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25A-123 (3) 324 BRIDGE ST BP-2016-1531 GIS 4: COMMONWEALTH OF MASSACHUSETTS Mao:Block:25A-123 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: ROOF BUILDING PERMIT Permit# BP-2016-1531 Project# JS-2016-002603 Est.Cost:$13000.00 Fee: S40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MATTHEW BEAUDRY Lot Size(sd. ft.): 5619.24 Owner: WALKER AARON B& MARYANNE MORRIS Zoning: URB(100)/ Applicant: MATTHEW BEAUDRY AT: 324 BRIDGE ST Applicant Address: Phone: Insurance: 117 FERRY ST (413) 320-1348 EASTAMPTONMA01027 ISSUED ON:6/24/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:Strip roof and install asphalt shingles 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 ti 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: FeeTvpe: Date Paid: Amount: Building 6/24/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck-Building Commissioner - _ Department use only �r_i City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability - • JiI I Room 100 WaterNVell Availability__ Ji Northampton, MA 01060 Two Sets of Structural Plans Demon nuc .��" pl nel413-587-1240 Fax 413-587-1272 Plot/Site Plans N"lamFVPCA I:A-' < Other Specify. APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Pro a )Ad ess c This section to be completed by office --52 brl 0 SJt. Map Lot Unit__ I V� \\5 q�, I ` 0 o Zone _Overlay District 1+'tY�f„� ',Y{�L//�], __ Elm St.District _ CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Qwner of Record: nvn U ri_- .59 k,heica , r,i OAA° Name(Print) Current Mailing Address: fit' - ^ -- ja f% Telephone 4\-5 �4 4 0~ r .1l1 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS -i Item Estimated Cost(Dollars)to be Official Use Only __ cy .Med b 'grind a.•(cant 1. Building (r j 3 600 (a)Building Permit Fee e 4 2. Electrical 1 _ (b)Estimated Total Cost of Construction from(B) ,{, 3. Plumbing Building Permit Fee r3 4. Mechanical(HVAC) "f VVV �T 5.Fire Protection /V7 6. Total=(1 +2+3 +4+5) Check Number 6 / ♦ - _ This Section For Official We Only Building Permit Number' u Date F J i. Signature'. .ca� J /AA ._ _.- zA - V-K ommissioner/Inspector of Buildings Date Section 4. ZONING AU Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be Mich in by Building Department Lot Size Frontage Setbacks Front Side LC. . R: - L'.' . R: Rear Building Height Bldg.Square Footage '3b Open Space Footage m tlamminus vas bldg&pmveJ parkinSL ^...... _._. _._. ..... H of Parking Spaces Fill: Datums Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW 0 YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES V NO Q IF YES, describe size, type and location: E. WIC the construction activity disturb(Gearing, grading,excavation,or filling)over 1 acre or is it part of a common plan that Mit disturb over 1 acre? YES Q NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SE TION 5-DESCRIPTIO OF •RO.O5. 0 . 0-ft check all a.dica'le) New House (1 Addition J Replacement Windows Alteration(s) in Roofing 0 rr--�� Or Doors O Accessory Bldg. I I Demolition LJ New Signs [D] Decks [C] Siding[DI Other ID) - Brief Description of Proposed NIP Work s-�YI10 NIP 1 [ I �1 r— Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _Yes No Plans Attached Roil -Sheet 6a.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. Foadpfain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No_ 1. Septic Tank City Sewer__—,_ Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENTNOR CONTRACTOR APPLIES FOR BUILDING PERMIT I, [ /M1114 4.1/eµe ,as Owner al the subject property yytt`pp�f j�,�r,l) hereby authorize i i 4 .�JUI/GYN I to act on my behalf,in all matters relative to w' lauthorized by this buil g permit applic tiotj1 , ,L.w. / 41 2-1 /tfk Signature of Owner Date I, l-fhv(IY j kid a%.-Qr as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to tine best of my knowledge and belief Signed under the pal and penalties of pgnuur�. n y\ WO bje,Print Marne r Signature of Owner/Agent Date SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supst so ' Not Applicable{ £ �r4/ Name of License HolderI! AudiInt u _ limb t/Q Y5 1 //�� License N mb a di. i O :] 3 JI ! 9� Expiration iration Da i /�%. i i ,le Signature Te ephone 9.Rem i to allo. el t'roveme tContr. .Y: f("'lt l .�/a ttQ Not Applicable £ {i •l r t IL • 1 �.i u! r �A Company Namett Repistr.tio r • F r ( Telephone f f ti p > Address he Expiration sale ✓�!� 0 0 '-f ... (413-32U— 3' SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8)) 1 Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the imam.- of the building permit Signed Affidavit Attache. Yes._.... £ H. -Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(t) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts P3 supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of 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 two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home hi a two-year period shall pot be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall be responsible for all such work performed ed under the buildingperuilt. As acting Construction Supervisor your presence on the job site will be required front lime to time,during and upon completion of the work for which this permit is issued, Also he advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,von m ay,lte liable for person('s) you hire to perform work for you under this permit The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature �,�,,,, The Commonwealth of Massachusetts w.t Department of Industrial Accidents _y��', _l Office of Investigations 600 Washington Street c++V Boston, MA 02111 k.„. 4/1 -te _tss www.tnass.got/dia Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information p Please Print Legibly Name(Business/Organisation/Individual: 620 thl_ltbAliter0 iQtp{rt, Address: 117 rent( S'' City/State/Zip:. f to. /.,.1 MA 17 Phone#: LII3 — 3 — 1 3 7 h_ Are n an employer? Check the .ppropriate box: Type of project(required): I. I am a employer with 4. [ I am a general contractor and I t employees(full and/or part-time),* have hired the sub-contractors 6. ❑lvew construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. fl Remodeling ship and have no employees These sub-contractors have 8. 9 Demolition working forme in anycapacity. employees and have workers' p ty. _ 9. L Building addition [No workers'comp. insurance tAmp, msuranez.t required.] 5. 9 We are a corporation and its 10.9 Electrical repairs or additions 3.9 1 am a homeowner doing all work officers have exercised their 1 L Plumbing repairs or additions myself. [No workers' right of exemption per MOL I cv� Y comp.1 2. Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.9 Other comp. insurance required.] *Any applicant that checks box HI must also fill out the section below showing their workers'compensation policy information. tHo meowners who submit this affidavit indicating they ate doing all work and then hire outside contactors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and sidle whether or not those entities have employees. if the sub-contractors have employees,they most provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /i, it as... Y Policy#or Self-ins. Lie. 0: Expiration Date: 7pi Job Site Address: - e.-14 Py1/ (],1 sA(4f4Q hip,if 01°City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby reran,under pains and penalties of perj ty that the information provided ahoy is to and correct Sir?nahlre: L1� _. {�:.. lir -'�� .. Date: 6�? I Ito Ph9ne#: "1 13-1a-o - 13 `I 0 _...... Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: City of Northampton - Massachusetts s + r f�f � � � DEPARTMENT OF BUILDING INSPECTIONS I w 2. 5 212 Main Street • Municipal Building Northampton, MA 01060 p21 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to act as his/her construction supervisor. The state defines"Homeowner"as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two- year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages,which include foundation/footings (before backfill). sonotube holes (before pour), a rough building inspection (before work is concealed), insulation Inspection (If required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will he responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit Sued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made understand the above. (Home owner!resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: 3j4.. 6Y IrlL L " The debris will be transported by: '1YUIS I Yuf,kV nq _ The debris will be received by: Building permit number: �/I IL Name of Permit Applicant /r (I Ski Date Signature of Permit Applicant 60/21/ l (1J ACORD CERTIFICATE OF LIABILITY INSURANCE °ATE,MMIowv+TY) 6/14/2016 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 MrN ••BELOW. THIS CERTIFICATE OF-INSURANCE+DOES 4NOT 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 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 CtlNTAET Elizabeth Carballo NAME: Finck 6 Perras Insurance Agency Inc. PHONE n Ey,. (413)527-5520 _ASKS,(413)527-5970 6 Campus Lane gpD2ESS:bcarbal log finckandperras.com INSURER(S)AFFORDING COVERAGE I NAIL% Easthampton MA 01027 INSURER A;Safety Insurance 39454 INSURED .—. ......... —_. .-.....- INSURER O; I .. Matthew Beaudry, DBA: geometry Some Improvement INSUAERo 117 Ferry Street INSURERD: _ INSURER E: Easthampton MA 01027 INSURER F: _ —. . COVERAGES CERTIFICATE NUMBER:CL1651002246 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. mal ADDLISUSR POLICY EFF I POLICY EXP - -- -- LTR TYPE OF INSURANCE IVSD WVIDI POLICY NUMBER I IMMIODIYYYVI Y MM/ODIYYYYI LIMITS % COMMERCIAL GENERAL GA31LnY I EACH OCCURRENCE I a 1,000.000 AOISTO RENTED A I CtAIMS,,MADE I c OCCUR 1.PREMSFS(Ea obwrrencel $ 100,000 B10,0021095 1/14/2016 } 1/14/2011 MEC EXPIMy004person) I $ 10,000 1 PERSONAL a AN/INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 • A POLICY�- JECT MP/OP AGG 000 ,$ 2,000,RPft^ � LOC PRODUCTS _.$ AUTOMOBILE LIABILITY 1 come{NEDSINGLE LIMIT $ ANY AUTO BODILY INJURY(Pperson) I $ ALI OWNED 1 (SCHEDULED I [BOD4-INJURY(P cCPft)'$ AUT05 —{NONOWNED I PROPERTY DAMAGE E , HIRED AUTOS AUTOS (P -demiI .._ $ 'UMBRELLA UAS i OCCUR III EACH OCCURRENCE i$ ' EXCESS LIAR I . CLAIMS-MADE I IAGGREGATE _ $ Ios0I RSENTON5 - _ S WORKERS COMPENSATIONPEP I°m- I AND EMPLOYERS'UABILITY STATUTE ER ... (ANY PROPRIETORPARTNER nECUTIVE Y�N:N/A EL EACH ACCIDENT �S Of FICEWMEMBER EXCLUDED? O.ta e l ry in NH) EL DISEASE-EA EMPLOYEE $ Ifdescribe under DESCRIPTION OF OPERATIONS below I EL DISEASE-POLICY LIMIT IS I ; DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached If more space Is requIr d) Proof of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 210 Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE E Carballo/BETH a`Xe'�,r() ._Z�� �e-a ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1 5025(201401) ACORD CERTIFICATE CERTIFICATE OF LIABILITY INSURANCE DATE MWOOIY,-'y) 1/4.------ 06/14/2016 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 THECERTIFICATE HOLDER: IMPORTANT: If 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). PROO'WFR CONTACT NAME: BRU Wildman FINCK&PERRAS INSURANCE AGENCY INC rant pia (413)527-3000 ac Nv:,_ ADDRESS: bwildman@finckandperras.com 6 CAMPUS LANE INSURERls)AFfGROING COVERAGE TWO., EASTHAMPTON _ MA 01027 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: _ BEAUDRY MATTHEW i_suRERc,, _ INSURER D: _ i 17 FERRY STREET INSURER E: EASTHAMPTON MA 01027 INSURER F. COVERAGE CERTIFICATE NUMBER: 61135 REVISION NUMBER: THIS I5 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 S SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INS*ywO POLICY NUMBER rMOP s�IOtYYYri IMWDPIYYYY)ere ewer UP I LIWTS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE IS [AMADEI RENTED CIARAS.MADE OCCUR PRF.ML9ES(Ea eceunetice) S MED EXP(ART a^acettan) 5 N/A PERSONAL HAW INJURY $ GENY.AGGREGATE LIMIT APPLIEIS PER I GENERAL AGGREGATE 5 POLICY PRDT L. _I LOC ` PRODUCTS.-CGMPIOI'+AGO $ C OTHER: $ �AUTOMOelLEL4EILITY CGMBINEO tSINCLEE LIS 's Mt I ANY AUTO BODILY INJURY(Per['Arson) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) S NON.OWNED PROPERTY DAMAGE $ HIRED AUTOS MHOS 'HVL UMBRELLAUAB I OCCUR EACH OCCURRENCE $ — EXCESS LAB CIA!MS MADE N/A I AGGREGATE S —T DED RETENTIONS _ $ WORKERS COMPENSATION /N'=A7,ULE )„1 IPr AND EMPLOYERS LIABILITY MROPRIETOMPARTrvMWE%ECUTNE YIN i EL EACH ACCIDENT 's 100.000 A OnyernRiantlMory lr,NH)E%CLUED+ NEA) NIA NN 6$j60UB2EB6300016 05104 104 )2016 0512017 E-L,DISEASE.EA EMPLOYEE $ 160,069I CES((RIFrIOMOFOPERAT p1.i ERR!: ----_. EI..OLBEASE-POLICY L:Mrf,$ 500,000 N/A J DESORPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule.may be attached If more$Wca Is required) Workers'Compensation benefits will be paid to Massachusetts employees only_Pursuant to Endorsement WC 20 03 G9 B,no authorization is given to pay claims ter benefits to employees in states other Than Massachusetts it the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in for eon the date that this certlicate 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 Vehfication Search tool at www.muss gov1Iwdlworkers-compensat'IONinvestigaUons/. Sole proprietor has not elected coverage. 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. 210 Main St. AUTHORIZED REPRESENTATNE Northampton MA 01060 x.ni LLS' I Daniel M.C-9 y,CPCU,Vice President-Residual Market-WCRIBMA (101988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD