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31B-231 (7) BP-2022-0236 57 GOTHIC ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-231-001 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-2022-0236 PERMISSIONIS HEREBY GRANTED TO: 2022 CHIMNEY, SUPPORTS & Project# FOUNDATION REPAIRS Contractor: License: Est. Cost: 20670 DAVID OSIECKI CSL089376 Const.Class: Exp.Date:01/05/2024 Use Group: Owner: 57 GOTHIC STREET LLC Lot Size (sq.ft.) Zoning: CB Applicant: WESTERN MASS MASONS LLC Applicant Address Phone: Insurance: 383 COLLEGE HIGHWAY 413-527-1800 6S60UB4N95684A21 SOUTHAMPTON, MA 01073 ISSUED ON:03/11/2022 TO PERFORM THE FOLLOWING WORK: REMOVE CHIMNEY TO BASE, REPLACE 3 LALLEY COLUMNS, REBUILD SECTION OF OUTSIDE FOUNDATION 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: :Kt I. 4 I A LIL ' I Fees Paid: $137.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner File #BP-2022-0236 APPLICANT/CONTACT PERSON:WESTERN MASS MASONS LLC 383 COLLEGE HIGHWAY SOUTHAMPTON, MA 01073 413-527-1800 PROPERTY LOCATION 57 GOTHIC ST MAP:LOT 31B-231-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST • ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $137.00 Type of Construction: REMOVE CHIMNEY TO BASE, REPLACE 3 LALLEY COLUMNS, REBUILD SECTION OF OUTSIDE FOUNDATION New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:* Intermediate Project: Site Plan AND/OR SpecialPermit With Site Plan Major Project: Site Plan AND/OR SpecialPermit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Av a ilability Septic ApprovalBoard of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay /7€ 3- j 1-2czZ. Signature of Building Official Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. 171 ' i The Commonwealth of Massachusetts ` :' Board of Building Regulations and Standards FOR s ' CD Massachusetts State Building Code, 780 CMR MUNICIPALITYUSE =Building ermit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 I < One-or Two-Family Dwelling I. This Section For Official Use Only Building Permit NAM : _ew— " .A. , `,t Date Applied: �v1, s 5} //— 3-/I-20Z2 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property A dress: , 1.2 Assessors Map&Parcel Numbers .57 6o7/ ,c S/. 1.la Is this an accepted street?yes 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 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 2 --� S/a-y� %AA, 1/,�A/7J 3 /�7 �jci/h,L S`��f c.-% ./l_ t UY6 Name(Print) / City,State,ZIP 57 C1743 .s - Pc?- 6.5.-(ills7 SA-frtii t�L,T cis A. t/1re No.and Street Telephone Email Altftress SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': Sc.= _A-i?4-ta SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost' (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: S 0/0 /?U cz 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Od'q32 V D4- IC) £73 c.14 License Number Expiration Date Name of CSL Holder code /174L- List CSL Type(see below) No.and Street `1 / Type Description /Z', / 0/0? a U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,St ,ZIP M Masonry RC Roofing Covering WS Window and Siding L _ 1 SF Solid Fuel Burning Appliances y/ s7.? 1p t� �t,.�1,77 e�+JII��/LI j3�1/�furl� I Insulation Telephone / Email address �'^` D Demolition 5.2 Registered Home Improvement Contractor(HIC) s 41 .0 ,is HIC Registration Number Expiration Date HIC Conap anxName or HIC Registrant Na No.and tree Email address City/Town, S te,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 V 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 Owner'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 application is true and accurate to th st of my knowledge and understanding. Print Owner's or Authorized Agent's N lectronic .gnature) Date 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" CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton `4 j~ Massachusetts ,..'Y*i:, '1;-- i. ti x1 DEPARTMENT OF BUILDING INSPECTIONS . , 212 Main Street • Municipal Building �i s Northampton, MA 01060 1.sSNiV ,‘. CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 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, S 150A. The debris will be disposed of in: Location of Facility: D 4 'IC. r The debris will be transported by: Name of Hauler: .