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25C-018
180- 182 NORTH ST BP-2020-0402 GIS#: COMMONWEALTH OF MASSACHUSETTS ME:Block:25C-018 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: FIRE RESTORATION BUILDING PERMIT Permit# BP-2020-0402 Proiect# JS-2020-000681 Est.Cost: $85374.00 Fee: $552.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BAYSTATE RESTORATION GROUP 056785 Lot Size(sg.ft.): 6838.92 Owner: MARDAS PAUL A Zoning: URB(100)/ Applicant. BAYSTATE RESTORATION GROUP AT: 180 - 182 NORTH ST Applicant Address: Phone: Insurance: 69 GAGNE ST 413 532-3473 WC CHICOPEEMA01013 ISSUED ON:10/16/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-FIRE REPAIR - REMOVE & REPLACE ENTIRE ROOF STRUCTURE, REFRAME DAMAGED AREA AND FINISHE WORK 7 POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspec or of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire ft)artment Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BEREVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND GULATIONS. Certificate of Occupancy Signature: Feer e: Date Paid: Amount: Building 10/1(/2019 0:00:00 $552.00 12 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2020-0402 APPLICANT/CONTACT PERSON BAYSTATE RESTORATION GROUP ADDRESS/PHONE 69 GAGNE ST CHICOPEE (413)532-3473 PROPERTY LOCATION 180- 1 82 NORTH ST MAP 25C PARCEL 018 001 ZONE URB 100 / THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICA CKLIST ENCLOSE REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid Typeof Construction: FIRE REPAIR-REMOVE&REPLACE ENTIRE ROOF STRUCTURE REFRAME DAMAGED AREA AND FINI E WORK New Construction Non Structural interior renovations Addition to Existin Accesso Structure Building Plans Included: Owner/Statement or Lice se 056785 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTE Approved Additional permits required(see below) PLANNING BOARD P RM IT 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 PER IT 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 Co servation Commission Permit from CB Architecture Committee Permit from EI Street Commission Permit DPW Storm Water.Management Demolition Del y ti1 v q Sig ture of Building Official 10 Date Note: Issuance of a Zoning pe mit does not relieve a applicant's burden to comply with all zoning requirements and obtain all quired permits from Board of Health,Conservation Commission,Department of public works and other ap licable permit granting authorities. *Variances are granted only tthose applicants who meet the strict standards of MGL 40A.Contact Office of Planning& Development for I ore information. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit A , 212 Main Street Sewer/Septic Availability ( a Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans- - Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A NE OR LL SECTION 1 -SITE INFORMATION / SEP 2 6 1.1 Property Address: This� j to be complete by ffice `30 - I8� �0RTH 5 irgfitt>>ni� ~-.. Map clit4t7n Ih1Sp� _ U it xs�Aolo�rr NS �1OrL?HAMPToo MR Otolso Zone Overlay Distric Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: PAUL- MKNAAS PO e�ol 6019S FtOewcc— AU Name(P int) Current Mailing Address: Telephone `7 I/2_� /7 Signature .J f70 _ 0Gv 2.2 Authorized Agent: GQ2G'4�; ` lW'(;TW=SaT0"T1©N Czoyp 69 GASr S,— Chit CoPre- m Oloo Name1Print) Current Mailing Address: 67001> Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 0 O (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of �a 9a Construction from 6 3. Plumbing 715733 , 00 5733jp0 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total=(1 +2+3 +4+5) j 3716 30 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date yeo". to ias @ IgerC/56'2 ry c )M EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement V1Wdows Alteration(s) Roofing Zir Or Doors ,M Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding ( Other[a Brief Description of Proposed F>AhA&& C`UST--D C-1yzv;. Work: FL=Moyr-_ AN"D QtftA f EN'f1►2r^� goof- Srpv crj"z:_ MA-C-CP 4P AP) PAI1s W O ILS( Alteration of existing bedroom Yes )<' No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes AC_No Plans Attached Roll -Sheet sa. If New house and or addition to existing housing, complete the following: IJ7�' A- Nom✓ I4V s - 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? N V c� d. Proposed Square footage of new construction. 000 SR VT Dimensions 1,1 e. Number of stories? d1 f. Method of heating? GA Fireplaces or Woodstoves No Number of each O g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 'Vnyuts 4 j(zi-o RA,r1 U +J 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,X, Pmu 1' I wmiy) as Owner of the subject property hereby authorize ` )C J V��4Tj Al OC to act on myW31 rs r ative to work authorized by this building permit application. 2_7 l Signature of Cfwner Da e as Owner/Authorized Agent 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 andpenalties of perjury. 5��J1ZGr=. JY2rs Print Name ��-- 012 Signat f Owner/Adgnt f Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning • �� This column tobe filled in by /x-11 Building Department Lot Size Frontage _.. - ��__ �� _ _-_.._.__. Setbacks Front Side L:-� R:i..�_ _._. L:';. R Rear L l I-----------' Building Height I Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location .... --- 'A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 1/ DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW (Rr YES O IF YES: enter Book # Page= and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW © YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained © Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,exc vation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO 9 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton r Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •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: 1 g0 - l '2a N olzTN 5 T N oV2-T H 4-M P'T0 N (Please print house number and street name) Is to be disposed of at: CZV--Vo314 c SY--VV)r'E-� 8y� v�`� �- 4 C Ic-MPEG - 010 -9-'L) (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: �—t—VU2>W C- �S E (Company Name and Address) Signature oKPermit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. City of Northampton f Massachusetts c. A+z � m: DEPARTIMNT OF BUILDING INSPECTIONS 212 Main Street • 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:If the homeowner has contracted with a corporation or LLC, that entity must be registered Type of Work: �I)V-Y,- �Z N-s 1 O N3 Est.Cost: 25137 Y+30 Address of Work: 17 0 ^ I g�' No tz-7 Date of Permit Application: �/�/� O� cI I hereby certify that: �!=uded not re q uired for the following reason(s): by law(explain): 00 Job under$1,00 -00 MO Owner obtaining)own permit(explain): Building not owner-occupied ,�Other(specify): Li SPA- PVz PWtrr-), 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: /I ala o 1 n I r..,,, :, ^, 1 80`7 Dae I Contra or Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the 94Ner of the a ove property: 27 2a 19 PA01- A M14ADAS Date Owner Name and Signature SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: r� /� /� Not Applicable ❑ Name of License Holder: ' I!'i1� 10AAU V) C3-056795 n License Number 01073 ocia.0 D I A ress Expira ion Dite (113 -53 3 73 i a e Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ RCS'Tor-Ann ots) Group 1910q,719 Company Name Registr tion Number 6g GAC K)r S- T Golcdpeve-- MIA 0/ 0 Address ? /y Ex Oration ate �J?? Telephone 'S32.m3 SECTION 10-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....... No...... ❑ Commonwealth of Massachusetts Division of Professional Licensure 1 Board of Building Regulations and Standards Constpu&ii n� Nisor CS-05&785I E3.pires: 09/09/2021 11 MARK R DAVIAU 75 GILBERT RD SOUTHAMPTOO1 MA 01073 Commissioner A,li..�-c. � r r F Office of Consumer Affairs Business s Regulation 1000 Washington Street - Suite Boston, Nlgssa,chusetts 02118 Home Improvem6 41,61optractor Registration Type: Corporation Registration: 180478 TION GROUP,LLC `-'` Expiration: 11118/2020 BAYSTATE RESTORA - ; ��rl, VA 69 GAGNE ST CHICOPEE, MA 01013 Update Address and Return Card. SCA 1 0 20M-05/17 The Commonwealth of Massachusetts Department of Industrial Accidents a 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia NN'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aaalicant Information Please Print Lesibly Name (Business/Organization/Individual):Baystate Restoration Group Address:69 Gagne St City/State/Zip:Chicopee MA 01013 Phone#:413-532-3473 Are you an employer?Check the appropriate box: Type of project(required): 1.[E]I am a employer with 37 employees(full and/or part-time).* 7. ❑ New Construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑ Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.F1 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.[:]Other Fire Restoration 6.F1We are a corporation and its officers have exercised their right of exemption per MGL C. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] IL *Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors 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 state whether or not those entities have employees. If the sub-contractors have employees,they must 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:Ace American Insurance CO Policy#or Self-ins.Lic. #:UB-1 K792313-19 Expiration Date:01-14-2020 Job Site Address:180-182 North st City/State/Zip:Northampton MA 01060 Attach a copy of the workers' compensation policy declaration page(showing the policy number 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 certify under the pains andpenalties ofperjury that the information provided above is true and correct Signature: Date: Phone#:413-378-7007 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DATE fMM/DD/YYYY) ® CERTIFICATE OF LIABILITY INSURANCE TTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR AL 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: BERKSHIRE INS GROUP INC PHONE �C,N (AIC,No,Ext): 138 LONGN E OW STREET E-MAIL LONGMEADOW,MA 01106 ADDRESS: 78T3H INSURER(S)AFFORDING COVERAGE NAIC 4 INSURER A: ACE AMERICAN INSURANCE COMPANY INSURED BAYSTATE RESTORATION GROUP LLC INSURER B: INSURER C: [INSURER D: 69 GAGNE STREET SURER ECHICOPEE,MA 01013 SURER 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LIMBS LTR TYPE OF INSURANCE L R POLICY NUMBER -(MMIDDIYYYY) (MMIDDIYYYY) CH OCCURRENCE iEH GENERAL LABILITY COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS MADE F7 OCCUR. PREMISES(Ea occurrence) ED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY El PROJECT F7 LOC PRODUCTS-COMP/OP AGG I$ AUTOMOBILE LIABILITY COMBINED SINGLE $ LIMIT(Ea accident) ANY AUTO BODILY INJURY $ ALL OWNED AUTOS (Per person) I !I SCHEDULE AUTOS BODILY INJURY $ HIRED AUTOS (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE I$ (Per accident) EACH OCCURRENCE $ UMBRELLA UAB 8 OCCUR AGGREGATE Is EXCESS LIAR CLAIMS-MADE is DEDUCTIBLE I$ RETENTION $ WC STATUTORY OTHER l A WORKER'S COMPENSATION AND UE-11<792313-19 01/14/2019 01/14/2020 x LIMITS EMPLOYER'S LIABILITY YIN E.L.EACH ACCIDENT $ 500,000 ANY PROPERITORIPARTNER/E ECUTIVE FN7 NIA OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE I$ 500,000 (Mandatory in NH) E.L.DISEASE-POLICY LIMIT $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. TEE INSURED'S MA WORSMIS COMPENSATION POLICY AND ITS I.DA=OTHER STATES INDORSEMENT AUTHORIZES THE PAYMENT OF BENEFITS FOR CLAIMS MADE BY THE INSUREDS MA EMPLOYEES IN STATES OTHER THAN MA NO A.=CRSZAnON IS GIVEN TO PAY CLAIMS FOR BENEMS IN STATES OT11ER THHIR AN MA IF THE INSURED ES1. A,OR HAS HIRED EMPLOYEES OUTSIDE OF MTHIS POLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL B DELLA D IN ACCORDANCE WITH THE POLICY PROVI AUTHORIZED REPRESENTATIVE DATE(MM/DD/YYYY) AC"Rl:? CERTIFICATE OF LIABILITY INSURANCE 01/31/2019 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). CONTACT - Marion Lentes PRODUCER NAME: FAX (413)567-5300 PHCN -1200 AJNo): Berkshire Insurance Group,Inc. AC . Ext 138 Longmeadow St. E-MAIL-ADDREs: mlentes@berkshireinsurancegroup.com INSURER(S)AFFORDING COVERAGE NAIC# Longmeadow MA 01106 INSURER A Philadelphia Insurance Companies 