23A-024 BP-2024-0326
31 PARK ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-024-001 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-2024-0326 PERMISSION IS HEREBY GRANTED TO:
Project# 2024 RENO Contractor: License:
Est. Cost: 31000 RICHARD HANKS CS-108730
Const.Class: Exp.Date: 03/30/2025
Use Group: Owner: C DRISCOLL ROBERT J&ANN
Lot Size (sq.ft.)
Zoning: URB Applicant: HANKS CONSTRUCTION COMPANY
Applicant Address Phone: Insurance:
267 FOUNTAIN ST (413)433-7425
SPRINGFIELD, MA 01108
ISSUED ON: 03/26/2024
TO PERFORM THE FOLLOWING WORK:
ROOF REPLACEMENT, KITCHEN RENO, REPAIRS
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 VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
/6"2
Fees Paid: $202.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
A .
V t '
' - -
_O24 Tile Commonwealth of Massachusetts FOR
Board of Building Regulations and Standards MUNICIPALITY
!m -, Massachusetts State Building Code, 780 CMR USE
Building 1 r€xtit Afpplication To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
_ One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: r./'-a 54• ,.;e2A Date Applied:
1) .,5a /� -25-2621-f
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
3/ /�/,t( J . /1/4/7x ,val-o,. frvt
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal On site disposal system ID
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: ✓/t
Joe-A /fa. ' AA a4�7,S,
1.
/�l'i�Q4 ‘40p
� 1it7 xi! /1/ n j 444 6�
Name(Print) City,", State, A e a/-tA7 4e 191, !,4'h m A---
7 s 64,,,, ft . y/3-Sys-2?9/ .3�o�f I Q, all CO Al
No.and Street Telephone Etfiail Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing BuildinA Owner-Occupied 0 Repairs(s) Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': fj`'lo f r'ep14lQ M e ' (-'4 6 i',, efr?pke 40,,Gr,i
Dry w4i ?-60 1)-- afil) /'a P/1T., h ter/i/o o /- /4P S h 11 .
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ /g 0 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ' 0 Standard City/Town Application Fee
�J 0 c' ° - 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 5- a- a 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: 5
Check No. flgr Check Amount: �dp`
6.Total Project Cost: $ 31 I�p p 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts w ,. `.'
.4- DEPARTMENT OF BUILDING INSPECTIONS 3s 4 a° 212 Main Street • Municipal Building � ti
Northampton, MA 01060 -tl1
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
1. Building Permit Application signed by legal owner and filled out
by owner or authorized agent.
2. One set of plans and specifications of proposed work(Digital and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate(new/replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements(if applicable).
9. Energy Code—all new construction (Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
t
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) ,/ F3 /Q 2 ��7 S
kJLicense Number E ua n Date
Name of CSL Holder (/
7 r List CSL Type(see below)
2J r°G'ni .-ft
No.and Street Type Description
^ Q U Unrestricted(Buildings up to 35,000 cu.ft.)
A�
/V j,/In Q R Restricted 1&2 Family Dwelling
City/Tow State,ZIP M Masonry
RC Roofing Covering
/ �, WS Window and Siding
�G¢Nh y �e�A zor-Aerk1 SF Solid Fuel Burning Appliances
3—y33'7(./zs re) � ,vi R J.�O� I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
� l83 /9z yo7/2.,,25
Rit'#& t 1 //gym J HIC Registration Number xpiration Date
HIC Company Name or HIC Registrant Name 2.6 7 fdh/I'tA/n 4Pe tA, e y4 cb,_15-0/204o
No.and Street Email address"'
1 th^ jj,C/Y/J/ /t v1. .4/o g 3//3-t1,3 3--J4?z5 9 //, 0/7
City own,'State,ZIP Telephone
SECTION 6: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 . 0
SECTION 7a:OWNE AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize /5
to act on my behalf,in all matters relative to work authorized by this building permit application.
KIlity!/0 3/1-7
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
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 accurate to the best of my knowledge and understanding.
Date
y
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Alassachusetts
ro.=7,1=71 Department of industrial Accidents
,
row 1 Congress Street,Suite 100
arislOn, MA02114-2017
wovw.mass.gor/dia
11 rnk rs ( oritpensation Insurance Allitht%it:BuildersiContractorsitketriciatisiPlu m hers.
