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38B-066 (9) 251 SOUTH ST BP-2021-0127 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B -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:ROOF BUILDING PERMIT Permit# BP-2021-0127 Proiect# JS-2021-000200 Est.Cost:$6900.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group: ANTHONY ROBITAILLE 102453 Lot Size(sq. ft.): 9583.20 Owner: PIERCE DARREN zoning: URB(100) Applicant: ANTHONY ROBITAILLE AT. 251 SOUTH ST Applicant Address: Phone: Insurance: P O BOX 892 (413) 626-5296 WC ThorndikeMA01079 ISSUED ON.81312020 0.00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE BACK FLAT PORTION OF ROOF 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 Siinawre: FeeType: Date Paid: Amount: Building 8/3/2020 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner "—" The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY z ( USE M0 MJ Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 D c One-or Two-Fandly Dwelling Oq 00 This Section For Official Use Only °z-D Buil ' rmit umber: D!2Applied: sro 3-zozo m T _V/u 05r1_5 o LJIBM ficial(Print Name) Signature Date z m SECTION 1: SITE INFORMATION 1.1 Pro a ity Address: 1.2 Aesst�j�p&Parcel Numbers Z oJi H o HO V (—� _ (7 D 0 1.1 a Is this an accepted street?yes y no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) 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: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1Owner'of Record: su, ,0A PLOV PPRU 2 51 5Wsr 1V09r)J/q#1 t0ly lklj Name(Print) City,State,ZIP `1(3Wi-1(49 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'-(check all that apply) New Construction❑ Existing Building X Owner-Occupied J0 I Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work':_51 I` AND FIVOOF 10 FXX Pj6hl S'A'C 70V' 1,M A LV3:T H .0 Go EFV iA PUBQ UK SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 6 () 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fe Check No. Check Amount: ` Cash Amount: 6.Total Project Cost: $ � G 0 Paid in Full 0 Outstanding Balance Due: City of Northampton Massachusetts tC; ^ 7 z DEPARTMENT OF BUILDING INSPECTIONS S 212 Main Street • Municipal Building Northampton, MA 01060 sy"grii��� PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 &2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR, ETC. I. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work. (Digital and hard copy) 3. Site plan with location of proposed structure(s)and set backs. 4. Construction Debris Affidavit filled out and signed by applicant. 5.Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (new/replacement windows). 8. Home Owner's License Exemption Form filled out and signed by Homeowner(if applicable). 9. Note any Conservation and/or special permit requirements(if applicable). 10. Driveway Permit(if applicable). 11. Proof of Water and Sewer entry fees paid (if applicable). 12. Trench Permit-public land by DPW/private land by Building Dept. 13. Stretch Energy Code -all new construction will require a HERS Rater Affidavit to be submitted with permit application before issuance of permit. ri*To..>I;, The City of Northampton Building Department 'F 5 212 Main Street 9p�"ATEOAf�IF��, Northampton, Massachusetts 01060 Phone (413) 587-1240 Fax (413) 587-1272 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVAT ION PROJECTS) In accordance with the provisions of MGL c40, s54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, sl 50A. The debris will be disposed of in: Location of Facility The debris will be transported by: Name of Hauler Iy , r , w0f Signature of Applicant:I ���!'� �r� Date: 7- 3o-2N The Commonwealth of Massachusetts Department of Industrial Accidents n o 1 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 Leeibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).' 7. ❑New construction 2.r7 I am a sole proprietor or partnership and have no employees working for me in $. E]Remodeling any capacity.[No workers'comp.insurance required] 3.7 I am a homeowner doing all work myself.[No worker'comp.insurance required.]t 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.0 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.* 13.QRoof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] "Any applicant that checks box#1 must also 511 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. 'Contractors 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. 1 am an employer that isproviding workers'compensation insurance for icy employees. Below is thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: 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#: City of Northampton Massachusetts DEPnuMdENm OF BUILDING INSPECTIONS �`- t\ 212 Main Street • Municipal Building Northampton, MA 01060 s :yY 314 HOMED R 'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born _ (insert month, day,year),herelnj depose and state the following: 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.85.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.83. 3. I qualifi/under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Ferson(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of 20_. (Signature) :E The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress,Street,Suite 100 Boston,KA 02114--2017 ,Y wiww.mass govtdia Warkers'Compensation Insurance Affidavit:Builders/Contractors/Eleetricians/Plumbers. TO BE FU"WITH THE PFJM TING AUTHORITY. Applicant Information / PIease Print Legibly Name (Business/organizationllndividual): t UL:�L- Si t�j j, & T fIg'�jf L r(G Address: PG 50k � 72- t1100 K 4,14 Ulf/ City/State/Zip: Phone#: 4/3 CG 6 S Z,f Are you an employer?Cheek the appropriate box: Type of project(required): 1.W lam a employer with Lf_employees(full and/or part-time).* 7. E]New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.1No workers'comp.insurance required.] 9. ❑Demolition 3.[:]l am a homeowner doing all work myself,[Noworkers'comp.insurance required.]t 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 iusurande or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.F1 Plumbing repairs or additions 5.Q 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? 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.II Other I52,§1(41 and we have no employees.[No workers'comp.insurance required] *Any applicant that checks box#1 must also fill nut 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 ofthe 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_ I ant an employer that is providing workers'compensation inslirance for my employees. Below is the policy and job site information. Insurance Company Name: U fiE l i t W 6 L Policy#or Self-ins.Lie.#: 14,C 57 3/.S S 7 97 9 6 02 Expiration Date: (0 1[` Z 0 Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-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 ofthe DIA for insurance coverage verification.. I do hereby certcfy under the pains nd penalties of perjury that the information provided above is true and correct. Signature: et'ollw ' f`�'� Date: Phone#• 9l 3 &�� 7 Z g b Official'rise only. Do not write in this area,to be completed by city or town offrciaL 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#: SECTION 5: CONSTRUCTION SERVICES 5,1 Construction Supervisor License(CSL) cS - 1021153 3-/6-2( /.1 M{fK f 1 Ptlf tI f 1I f- License Number Expiration Date Name of CSL Holder ( 1 P�RG k Z JyOPN r,f K� /v1 t? 6116"7 List CSL Type(see below) V No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted M2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances `[l3GZ6Lq� I,OGA6r6TYihlLL,l6,X I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) WA-L PkiiO��t 1?tll�U,1tA6 16 t�lS"7 rid zt HIC Registration Number Expiration Date HI Company Name or HIC Registrant Name No,and Street Email address Ci /Town, State,ZIP Telephone 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 b this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes...:...... ❑ No...........0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERIVHT 1,as Owner of the subject property,hereby authorize to act on my behalf,in all matters r alive to work authorized by this building permit application. i wner'sIla-me(E ec nic Signature) Date SECTION 7b: ONVNERt OR AUTHORIZED AGENT DECLARATION C� 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 Owner415iAuthorizAhCut's-Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor ,9 (not registered in the Home Improvement Contractor(1-11C)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.masLgov/oea Information on the Construction Supervisor License can be found at www.mass.eov/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" ' Local Building and Remodeling Anthony Robitaille Contact Information: MA License#102453 P.O.Box 892 Cell:(413)626-52% MA Reg.#169957 Thorndike,MA 01079 Fax: (413)289-%11 CT Reg.#615780 SUM of: $6.900.00 (Six Thousand Nine Hundred Dollars) 54.000.00 is due on or before the start date of the job. Received on: $2.900.00 is due upon completion of the roof work. Received on: Customers' Signature: X JA, , L_ Date: 313 u lio Contractor Signature: dLA _Date: 7- 30-2O The following schedule will be adhered to unless circumstances beyond the contractors control arise including weather or unexpected problems with other jobs. Scheduled to Begin: Expected Date of Completion: Required Permits The following building permits are required. It is the obligation of the contractor to secure such permits as the homeowners'agent: Building Permit I Sheri/Darren.Pierce.authorize.Local Building and Remodeling to act as my agent to secure all necessary permits to carry out all work stated in this contract. X S.AaA 4 - 0104 L Warr&U11 A 5-year warranty will be provided by Local Building on labor. 10 year warranty on material by manufacturer. NOTES: -Extra care will be taken to protect shrubbery and plants but we cannot guarantee against damage due to the nature of the work performed. - Property is to be swept with commercial grade magnets to remove any excess debris. -If applicable, Local Building will remove and reinstall any satellite dish, however, the homeowner is responsible for any fine tuning needed, or any charges that come along with it. -Local Building may provide a dumpster and it would be put in the driveway for this job;this would be included in the total cost. Proper precautions will be taken, i.e. planks under dumpster to prevent damage but we cannot guarantee against any damage caused due to the weather and materials composing the driveway. Please sign below stating you've read and understand the conditions shown in this contract. (Sign Here ---OX **If you agree to the work and pricing listed above,please sign the original copy of the contract in the designated areas.** CERTIFICATE OF LIABILITY INSURANCE "�"`-"""""' 10/10/2019 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(ms)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 ACT Gaudette Insurance Agency,Inc. 508 �� FAX —- 1 Plummers Corner _ ._�- lMc.! � ___._________._— Whitinsville,MA 01588 ___------,_-----NBURER(S)AFF�COVERAOE ---------- NAILE— MISUPER A_Adandc Casualty Wunum CcL --_ — INSURED rauRE.R Insurance-Compm C 34754 Local Building&Remodeling LLC 4212 Church Street �.w(suRcle ------------ ------—-- — ---— ---— --- PO Box 892 RMRER u --------- ---- --- ...-- ----- Thorndike,MA 01079 wSIiRER E; VISURER F• i COVERAGES CERTIFICATE NUMBER: 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. TYPE ADDL SUER ,Y INFER POL=EFF !M&EXP LINSTt3 A X COMMERCIAL GENERAL UABLRY1 ; 1,000,000 El1CH OCCURRENCE—_.1.£DAMAGE TO RENTED _.. CLAIMS-MADE 1 X l OCCUR I M2050007570 i 1 W112019 ; 10/1/2020 [PRESS Mi..o a mnce)^�-�-----_. 100,000 --_- ---.. 5,000 !L�Ems..-( _D )_ ;- 1,000,000 v_----- —_---- PERSONAL&AIN eJJURY S _9P&AGGREGATE LIMITAPPLIES PER: I _GENERAL 699MGATE2'W'000 -- --� - I POLIcr Loc i PRootxTs=oowP,w – -- ;000 I 13 AIROINGSILELIABILITY OOMBINIED SINGLE L/IQT s'1 1,000,000 ANY AUTO t FCS081 1 1/1W2019 1h W2020 BOD Y IN IUittr Pe,>tssa�-. _i -- AUTOS 1 X t AUTOS SD I,B�pILY/,lA1RY(Por.aoddM i .... _ AUTOS ONLY Np�pyy ggl�pppgER�'iy(pH,AI�AAA X HND { X I AUTOSONLY .�at0_a_cciITT_YLrZ.._._ _---- —__---- Il1110RELLA LIAB OCCUR EXCESS LIAB CWMS4V.0EI AGGREGATE-------------- �--— DED RETENTION$ WORKERS COMPENSATION I PER I 0714 AND EMPLOYERS LIABILITY YIN —1_$TATVW__L—i_ER ANY PROPRIETORIPARTNERIEXECUTIVE j ER Ilrbba EXCLUDED? NIA — E ------ E.L.DISEASE-EA EM.DLOYEE S ■ describe under SCRIPTION OF OPERATIONS bebw El.DISEASE-POLICY LIMIT i S DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks StSNdlde,may be attached H more space is requtred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Jenna Sultan THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 429 Valley Drive IT ACCORDANCE WITH THE POLICY PROVISIONS. Westfield,MA 01085 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACC>O R ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDONYYY) 10/22/2019 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 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 GAUDETTE INSURANCE AGENCY INC INAAME' ONE PLUMMERS CORNER PHONE FAX WHITINSVILLE, MA 01588 E-MAIL �` No ADDRESS: OPUREFLLS)AFFOR131IN6 COVERAGE MAIC s INSURER A: LM Insurance Corporation 33600 INSURED INSURER B LOCAL BUILDING&REMODELING LLC PO BOX 892 INSURER c THORNDIKE MA 01079 INSURER D: INSURER E: HISURERF COVERAGES CERTIFICATE NUMBER: 51923611 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. - IN --- --- SR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER LIMITS CMIMERCIALGENERAL LIABRM EACH OCCURRENCE S CLAMMS-IIADE n OCCUR PREtiSES ocanence $ MED EXP(Any ane person) $ PERSONAL d ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ -_ POLICY❑Jf EQ LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY CEOI IINEEnISINGLELIMIT S ANY AUTO BODILY INJURY(Per parson) S OWNED AUTOS ONLY AUTTOESDULED BODILY INJURY(Per accident) S HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY accident $ H 1 $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTIONS S A WORKERS COMPENSATION WC5-31S-623162-019 10/19/2019 10/19/2020 AND EMPLOYERS' ABILITY Y/N � LIATUTE ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $1000000 OFFICERWEMBER EXCLUDED? Q NIA (Mandatory In NH) E.L DISEASE-EA EMPLOYES K loppm IPTIO a under EL DISEASE-POLICY LINT S 1000000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers Compensation coverage. CERTIFICATE HOLDER CANCELLATION TOWN OF LUDLOW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 488 CHAPIN STREET, ROOM 305 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. LUDLOW MA 01056 AUTHORIZED REPRESENTATIVE Jon Smith / -- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 51923611 1 1-623162 119-20 WC 1 n0270258 1 10/22/2019 5:52:56 PN (PDT) I Page >, of 1 Local Building and remodeling Anthony Robitaille Contact Information: MA License#102453 P.O.Box 892 Cell:(413)626-52% MA Reg.#169957 Thorndike,MA 01079 Fax: (413)289-9611 CT Reg.#615780 HOMEOWNER INFORMATION CONTRACTOR INFORMATION Name Company Name Sheri and Darren Pierce Local Building and Remodeling Address Contractor/Owner Name 251 South Street Anthony Robitaille Cibmwn State Zoo Business Street Address Northampton MA P.O. Box 892,4212 Church Street Contact Number Citv/Town State ZaR 413-584-6144 Thorndike MA 01079 Email Business Phone lithsun@verizon.net 1(413)626-5296 Contractor Registration# 169957 July 29, 2020 NLA,CSL# 102453 Work to Be Performed Roof Work: } Strip and re-roof the rubber roof on the back part of the building ■ Install all proper flashings ■ Replace the gutter on the section that is damaged ■ Replace any rotted fascia on that section ■ Replace the few cedar shakes that were damaged and paint the repaired area to match as close as possible TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The contractor agrees to perform the work specified above for the