23850 INSURED INSURER B: Tokio Marine Specialty Ins. Baystate Restoration Group,LLC INSURER C: 69 Gagne St INSURER 0: INSURER E: Chicopee MA 01013 INSURER F COVERAGES CERTIFICATE NUMBER: CL1912256794 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 70 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 am POLICY EFF POLICY EXP LIMITS LTR TYPE OF INS7NINS. WVD POLICY NUMBER MMIDD MMIDD X COMMERCIAL GENERLIABILITY EACH OCCURRENCE $ 1,000,000 DAMA EN D 100,000 CLAIMS-MADE PREMISES Ea occurrence 5xPO Deductible 1,0MED EXP(Any one person) $ 5,000 A PPK1892057 10/0712018 10/07/2019 PERSONAL&AOV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 2,000,000 PRODUCTS-COMPIOP AGG 5 POLICY 1-1JECTPRO- LOC $ OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ea accident BODILY INJURY(Per person) $ ANY AUTO OWNED SCHEDULm BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE $ HIRED NON-OWNED Peraccident AUTOS ONLY AUTOS ONLY $ EACH OCCURRENCE $ 1,000,000 X UMBRELLALIAB OCCUR B EXCESS LIAS CLAIMS-MADE PU8650405 10/0712018 10/0712019 AGGREGATE $ 1,000,000 DED I I RETENTION 5 PER OTH- WORKERS COMPENSATION STATUTE ER AND EMPLOYERS'LIABILITY Y 1 N E.L EACH ACCIDENT $ ANY PROPRIETORIPARTNE(EXECUTIVE ❑ NIA To be sent direct from carrier OFRCERIMEMBER EXCLUDED? E.L DISEASE-EA EMPLOYEE .$ (Mandatory in NH) If yes,describe under EL DISEASE-POLICY OMIT $ DESCRIPTION OF OPERATIONS below Limit 1,000,000 B Professional/Pollution PPK1892059 10/0712018 1010712019 Deductible 5,000 LL_ I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) 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 7 NJ 07054 @ 1988-2015 ACORD CORPORATION. All rights reserved. To the best of my knowledge these plans are drawn to comply with owner's and/or builders specifications and any changes made on them after prints are made will be done at the owner's and/or a builder's expense and responsibility.The contractor shall verify all dimensions and enclosed drawing. LAURA'S ARCH DRAFTING AND DE516N is not liable for errors once construction has begun.While every O effort has been made in the preparation of this plan LL < to avoid mistakes,the maker can not guarantee w F I against human error.The contractor of the job must < N p check all dimensions and other details prior to w construction and be solely responsible thereafter. p z z< � OC �z GONT'D RIDGE VENT 2X12 RIDGE BOARD N 12 8 � 1/2"COX 5HEATHING 2X10 RAFTERS @ 16"Or, ASPHALT SHINGLES VV/15#FELT 2X6 COLLAR TIES @ 32"OG l2"ICE AND WATER BARRIER R-49 INSULATION Z X8 2X8 CEILING JOISTS @ 16"OG 2BOX SILL 0 M 2X6 PLATE b"FA56IA M 12"VENTED SOFFIT it 111131MUM. I= R-21 INSULATION2-2X4 TOP PLATES W ❑®® FM Co 2X4 EXT 5TUD5 @ 16"OG 111111 1111❑. 4' 8G A EGH 1/2"COX SHEATHING 2X OR J I "OG VINYL SIDING 00 \ V K HOUSEWRAP 1/2'DRYWALL INT FINIS 2-2X10 HEADERS 111105TUD Z O� [100 � `n A W ry 00 Ir 2X10 BOX SILL "R-21 IN BAYS APPROX GRADE p?o o LL o 2X6 PT SILL"SEALER o m RW "POURED GONGRETE ALLS Z 2 5/8"THERMAX INSULATIO z DAMPPROOFING w� = in � 4 o Q (V J (V 18"X10"GO T'D FOOTINGS M 2X4 KEYWAY DATE: 10/11/2019 SCALE: 1/4"=1'0" SHEET: P-1 D 0 z UP � o � � o 'nz uj � o 0� 3050DH ? z 0 2 o� Z 3068 oy z � LL oLU = a LU d3o � 0 77 0 3'-4"-�'ry 5 15'-l" o MAIN I ~ m UP LEVEL Amo ENTRY n FA M I L\'ROOM 2668 CLOSET q z m MIDDLE BEDROO'-+ DINING ROOM J N �D N z 2668 6066 IN CLO5ET m z m BATHROOM p z m r o u o °J MI OLE w LYVAYa KITCHEN o o E (L to - 3,8„ k z 26 8 2666 z v w� C =a 12'-2" oQc o � J QN Q K� ;- 2666 2668 a n REAR BEDROOM 5'-1" m REAR HALLYVAY PANTRDATE: Y 2ND FL AI D NS E T I m UP 10/11/2019 Ad J 3068 SCALE: 1/4"=1'0" SHEET: P-2 rc of Q � `no lux 04� 30500H ? Z i 3068 as��ti oc - z � LL of LANDING F O ATTICn o Q. } � ry FRONT MA N FAMILY ROOM LEVEL ENT Y Z 2X10 RAFTERS @ 16"OG 2X8 CEILING JOISTS @ 16"Or, 2ND FLOOR LANDINGT IL m N IOL U- MIDDLE BEDROOM Q fl DINING ROOM Z N ,O` V .W^ O N Z 2668 6068 w n CL05ET o rL 8'-1" 3'-9" � < v BATHROOM _ F mu m "BEORO zmw -j v KITCHEN x%n %3 F �- 2668 2668 g n REAR 2ND FLOOR HALLYNAY PANTRY m DATE: 10/11/2019 3068 SCALE: 1/ SHEET: P-3