTING At:THORM. ARWieant information Please Print Leoibly Name 1,Business'i)rgattizatiott%1Fadieiduali: y() �IZ'�� tfC;y�� �m,n,� 1P_ m�r� � �t r-tC AClCltl'SS: {U OAC.v `o\6& �GX�CI,Z� City/Stag/Zip: T- l C>ren(..G kci 0100'2. phone *: U t3- �Sq-7s,2-2- Are q-`1 s,2-2 Are you an employer?Check the appropriate hos: Type of project(required): L�I am a employer with g ctupluyees(full and orpan-(into) 7. C]NeW CunUruction In I ani a Sole proprietor or p:utnership?nd have no employees working for m:in S. Ig Remodeling ary capaci".Rio.rnrkcrs'Lump.irtsuranca requircrl.l it..J i;un a hemcuv:ner dainG,alt wotic mvcalf.Nu v,•urker;'sump.insurance requircd.J t g• F1 Demoliti(m ln 10❑Building addition Q 1.ua a ltvrnco.Ser and rill be Linag contactors to coaduct all v:otk on my propels;. I vat, ensue that all c,-rntructot's cidier bare til orl:er;'n+nrr�ensation ittstiraace or mc sW+ i I-n EIeC,rical repairs or additions prop rierors with no empli,yees. 12.D Plumbing repairs or additions 5.®1 am a g:mewl comiactor and I have hired the sul?-contraccors li;ted on the attaatre,:heel. Tilc,e;tth_._onirectrr.I,,,rmhlm ee.;and hale,coi rr;:'c,:ny ir•:,uanrr; l'.❑Rot?(1'cPaU" 6. 1�1.(�Other �1t'e are a cr?�lx,rattun and i[s,�ft7cer,hate eser_iscd their ri��ht of xxcmpt)on pa[\it t-c. 1`'_.11(-1).and we have nu t:mplo}•eel.(�o v:orkcrs'cun;u.insurattre re wrc,1,1 Y.Aw applicant that check,box,I ilmsl also 1)11 out Ole,cction bel as,hila Lig their r:orkers'comp;t;satiun polio) 1:1I'Muatiou. °HemCort?et s Who submit this afkida'Jt bidicaring they axe doing al.1 n•orlc and that Lire )utsidc ct nti-ait,ors MUSE SUbmit a n:R'.1 J dci.it in.Lt.atina;Ueh. tContractoc that chi:tk lhi-but:nutst attached as addidunat::fleet sNmia-the name of Lbv sub-cuntrac(ors acid staic umber ur no;tl.lose eniittr.;have emr1il yeeS. if the cull-contractor:have eml)IO rev<,then rriuet provid:their ,wort.er;'cnmr,r,al;ry nurnl-r. I air:an emplo)ler that is proridin workers'compensadon insurance for rrrY emplaJ ees. Relott•is the policy and job site inArrnation. Insurance Ct+lnpanv Nat11e: Pulicy=or Self-Fns. Lie, n: (,>( eJe�p" ��.Z F;;piration Dater ( fir~ ,�C. x Joh Site Address rd IV4� � Cit}:;State..Zip: Attach a COP of the wrorkem' coin elnsatia�,declaration� a;f P t� a be(s110wina the policy number and expiration date). Failure io secure coverage as requu•cd under MGL c. 152. ti'_5A is a criminal vit)lation l�ttnishabk by 1 fust tip to JI,�O0( anid'or ant-ti ear imprisonment_as well as oil°i)pzJ Jlti<s in the form of a STOP WORE;ORDER and a fine c,f u1?to 5250.00 a dal`against the Violator.A copy of tilis statement may be fwwarded to the Office of Investigations of tine DLA for insurance covera-e tr;:rificatlon. ` I do her•ebt•cerdfi.•unrjer•dre puirr,s acrd p< allies f p, im hat the information proruled aTu-re is true and correct. Si,nattu.c: %�, ��� �� ; , f: - Date: Phone ' 7J_• ����t- 1 C�>2 2- Ofj"arirrl rose v+(lir. Uo rtnt weite ire(leis ar,u,tri c rnrry3lc�tcd h,,Citi or tofu((nfficiul. ,~�~ —, City or Town: Pert»itll,icensc 18511111n Authority (circle ono): I. Board of Health 2.Building Department 3.Cit•/To«r► Clerk 4. Fleetrical inspector 5. Piumbin;inspector LC tact 11e1-gnn: Phone t:___ 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: 4 o Wes The debris will be transported by: The debris will be received by: Uer . Building permit number: Name of Permit Applicant rt�e`oL6c- co.,,�,J Date Signature of Permit Applicant 840 WESTHAMPTON RD BP-2020-0398 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:42-060 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2020-0398 Project# JS-2020-000677 Est.Cost:$4061.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sg. ft.): Owner: TORO LISA Zoning: Applicant. VALLEY HOME IMPROVEMENT INC AT. 840 WESTHAMPTON RD Applicant Address: Phone: Insurance: P O BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON.9127/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSULATION 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 9/27/2019 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner City of Northampton Building Department S P 2 212 MainStreet ATION Room 100 °F�'T o� Northampton, MA 01060 '�°RrH n;n°°'o ^'spi c phone 413-587-1240 Fax 413-587-1272 ",°,1p 01060O1�s NLY APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: This section to be completed by office h# Map Lot 01..E /v Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: L '4a -FdY-0 1840 bjupo-sl Name(Print) Currejnt1 Mailing Addreesss: g Tel one Signature 2.2 Authorized Anent: �, c IV�cc Name(Print) Current Mailing Address: '�p '4139 q�6b 9 5 Signature Te ephon SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection orx 6. Total=(1 +2+3+4+5) Check NumberqqW This Section For Official Use Only Building Permit Number: Date Issued: q Signature: 6&8, 1 oZ 7 �i Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) n s - o�2Z C V V�YW,�tti LLi--cense Number'i Expira ion Date Name o CSL Holder I S List CSL Type(see below) V Noland Street Type Description r U Unrestricted(Buildings up to 35,000 cu.ft.) "� �1• R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I I Insulation Tele h ne mail 6ddress D Demolition 5.2 Registered Home Improvement Contractor(HIC)1 109 5>1 3 -- - CIA �_ --RIZ-Ibegistration Number Ex iratiod Date HfC Conrip—anVNatne or HIC Registrant t4ame 0 ZUa-) C v ear8 i rile —Mr. ��0 �,��2 � LO M No.and Street Emai ddress City/Town, State,ZIP '^Telehon_` e SECTION 6: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 ..........6L No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S 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. Print Owiier's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information - _---- - contained-in-this-applicat' a est o my owledge and understanding. t r , Print Owner's or Authorized Agertqs Name(E to ignature) D P, NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program), will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.2ov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" 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: 4 o W Lo-sAk&akAkx�2 L �p� A�� The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant PW—n n ' Date Signature of Permit Applicant The Commonwealth of Alussachu.cetts " � " Department of Indiistrial,lccidents —� � 1 Congress Street,Srdite 100 .Boston,. 11A 02114-2017 m-ivm,.mass.gotifdia �l orkei•s' COMPensation Insurance Affidae•it: BttilderslContl actors�Eit ell icians,'S'tutnbers. `1'O BE FILED WITH111F PERMITTING ACTHORM'. Applicant information . Please Pt-r�i�n t Legibly Name -T� n,�-aennr,-)-I Address:_ �-IU & City/Mate/Zip: T- kcwe_ LC kCJ 01002- Phone Are you an employer.'Check lite appropriate hos: Type of project(required): 1�I ate a employer t�irtt e;vployeas ifull and nr hart.-timcl.' 7. �Nei<<constrtieliol� 2.[]l ant a Sole .ro rietor o[ mIn rshi ,. t' p I p nd base no eniplo ees:;rrlcin, ft�r m;in 8. �R4tnaclelin� tn;,e:rlci'.Ir:oxorLers'comet.in;urarn.c requirctl.l _ 3.E]I'm n homeowner doing all Wolk nvc,;if,l'Vu worker;'comp.insugtnce required.)r 9. Dcniolition ❑l.un ahiunco -mrand rill bec 10 E]Building addition Lirag cantra;tots to caaaut.�t all-:,al;on m_:i;t npctt,. I vril, ens"re that all contractors either have workers'conrimisatioa insure a"or,re sole. l t ' t I.[]El,c,rical repairs or additions rrogrie!ors with ne?empia)'ees. I i 2.3 Plumbing repairs or additions I 5.®1 nm a general cont[acior and 1 ha,a hired the.cul?-contracnxs listed,v,th_atwehe,',;beet. T,r,e:,th-•_onb3etorx h.ac rothie�_ee;ama ha+e tc.xnrr c.=nth in:nrat rr; J3.[]Roctf renal: 6.Q We are a cmgK,ravon and its Otiicers have eser_iscd th it right of z:xemption pct M1.C. � 14, l`9•a If•31.and we have nu etnptoyees.(Tin workers'conn.in5u1'anc;regwt'cd.1 _..^-- f A[r�applicant that cheicFs bas l must also.till out Ole section b1:1v%V!tea int their o:otkcrs'comp;tisauon pope) ltuomation. Hmteot,.rcis Who+,limit this aftidx•it indicatim tl[ay ttxc dnq 31.1 wort.:and that Lire outside cattuactors must submi[a I-im,likiNit indtcatin tCnntractore that check thi=bo-c nurst attached an additional sheet shmvim,the nano of Otc wt-i:onu"acors and state wlicihe;L.I.no,tf:[o:ie entittr.;have employez, If the sub-contractor;have empimrces.the, mu-t pmvitl:their tvrrS er;'comr.pnD p t,urr,t, r, I aite an emplo),er that is proriditr•;;siorkerscompensation insurance for iul,eraplo}'ees. Belo iv is the policy and job site inArmation. Ins-urance Cunnpiny 1va[Iie: Policy 6=or Self-in . Lic, 4: C�(j�C�O� �-`.Z 1 Cj — �� FXpiration Hate:__ Jt[h Site Address:_$� -�� �?��31L�• � �f�ity%Statz�.Zip:_ ri��� _--� Attach w copy of the workers' cetrnpeams.ation p licy declarat=_ozl psg (slmowing the policy number and expiration date). Failure to secure coverage as requh•cd under MGL c. 151 y25A is a crinminal violation ptmishable by a fine up to S1,500.00 and or one-year impt•i,onment. as well as civil pet 'Itie:; in the foram ui a STOP NVOR.K ORDER and a rine of un to S250.00 a day against the violator.A ropy of this statement may b,:forwarded to the Office of l.m°estiRations of the DIA for insurance coverage v,rificaUon. 1 der herEh)'rertifi'llt![fel'the pttI71.S Q1i(�1)t.' allte,Sof ell.)• hat the i"forl"ation provided abo-re is trite and c'O}rrea. Date Pho[teu Ofjarirtl tee o:rly. Do not trrite in this aler(,to be r(nulslc'terl b} eitl of tojvlr official, rv– City'or Town: Permir.•'Lacen.s e tsciiiog Autboritli (Cir"CIC 1. Board of Health 2.Building Department 3.City:+To«'t► Clerk 4. 1•:IeLtricrtl Inspector- S. Plunibin_inspector ! Contact Pcl-son: Phone th l Commonwealth Of Massachusetls Oiv'SiOR of Professtonaf Licensure Board of Building Regulations and Standards Constr .tiSti''SiSn+:rvisor CS-077279 4L �ires: 0612112020 STEVEN A S&ERMAN-" 268 FOMER RQ SOUTHAMPTON MUTA 0110.7-3,-* CCtTI[Tlissioner CL � Pi�, ��zc� ��r�'� f , - /pct - �r -� Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration, -- Type: Corporation VALLEY HOME IMPROVEMENT INC Registration: 105543 P.O.BOX 130627 - Expiration: 07/16/2020 FLORENCE,MA 01062 Update Address and Return Card. SCA 1 0 2y:142g17 Office at Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE.,Corwadon before the expiration date. it tound return to: a istration fiSRkatio.1? Office of Consumer Affairs and Business Regulation 07i16M0 One AshbuRon Ptact-Suite 1301 VALLEY How=!)AP D�AtRT INC Boston,MA 02108 flVEN A.SILVER MAN.: 340 RIVERSIDEDI.:, ' (� ` � '� ✓ /� �' NORTHAMPTON,N14'010'62 Underseorewry Not valid-without signature ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDWYM) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO /0912019 RMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATNELY 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. K the certificate holder Is an ADDITIONAL INSURED,the pollcy(lee)must have ADDITIONAL INSURED provisions or be endorsed, If SUBROGATION 18 WANED,subject to the terms and conditions of the poUoy,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: Barbara Grynldewicz Webber&Grinnell O N 8 North King Street (413)586-0111 N,, (413)586-6481 LINC, AEiDREss: bgrynklewicz@webberandgnnnell.com Northampton INSURER MA 01080 APpORDING COVERAGE NCp INSURER A: Arbda Protection INSURED 41360 Valley Home Improvement,Inc. INSURER 0: Arbelia Indemnity 10017 INSURER C: Attn:Steven Silverman P O Sox 60¢27 INSURER ff; Florence MA 01062 ENSURER P COVERAGES CERTIFICATE NUMBER: Exp 211/20 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF BJSIfMANCE POLICY NUMBERMGfIDD NIoLjcyupF- LIMITS COrdMERCiAL GENERAL LIABILITY EACH OCCURRENCE $ 1,0001000 CLAIMS4AADE 19 OCCUR -- PREMISES(Es o R Ge $ 100,000 A MED EXP An one person) $ 5,000 8500063755 02!0'!!2019 02/01/2020 i 000000 PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMRAPPLIES PER: $ 2,OOD,ODO POLICY ®JECT LOC GENERAL AGGREGATE PRODUCTS-COMP/OPAGO S 2,000,000 OTHER: AUTOMOBILE LIABLJTY $ COMBINED ING LI $ 1,000 ANYAUTO E cc a ,000 A OWNED SCHEDULED7 BODILY INJURY(Per Pelson) $ AUTOS ONLY AUTOS 102003.7691 02/0112019 02/01/2020 BODILY INJURY(Per accident) $ HIRED NON.OWNED AUTOS ONLY AUTOS ONLY DAMAGE $ Per accident Uninsured motorist at $ 100,000 umeREn LA I.IA1I OCCUR A EXCESS UAB EACH OCCURRENCE $ 5,000,000 CLAIMS-MADE 4600063758 02!01/2019 02/01/2020 AGGREGATE $ 5,000,000 DED RETENTION S 10,000 WORKERS COMPOMT $ AND EMPLOYSRS'LIABILITY Y 1 N STATUTE EOR B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? F7N NIA 4220051237 (Afandatory in t4H) 02/01/2019 02/01/2020 EJ.EACH ACCIDENT $ 1,000,000 If m,deswbe under E1.DISEASE-EAEMPLOYEE 110001000 DESCRIPTION OF OPERATIONS babes E.L.DISEME-POLICY LIMIT d 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS f VEHICLES(ACORD 107,Additional Remarks SchedUfa,may be attached H mora apace Is regWrad) CERIIFI ATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Greenfield ACCORDANCE WITH THE POLICY PROVISIONS. 14 Court Square AUTHORR®REPRESENTATIVE Greenfield MA 01301 +)( Y. ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and 1090 are registered marks of ACORD 840 WESTHAMPTON RD BP-2020-0397 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:42-060 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2020-0397 Proiect# JS-2020-000676 Est.Cost: $4393.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(ss .ft.): Owner: CHILSON NANCY Zoning: Applicant: VALLEY HOME IMPROVEMENT INC AT. 840 WESTHAMPTON RD Applicant Address: Phone: Insurance: P O BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON.9/2 7/201 9 0:00:00 TO PERFORM THE FOLLOWING WORK.-ATTIC AND BASEMENT INSULATION AND AIR SEALING THROUGHOUT 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 Firleplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Fi al: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPT DN UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 9/27/2019 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 041 SEP 2 E -'J � The Commonwealth of Massachusetts FOR Board of Building Regulations and Standards MUNICIPALITY °E� Massachusetts State Building Code, 780 CMR USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: 7 Building Official(Print Name) Signature azure SECTION 1:SITE INFORMATION 1.1 Property Addr ss: 1 Assessors Wap&Parcel Number l.la Is this an accepted s �ves (. no Map NumberParcel Num er 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ Check if yes[] SECTION 2: PROPERTY OWNERSHIP' 2. Owner'of Record: ame(Print) -City,giate�— 11) £ � a 3 2,o . 5}1 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repa' (s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other Cj�specify: t .)A n -.L Brief Description of Proposed Work': I SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item (Labor and Materials 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costs(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: S.Mechanical (Fire $ Total All Fee • Suppression Check No heck Amount: Cash Amount: 6.Total Project Cost: $ i���. 13 Paid in Full 11 Outstanding Balance Due: ' SECTION 5: CONSTRUCTION SERVICES 5.1 Construction S pervisor License(CSL) n G1�nAP U AA- License Number ExpiraionD to Name of CSL Holder List CSL Type(see below) L) No.and Street Type Description a RA U Unrestricted(Buildings u to 35,004 City/Town,State,ZIP R Restricted 1&2 Tamil Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Insulation ere one Email a ess D Demolition 5.2 Registered Home Improvement Contractor(BIC) e 43 HIC Com Name or IIIC egistr nit Name HTC Registration Number Expiratioh Date " " p MAPCb%J91 r -1) No,and Sheet E address N lan„r S e r r a O 1 CMZ I Ci /Town, State,ZIP ele hone9) S + SECTION 6: 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..........bt No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner;..otthe subject property,hereby authorize V G to acl on,riiy behalf,in all matters relative to work authorized by thi uilding permit applicat n. Print Owner's N (E] etronic Signature) ate SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's N e(Electron gnature) ate NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the BIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.nrass. ov/dns 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Commonwealth of Niassachuselis Division of Professional Licensure Board of Building Regulations and Standards Cons#ru.'ti"n'-Upervisor CS-077279 f • -: �� ires: 08121/2020 STEVEN A SIl:VERMAN''` f 268 ScOMER R'A'n SOUTNAMPTOfY JVIA "�t�fSSi3G� f.. Commissioner CIL Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Horne Improvement Contractor Registration- - Type: Corporation VALLEY HOME IMPROVEMENT INC - - Registration: 105543 P.O.BOX 60627 _- Expiration: 07/16/2020 FLORENCE,MA 01062 - Update Address and Return Card. ZZ office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Ragistretion valid for individual use only TYPE,Corporation before the expiration date. It found return to: f3ggjstr ion 9114iratlon Office of Consumer Affairs-and-Business Regufation OW16A2020 One Ashburton Place-Suite 1301 VALLEY HOME Boston,MA 02106 Srl VEN A.SiLVEF11-iAtJ 340 i3lVERSJDFQN:. '.',_. C� �-�•- NORTHAMPTON,Phk 01062 tfndereearetary Not valid-without signature ..f"R The C.�omE7dilDlft`ealth of Alassachmsetty Department Oj`1#YdustrialAcCIE encs l: t Congress Street,Suite 100 EK;.;, Bostwa4-1A 02114-2 017 ww.t.muss.g uvfdia )`orkers' CotiiPeitsation lostirance Affidavit: Buildei-s/Cotztractors/Electa'fcians,/I'h!nlbers, TO BE FILED WITH THE PERMITTING AUT11ORITY. ApHlicantinformation Please Pilnt Legibly Name113usiness'Lha<irrizatiatt%lndiriduall:� yC•t -Tm ACdreSs: �tAd ,\_Y?.v"aice_!J."t\Tt City/State/Zip: 1orenL_ k(4 07 C1(e"L Phone :_ 1 -GS4---71>?Z Are you an employer?Check the appropriate hoT: _ Type of project{required): am a employer�ridt. � .�emtpluyees(full and or part-timtCl-" ?.n I ant a Sole 7. [�Ne�s�constructiont'o :tor m rartners P I?n hi.p nd has>c no cmtplJrec i R'R?'l{+,t}g fur fI}; in S. Remodeling any capaci^•.f11Io:rorkGts`comp.insurance requirecl.l 3.�1 am a hemcou•ner doing alt work nti gcit'.1'+lu uurkersDemolition 'comp.insurance required.] 9• ���^^�� T.�I u.a homcc:mcr and vall be L•iriag cant.actors to conduct all v;,,t';;on m}1 roper(;.. I v:il9 1()I.J Building addition zns arc that all umtructvrs either lvvtc`.corkers,c„nrt citsati'm insurtn e or v.so"Ie I I.❑Electrical repair's or atlditiUM 1 propriet..s with no empfoyees. 5.� 12.1 mr,a vnerai contractor and 1 have hircel theSoh-cJnUac[or;ir,wd on dt-aua;red:hcet. .Plumbing repairs or additions T1,r•e.-.!h-•_„nir3.tine i+ c rmt,17_ee;arra hi, ;c,.rktr:'c„rn1 usu:a.,.r ] ®R[-)of repin:a fi-E]1b'e are a ct„iN,tatton and its oftice.r,lzarc eser_iscd d} is ri>ht os xxempztea pc[\1C1i_c. 1 # ULhet' l 52. Lal),and w•c bave nu onptovecs.rto�:nrkcts'Coi nu.insurance recuuc,l. — _....__ I-Auy applicant that chcclsbox r l mug a!,,()jilt out the section bcictii moa im their n:orkcts'comp,rsaiion policy mfom}atiini. a Hrmieovmen wlw titthnnt thr.affidavit indicating tlrev uc dowg ai.l trJZlt and then!tire outside c ntrac%Xr ""ISEsubrt}it a new ariUmit indicating,such. CrmGactrtt_that Cit::tl:thi-bm must attached art iddiuunai she;:(.,lloN is +h_naric of the sub-coavaceors acid state whether[u no;drnsu entities ha, ernptn},tea, If the cph-c,�ntracG,rs have emplovecs•thty mu.>i providz their wort.er;`t qmr.r'll;%,num>er, 1 ant an eniployer that is providit{;workers'compensation insurance for•lilt,employ ecus. Below is the police and job site inj6rination. Insurance Cruinpany Name:. Policy 4 or Self-ins. L.ic, r: C3 e�p`3 l;„” 2- \cj Expiration Flute: Job Site City!City State ZiP:_.FLc_f.P1 ' t? • '� ®i�Z Attach w copy of the workers,rs' en npeats,atiQn aoliry decl.arat?oat V ge(sttawiitg the pollry nutlilncl and eiytirahctr.date). Failure to.secure coverage as required under NIGL c. 152. ti25A is a criminal vi[ laiion punishable by a tine up to S1'i;00.00 and or one-year imprisonment_as well as civil pet Aries in the form of a STOP WORK ORDER and a fine of ul?to S250-00 a dal against the violator.A copy of this statenlellt t nav be forwarded to the Office of Investi`gations of the ULA for insurance coverage t Grificattcrn. I do hereby vertifz un#el'the pains and peg,alties rf P y tat•)' !tat the Irl f0r"lation provided above is true attd correct. Date: Phor _ OfjWittl'(Se ottiv. Do not write in thin at'ca,yto be completed by city o•tanvtr offieiul. City Or Town: Permic'L.icense; lmiring�tlltlAOl'it;t'tCil'Gle tfllf y. 1. Board of Health ?.Building Department 9.Cltv!Towo Clerh- 4. Flecti-ictrt 1"Spectol- 5. Plumbing inspector• 6, (M air Contact l3rrnon: Pconn; •_ _ ACC?ISjC� CER i IFICA OF LIABILITY INSURANCE OATE(JMM10DM/YYi 04/0912 0 1 9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT�ICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AWAENQ,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 pollcy(tes)must have ADDITIONAL INSURED provisions or be endorsed. N SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement; A statement on this cartiticate does not confer rights to the certiticate holder in Neu of such endorsement(s). PRODUCER NAME: Barbara Grynklewlcz Webber 8 Grinnell PHONN (413)586.0111 (413)508-8481 8 North ting Street ­1LbWynkiewicz@webberandg6nnell.com No! ADDRESS: b9rYna<Iswicz@webbarandgrinnell.com Northampton INSURER ARFORDING COVERAGE NAIC4 MA 01060 INSURER A: Alt d;12 atectian a13sD INSURED Valley Home Improvement,Inc. INSURER B: Arbeb Indemnity 10017 Attn:Steven Silverman INSURER C: P 0 Box 60627 INSURER 0: - --- - Florence MA 01062 f1-(SURER E: URER P; COVERAGES CERTIFICATE NUMBER. Exp 211/20 _PSREVISION NUMBER THIS tS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT D 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. WK LTR TYPE Of BISURANCE AUD POLICrY NUMBER MMIDD POLICY EXP Lii1SRS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE ®OCCUR PR Ml Es e,- Ca $ 100,000 A MED EXP An one rson $ 5.000 T 8500063755 02/01/2019 02/01/2020 PERSONAL aADV INJURY = 11000,000 GEMLAGGREGATE LIMIT APPLIESPER!O. GENERAL AGGREGATE $ 2,000,000 POLICY ©JJEECTT 0 LOC PRODUCTS-COMP/Op AGO $ 2,D00,000 OTHER: AUTOMOBILE LtABALITY ANYAUTO EaacCOMSci en—D-91—NG— IM $ 1,000,000 BODILY INJURY(Per parson) $ A A{1TOES ONLY - SCHEDULED 10200 7691 02/01/2019 02101/2{120 BODILY INJURY(Per ecddant) S HIRED NON-OWNED 0 AUTOS ONLY AUTOS ONLY Per accident $ UUninsured motorist BI S 100,000 NBRHLI,A LiAB OCCUR �Y A ExCEBB UAB 0&OCCURRENCE j 6,000,000 CLAIMS-MADE 4600063756 02/01/2019 02/01/2020 S 5,000,000 ti DED RETENTION 10,000 AGGREGATE WORKERS COMPENSATION $ AND EMPLOY111W L ASLIrY YIN SPER TATUTE R B ANY PROPRIEfORMARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED? a NIA 4220051237 02/01/2019 02/01/2020 E.L.EACH ACCIDENT $ 1,D00.000 OkrAstary in C411) H yes,desmbe under E.L.DISEASE-EA EMPLOYEE 1,DOO,DOt) DESCRIPTION OF OPERATIONS bebw 1,000,000 E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,AddItImml Remarks Schedule,may be attached N mare apace is requlrad) CERTIFI ATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPiltxnoN DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Greenfield ACCORDANCE WITH THE POLICY PROVISIONS. 14 Court Square AUTHORIZED REPRESENTATIVE 'n Greenfield MA 01301 ®1988-2015 ACORD CORPORATION. All rights reserved, ACORD 2s(x016/03) The ACORD name and logo are registered merits of ACORD 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: 84 n W"X (-�j rl- 1 The debris will be transported by: \)'>ilm -A� 10 The debris will be received by: \JaAA:L,4 Building permit number: r r Name of Permit Applicant q t) 2,o / 19 Date Signature of Permit Applicant