�c� /Af, ,j Signature of Applicant: Date: N. as 7\ The Commonwealth of Massachusetts i t / Deportment of Industrial Accidents ►s I Congress Street,Suite 100 7' Boston,MA 02114-1017 7 v,. www.lnass gov/dia 11„t key+' Compensation Insurance AlTrdavit: Builders/Contractors/Electricians/Plumbers. `1'D BE FILED 551"1'11-till:PERMUTING AUTHOW'I'y'. ‘tittlicant Inforrnation A Please Print L.eeiht+ Name Il3u„ t h untrauun:Indr‘idual): l ,e ( er,.-_ . AilU 1 _a Address: 3 e_ CJi(it— City/State/Zip: L,../h /2 ^ "0 11"071 Phone#: �, 7—/ C,-c-- Are you an employee Cheek the appropriate lit Type of project(required): 1. Trn a employer with._.S .. ,.__cmplo,(full andior part-tinse).• 7. 0 New construction 2.7 I 41n a wle pn,pnctar or partnership and have no employees working for me in 8. 0 Remodeling an.,alvedy'_[Nu w^urtera'e.omp,tru ir.Ine* requited,.] (—� 9. 0 Demolition ._.t_.1 i am a homeowner doing all wort myself.[No workers'(mop.imuram<c required.)' 4.0 1 am a homeowner and will be hiring wen-actors to conduct all work on my property. i will 1 U l3Ullding addition ensure that all tonrractues either have workers'compensation inseams or ate sole i 1.0 Electrical repairs or additions pmpriciors with no empiuveca. 12.0 Plumbing repairs or addition_. co I am a general contractor and 1 have hired the sub-contraeton lined on the attached sheet. 13©Roof repairs These sub-contractors have employees and have workers'comp.insurance.; h.�we are a corporation and its officers rter s have eeisect their right of exemption per MCGL r. 14.0 Other-- — 152,Q 1(4),and we have no employees.[No workers'cerop.insurance requited.) •Any applicant that eho.:i..h os el must also fill out the section below showing then sa arker compensation polity information t Homeowners who submit this affidavit indieat ng they are doing all wort and th.r hire outside contractors must subunit a re» affidbt'it indicating such. IContractors that check this but must atta•hed an additional sheet showing the name of flue sub-contractors and state whe iaer i.r not thuse entities have emploYeCN If the suh-contractors lure cnaplos er..they must prat ide their %linkers'.onnp.pinny nurnher i am an employer that is providing workers'compensation insurance for nth employees. Below is the policy and job site in frrmation. f 4insuran a Company Name: ,/X'7T�✓l. ,Zi'fry ia•r'I/"J /i f Policy#or Self-ins.L c.#: J 6 0 a 1`l/V Y i.0 7 ibt / Expiration Date /6 4)-0T3 Job Site Address: cc? 6 i -i• .Si. Ci /Statei'Zi r� d 4 // policy a copy of the workers'compensation pol declaration page(showing the policy num and expiration date). Failure to secure coverage as required under MGL c. 152, *25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certllj' er the i and penalties of perjury that the information provided above is true and correct. Signature: Date: -.-?'),, Phone#: /77 s,;>--7--(/ 'i Official use only. Do not write in this area.to he completed hy city or Willi official City or Town: PermiLrl.icense i Issuing Authority(circk one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical inspector 5. Plumbing Inspector 6.Other ` Contact Person: Phone#: RN , 383 College Highway QUOTE Southampton, MA 01073 1 if LICENSED - REGISTERED (413) 527-1800 INSURED WesternMassMasons.com qualrty@westernmassmosons.corn 41S 0\111) SAM WHITNEY Date: 2-04-2022 To: 57 GOTHIC ST. I Quote# 8923198 NORTHAMPTON MA Project MM. Phone: 808-635-2157 E-mail. 0.1,7 Description of Work To Be Done: , •RS: 1. CHIMNEY: the chimney will be removed from the top all the way down to the basement floor. Temporarily cover the roof, homeowner responsible for roofing cost. Open up walls as needed throughout all levels of the home to remove the existing fireplace and chimney. Walls and floor will remain open and is the responsibility of the homeowner to infifl as they see fit Install any support Lally columns in the basement as needed. Homeowner responsible for plumber disconnecting and re routing the heating system prior to the work beginning. TOTAL S 10,885.00 2. 3 brick Lully columns are also failing structurally and must be replaced with new steel and concrete columns. Dispose of all old material. TOTAL S 5785.00 3. Remove and rebuild one section of the outside foundation wall on the inside of the home where the bricks are breaking down. TOTAL $ 4000.00 WE HEREBY PROPOSE TO FURNISH MATERIALS AND LABOR IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS, OR THE SUM OF. This quote may be withdrawn from us if not accepted within 30 days.Quote Prepared By: David Osiecks Thank You For Choosing Western Mass Masons! - • --..lr-- , ... 383 College Highway , ; 1 • QUOTE r# Southampton, MA 01073 1 ' l'i ' \ 0 LICENSED • REGISTERED (413) 527-1800 INSURED WestemMassMasons.com quality@westernmassmasons.corn 4S0 TERMS:Any alteration or deviaben trore above spocilleations implying extra costs eel be executed tiny upon written orders,and volt become an Entra chaTge over and above the esttnale.By sogning this quote,you agree and unierStand 1 the above terms ar4 c.onditirm that an*to this ph AnY rhanniK Mar are to tPrilarSo.rtue.t hP dscussed prior to coristrusixon and agreed upon by waractof and may aiso affect lo the tin*deice PAYMENT TO BE MADE AS FOLLOWS:One had of quoted amount't di le when,vb oaretruction has begun Remareve balance of bit en14 be paid in full when job is oornalete. 4 nnanoe Charge of 1 It?(18%annuat rate)per month will be added to any unpaid bake=over 30 days ACCEPTANCE OF PROPOSAL:the above pnte .sp.m'fIcations and CXXX111015 are satistactray and hereby accepted You are authorized to do the work as specrtiod h Paymvx era be made as outlined above ' pending successful close of escrow, currently scheduled for 3-11-22 svaturo 1 fr,q,rz.v3.rt Dote i.. 1.I iilul Thank You For Choosing Western Mass Masons! ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `.� 02/16/2022 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: tf 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: Beth Carballo FINCK& PERRAS INSURANCE AGENCY INC (ac.No. ): (413)527-3000 FAX INC,N,): nnAIDREss: bcarballo@finckandperras.com 6 CAMPUS LANE INSURER(S)AFFORDING COVERAGE NAIC# EASTHAMPTON MA 01027 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: WESTERN MASS MASONS LLC INSURERC: INSURER D: 383 COLLEGE HWY INSURER E: SOUTHAMPTON MA 01073 INSURER F: COVERAGES CERTIFICATE NUMBER: 745926 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 ADDLIS SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JE T LOC PRODUCTS-COMP/OP 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 LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY A OFF CER/MEMBEREXCLUDED ECUTIVE N/A N/A N/A 6S60UB4N95684A21 06/01/2021 06/01/2022 E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 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.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 JDR Builders ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 66 AUTHORIZED REPRESENTATIVE Whately MA 01093 Daniel M.Cro(IyMy,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 CO DATE(MM/DD/YYYY) A CC CERTIFICATE OF LIABILITY INSURANCE 02n6/2022 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 CONTACT Elizabeth Carballo,CISR,CPIA NAME: Finck&Perras Insurance Agency Inc. (A/C E Extl: (413)527-5520 FA No): (413)527-5970 6 Campus Lane E-MAIL bcarballo@finckandperras.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Easthampton MA 01027 INsuRERA: State Auto Insurance Companies INSURED INSURER B: Commerce Insurance Company 34754 Western Mass Masons LLC INSURER C: 383 College Hwy INSURER D INSURER E: Southampton MA 01073 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2142805541 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 INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE CLAIMS-MADE X OCCUR PREMISESO(Ea occcu r nce) $ 50,000 MED EXP(Any one person) $ 5,000 A Y BOP273419708 04/20/2021 04/20/2022 PERSONAL 8,AOVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 50,000 B AUTOS OWNEDONLY /� AU X SCHTOSEDULED VW51 50 11/08/2021 11/08/2022 BODILY INJURY(Per accident) $ 100,000 X HIAUREDTOS ONLY X AUTOS ON NON-OWNEL D PROPERTY DAMAGE (Per accident) $ 100,000 Y UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) JDR Builders is listed as an additional insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN JDR Builders ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 66 - - AUTHORIZED REPRESENTATIVE Whately MA 01093 .r,y)/ ( -iedl lr/D ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD