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23B-011 (12) BP-2022-1291 193 LOCUST ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23B-01 1-001 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-2022-1291 PERMISSIONIS HEREBY GRANTE'S TO: Project# INTERIOR RENO Contractor: License: Est. Cost: 131500 WALTER MAREK 111 055201 Const.Class: Exp.Date:06/23/2024 Use Group: Owner: 193 LOCUST ST ASSOCIATES LLP Lot Size (sq.ft.) Zoning: 01 Applicant: W MAREK INC Applicant Address Phone: Insurance: 73 SOUTHAMPTON RD (413)977-9539 WCC-500-5014290 WESTHAMPTON, MA 01027 ISSUED ON:10/12/2022 TO PERFORM THE FOLLO WING WORK: INTERIOR RENO 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL TION OF ANY OF ITS RULES AND REGULATIONS. Signature: Q C • Fees Paid: S920.50 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner go iza ECE� I The Commonwealth of Mask3ac usetts I�1 Office of Public Safety and Inspectio 0 j i n Massachusetts State Building Code(780 ) Building Permit Application for any�on For Officiali Ugeother than i One For Two-Farmilri5 rc11oNS g (ThisOnly) n,,.,,ON.h9 01060 .ITV � Building Permit Number.(? ' i?t4 I Date Applied: Building Official: c SECTION 1:LOCATION No.and Street City o n Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot # SECTION 2 PROPOSED WORK Edition of MA State Code used 9 th If New Construction check here 0 or check all that apply in the two rows below Existing Building! Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No 2 Brief Description of Proposed Work:Renovate&reconfigure a portion of the building to provide a formal area for sick visits(VIP area)Revovate the office area for improved efficiency. SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) O Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) Total Area(sq.ft)and Total Height(ft) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business r E: Educational 0 F: Factory F-1 0 F2❑ H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility• Special Use 0 and please describe below: Special Use Description: SECTION&CONSTRUCTION TYPE(Check as applicable) IA 0 IB ❑ IIA ❑ IIB 0 ILIA CI IIIB ❑ IV 0 VA 0 VB SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal: Public IICheck if outside Flood Zone ElIndicate municipal 0 A trench will not be Licensed Disposal Site 0 required II or trench or specify: Private 0 or indentify Zone: or on site system U permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 0 Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: 9 th Use Group(s): a/S2 Type of Construction: VB Does the building contain an Sprinkler System?: No Special Stipulations: Design Occupant Load per Floor and Assembly space: 86 _ SWOON 9t PROP TY OWNER A[UI1 fORIZATION Name and Address of Property Owner 193 Locust Street Associates, 193 Locust St.,Northampton MA 01060 Name(Print) No.and Street City/Town Zip Property Owner Contact Information; David Steele,managing partner, 413_517-2226 413-325-6106 alok@napeds.com Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Kimberly Brewer,Practice Administrator, 193 Locust St.,Northampton,MA 01060 Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION ilk C1QNS3'*UC111ON CONTROL(PI.ee fill anti Appendix I) If a building is less than 35,00a cu.ft.of endured apace and/or not w'der..0 etion Contralti=dwelt bin 0. OtherwiseiLi prove 5onttuctianeu •to� (fee•Se ail ifs in thte code)as re intit 10.1 Registered Professional Responsible for Cw1 Coslrei't;11 pedeaioual erearib ffiisdQea sot .bioittaia) Thomas C Chalmers 617 538. 7886 tom c©austin.design 8317 Name(Registrant) Telephone No. e-mail address Registration Number 167 Main St—Ste 302 Brattleboro VT 05301 Architecture 08/202.3 Street Address City/Town State Zip Discipline Expiration Date 10 0e0at Lesitea'lntr W Marek Inc. Company Name Walter Marek Ill CS-055201 Name of Person Responsible for Construction License No. and Type if Applicable 73 Southampton Rd Westhampton Ma 01027 Street Address City/Town State Zip 413_977. 9539 --- --- wmarek3(a)comcast.net Telephone No.(business) Telephone No.(cell) e-mail address $10NAIA:t+y + iss'eor,�st�rsAl to 8;�»AVlT(M.G.1-c.152-i ) A Workers Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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 Is a signed Affidavit submitted with this application? Yea LI No Cl , SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE , Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=5_ 1.Building $ 90,000 Building Permit Fee=Total Constnutio Cost x 2.Electrical $ 17,800 appropriate municipal fact )=S. �a 1 3.Plumbing $ 0 4.Mechanical (HVAC) $ 23,700 Note:Minimum fee=$ ( start munrapali , 5 Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 131,500 (contact municipality)and write check number here O a7O SECTION 13:SIGNATURE OF WILDING PERMIT APPLICANT 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 accura to th f my knowledge and understanding. Kimberly Brewer .—� Practice Administrator 4131517- 221 10/7/2022 Please print and sip name Title Telephone No. Date 193 Locust St.,Northampton MA 01060 kbrewer@napeds.com Street Address City/Town State Zip Email Address Ldli Municipal Inspectoe In fill sat this secliunupon appliicatlon approval: f 0/1</ Name •Date Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Recuired 1 Architectural x 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) 10 Surveyed Site Plan(Utilities,Wetland,etc.) 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been app oved by the authority having jurisdiction. Registered Professional Contact Information Thomas C Chalmers 413.624_9669 tom@austin.design 8317 Name(Registrant) Telephone No. e-mail address Registration Number 08/31/2023 Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date • Please follow this link for construction control forms to be used by Registered Design Professionals. October 01, 2022 Northampton Area Pediatrics, LLP 193 Locust Street Northampton, MA Building Code Narrative Existing Conditions and Summary of Proposed Work The property at 193 Locust Street houses a pediatrics clinic The purpose of the proposed work is to reconfigure a portion of the building to provide a formal area for sick visits and to improve efficiency in the office area. The work affects 20% of the first floor area. There is no change in use or additional space added. The building is not sprinklered and the proposed work does not trigger requirements for sprinklers. Proposed work includes: • Interior renovations to reconfigure the space include relocation of an exterior entrance, relocation of three windows, relocation of interior partitions and doors, reconfiguration of ceilings, millwork and casework. There is no work to bathrooms or plumbing systems. There is HVAC, electrical power and lighting work related to the alterations. Alarm systems will be modified as necessary. • Exterior Renovations include the new entry door and windows, and a concrete sloped walk to make the relocated entry accessible to persons in a wheel chair. The walk slope is less than 5%, and not a ramp. • Code related work: o Alterations to make the relocated entry door fully accessible. o Installation of new emergency lighting and exit signs as required. o Modification of alarm equipment as required. Applicable Codes: • MGL ch 148, section 26G: sprinkler protection in certain buildings which total more than 7,500 gsf in floor area. • 2015 IEBC International Existing Building Code with MA Amendments 780 CMR Eighth Addition. • 2015 IBC International Building Code with MA Amendments 780 CMR Ninth Addition. • 2018 IECC International Energy Code. • 2010 ADA Standards for Accessible design IEBC classifications for work include Chapter 9 Level 3, Chapter 8 Level 2, and Chapter 7 Level 1 Alterations. All new work will conform to 780 CMR ninth edition and the IBC. ■Austin Design Cooperative, Inc. •tom@austin design ■ 167 Main St, Suite 302, Brattleboro, VT 05301 ■802.451.59s6 ■289 Main St, Greenfield, MA 01301 ■ 413.624.9619 Northampton Area Pediatrics Building Code Narrative October 01, 2022 Page 2 Core Building Data: Existing and Proposed: • Gross SF Building Area = 10,650 gsf • Number of stories = 1 and basement • Building height= 20 ft. • Construction Type: VB, unprotected (concrete slab on grade, wood and steel studs, wood exterior siding, mixed interior partitions, asphalt roofing) • Use group and Occupancy: Mixed use—non separated, B and S-2: • S2- Basement Storage 3,325 gsf • B—Ambulatory Care 7,325 gsf • Occupant Load: Total = 86 • Business = 7,325 gsf; 74 (100 gross) • S2 = 3,325 gsf; 12 (300 gross) • Table 504.3 Allowable Building Height: Type B, NS 20' (40) • Table 504.4 Allowable No. of Stories: Type B, NS 1 story (2) • Table 506.2 Allowable Floor Area: Type B, NS 7,325 (9,000) • Construction Type Table 601 Type VB • Sprinklers Not provided or required. • Partition Ratings: Not rated • Egress Number of Exits 6 (2) Travel Distance 103' max. (250) Common Path 75' max. (75') Egress Illumination Yes Exit Signs Yes • Accessibility: Common Spaces Accessible Applicable Code Review Summary: MGL ch 148,section 26G • Every building or structure including additions or major alterations which total more than 7,500 gsf in aggregate floor area shall be protected with an automatic sprinkler system. • For existing buildings, renovation work triggers compliance if A: work is deemed major; and B: if scope and cost meet certain thresholds. • A: Work is deemed major if it includes demolition or reconstruction of ceilings; demolition or reconstruction of subflooring; demolition, construction or repositioning of walls, stairways, or doors; removal of significant portions of the building's MEP systems that involve penetration of walls, floors and ceilings. • B: Scope is considered major if 1: when work affects 33% or more of the total gsf; and 2: the total cost of the work is equal to or greater than 33% of the assessed value of the building. • Conclusion: While The building, including basement, is over 7,500 gsf, the scope is not considered major as it affects only 20% of the first floor area, thus sprinklers are not required under MGL ch 148. ■Austin Design Cooperative, Inc. ■tom@austin. esign ■ 167 Main St, Suite 302, Brattleboro, VT 05301 ■802.451.59 6 ■289 Main St, Greenfield, MA 01301 ■413.624.96 9 Northampton Area Pediatrics Building Code Narrative October 01, 2022 Page 3 Relevant Sections of 2015 IEBC as amended by 780 CMR 9th Edition: Chapter 9 Alterations—Level 3 • 901.2 Compliance: Work shall also comply with the provisions of Chapters 8. • 904.1 Automatic Sprinkler Systems: Automatic sprinkler system to comply with 804.2. • 904.2 Fire Alarm And Detection Systems: Fire alarm and detection systems to comply with 804.4.1 and 804.3 and IBC. • 904.2.2 Automatic Fire Detection: Automatic fire detection system shall be provided where required by IBC. • 905.1 General: Means of egress to comply with Section 805. • 905.2 Means Of Egress Lighting: Means of egress lighting to be provided in accordance with IBC. • 905.3 Exit Signs: Exit signs to be provided in accordance with IBC. Chapter 8 Alterations— Level 2 • 801.2 Compliance: Work shall also comply with the provisions of Chapters 7. • 803.4 Interior Finish: Interior finish shall comply with the requirements of the IBC. • 804.2 Automatic Sprinkler Systems: An automatic sprinkler system is not required by this section or by the IBC and MA amendments for B use<12,000 gsf. • 811.1 Energy Conservation: Alterations shall conform to the requirements of the IECC for existing and new construction. Chapter 7 Alterations— Level 1 • 702.1 Interior Finishes: Interior finishes shall comply with Chapter 8 of the IBC. • 703.1 Fire Protection: Alterations shall be done in a manner that maintains the level of fire protection. • 704.1 Means of Egress: Alterations shall be done in a manner that maintains the level of protection provided for the means of egress. Relevant Sections of 2015 IBC as amended by 880 CMR 9th Edition: 2015 IBC Chapter 10 Fire Protection Systems: • 903.2 Where Required: MA Amendment Table 903.2 Occupancy Automatic Sprinkler Requirements: B> 12,000 sf; S2 Not required. 2015 IBC Chapter 10 Means of Egress: • 1006.1 Number of Exits and Exit Access Doorways: The number of exits required shall comply with Section 1006.3 for stories. 2 • 1008.1 Means Of Egress Illumination: The means of egress, including the exit discharge shall be illuminated at all times except as follows: • 1013.1 Exit Signs Where Required: Exits and exit access doors shall have an illuminated exit sign except as follows: ■Austin Design Cooperative, Inc. ■tom@austin.design ■ 167 Main St, Suite 302, Brattleboro, VT 05301 ■802.451.5916 ■289 Main St, Greenfield, MA 01301 ■413.624.96:9 Northampton Area Pediatrics Building Code Narrative October 01, 2022 Page 4 2015 IECC Energy Conservation and MA Stretch Code: Chapter 5 Existing Buildings: • C503.1 Existing buildings, Alterations: Alterations shall conform to the requirements of the IECC for new construction with the following exceptions for which they need not comply: 1. Surface applied window film. 2. Storm windows applied over existing windows. 3. Existing ceiling, wall or floor cavities exposed during construction provided that these cavities are filled with insulation. 4. Construction where the existing roof, wall or floor cavity is not exposed. 521 CMR: • 3.3.1.b if the work costs $100,000 or more, then the work being performed is required to comply with 521 CMR. In addition, an accessible public entrance and an accessible toilet room, telephone shall be provided. • Currently the work is expected to be more than $100,000 and less than 30% of the value of the building. The existing building has an accessible entrance, accessible toilet rooms, accessible exam rooms and an accessible entrance. • All new work will conform to 521 CMR. In addition, an existing non-accessible entrance will be altered to make it accessible to persons in a wheel chair. Respectfully submitted Thomas C Chalmers, AIA, NCARB Austin Design Cooperative, inc. it F,REUAq Mg \\ of0F/ ■Austin Design Cooperative, Inc. ■tom@austin..esign ■ 167 Main St, Suite 302, Brattleboro, VT 05301 ■802.451.59:6 •289 Main St, Greenfield, MA 01301 ■413.624.96.9 Initial Construction Control Document To be submitted with the building permit application by a vl�ll Registered Design Professional t! for work per the ninth edition of the �—sY.,. Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Northampton Area Pediatrics Date:10-09-2022 Property Address: 193 Locust Street, Northampton, MA 01060 Project: Check (x) one or both as applicable: New construction X Existing Construction Project description: Interior Alterations to staff area I Thomas C Chalmers MA Registration Number: 8317 Expiration date: 08/31/2023 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project. I, or my designee, have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge, information, and belief the Work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet"or electronic signature and seal: 49;c�`y.�C C e4, 1. t • o Phone number: 413-624-9669 Email: tom@austin.design ,., MoF Building Official Use Only Building Official Name: Permit No.: Date: Note 1. Indicate with an 'x' project design plans, computations and specifications that you prepared or directly supervised. If'other' is chosen, provide a description. Version O1 01 2018 City of Northampton 0�tN';Mp Massachusetts he'(41 . d 1 if, r � a DEPARTMENT OF BUILDING INSPECTIONS v- r 212 Main Street • Municipal Building J . w� Northampton, MA 01060 ay" } 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: Valley Recycling The debris will be transported by: Name of Hauler: AmherstTrucking Signature of Applicant: '�� Date: 10/10/2022 ...._. ,` _ The Commonwealth of.t1assachusetts era.-...�.. Department of Industrial Accidents ?,a1tl 1 Congress Street.Suite 100 Boston, .V.402114-2017 WIVWe mass.gor/dirt 11 utkers'Compensation Insurance.Uftdas it:Buildersi('ontractorsiElectricians/Plumbers. 10 Bt. t 1l.t.l)%%1111 11i1.:I't-R'11l I IM Al: I Itt)RI I N. Applicant Information Please Print Leitihls Nitrite(Business't)r aniration Individual i: W. Marek. Incorporated Address:_ 73 Southampton Rd City(StatelZip:_Westhampton,Ma 01Q27 Et]tt)Iti' -: 413 977 9539 Are you its eirpinyer'Cheek the appropriate blot: Type of project(required): 1. 1 am a employer wtih 5 empltsyc`t (full a ak*part-time)-" 7. `ant construction .:D I am a sole proprietor or p nner hip and have no empk,e ees workitng forme apt 8. t:u! Remodeling tiny e`apa.aty.[NO wtaker>'comp.trrauraner required" 9. []Demolition I am a totnoantar Jorn.t all work myself.[No worker,'comp.linutrancc required.]1 4.0 I am a In n .net and N ill he hiring.contractor%to conduit all n,rk on my ptvperty. I wilt 10 Building addition o ensure that all contr cton either hate workers'cenlq,eniaitent insurance ea arc sac 1 i.0 Electrical repairs additions proprietors with no cmployccti. 12.0 Plumbing repairs additions < I ant a g,-rw-ral contractor and i has c hoed the sub-cerntracfam Wave on tttc attached`heer.. ]'hex 13.DRoof repairs subauistractun hashas.: la employee,and %e weakens'et np.irtcurarne.� Other 6.0 We are*corporation and its officer.ha,e.eteicn.ed their nbhi of exemption per Will.c. 1$ 152.f 10►.and we hate no urgtloy-aces.[No worker'cutup.insurance nequivedj *Any applicant that chocks boa 1+1 anent also fall out the section beton%tow inp their worker,"compensation policy infnnnation_ Itomeowran%w hi,%went[tinsaflidasrivaJacatanrilheyare,k,ingallnor%andthenhue„utiade,ontractursmint,ul,mrtaneNatywlasrtnalatais ,e h :Contractor,that beck this kit anus i ait_ched an:,1dttionat sheet shin,ma?the name(It the,yh-ed.inf aeke as and state N painter a.,rtui tln.se aal1iti s pact i nnidoyce,. If du sub-contractors hose eiavloyees.11tey 1111.04 pre„talc their ,corkers'.e+urp.p,atte y r.Lsnlvt. I am an employer that is providing worAen'compensation insurance Or my employees. Below is the policy and job site information. Insurance('otnp.tn Name: AEICO Policy#or Self-ins.L►e.::. WCC-500-5014290-2022A Exptt.aitt,n Data: 02/10/2023 Job Site Address:__193_LQcust nit% state Lip: Northampton, Ma 01060 Attach a copy of the workers'compensation polio) declaration page(shcming the polio, number and expiration date). Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a tine up to S .500.00 and/or one-year imprisonment.as well as civil penalties in the form ofa 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 ce coverage serification. I do!hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sienalilit:: Date Phone 413 977 9539 Official use only. Do not write in this area.to be completed by city or town official ('its or Ton n: Permitl!.icense Issuing.luthorit% (circle one): 1. Board of'Health 2. Building I)epariment 3.('ih Ton a Clerk 4. Electrical Inspector 5, ilumbing Inspector 6.Other Contact Person: Phone#: ACC3R Er CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOD/YY Y) 03/29/2022 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 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 RAW: I K.S.K.INSURANCE AGENCY,INC. j,,NO,�"Naf,t):(413)527-7859 !FAX Nej:(413)52741314 203 Northampton St. annepas, travIssiasaksk4naurance.com P.O.Box 597 **ultras)AFFORDING COVERAGE I NAIC# , Easthampton MA 01027 INSURER A: REPUBLIC FRANKLIN INSURANCE CO INSURED INSURER a: ASSOCIATED EMPLOYERS INSURANCE CO] . W.Marek Incorporated INSURER C: 73 Southampton Rd INSURER 0 Westhampton MA 01027 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 T 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 SEEN REDUCED 8Y PAID CLAIMS. MISR A00LSUBR( POUCY EFF POLICY EXP i 1 LTR TYPE OF INSURANCE Dunn own. POLICY NUMBER ,(MMIDOMYYYYI IMM/DD/YYYY1; LIMITS X COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE $1,000,000 A I CLAIMS-MADE OCCUR PRFMGE TO RENTED GOO PRFMISFR(Fa nrrlv a renca) $ _____ 5406031 11/01/2021 11/01/2022 MED EXP(Any one person) $5,,000 ____ PERSONAL.&ADV INJURY $1,000,000 _,4_ GEM.AGGREG TE LIMIT APPLIES PER: GENERAL AGGREGATE ,$2,000,000 ��X POLICY 1 I LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s (Ea accident) ANY AUTO BODILY INJURY(Per person) S UT OWNED I SC SCHEDULED BODILY INJURY(Per accident) S 111 NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Per accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE -._ _..$ --_--- DEO I RETENTION S $ WORKERS COMPENSATION PER OTH- X STATUTF FR AND EMPLOYERS'LIABILITY Y(f� B OFFICER/MEMBANY ER EXCLUDED?ARTNER/EXECUTIVE�,('N/A WCC-50 0-5 01 429 0.2022A 02110/2022 02/10/2023 E.L.EACH ACCIDENT $1!00,000 (Mandatory In NN) U E.L.DISEASE-EA EMPLOYEE $1O9,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT ;$500,000 • DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached Brunie spacer Is raquk.d) GENERAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE 'DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE `` 01 4 <DA,' 414" 01988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD vsn,u.nn.nrg,u. a..naaaaeuuaecw ' Division of Occupational Licensure Board of Building R ul__acctions and Standards Con r 6tA VS15,_4 vd of CS-055201 a l c�pires:06/23/2024 WALTER L MAREK,Ill 73 SOUTHAk4PTON RD WESTHAMPTN MA 01027 or \twig,/ Commissioner 0) vt?li.A. Commonwealth of Massachusetts Division of Professional Licensure Hotsiftfitgn'cr HE-156708 ,pires 06/23/2023 WALTER L MAREK,RI 73 SOUTHAMPTON RD r ^` WESTHAMPTON MA 01027' Commissioner t THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs;&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Corporation aegis ra'on iqn 159488 04 29/2024 W.MAREK INC. WALTER MAREK Ill 73 SOUTHAMPTON RD. WESTHAMPTON,MA 01027 ga"^'`'r� Undersecretary