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24D-087 (6) AC'oRID0 CERTIFICATE OF LIABILITY INSURANCE DATE 1201 YYYj ��. 11/03!2014 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. OfIPOi=TANT: It the certificate holster is an ADDITIONAL INSURED,the poiieviiesi must be endorsed. if SUBROGATION IS WAIVED.subiect to i u..;,j„utb>w. . l:i of zhe r..u_l' � a.d ssar_nntr:m _e,ta,d.,;;eT'mrl-a F-Qi'v'-z T5C.--u",. I 'White.§tihinvillp Inn Anr-.y 1nr I '`: i y {;�,g,f?- (413}538-5293 r N� (413}538-b970 _ P 0 Box 7$ i -- South Hadley P.4A 01075-0789 NarC#_._.__ A.I.M.Mutual Insurance Company � � --- INSURE Selkirks Family Chimney Cleaning LLC INSURERS;INSURER C 272 Fes-rton Street i South Hadley, MA 01075 INSURER D `- ------ �- I INSURER E: INSURER F, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER., 3 O - - -- , 9:t"i.r ..� ii,. 1.L:'(3 a,i`3..� THE E�?.iid..a�., .1 +�'ivis?'Simi..i �i'�+LJ L=:^� r.1-,sG .1,=i'i lJ..i.:_t..i T L-U Nniti3LU f=fJV.rL. '.' HL r i GFNERALkGGREGAiE or ff i KiN'LAGGREGATELIMIT APPL'±ESg PFR: I i f I f j PRODUCTS-COMP/OP AGO I44 E .ET—L I I I I 1 AUTOMOBILE LIABILITY ( I COMBINED SINGLE LIMIT � � --- -j ANY AUTO I BODILY INJURY(Per person) $ r—�ALL OWNED n SCHEDULED -- --T-- AUT05 AUTOS 9001LY INJURY{Per accident) HIRED AUTOS �NON-OWNED PROPERTY DAMAGE — I AUTOS t(Per accidenti $ _----- i II I UMBRELLA LIAR '--1 f OCCUR f i EACH OCCURRENCE a 1--1 I k ! I EXCESS LIAR I CLAIMS MADE i AGGREGATE $ ::�A DEL) I RETENTION S { l I 1 1 3 'M'J03tIS£A C P£N ATtO r �/ 3 ran err a ,3+ ` lTC7Y,riM1�ifFS�_ _iER I -_ 9 I al S u. $ ��'Ei tm - xv y .. - ,.. .^..L F-91-H,At CD a nE ' r a Il i'3' Y ti 1 (it § }.idtd r" .`�NH) - _ _.. _ � Fi.DiSEASE EA EMPL.O?i EEiS E? n¢4EA$c _,w„ s S4i3.00(#.(#3 i : DESCRIPTION Or OPERATIONS!LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) CERTIFICATE HOLDER CANCELLATION Town of Granby 10-B W.State St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Granby,MA 01033 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE .§n-lA A!-nn;ra r+so F?T1n aA Tinki Ale rnhvc hfse .a awe-... w�,w..e....... +. •w�ww - - - - a.. -_ -..__.-_a___1__,._..— .L•PAi1iY Client#: 18316 SELWAI ACORD�I CERTIFICATE OF LIABILITY INSURANCE 1013112014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE C-OVEPAGE AFFORDED BY THE Pr)L1,C1E'-` --,N-7H 1 S CE.Tl FICAT F OF 1�1 S UR AN Cr 7,1017 S NOT CO-NS— V.7 Z! A 'CON'TRACT TLiE ISSUI'Na^1N5!J1r-=RfS`.Al'UTHORiZED -r--P-T'?'F-SFNTATIVF OR PROr)tlrFR AND THE f-FRTIf-IrATF Iini r)Fr, -n-AIT!nl,'t. I P;::n "i-B�'.nfz. t�-, 5-,,-u-,��,v h, of the ooiicv, r"uiTc� .n,cndr)rsemcnt.A staterri,' t on this cortif cay.does no! ulhii- v i f 11 cv 1 J�4 Lamb 15trpci i Box 789 I Sr,ufh Vlaflev, MA 01(1755 ------ ----- i -is JeqSuRL,<F COVERAGES GLRT&iCATIL NUMLLt>: -'-Irk��i i NiE 4 0; MI MS 1 GENERAL LIAPM 9 y P,(-PI Mr)7AGG 'I n i -f',14 1(111 Fi?01 r,r� gnn ring rnn vv 'azi 7. —?MAT- .1J I UNIUZ+L.L-111.1LI I y 1 U;uLizul 4, 1 uluzlyu l;3 K,A'A",I Wi'lkftc wer pe,sw nza�-c -,-, "LN!P11 1pp�117�`11.1) '1vu,uuv i Atj f 03 i A T i I , HIREC)AUTO 00 ow) S UM6RELLA LIAB EA.1-H 0XURRENCE i S i OrXVR EXCESS LIAO t CLAIMS-MADE j I AGGREGA I E r)Fn i I RFTrNTqoN WORKERS COMPENSATION AND EMPLOYERS'LIAt310TY N ---- - - by fha C fr,'-UT —Aer ---------- ---J J J The-$a a-a ihis Iftnits at 0--lic" y CEPTIF!CATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE F- Town of Gran'y- THE EXPIRATION DATE 1HEREOF, NOTICE BE DELIVERED IN e"Building losp ctor ACCORDANCE IMTH THE POLICY PRO*,A'SiONS, iri-B West State Street Granby, MA 01033 AUTHGRiZED RLPRZ3ENTAT;',T J -HON.Aii rights reserved, ivl 1988-2010 ACORD CORPORA ACORD 25(2010105) 1 Oi 1 The ACORD name and logo are registered marks of ACORD *S,i764i!Mi7640 c Ewl City of Northampton •�'°� Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building yetis, `ta Northampton, MA 01060 '6�• _,i` SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION FOR WOOD, COAL, PELLET,CORN, STRAW OR SIMILAR STOVES,OR FIREPLACE INSERTS Permit Fee: $25.00 Check# 11 .0 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: - '+"' ��%�y�tif S EL --1 r'_' K_ Address: c µi 0 -"- SG t, uGllr�.0, Telephone: 35"� � c it K5 2. Owner of Property: lz_-_'4a Address: r�'_ YV m Telephone: jG' c/C 3. Status of Applicant:_Owner _Contractor 4. Type or Brand of Stove: w''�V L , 6'C7 If applicant is not the homeowner: Z Construction Supervisor's License Number S S Expiration Date Home Improvement Contractor Registration Number Expiration Date All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit s. Certification: I hereby certify that the information contained herein is true d accurate to the best of my knowledge.DATE: APPLICANT'S SIGNATURE 44'_'4_ DATE: s / ��f HOMEOWNER'S SIGNATURE t APPROVED DATE: BUILDING OFFICIAL 50 NORTH ST BP-2015-0673 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D-087 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: woodstove BUILDING PERMIT Permit# BP-2015-0673 Project# JS-2015-001287 Est. Cost: Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WAYNE SELKIRK 159582 Lot Size(sg. ft.): 7927.92 Owner: STABILE JOHN T&PAMELA C C/O BRIGITTE M PAROT Zoning: URC(101)/ Applicant: WAYNE SELKIRK AT. 50 NORTH ST Applicant Address: Phone: Insurance: 272 NEWTON ST (413) 455-9965 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON.1211612014 0:00:00 TO PERFORM THE FOLLOWING WORK.JOTUL F100 WOODSTOVE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 12/16/2014 0:00:00 $25.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner