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06-010 (6) BP-2021-2007 595 HAYDENVILLE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 06-010-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-2007 PERMISSIONIS HEREBY GRANTED TO: Project# CHIMNEY REPAIR Contractor: License: Est. Cost: 7376 FIRESAFE CHIMNEY SERVICES INC 105507 Const.Class: Exp.Date:01/19/2022 Use Group: Owner: GREGORY, SETH H &ANGELA J Lot Size (sq.ft.) Zoning: RR Applicant: FIRESAFE CHIMNEY SERVICES INC Applicant Address Phone: Insurance: 277 PALMER RD (413)436-7946 7pjub06033546 WARE, MA 01082 ISSUED ON:10/07/2021 TO PERFORM THE FOLLOWING WORK: CHIMNEY 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. Signature: r �I 1 • Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts �jc FOR . VtiBoard of Building Regulations and Standards / `C i.: ITY , Massachusetts State Building Code, 780 CM Building Permit Application To Construct,Repair,Renovat: Or I - , , :r 201 One-or Two-Family Dwelling 1 ' 2021 This Section For Official Use Onl, bsnr OF Building Permit Number: iQ— 2) 0 .200'7 Date Applied: NORr,8$i b,/y410 --0,5 1/ � ONMApo�'ON Building Official(Print Name) Signature SECTION 1:SITE INFORMATION 1.11roP rty)Addre�s��Jl `1 _ 9-3 � 1 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accJpted street?yes IC nono- 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 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ �(V SECTION 2: PROPERTY OWNERSHIP' 2.1 w Y1 RC e rf) (131"y Le sS i M 14 0 t V5 Name(Print) (� / City,State,ZIP 59 5 144 clan Vt Il,e _ 12 -ell ka -2‘11_53e4-hcire ccr r rl, (©� No.and Street Telephone E ai A ess SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0 ` Demolition 0 Accessory Bldg. 0 Number of Units _ Other VCSpecify:C tl LVVI. re .1 r3 Bri f Description of Proposed Work': LIrk _ 'U) I +VI ( l,v t S t d lQ \OJtkN r' ca l� ( �� -1 t e.SrS St-Q�G S Qom-- � SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 137 i t W 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ rx 0 Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ (7 2. Other Fees: $ 4. Mechanical (HVAC) $ z List: 5.Mechanical (Fire $ Suppression) esTotal All Fees: $ /'S Check No.i SO° Check Amount: u Cash Amount: 6.Total Project Cost: $751 Le ,Do 0 Paid in Full 0 Outstanding Balance Due: • 'f}•€ . r,s� tJ c.)1leJ"ui11 }�.Y} :ur, •• r . ' . 1. :r „�.r :• r i r .. ._ ._. .._ . i i -i':C:1i'►r s ':°.Jt�i �dF.i; a tirr.iilt ,.; iitr „• : 1 1 . J,7 .!; �� 'r;r✓ifi1.,- tl,rt t�. j, -.I.' ii: t /.iJ'r.�_:.._._ >.,.. r „ • , „ +, •7-7 CJ : `YL. r!i_jt. :ri7 t7:.,. f ' . , r fr; 7. f"I,;.;(I.#`()} .R) (cfst,r.r 'at: t►J^Jt :ii)ii; , :••t (itrs;':' . tii1;54,.l1-t! • r ,1 N()J: ) #>$t)1,i.:K.1! ()Jt./L:! . LT; a i / 7 , "„ v „ } 4' ii•i,' S. tetiJ}s: t! I:1/%1- 11.4ot ilq'JJJ•Or • ..Ft`3''r. I '.11t, t (,:! ` 1 }1 , 1. ',571.':;:: >3 el :;ii,:•1,1a;: �•._ ,1 C11Y1.1,1i, ;a•t i.Jlit➢tit: 1 rc.. .^,ill. j?t6r<ila"2 f;'ti; r/ f„.11%CI /11JJJ}1rJ! ..f }: f.i.i.�: i1.fl()t4ll`f. .i(3 .t,f7 ?(. t r" ;.i,. '�lfr.!'•IfJ� i or!� i... -_ _ - _ __. 11+ ii ,a ! r' iU 'l - %}tr.rit:<, If, t' 1J<i''. .f �;s;!� 1<7;!.. 7i. . ):. il�lJi jr<' : "J .. • • ... - 'f 1 , '• f7i!. •_ 1,e SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 10 5 O1 1 i Qc? r.i_tv\o_ LOall),A6 License Number Exp ation ate Name of CSL Holder Li,0 t 11,311 St PO 6e)/- / 1J� List CSL Type(see below)No.and Stree`■t I lJ `[(J Type Description SD CL In I Winne � et f 0 7 U Unrestricted(Buildings up to 35,000 Cu.ft.) 1 1 1 Ic�(.0 1 l ` R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry V, ,U � ` 43�`D�'`� `i c cli u/iC (v�► RC Roofing Covering Window and Siding ' Co 1/1"-1 Solid Fuel Burning Appliances el 131 -7g L 0 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1 dL-iI q a ct ( chu- i11.e. �L ft S HI Registration Number E iration Date HIC CAn y�i�me err HIC Regis N me No. d Street u re 1 ii n OW £a ( ({r. lap Email address-7G4� 5 /LCO S, WO') City/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 this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes 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 �1 re 5('2- ( Inl (' 1i1 CD S to act on my behalf,in all matters relative to work authorized by this building permit applic Lion. S -W\ Cie acr 113O a I Print Owner's Name(Electronic Stature) / 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. q ) so al Print Owner's or Authorized Agent's Name(Elect is ignature) Die 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/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"may be substituted for"Total Project Cost" . . • • ' • • - • )/...g11 - • -- • '•• - ,21 .•• •,., ; • ( 1 . - • • • -- r ,• 1`.! (-4 4. •••., C' '•,;'%; W'IP• !1' tr.-.7 - ta..!•:1 ; I .;. ;7: ;;;;;:, ;., ; , -; t*r,.,.,!;4o ii;r; 4 " t):; filff ..._.__ . . • 0 I 1.2?: ...„ . ' ••• • -44 • ..• ;! _ . . iir,•0) 71. • ',I •••11!fl 7, . • ; 7,1// frt. ftii :4. . . . _ ....__... .. . , (.)?/1,1...1-ft OK lz I tlt 7r.`.i. /I OF': (.1.1();` . . _ • .,4 • YL+1,:,4".91g)I1 7 'fel. ; t)/:./17K 41',,i..!!•( !-.;11.1.11()00 1. 1 Z.11 _ . - . - - • .1 4., 1,1 "it ••' i•-•;f ';17. AiLi;11,."73107: ';'41•2( • I'll'.1•14-11- -:•firlf, :•i . _ ,„•'; 1.16: 1 11!;;')• t17Sti,l+.0.?1 if.41( ' •3. -7 •—• lq; - It; 1 .!4411 11/IL , !C(. ( JO, i • • ,,!;?' , ,41r. . . _ . _ - - 7 , • . . $ /..1! i 4. .4 44 /r l4a4.!F . . City of Northampton /" Massachusetts tee?`' et\ f' DEPARTMENT OF BUILDING INSPECTIONS 9k. :;j,`" 212 Main Street • Municipal Building Northampton, MA 01060 j: ;..,a;:j...o CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, 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, S 150A. The debris will be disposed of in: Location of Facility: 7 7 i96-I ill� 1Z Care t_ 011 & ()(Oea The debris will be transported by: m of Hauler: CI �(� (mot _ d l� V `Sail El I Na e erV Signature of Applicant: Date: ALPOf r ; ;1 ..,v; - • - - • f. :‘•, -g: • •:! • ; • ;,; : 1.,} • fILL ,OS (2 r c07; The Commonwealth of Massachusetts -si' Department of Industrial Accidents ii —r• 1 1 Congress Street,Suite 100 �Y p �,� .__ r,: Boston,MA 02114-2017 °;, ` �''` w'ww.mass gov/dta 11 utkers'Compensation Insurance Affidavit:Builders/Contractors/Electrician/Plumbers. $0 BE FILED WITH THE PERMI'EIING AUTHORITY. Anolicant Information r(�,-, Please!rant Lead* Name(Husirtcss:(lrganizatiowtndividttal): FCeS (Lee CO L.,vh.rtet r5eyV l e-e S Address: 02 7 7 P mex, Y C_d- C'ityfState/Zip: L,,0 P t O - 0 l Oa Phone#: GLf i 313(s— ?q qc Art you an etrptrwer'!Check the appropriate bona Type of project(required)- I I am a employer with 77 _ cmpkryocs(full and or part-tin el.' I. D New construction 2 I am a sole proprietor or partnership and hart no employ INS working fur nee in any capacity_]No workers'ate.uti+urancr required.] �• Remodeling 9. ❑Demolition 301 am a honroroo cr doing all work myself_[No sooners'comp.insurance required.]' 10 Q Building addition 4.a 1 am a homeowner and will be hiring contractors to contact all work ore my property. l w ill ensure that all contractor.either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with nu employees. ill:Plumbing repairs or additions 50 I am a gaicral contractor and I have hired the sub-contractors listed on the attached sheet. 13.1 Roof repairs These sub-cuntracwn hale employees and have workers'coop.Insurance. t,.0 We are a eurpararion and its officer,have exercised their nght of etennrtion par lit(iL t 14. Other ` C.. 132.§144).and we hose no employees.R'u workers'comp.insurance required.] I C `1 `// •Any applicant that checks hot rI must also fill out the section below slxru,ing their ma rakers'tam peosation polity iofornmion. +ItomOWwnen who submit this affidu it indicating they are doing all nuik and theta hire oue.ide eostaraetows mind auknit as sew affidavit uhhratrnc„mdi. :tonnacton that check this bo in mt atta.hcd arm additional ahuet.hoar int the nameul the w1*-etrutactors and Male Whether ornot those entities hale employees. It the sub-eont[aeters lose n1104.,1 tis.they mu-a pros red ur ,.then maker.'omen,.pon n e. uanbcr. I am an employer that is providing n orrers"compensation insurance for my employees. Below is the policy and job site Information.Insurance Company Name: Q V e,Le it's Policy#or Self-ins.Lie.#: 7 Pi LA j2 O no 5/-iL Expiration Date: 51 IQ_ 1 t;(Gc lob Site Address: BC! S 40._„ (LOX\ V I City.'State.Zip:L.e nil 11- o k t,r, Attach a ropy of the workers'comp#tsallsu potty dedoratiott page(showing the policy number andtexpiration date). Failure to secure coverage as required under MGL c. 152,125A is a criminal violation punishable by a line up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a line 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'certi ' a r the pubes and penalties of perjury'that the information prorided aabore is tare mast correct Signature: ` Date: 1j 30 R ' Phone#: Cif 13) u367—� ` q c t , • Official use only: Do not write in this area.to be compkted by chy or town official City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2.Building Department 3.('ityffown Clerk 4.Electrical Inspector 5. Plumbing Inspector (,.Other Contact Person: Phone#: utvtslua ar rratesstuneu L e11SuiC Board of Building Regulations and Standards C nsr;ucdor34Nl lis,rSpecialty CSSL-105507 Expires:Of/18/2022 JAMES J WALLING .►- 40 HIGH STREET P.O.BOX 40 -., SOUTH BARRE MA 01074 ti vise Commissioner .;)1/46-0,-°4---- • Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation i — Registration: 182449 FIRESAFE CHIMNEY SERVICES INC it ( ='= Expiration: 06/25/2023 277 PALMER RD UNIT 2D Z"'j • WARE, MA 01082 9 -' Update Address and Return Card. SCA 1 0 20M-05/17��77 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 182449 06/25/2023 1000 Washington Street -Suite 710 FIRESAFE CHIMNEY SERVICES INC Boston,MA 02118 JAMES WALLING JR 277 PALMER RD C'(� "l` WARE,MA 01082 N alid wi signature Undersecretary AC R J CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) fr......./ 08/03/2021 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 pollcy(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: Jessica Pierce BRABO INSURANCE W�" _ ); (508)830-3800 FAX WIC.Not E-MAIL ADDRESS: jelerce@braboinsurance.com 65 Cordage Park Circle INSURER(S)AFFORDING COVERAGE NAIL I Plymouth MA 02360 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER 8: FIRESAFE CHIMNEY SERVICES INC INSURERC: INSURER D: 277 PALMER ROAD INSURER E: WARE MA 01082 INSURER F: COVERAGES CERTIFICATE NUMBER: 681364 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN D SyvD POLICY NUMBER IMM/DD/YYYYI (MWDDIYYYYI uMITs COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ DAMAGE TO CLAIMS-MADE OCCUR PREMISES(EaENTED occurrence) $ MED EXP(My one person) $ N/A PERSONAL a ADV INJURY $ GENII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECT LOC PRODUCTS-COMP/OP AGG f OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS N/A BODILY INJURY(Per accident) $ _ AUTOS NON-OWNED PROPERTY DAMAGE $ _7 HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS L1AB CLAIMS-MADE N/A AGGREGATE $ DED RETENTIONf , $ WORKERS COMPENSATION X PER OT H- AND EMPLOYERS'LIABILITY A OFFICEER OR/MEMBEEXCLUDED/ECUTIVE Y� WA WA 7PJUB0003354621 05/12/2021 05/12/2022 EL.EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE f 100,000 If es,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached M more apace 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.gov/Iwd/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 St AUTHORIZED REPRESENTATIVE y Northam to MA 01060 `-" P I Daniel M.Cr v ey,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 t:.•(.t(t-r+;t.•.:•ive.,.., .lf;t''r'. .%Kit'...;d.ARAiiii lc,i'i:nt•, ;:Fif?t&„i..., . , . t•... is 1''. 'it.7'Itir 'S:3`1')i4J•l'0.-Yor yK1.•-•1!,'' :a.•- 1's7 1 ..‘' (. i.iit;' .... ... 1. �C.ti :.f't:; ..r/' 4.. .. tri1(.), i?tC`it? i• ........._.. _.. .�.......... ....._ -.,- ..,... Mom..�.�..�.........._............. .._-. ...�_.... 4..... �._..Y. ..._. .. - .....,...._. r_ w...._....._w..-.�__....... ........ ....._.....- .� - .. - _ ,. ..AI•! . '4,.., I. t + ,A i Yi , • i i i I s i' _.NRt-1,� _FuicC�+tl..'>s. _;Yi•v Y,' . :F;._. '.', , . (:: '1 s' i.- f;' .. t.11 i'. .. .., .. .. .4 .• ct_ .Ic 1.(:1. 1r:d.; '"E14 "t:; . ' ii',1. . t , i5 • !' i i 1-.1 r: t 1.,r.. 1 • •+ .. • lat.,: :c... .. C 711tt.•'"` -%l(FF 1 t. ' '.:.j-'U.'SV! . ,O_9':L•.,d, 'q ii.QCR,.ni''.F i' '7 .f 1Glr(:1?. L., ,1..: ,."tlit.t..'ii. (IAC,; . .)a,,..t .u,'. :t. .,7`. 1 • is .t. • .etj .R - '.It•vfsl pa., `i:Ai ;,4"-(r,cj; ,;0 bril:. .vi It,.,; ls, ttutjc-trcy 'Ilf.r.C. :7J;:' t ' ,1AFj.)' fN•, :1 1 (.. ta.ikl, , R„t . . . i. •,. ?Ote hOJ .'+'..t:._ it' ., . _(.o1:Lb.f:1, Of„IV,: _Ai ±F+.1 !a-'f11 d,_R* . r-!:. L. yc1: .t' ,)1-.. 00.:. +F i- ..r; 1t:f'c 1!J.i VY?al .'J - O (, ' :;f'< 5;:r :;O••, .e-';'C ., c.:', :".'':.t." t.,- :..-IF bG:, . - 1 i. '-'..1,- i.t.' :' '. :' µl' - •1- (_'•t' !•t.OLli".4, F3 . ''tf r vr, Qiii+ _ �J ,i..1.. r1-: E l.iF • t+ t's .i•11'e�. C FIRECHI-01 JPIERCE ,4coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM2DD/YYYY) 8/3/2021 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 ACT Brabo Insurance Agency E FAX 65 Cordage Park Circle PHO No,EEst):(fi08)830-3800 (ANC t (A/C,No):(508)746-1540 Plymouth,MA 02360 ittA,1pASS:Info@braboinsurance.com RIBURER(S)AFFORDING COVERAGE NAIL It INSURER A:Northfield Insurance Company INSURED INSURER : Firesafe Chimney Services Inc. INSURER C: 277 Palmer Rd INSURER D: Ware,MA 01082 INSURER E: INSURER F: 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. I Y EXP LTSRR TYPE OF INSURANCE ADOL PAM POUCY NUMBER (wDnyyyyl POU C 1 UMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR WS420788 7/15/2021 7/15/2022 DPREMISAMAGEES!TO Ea RENTED $ 100,000 or�rxrancal MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 HPOLICY n JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (Ea accident) LE LIMIT $ ANY AUTO BODILY INJURY(Per Person/ $ OWNED SCHEDULED AUTOSED ONLY AUTOS WNE BODILY INJURY(Per accident) $ _ AUTOS ONLY „_ AUTOS ONLDY (��accident)TY $ $ _ UMBRELLA!JAB _ OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'UABILnY Y/N PER ERH ANY PROPRIETOR/PARTNER/EXECUTIVE n E.L.EACH ACCIDENT $ QNandat/MMBE�EXCLUDED? N/A FIFI E.L.DISEASE-EA EMPLOYEE $ H yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached r/more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Northampton ACCORDANCE EXPIRATION WITH THE PO POUCY PROVISIONS. WILL BE DELIVERED IN Puchalski Municipal Building 212 Main St Northampton,MA 01060 AUTHORED REPRESENTATIVE ACORD 25(2016/03) ®1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD . .. .417r! .. 3314.4.51t.ii31/1! `;'11,.. Ai...! i0 -et- , 1:-:::c•f-,8 . .. . .... . .. . .... ... _ .. . . . . _ __ ....7..,-17 ttalit!;.:.(9ill.i;:)iiti?:5•413:i.;rii:J)(IAA 'r...t4t) ;aCii Tit:0540-4;4i '--t,:_-t •.;.: "Trk.lt,41 ak :. 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