25-066 (4) 85 RIVERBANK RD BP-2020-0363
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25 -066 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ELECTRICAL BUILDING PERMIT
Permit# BP-2020-0363
Proiect# JS-2020-000017
Est.Cost: $125000.00
Fee: $812.50 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ACE FIRE &WATER RESTORATION INC 074416
Lot Size(sq.ft.): 26397.36 Owner: KWAPIEN ANDREA C
Zoning: Applicant: ACE FIRE &WATER RESTORATION INC
AT: 85 RIVERBANK RD
Applicant Address: Phone: Insurance:
18 ELIZABETH ST (413)750-5200 Workers Compensation
WEST SPRINGFIELDMA01089 ISSUED ON:10/24/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-FIRE REPAIR
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 SiLmature:
FeeTyue: Date Paid: Amount:
Building 10/24/2019 0:00:00 $812.50
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northa�pto Status of Permit:
Building DepartmeCe/ rb Cut/Driveway Permit
212 Main Street 4 4er/S tic Availability
Room 100 ( $�P W ter/W II Availability
Northampton, MA 0106V T o Se of Structural Plans
phone 413-587-1240 Fax 413-587-1272 P ot/Sit Plans
n,��� ther pec ify
n.
APPLICATION TO CONSTRUCT, ALTER, REPAIR
RE DMO ISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION J Ja' x 0 1 3 0 3
1.1 Property Address:
This section to be completed by office
�6_ kver&ti e
P J4Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: /�� JJ 1 /
v S K! Vef-Lil IC
Name(Print) V Current Mailing Address:
4o- 55q- 7 76-
Telephone
Signature"—L—`
2.2 Authorized Agent:
Ace i he er mss` r
Name( rint) Current Mailing Address:
4��
q(3-96-0_Samoa
Signa ure Telephone
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
1010 Construction from 6
3. PlumbingBuilding Permit Fee
OV-0 �j
4. Mechanical(HVAC) �.—
5. Fire Protection -�� t/ U �
6. Total= 0 +2 + 3 +4 +5) o29TC77V Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: �0 aLO 1
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors I]
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[p] Other[p]
Brief Description of Proposed
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 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 -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, /'1/1 dry k)o f e°I') t'-&" as Owner of the subject
property
hereby authorize Amy- ar /`a c—
to act on my behalf, in all tive to w ut ed by this ilding permit applicationt
Signature of Owner Date
I, l_TCIh/ �• Ptt�tt;�/� 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.
Signed under the pains and penalties of perjury.
Print Name /
Signatur Owner/A ent Date
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable El
Name of License Holder: �arCS — 0741116
License Number
PO L),bx j0 Granville l'YI9 2.11g �
,2
Address Expiration Date
Signature„, Telephone
9. Registered Home Innrove ent Contractor: Not Applicable Elcie i t-e-f �u er 2c a, 15V L/1�
Company Name Registration N tuber
e--9 yo
Address /� Expiration Date
( e- f/ Im/ 1 0/0 Telephone
SECTION 10-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 build kg permit.
Signed Affidavit Attached Yes....... No...... ❑
City of Northampton
i Massachusetts
-A
A DEPARTMENT OF BUILDING INSPECTIONS a
212 Main Street *Municipal Building yV�. Cbz
Northampton, MA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
(Please print house number and street name)
Is to be disposed of at:
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
i o-a/ 9 &0-10�1
(Company Name and Address)
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
City of Northampton
_.
Massachusetts
wf ;s
DEPARTMENT OF BUILDING INSPECTIONS 7t
212 Main Street • Municipal Building
�,. Northampton, MA 01060 �sYp.. ......
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC, that entity must be registered
Type of Work: QE I t'SOl� C� ,►.e_ Est. Cost:
Address of Work: 8- M CJI? �ct
Date of Permit Application: c,&
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law(explain):
_Job under$1,000.00
Owner obtaining own permit (explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
q�LAcA LAU.-I /5-/0)q1
Date ont ctor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Lepibly
Name (Business/Organization/Individual): Ace Fire&Water Restoration Inc.
Address: 18 Elizabeth St
City/State/Zip: West Springfield, MA 01089 Phone#: 413-750-5200
Are you an employer?Check the appropriate box: Type of project(required):
l.E]I am a employer with 1 employees(full and/or part-time).* 7. ❑New construction
2.❑1 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.a I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10E]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.E:]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 employees and have workers'comp.insurance.:
14.�✓ Other Repairs
6.F1We are a corporation and its officers have exercised their right of exemption per MGL c.
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
Iam an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: The Dowd Agencies
Policy#or Self-ins.Lic.#: VWC10060144772019A Expiration Date: 07/01/2020
Job Site Address: fC I�Qr Ilk ki City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and eilpiration 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 cern under the pains and penalties of perjury that the information provided above is true and correct
Signature: UDate:
Phone#: 413-750-5200
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#:
i Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards `
Constr�,tiMA`9bpervisor j
CS-074416 Z: apires: 09/1812020
GARY W 13RUNELLE
PO BOX 104 i
GRANVILLE M41034 V
Commissioner /J.,
�
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home ImprovemerA,Contractor Registration
Type: Corporation
ACE FIRE&WATER RESTORATION, INC. Registration: 151246
18 ELIZABETH ST. Expiration: 05/25/2020
WEST SPRINGFIELD,MA 01089
SCA 7 ti 20M-05/17 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. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
181246 05/25/2020 One Ashburton Place-Suite 1301
ACE FIRE&WATER RESTORATION,INC. Bos ,MA 02108
GARY W. BRUNELLE
18 ELIZABETH ST.
WEST SPRINGFIELD,MA 01089 acid without signature
Undersecretary
ACC>RJD0 CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDD/YYYY)
`� 1 09/17/2019
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 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 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 CONTACT NAME: Donna Desmarais
THE DOWD AGENCIES LLC PHONE (413)437-1018 AIC No):
ADDRESS: ddesmarais@dowd.com
14 Bobala Road INSURER(S) AFFORDING COVERAGE NAIC/
HOLYOKE MA 01041 INSURERA: AIM MUTUAL INS CO 33758
INSURED INSURER 8:
ACE FIRE &WATER RESTORATION INC INSURERC:
INSURER D:
18 ELIZABETH STREET INSURER E:
WEST SPRINGFIELD MA 01089 INSURER F
COVERAGES CERTIFICATE NUMBER: 449708 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
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.
INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS
LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE 1-1 OCCUR PREMISES Ea occurrence $
MED EXP(Any one person) $
N/A PERSONAL 6 ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY 7 PROJECT ❑LOC PRODUCTS-COMWOP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS N/A BODILY INJURY(Per accident) $
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION X I
STATUTE ETH
AND EMPLOYERS'LIABILITY
ANYPROPRIETORIPARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000
A OFFICER/MEMBEREXCLUDED? I N/A N/A N/A VWC10060144772019A 07/01/2019 07/01/2020
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If Yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000
N/A
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay
claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.
This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the
issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification
Search tool at www.mass.govAwd/workers-compensation/investigations/.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS.
212 Main Street#100
AUTHORIZED REPRESENTATIVE
Northampton MA 01060 Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
AC�® DATE(MM/DD/YYYY)
`� CERTIFICATE OF LIABILITY INSURANCE 09/17/2019
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 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(ies)must 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 CONTACT NAME: Donna Desmarais
THE DOWD AGENCIES LLC PHONE , (413)437-1018 AA/XC No:
ADDRESS: ddesmarais@dowd.com
14 Bobala Road INSURER(S) AFFORDING COVERAGE NAIC#
HOLYOKE MA 01041 INSURERA: AIM MUTUAL INS CO 33758
INSURED
INSURERB:
ACE FIRE &WATER RESTORATION INC INSURERC:
INSURER D:
18 ELIZABETH STREET INSURER E:
WEST SPRINGFIELD MA 01089 INSURER F:
COVERAGES CERTIFICATE NUMBER: 449711 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
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.
INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE F7 OCCUR PREMISES Ea Occurrence) $
MED EXP(Any one person) $
N/A PERSONAL 6 ADV INJURY $
GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY�PRO ❑ LOC PRODUCTS-COMP/OP AGG $
JECT
OTHER: $
AUTOMOBILE LIABILITY COBINED SINGLE LIMIT
Ea Maccident $
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $
AUTOS AUTOS PROPERTY DAMAGE $
NNON-OWNEDD
Per accident
HIRED AUTOS AUTOS
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR Ld CLAIMS-MADE N/A AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION X PER STATUTE ETH
AND EMPLOYERS'LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000
A OFFICERIMEMBEREXCLUDED? N/A N/A N/A VWC10060144772019A 07/01/2019 07/01/2020
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
N/A
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay
claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.
This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the
issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification
Search tool at www.mass.govAwd/workers-compensation/investigations/.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of Simsbury ACCORDANCE WITH THE POLICY PROVISIONS.
933 Hopmeadow Street
AUTHORIZED REPRESENTATIVE
Simsbury CT 06070 Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
Ace Fire & Water Restoration Inc.
E
> .tw
Client: KWAPIEN,ANDREA Cellular: (413)695-0769
Property: 85 RIVERBANK RD
NORTHAMPTON,MA 01060
Operator: GARY 18
Estimator: Gary Brunelle Business: (413)750-5200
Reference:
Company: LELAND CRAVER/HANOVER INS.
Type of Estimate: Structure Cleaning
Date Entered: 7/1/2019 Date Assigned: 6/27/2019
Price List: MASP8X_Jt3L19
Labor Efficiency: Restoration/Service/Remodel
Estimate: TOWN-DRAWING
File Number: 1900478911
This diagram is in reference to the first floor kitchen,bath and parlor area of the fire job located at 85
Riverbank Rd Northampton Mass.It was discovered that the above mentioned areas had some pre-existing fire damage.
Ace Fire& Water Restoration Inc(Contractor)proposes the following to correct this issue.Contractor to remove all
existing plaster to walls and ceiling.Including wiring and 65% of existing plumbing.Contractor will ice blast all effected
areas in the ceiling and wall areas.Then contractor will seal and encapsulate the effected framing members using
Fiberlock brand Ultra RECON smoke sealer.Existing joist are 2"x 10" and barring wall framing is 2"x 3".Contractor
will up the sizing for joist to 2"x 12"floor joist and 2"x 6"barring wall framing members.As discussed at time of site
visit with ABC Mr Miller,a 2"x 12"ribbon board will be used at exterior wall breaks along with 2"x 4"fire blocking
due to the nature of balloon framing.Also as pictured in the diagram,a 4 1/2" x 16" micro lame beam will be installed in
kitchen are to cover the load span.Joist hangers will also be used at ribbon board,and where necessary.
At this time,an inspection will be requested so we can Insulate the exterior walls.The drywall application will mirror
a commercial project.5/8" fire resistant drywall will be applied to exterior walls and ceiling area and fire taped.At
which time,the interior barring wall framing will be built and installed.Any penetrations to upstairs will be filled with
fire rated caulk,fire proof rock-wool insulation and then covered at finish with another layer of 5/8"fire rated drywall.
The 2nd floor party wall between the 2 units(only place 2 units meet),will be sheet rocked over with a 2nd layer
of 5/8"drywall,where applicable,or painted with a fire rated paint. As for code issues,the
items that were discussed last Tuesday are being addressed.A second egress will be built to accommodate the bedroom
and living area as discussed.If you have any questions please call Gary brunelle 413-626-2081.CS-074416 Ex 9-18-20.
HIC#151246 EX 5-25-20 Thank you.Gary Brunelle.
Main Level
—32'7"
3l'11"
?'9,
N T
m �
Basement 1
4 J
�ry ti�
�a %r
^ (V
N �
1 IVY 3.T
atchwe
. 4's•--• Lh J
Main Level
TOWN-DRAWING
10/24/2019 Page:2
LEVELI
ADD FrvE
...................... I 1'6"-
d, 11
atbn
T Office
18'2x12 FI c )r Joist(B2)
I losh
2"x 12"floor oist. 12'(B3) 6'5"
_6'T -3' 12'1
I I I L i
F= 1p
Kitchen
Dinette Foyer/Fntry
8'2 x 12"F14 or Joist(131) all
e
6'4" TV=A
Fireplace Rm
or
14'9"
LEVEL I
TOWN-DRAWING
10/24/2019 Page: 3
Level 2
7'8" - 27'8"
7' 10'8" _5'Y 10'7"
Pantry/Ten i
Bedroom/Tenant �0
d v�
Kitchen/Tenant losetl/Ien�
,,7� Re Burch/Entry toant Ilway/Tenant T 8'9"
3'
l
� � Cto u (nl.ht etl� t
Yo N N N
1✓ TV Room/Tenant a
6'8" _
~-7 Bathroom/l'enant 3'7"
Q
f2'2' 1 8":— T 8"
1 L
8'10" 2'8" 6" a�+/i op of StaT 3"
losetenant
b�,� 7.;
Porc 3
N 00
—4'7" aster Bedroom/HomeoGa 7'2" If-lee/Homeowr
3'9" Y5"--q
i loset2 N
J• r
Closetl/
7'2'
22'10"
a
Level 2
TOWN-DRAWING 10/24/2019 Page:4
Level 3
6'7"
ff75'
�i 6'2"
6'2"---t
5"
Office/Sewing Room 3'6"—+ 1
N T 10'
N
iC
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