Loading...
BP-19-1448 poolFile # BP-2019-1448 APPLICANT/CONTACT PERSON ZAYAC NICHOLAS & CARIA ADDRESS/PHONE 64REDFERN A VE LONGMEADOW PROPERTY LOCATION 76 RESERVOIR RD MAP 108 PARCEL 113 001 ZONE RR{I02)/WP(3)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid T eofConstruction: INGROUND PO New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan NCLOSED REQUIRED DATE 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 ____ Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit 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 Availability ___ Septic Approval Board 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 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. , City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 SECTION 1 -SITE INFORMATION ·r Department use only ELLING 1.1 Property Address: This section to be completed by office ?t M~/Vt66 Ef) Map L{) {s Lot ( { 3 Unit. __ _ L Zone Overlay District'-------- i---~--D __ fl1._VJ_O_) o_~_3 ______ E.....,1m St District'------CB District'----- SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT Name (Print) Signature SECTION 3-ESTIMATED CONSTRUCTION COSTS Item 1. Building 2.E~ 3. Plumbing 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 + 2 + 3 + 4 + 5) Building Permit Number: ____________ _ Current Mailing Addre~~ '::/13~1 ~ Telephone Current Mailing Address: Telephone Official Use Only (a) Building Permit Fee (b) Estimated Total Cost of Construction from 6 Building Permit Fee Check Number Date Issued: ____ .,, Signature: ------------------- Building Commissioner/Inspector of Buildings @ EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNb Section 4. ZONING All Information Must Be Completed. Per mit Can Be Denied Due To Incomplete Information Existing p roposed Required by Zoning This column to be filled in by I Building Department .J Lot Size !.---- -r-- Frontage .___ Setbacks Front :=] r- L-I I Side L: ...---, R:c==J L:== ------ ,------, I I c= R:_ ,.--.---- Rear --_ __J L ___ J Building Height C --, C=:J - Bldg. Square Footage --CJ % c= ~ -- ~ Open Space Footage ~ % ,--,- (Lot area minus bldg & paved ' L------' r----. L___; oark:ing) ,----, # of Parking Spaces ...___J --I --·--. Fill: ·-· . ·--. . ·.·• -=···=·~-~· -·· .. ·--·~ : r (volume & Location) A. Has a Special Permit/Variance/Finding ever b(Jen issued for/on the site? NO @ DON'T KNOW O YES 0 IF YES, date issued: ~------' IF YES: Was the permit recorded at the Registry >f D~eds? NO O DON'T KNOW O YES 0 IF YES: enter Book Pa1~e, and/or Document# '------- B. Does the site contain a brook, body of water or wetlands? ~ DON'T KNOW Q IF YES, has a permit been or need to be obtained from t~tion Commission? Needs to be obtained 0 Obtaineo 0 , Date Issued: Do any signs exist on the property? YES 0 NO ~ IF YES, describe size, type and location: L__ YES e there any proposed changes to or additions rn signs intended for the property ? YES O NO ~ YES, describe size, type and location: C ____ _ _ ---·--_____ ... , e construction activity disturb (clearing, grading, E xca ration, or filling) over 1 acre or is it part of a common plan ill disturb over 1 acre? YES Q NO ® then a Northampton Storm Water Management Pe nit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK (check all applicable) Replacement Windows Alteration(s) D Or Doors D Roofing D New House D Addition Accessory Bldg. D Demolition D D New Signs [DJ Decks [0 Siding [DJ Other [ Brief Description of Proposed ,\ Work: ~rc:a( v '-"f\_.. Alteration of existing bedroom ___ Yes_}£._ No Adding new bedroom ___ Yes __ 1'_ No Renovating unfinished basement ___ Yes &, No Attached Narrative Plans Attached Roll -Sheet &a. If New house and or addition to existing housing. complete the following: , a. Use of building : One Family ___ _ Two Family ____ Other ____ _ b. Number of rooms in each family unit: ______ Number of Bathrooms _____ _ C. Is there a garage attached? d. Proposed Square footage of new construction. ---------Dimensions--------------- e. Number of stories? f. Method of heating? --------------Fireplaces or Woodstoves _____ Number of each g. Energy Conservation Compliance. ---------Masscheck Energy Compliance form attached? ------- h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain ___ Yes __ No j. Depth of basement or cellar floor below finished grade------------ k. Will building conform to the Building and Zoning regulations? ____ Yes ___ No . I. Septic Tank__ City Sewer __ _ Private well ___ City water Supply __ _ SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner/Authorized Age hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Niol U!/R c_ Date SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable D Name of License Holder : f A,v., I £. 2 Pfr', (_ c~-01c.t6tY I License Number Expiration Date Not Applicable D (doS3 ll Expiration Date SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVI .. (M G.L. c.152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and sub 11itte·d with this application. Failure to provide this affidavit will result in the denial of the issuance of the building pen11it. Signed Affidavit Attached Yes ...... . No ...... 0 City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Streat• Municipal Building Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation ("OCABR") regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes, a contractor must be registered as a Home Improvement Contractor ("HIC"). M.G.L. Chapter 142A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units .... or to structures which are adjacent to such residence or building" be done by registered contractors. Note: I/the homeowner has contracted with a corporation or LLC, that entity must be registered. Type of Work: ~ l Est. Cost: 'fifiX2 Address ofWork: 7" ~1\Jl \7:;>(' 1:.b i&ldS (Yr{J-C>)oS~ Date of Permit Application: ______________ --'-----'------------- 1 hereby certify that: Registration is not required for the following reason(s): _ Work excluded by law (explain): ____________________ _ Job under $1 ,000.00 ie_ Owner obtaining own permit ( explain):-'O(l?"""--'--M'-'---_r___,/,__·~3,L..><..vV=· _).,,,J'-e__/ _______ _ __ Building not owner-occupied ( _ Other (specify): _________________________ _ OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L. Chapter 142A. SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT. SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: 5-(5 --f9 Date HIC Registration No. OR: ·Notwithstanding the above notice l~by apply for a building permit as the owner of the above property: 5 '-/),- Date e City of Northampton Massachusetts DEPARTMENT OF BUILJ)ING INSPECTIONS 212 Main Street • M\: nic:.pal Building Northampton, MA 01060 Massachusetts Residential Building Code Section 11 O.R5. l.2 Homeowner: Person (s) who own 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 tw family dwelling, attached or detached structures accessory to such use and/ or farm struc tures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Section 110.R5. l.3.1 Any homeowner performing work for which a bmlding permit is required shall be exempt from the licensing provisions of 780 CMR 11 O.R5 , provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. Such homeowner shall submit to the Building Ofi icic.l, on a form acceptable to the Building Official, that he/she shall be responsible for all su ~h work performed under the building permit. As acting Construction Supervisor your presence n <:he job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 15 2 ('~orkers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for p~rson(s) you hire to perform work for you under this permit. City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Streat •Municipal Building Northampton, MA 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: (Please print house number and street name) Is to be disposed of at: (Please print nam of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) ~-/~-11 c ason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the epartment as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of Industl'ial Accidents 1 Congress Str,:et, Suite 100 Boston, MA 021 '4-2017 www.mas~.go1~ldia Wo1·kers' Compensation Insurance Affidavit: uilders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMU TING AUTHORITY. Applicant Information Name (Business/Organization/Individual): ?Af~C, Address: 7l g~rllor g. C> CJ:yt., c ;.rr c.L-L f-; Ol"I w?e1$ !"J/J City/State/Zip: • Phone #: ~-::._--~=============- Are you an employer? Check the appropriate box: 1.0 I am a employer with ____ employees (full and/or part-time).* 2,eg-1 am a sole proprietor or partnership and have no employees working for · e in any capacity. [No workers' comp. insurance required.) 3.o I am a homeowner doing all work myself. [No workers' comp. insurance, equir:d.J t 4.o I am a homeowner and will be hiring contractors to conduct all work on n:y property. I will ensure that all contractors either have workers' compensation insurance ot ares J!e proprietors with no employees. 5 -0 I am a general contractor and I have hired the sub-contractors listed on the attac 1ed sheet. These sub-contractors have employees and have workers' comp. insurance .I 6.o We are a corporation and its officers have exercised their right of exempti, n pe1 MGL c. 152, § I ( 4), and we have no employees. [No workers' comp. insurance req ,ired. I Please Print Legibly Type of project (required): 7. D New construction 8. D Remodeling 9. D Demolition 10 D Building addition 11.0 Electrical repairs or additions 12.0Plumbing repairs or additions 13.0Roofrepairs / 14. 00ther+pt::c> ______ _ I • Any applicant that checks box #I must also fill out the section below showing th ,ir wc ,rkers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and th ·n hir e outside contractors must submit a new affidavit indicating such. !Contractors that check this box must attached an additional sheet showing the nru Je of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees, they must provide their work, rs' cc mp. policy number. ======================== I am an employer that is providing workers' compensation insui ance for my employees. Below is the policy and job site information. Insurance Company Name: Hv-'S ~ "'-H;-0 r-.Ci-( Policy# or Self-ins. Lie. #:. ______________ _ ExpirationDak, ~~~~ ~~ O/£~ ___ City/State/Zip: __ ~-~------- Attach a copy of the workers' compensation policy declaratio I page (showing the policy number and expiration date). Job Site Address: 7/z i2b/V Jor Failure to secure coverage as required under MGL c. 152, §25A i · 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 01' a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forward .:d tc , the Office oflnvestigations of the DIA for insurance coverage verification. nder the pains and penalties of perjury that the information provided above is true and correct. Si Date: Phone #: Official use only. Do not write in this area, If! be completed bv ci~v or town official. City or Town:-----------------Pe ·mit/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#: _____________ _ l!::::::===================·-=================::::::!J Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as " ... every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in ___ (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i .e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: Revised 02-23-15 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel.# 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia 1,~ ,\C::ORDAN(.f vVITH AN$i/t•J'Sl' /ICC-$ 2C l 1. •HE \';-J~LLER 1$ ~:.s~:JN~d?,.._E f(;P. PL.\(.IC\tG ONE SK1tvir\'·1EH I "(!H EVER" S(\) Si), .. AR~ FEfT (,f, SURt.ll.( E "REA AN[: (',N~ I ;i '. Tl li~l·J FOR F.Vf. 'l\' ~O:) ;,,(!U..'I.Rr. FEET OF '.,,)Rfil,( t ;.;::~ .. \ ~) I '· Jrj' [') 2' i i r--·-..... --····-· I! ICC ....... , 11@1 I . ! CFP1'' ., ... . ____ ::. ... :•J.-?l:· ?.7-§L !", h':'.,: ;, I! 1· .. , :' : -'"{ g· SKI MN.ER 1t " 1·1 -+ I 'I ')' ! ; . _G·' Tf'il_!· L-r•, · -· 4 Ji l}-r,•_;\:..: .... _,1 __ . !n,,:)rt (--·y ;~· ; r). :r-41 ! 2' !31 81 •.• I I J ·r+3 I • 1-1',1 ,t t l i, ~-: J: i-g 8 / ~ ' c· ~ ._.,,;\ ',:.,· J I h. II II e • ! J'i ii ! ; I ,. ! " i~ /\~ I I ''-/( ~ !•!~;I !1 I : \_'! \ ·1 l.'' 1 l . . . , , CPADi'\\. !n5~11 iT'>T' ··, I I r··I °'I: "" ,--.J t .J -·1 ' ,-' ' J ~' 61' ----i------·-=--1 j -' ,-.. I ' ·'~ ,-. -,t .. -I.) • '. i i..' ' ......... ····-··-----·--. --------·-'""'···· ................... ---···----... ·····---·-·---··-··, ·-··--------·-·--·· '-----··--··-----·--.. ---····· .......................... _'""'""• ·-···1 -------·-··--·-------------------·-" i i CUSTOMER·S,WSTP..TE · I L~ r_HAM _ S rm I ,: E ~~ANGLE :> •,~ R~~ -~ .o-o x 2_4~0~. . : / N ON-Dl_'.".'.I NGJ::Q.O~ ""·"'Mr 1ew cr :~?~., ~ TEE1 .. PANELS~ 1 __ dlM, '~·~ --->~O_ v_ .• ~LUM~ 1.U~-l.,.1._1 _____ -·----• 8400 4 ~~-USE OF Dl\'INr·. Et'.JUIPMENT 1)"<.,,,, *'3URiA,:::E lft') 3C,!) 1.'0LUMf: (1.!ters) 31$00 ,.. _ ._ .':"" l$ PROH1131TEO 2018-SPL-38254 LINEf{,:t'l ~~.; DATE 7/?./201!3 ~R. t(f'{~t \·~;i,-~,· .. __ .:._ __ ~----···--... ---. · ,..,_.... --... -· - • --1------- ---- · ---- .. -·- -·- -· -- • -- · - - - -----··----,.rr A',,...e~ t:·r;;::-1,<1::, c, .. ;.,.'l71Ji3"::::.;i1.1>:_r::::;--·-· ·------·-----K!Tr. Ci)$TOMKIT COVF!F, (f!'l ::,e-4. SCALE 1/,S" :: 1'-0" \'>'li.HA'I' -'A";'iP!l•"-0 ''1,11, ANC20:J.i$?-'oC & WWW. __. .......... --. .... ._-..... --~-----·--·------. . ..... ~ -L::! RECTANGLE --------.. -· -·-·--·--··--·--1 SHEET I OF 2 I l---·-··---"'"' ............ ___,,_,..J ---~- .;/~ ~h'tmo,,,,~,t,•ea~,;f-ry',.,,,;16a.J,Jac4,;e/,{;. Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE: Individual Registratioa 180534 . PAULE. ZAYAC Expiratio.n 03/27/2021 PAULE. ZAYAC 79 HIGHMEADOW DR W. SPRINGFIELD, MA 01089 M~U-~~,/t,' Undersecretary . f . dividual use only Registration v~hd. or '" e If found return to: . before the exp1rat1on da~ . d Business Regulation Office of Consumer Affairs a~te 710 1000 Washington Street • Su, Boston, MA 02118 ~ ZAYACON-01 csn••IRES ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) ~ 5/14/2019 THIS CERTIFICATE IS ISSUED AS A MA TIER 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 doo11 not confer right& to the certificate holder in lieu of such endorsement(&). PRODUCER License # 1780862 l.il?tU:~cT Cynthia Squires HUB International New England r..::g,N~o, Ext): I FAX 96 Shaker Rd. (A/C, Nol: East Longmeadow, MA 01028 ~~.al!.oo. Cynthia.Squires~hubinternational.com INSURERISl AFFORDING COVERAGE NAIC# INSURER A, Union Insurance Comoanv 25844 INSURED INSURERB : Zayac Construction LLC INSURERC : 64 Redfern Avenue INSURERD : Longmeadow, MA 01106 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR •••on ,-,n . A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 f--:=J CLAIMS-MADE 0 OCCUR ~tt;lf.~~J9F~~!~.?..n,., 500,000 CPA 5386492 4/1/2019 4/1/2020 $ -MED EXP <Anv one oerson\ $ 10,000 -PERSONAL & ADV INJURY $ 1,000,000 2,000,000 ~'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 fm 00 LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: s A AUTOMOBILE LIABILITY ~~~~~~';~"SINGLE LIMIT $ ANY AUTO CPA 5386492 4/1/2019 4/1/2020 BODILY INJURY /Per oerson\ $ f--OWNED ~ SCHEDULED 1,000,000 AUTOS ONLY AUTOS BODILY INJURY IPer accident\ • f--f-- iP~?~fc~d~t~AMAGE X ~L'WJls ONLY X ~8fo~'1%'r_~ $ f--f-- $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ f-- EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED I I RETENTION $ s WORKERS COMPENSATION 1 m TUTE 1 I ~iH-AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE D N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ ~m~r~r~ ~:;PERATIONS below E.L. DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS /LOCATIONS/ VEHICLES (ACORD 101, Addltional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER City of Northampton Office of the Building Commissioner Puchalski Municipal Bldg 212 Main Street Northampton, MA 01060 ACORD 25 (2016/03) 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. © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD N/F WILLIAMS I No. 76! NICHOLAS & CARLA ZAYAC LOT 1 H.C.R.D. PLAN BK. 212 PG.042 L~~-----------------------_!:N'_!7~0.~44~'3~2":E~2~73~.5~3':.___ __________ ~-------------;IRON ROD FOUND IRON ROD FOUND N/F WILLIAMS 100' BUFFER ZONE ,:"-• .i-. ~~'b. 4 ... ,....~· O' 20' r---.-. 1"=20' Plot Plan LOT2 40' 60' 1:240 76 Reservoir Road, Northampton (Leeds), MA For: Nicholas & Carla Zayac 76 Reservoir Road Northampton (Leeds), MA JUNE 18, 2018 SCALE 1" = 20' ~ R.A. FORESI Associates REGISTERED LANO SURVEYORS WEST SPRINGFIELD, MA