IL ED Wail THE PERA11111NG A11110R111,
Anglican! Info ma lion Please Print Let:ibis
Name iBusinicss;Organt ttoni
Address:
State!Zip: Phone#:
c you an employ yr?t'heck the a ,priate box: Type of project(required):
I im a N.-mph:yet with ‘'. •Opeth part-time t,' 7. 0 New ComitrUeti011
I am a Note prupnetur or parthersh . have no employees working for me in c) Remodeling
arty capacity.(No workers.'comp,M. •ranee rexplired
9. Demolition
I AM ahouswwner doing all NU&1/1}X Irish VCOrktn:comp.IrtsUralliCe roquared.1"
10 0 Building addition
4.0 1 ant a itinrstiinsnsa and skrzli he hiring co. -tors to ClICIdlta Lin%Lark on my p*oserty. 1 will
ensure that all contractors either haNe tvork.., comp.-matron insurance or are sole 1 1.0 Eleetrical repairs or addiill.11,
ptUr114:1071.with no mnpluyeu.
/2E1 Plumbing repairs or addition.,
srj I am a ocneral contractor and I have hued the aU,-LtUntractors listed on tb ann bed sheet
1 3.0 Root repairs
These Nub-erantrackrnk haw ertaiduyees and have • es'comp.insurance.:
14.0-Oher
6E3Vie are a corporanon und rtoffi4.7ers have extretsed 'ir right ores...mon.=per PNICiL c
I If 1).and!A c nu employees.[No workers'c znp,insurance regutnnij
'Any'applicant that checks bu rrru rbu till out the Neetioe bt. in. then worker.;cull:ix:m.2i pdhc:. talycznatNon.
lionaeou,nen who whim; mthcatmg they an:doing wort and then hue outside s'Antirsclecs rims/%Anal a new afiNda,..d indicating so..-h.
%Contractors that cheek this bax must attached in addational sheet N. Mg the flank:Of the sub-euntrutors,anti stak whether or not tho,c entltic,113V‹
iltiplo,ret'N II the sLiks-Condran-tors have enrrL,,ee,th,:, must pniVidi: ir top.polic).nunther
l am an employer that is providing workers'compensation -tsarance for my employees, Below is the polity and job.site
information.
Insurance Company Name:
Policy#or Self-ins. Lie.4: Expiration Date:
Job Site Address: City'StatelZip:
Attach a copy of the workers'compensation policy declaration page(s sting the policy number and expiration date).
Failure to secure coverage as required under!SIGL c. 152,*25A is a criminal % olation punishable by a tine up to S1.500.00
anitor one-year impnsonment,as well as civil penalties in the form of a STOP RK ORDER and a tine of up to$250.00 a
day against the %.iolator.A copy of this statement may be forwarded to the Otlice o nvesttgations of the[MA for insurance
coven14.!... crtlicati(m.
I do hereby act-rift under the pain.% and penalties of perjury that the information Novi above is true and correct.
Signature: Date:
Phone#:
Official use only. Do not write in this area,to he completed by city or mows official
City or Toss n: PermiVLicense
Issuing Authority (circle otie):
I. Board of Health 2.Building Department 3.City/Toss n Clerk 4.Electrical Inspector 5. Plumbing Inspector
6,Other
( uillact Person: Phone 4:
The Commonwealth of Massachusetts
` Department of Industrial Accidents
ii _u1= 1. Office of Investigations
= r 1 Congress Street, Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): / C.4e1----V /....7(
/(7.i"
Address: 6Y Ll.1 i z_
City/State/Zip: 4044, g///f'P. Phone#: L,//3 Ye?,c---- ,c 7----
Are you an employer? Check the appropriate box: Type of project(required):
I.❑ I am a employer with 4• ❑ I am a general contractor and I
ployees (full and/or part-time).*
have hired the sub-contractors 6. ❑New construction
2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
shipand have no employees These sub-contractors have g
❑ Demolition
working for me in any capacity. • employees and have workers' 9. Buildingaddition
[No workers' comp. insurance comp. insurance.:
❑
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL I2.❑Roof repairs
insurance required.] t c. 152, §1(4),and we have no 13.❑ Other
employees. [No workers'
comp. insurance required.]
*My applicant that checks box#1 must also fill 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:
Policy#or Self-ins. Lic. #: Expiration Date:
•
Job Site Address: 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 MGL 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 ad ' at.a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance co prage erific ion.
I do hereby c ijy der t pains an enalti s of ' ry th the information provided above is true and correct.
Signature: ,� Date:
Phone#: V/? 4/& 7
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#:
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 burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call. _
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 7-2013
www.mass.gov/dia
do-
City of Northampton
`t.1ti:T.1',4,,,
Massachusetts
a. a
r'' + , DEPARTMENT OF BUILDING INSPECTIONS
*
S It
Y�
-- `,, 212 Main Street • Municipal Building sR
-- ` Northampton, MA 01060
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:
5(r, fi?$ / /4
Location of Facility: Z$ (/ /1., prei i 0r 1414,0 �iO3~C
The debris will be transported by:
Name of Hauler: A 1N 5-
Signature of Applicant: /� Date: 2z 2V
7
City of Northampton
Massachusetts
R( F assacuse s
*' ,
r DEPARTMENT OF BUILDING INSPECTIONS i i I
*i 1'-s,,r / 212 Main Street • Municipal Building
---.• Northampton, MA 01060
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born (insert
month, day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or
work on a parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'
exemption, does not involve the field erection of manufactured buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns 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 in
a two-year period shall not be considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I
qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of
the project or work on my parcel, I am not engaged in construction supervision in connection with any
project or work involving construction, reconstruction, alteration, repair, removal or demolition
involving any activity regulated by any provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on
my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this day of , 20_.
(Signature)
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).
PRODUCER CDNtAet
NAME: Orlando Alban
Alban Insurance Agency PHONE 413 EAx
(Arc No,Est):EMAI
( )733-5630 (A/C,No):
85 Wilbraham Road AADDREESS: oalban@albaninsurance.com
INSURER(S)AFFORDING COVERAGE NAIC
Springfield MA 01109 INSURER A: Crum&Forster Specialty
INSURED INSURER B:
Hanks Construction Company INSURER C:
53 CLEVELAND ST INSURER D:
INSURER E:
SPRINGFIELD MA UI 1042401 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.
ILA TYPE OF INSURANCE A1UL H JUR PUDGY EFF PUDGY EXP
INSD WVD POUCY NUMBER (M1JDDIYYYY) ( ODIYYYY) LIMITS
K COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE S 1,000,000
UANIA(,t f U RtN I LU
CLAIMS-MADE K OCCUR PREMISES(Ea occurrence) S 100,000
MED EXP(Any one person) S 5,000
A BAK-91670-3 02/14/2024 02/14/2025 PERSONAL&taw INJURY S 1,000,000
CEEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000
K POLICY n 78, I I LOC PRODUCTS-COMP/OP AGG S Included
OTHER: S
AUTOMOBILE UABIUTY (.UMBINEU SINGLE LIMI I s
(Ea accident)
ANY AUTO BODILY INJURY(Per person) S
—OWNED —SCHEDULED BODILY INJURY(Per accident) S
AUTOS— REDONLY AUTOS
N-O PHUPLHIYDAMAGE
HIRED —NON-OWNED S
AUTOS ONLY _AUTOS ONLY (Per accident)
S
UMBRELLA LAAB 1 OCCUR EACH OCCURRENCE S
�—EXCESS UAB CLAIMS-MADE AGGREGATE S
DED I RETENTION S S
WORKERS COMPENSATION PEN UIH-
AND EMPLOYERS'LIABILITY STATUTE ER
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L.EACH ACCIDENT
OFFlCER/MEMBEREXCLUDED? N/A •
S
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S
If yes.describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S
DESCRIPTION OF OPERATIONS/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
OP-WMdo-AUX(M.
0 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
r�l Commonwealth of Massachusetts -Vim*
Division of Occupational Licensure
Board of Building Regulations and Standards
Const�dr1 iSSlpervisor
:r
CS-108730 Itpires:03/30/2025
RICHARD HANKS
267 FOUNTAIN STREET
SPRINGFIELB)YIA 01108 i
Commissioner �aA , . YE',
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:lndivldual
Reg1 tration Elilratlon
183192 09/07/2026
RICHARD HANKS •
RICHARD HANKS 2
267 FOUNTAIN ST
SPRINGFIELD,MA 01108
Undersecretary