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17C-252 (2) J 11 /3/2010 3 :47:05 PM 8935 02/02 (MMJDDIYYY) CERTIFICATE OF LIABILITY INSURANCE D ATE 11/03/2010 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 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 MIT ACT Regina Jasak PHONE FAX P 0 Box 483 (A/C. No. Eat): (A/C No): E-MAIL Ludlow, MA 01056 ADDRESS PRODUCER CUSTOMER ION. INSURED (0) AFFORDING COVERAGE ERIC N INSURED INSURER A: A. I .M. Mutual Insurance Co Pioneer valley Rebuilders Community INSURER B. Development Corporation INSURER C: 1325 Springfield Street INSURER D: Feeding Hills, W 01030 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 'MO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED_ NOTWIRHSTAEDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TEE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN IIAT NAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER POLICY ENT POLICY ERP rmarrs Ltr TYPE OF INSURANCE OM/DD/ms, ,RWDD/rree, GENERAL LIANILITY EACH 0CCURANCB 8 DC(OEERCIAL GENERAL LIABLE, ITT DAMAGE TO RENTED PREMISES (Ea. occurrence ) DID CLAIMS MADE DOM.. NED EiP (Any one person) 8 ❑ PERSONAL. i MR INUURY 8 ❑ GENERAL AGGREGATE — 6 - -� GEN'I, AGGREGATE LIMIT APPLIES ER: ❑POL ICY ❑PROSE CT ❑LOC PRODUCTS - COm1 /OP AGG 6 AWMIS BILE LIABILITY COINED SINGLE LIMY (ea accident) 6 DENY AUTO BODILY INJURY (per gram) $ G AIL CANED AUTOS BODILY INURED (per accident) 8 SCHEDULED AUTOS ❑ HIRED AUTOS PROPERTY DAMAGE (per accident) 6 ▪ NON- O441420 AUTOS 6 ❑ ❑ UMBRELLA L IAB ❑ OCCUR EACH OCCURRENCE 6 ❑EYCE SS LIAR ❑ CLAIMS MADE AGGREGATE 8 El DEDUCTIBLE 6 ❑ RETP. DTION 9 8 WORKERS COMPENSATION DC sUe DTN- AND EMPLOYEES LIABILITY mDr L mxO PA THE PROPRIETOR /PARTNERS/ E.L. EACH ACCIDENT 6 100,000 A EXECUTIVE OFFICERS ARE ® incl ❑ excl 7024303012010 07/02/2010 07/02/2011 SE E.L. DISEASE - EA EMPLOYEE 6 500,000 E.L. DISEASE - EA EMPLOYEE 8 100,000 CUIN/BMTS / De SCRIPT ION OF OPRRASIONS DR LOCATIONS CERTIFICATE HOLDER CANCELLATION CITY OF NORTHAMPTON BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE SR?iRSTLON DATE' TNERZOF, .IIM'IG.& !CELL AN DEL155550 a AIYY0RfANCR IQIR TEX POLICY PROVISIONS 212 MAIN STREET NORTHAMPTON, MA 01060 AUTHORISED REPAIR SENTRY -7 A A 4 1 ----- . 9 1 1\ roy) j c _,.. . - 0.....„ v .-. - \ \ I , _ \ N,... . _ \ .-- , .c ---- ',... •••=.• It - A \ \ \...: ' ) t .- \ \ . ...' ,f- 1- ' 0 ,' -, • 'C V 1 ''''• 1...P 1 \ .. .1 ' \ 1 . \ t __. L.: --, , ‘ , 55 hcrliv0/1 5 Information and Instructions Massachusetts General Laws chapter 152 requires all employ& 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, constriction 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 contact for, theperfonmance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been preseatedto the contracting authaoty." Applicants • - • .Phase fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if may, supply r(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (Lip) with no employees other than the members or partneta, are not required to carry ' won insurance. If an LLC or 112 does have employees, a policy is requited. Be advised that this affidavit maybe submitted to the Department of Industrial - Accidenis for Continuation of insurance coverage: Also be sure to sign p d date the affidavit. The affidavit should be returned to the city or to that the application for the permit or licensees being requested, not the Department of • Industrial Accidents. Should you have any questions regarding the law orif you are required to obtain a workers' . compensation policy, please can the Department at the number listed below. Self - inured companies sh enter their self-insurance license number on the appropriate line. City or Toroth Officials • • Please be sure that the affidavit is complete and printed legibly. The Depadment has provided a space at the bottom of the affidavit for you to fill out in the event the Ofi6e a of Investigations has to contact you regarding the applicant Please be sure to fill is the permit/license mnnber which ',nil be used as a nefe ence number. In addition, an applicant that most submit mnitiple per iWliccnse applications in any given year, need only submit she affidavit indicating current pommy information (if y) and under 'lob Site Address" the applicant should write "an- locations in . (city or town)." A copy of the affidavit that has been officially stamped or mask d by the city or town Maybe provided to the appliesse as roof t eta valid affidavit is on file for fumnepa is or licenses. A must be filled out each yam., • .ifamen cecelti eb a.ideahse.a pest* not rdstedtb ►.bsin�**'4in. a�dal reatare • 4.1e• a dog t►I>nmkavcs c, *Pe !1O' I �` `' .1-'•,F • .T Of In out woul Me to ironic y ou in advan a fcc yoar000paatiion rod iclhbnldyon hsv�o imy que oas; • pllassdo �t to �av7Yh.1 �!'ra"4'9 "."' 3':. .c i• r l i . ._ . y � } . :+ :i.' .t•..:� - .. . . The Deintmenti# address, telephone•and fax number: :. . The Commonwealth of hsassachuseuts • • Dq mez of Indastdat Accidents - " "Officelof luitioas 600 Wesh1ngtiori Sheet • ..,. 11i1A021I1 • • Tel, # 617- 72?- 44Od 1477 AS$APB • RevLed 11-22-06 Fax # 617427.7749 • . . - www.mass.gov/dia • • • The Commonwealth of Massachusetts _,_ = Department of Industrial Accidents PE — , . , fir. _ f!, Office of Investigations • = °fit= 7 • 600 Washington Street It -f= " Boston, MA 02111 y '':.;,• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly • Name ( Business /Organization/Individual):. . \ QU Q \ U-- (\ • Address: A 15 s s Q_A- �J�T • Cit /StatelZip: ..j,,`U. l,� Phone. #: y 1 3 - 73 ( - < 63L( 1 Are you an employer? Check the appropriate box: Type of project (required): 1.0 I am a employer with 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. 0 New construction 2. ':4 I am a sole proprietor or partner- listed on the'attached sheet. 7. 0 Remodeling ship and have no employees . These sub - contractors have 8. 0 Demolition . working for me in any capacity. employees and have workers' g. ❑ Btli1ding addition [No workers' comp. insurance come. insurance.t - r ed.] . • 5.0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their . 11.0 Plumbing repairs or additions • myself [No workers' gi right Of exemption per MGL 12.0 Roof repairs . . insurance required.] t c.152, 11(4), and we have no - 13.0 Other employees. [No . . . comp. insurance requir dod.] - *Any applicant that checks box #1 mat -abo fill out the section below throwing their auxins' compensation policy information. t Bomoovwecs who submit iris affidavit iodic', g they are doing all wait and then hire outside contractors trust submita new affidavit india6ag such. • :Contractors that check this box mat attadied an additional be showing the name ofthe tub -cons acacia and state whether or not dose entities have employees. If the sub- coohactors have employees, they smut provide their vwrfaas' comp. poky number. . - I am an employer that 1s providing workers' compensation lnsuratcefor 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/Bp: Attach a copy of the workers' compensation policy declaration page'(shovviag the policy number and expiration date). Failure e.to secure coverage as required under Section 25A ofMt3L c. 152 can lead to the imposition of critsiuialpetsalfies of a . no trip to $1.50000 and/or one-year hipritonnierst, as well as civil pesiltie isi the fotniofa STOP WORKORDBtt and a fine . • of up to $25000 a daYsgabistttrcviohbor. Be advised that aoopyofbait atateriesittny be fo<Wardedto the Office of ., sonsoftheDIAfor ,;..,ii, cove a: - verification. • . - Id. y7 pa fpeilu+y oro the lu taalon prmtfded abov is true and atrect ' $itsatssre: . 2P,, � '�/`� 4 i aft . iG • Phone L{>' - 7 3 i -. 3 y j • • Officia use only. Do not write to this area b t be compIeteabycky o r toter official. • • City or Town: • ' PeraiiNll # Issuing Authority (circle one): • .1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector ' 6.Other . Contact Persons . • • Phone #s • t Ara IL pioneer Valley 235 Eastern Avenue �e b � l '�er� Springfield,MA01109 ,� 413.827.7060 A community development corporation. 413.827.7066 Fax ! : www.PVRebuildersCDC.org NNW "Rebuilding community, one job at a time." CS 054917 / HIC 1 53979 Versionl.7 Commercial Building Permit May 15, 2000 SECTION 10 STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes ® No 0 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Ni I, Ci�YY' ) 7/ / G e , as Owner of the subject property hereby authorize &IA K to act on my If, in all matters rel ve tow au by this building permit application. Sign re ner Date V I, (.', tV /7 /- / J / r 42. , 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 and penalties of perjury. V ym 9)-; vr/11/f ' C Print Name Signature ner /Agent / Date A SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Steve Thorn 80004 _� License Number /?' I S QG. 5 Q'k 5� 3 ` 1 U 09/17/2011 Addre Expiration Date Addre (413) 221 -6698 i bli Signature Telephone SECTION 13 - 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 0 No O Akik Pioneer Va l l ey 235 Eastern Avenue Re b u d e rs Springfield, MA 01 160 ,� 413.827.7060 413.827.7066 Fax A community development corporation. www.PVRebuildersCDC.org i llear , "Rebuilding community, one job at a time." CS 054917 / HIC 153979 Versionl.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3-General Contractor \ r 1 C)'(\ �J �\ ` R RQ- \OU ) UQN 5 Not Applicable ❑ Company Name: ''V-Z(,) id) ---1 n Responsible In Charge of Construction .c \fAk Addres / �> Signature Telephone 4 i d kk Pioneer Valley 235 Eastern Avenue Re b u i d e rs Springfield, MA 01109 � , 413.827.7060 A community development corporation. 413.827.7066 Fax a lt ‘.4 4111111 / "Rebuilding community, one job at a time." CS 054917 / HIC 153979 Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by a ( � Building Department Lot Size /33 1 ✓fie Frontage Setbacks Front Side L: R: L: R: Rear Building Height 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 O DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW 0 YES 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 0 NO IF YES, describe size, type and location: 15' off road, D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. , , A t• k Pioneer Valley 235 Eastern Avenue Springfield, MA 01 109 ,� 413.827.7060 A community development corporation. 413.827.7066 Fax www.PVRebuildersCDC.org 14 l e, v, "Rebuilding community, one job at a time." CS 054917 / HIC 153979 Version1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition 0 Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other 0 Brief Description Replace front entry steps. Of Proposed Work: SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 [$' 1A 1 ❑ A-4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B 1 ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S -2 ❑ 5B { ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 51 1 st 2nd 2nd 3rd 3'� 4 th 4 Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Pioneer VaHHey 235 Eastern Avenue Apirak Re b u i Springfield, MA 01109 ,. 413.827.7060 A community development corporation. 413.827.7066 Fax !: www.PVRebuildersCDC.org NNW "Rebuilding community, one job at a time." CS 054917 / HIC 153979 Versionl.7 Commercial Building Permit May 15, 2000 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit �. ! ! '212 Main Street Sewer /Septic Availability 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, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office 35 North Main Street, Florence MA Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Seventh Day Adventist Church of Southern New 35 North Main Street, Florence MA Name (Print) Current Mailing Address: (413) 586 -3365 Signature �� 1 -'Z Telephone 2.2 Authoriz =d A. t: Gene Kennedy 93 Mill Street, Suite #B4 Name (Print) Current Mailing Address: (413) 636 -3960 7 ✓ Signature C a/ U Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building $13,300.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number /9' ?I — This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date , File # BP -2011 -0409 ii (J J y_ LO C Q(Pt APPLICANT /CONTACT PERSON PIONEER VALLEY REBUILDERS COMMUNITY DEV OK � k 0 ADDRESS/PHONE 93 MILL ST #b3 SPRINGFIELD (413) 636 -3960 PROPERTY LOCATION 35 NORTH MAIN ST MAP 17C PARCEL 252 001 ZONE GB(2) /SI/URB(98)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out r �G Fee Paid / 7 0 p ?3 IS Typeof Construction: REPLACE FRONT ENTRY STEPS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 80004 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN� F9 1MATION 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 11 4 r a Sig e 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. a , 35 NORTH MAIN ST BP- 2011 -0409 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C - 252 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2011 -0409 Project # JS- 2011- 000677 Est. Cost: $13300.00 Fee: $80.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PIONEER VALLEY REBUILDERS COMMUNITY DEV 80004 Lot Size(sq. ft.): 14461.92 Owner: SEVEN DAY ADVENTISTS CHURCH Zoning: GB(2) /SI/URB(98)/ Applicant: PIONEER VALLEY REBUILDERS COMMUNITY DEV AT: 35 NORTH MAIN ST Applicant Address: Phone: Insurance: 93 MILL ST #b3 (413) 636 -3960 WC SPRINGFIELDMA01108 ISSUED ON:11/8/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE FRONT ENTRY STEPS 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 11/8/2010 0:00:00 $80.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner