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18D-066 (3) Client#: 18589 SIFIN ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMfOD/YYYY) 11/09/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Alton E. Woodford, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 10 North Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. West Hartford, CT 06107 860 236 - 5861 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Peerless Insurance Co. Sifco, Inc INSURER B: S.N. Smith & Co Inc 2643 Day Hill Rd INSURER C: P.O. Box 787 INSURER 0: Windsor, CT 06095 INSURER E: COVERAGES I THE POLICIES OF INSURANCE USTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'C TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS LTR r1SRt DATE IMMIDD/YY) DATE fMMIDDIYYI A GENERAL LIABILITY CCP8007507 02101/09 02/01/10 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES rFn eminence) $50,000 CLAIMS MADE n OCCUR MED EXP (Any one person) $5000 XCU INCLUDED PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000000 GENT. AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 • POLICY n EC n LOC A AUTOMOBILE LIABILITY BA8055465 02/01/09 02101/10 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY $ _ SCHEDULED AUTOS (Por person) X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) X Drive Other Car ` PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESSIUMBRELLA LIABILITY CU8009807 02101/09 02101/10 EACH OCCURRENCE $10,000,000 ,) OCCUR n CLAIMS MADE AGGREGATE $10,000,000 DEDUCTIBLE $ RETENTION $ 10000 $ A WORKERS COMPENSATION AND WC9936420 02/01/09 02/01/10 X STATLL {1 ItOTH- EMPLOYERS' LIABILITY I TORY LIMBS I f ER ANY PROPRIETORIPARTNER!EXECUTIVE E.L EACH ACCIDENT S500,000 OFFICERIMEMBER EXCLUDED? E.L. DISEASE . EA EMPLOYEE $500,000 If yes describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $500,000 B OTHER POLUTION 09CPL00510 , 05/14/09 05114110 $1,000,000 OCC. LIABILITY $1,000,000 AGG. DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ 3A DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZSDAEPRESEN TIVE ar, {' - ACORD 25 !2001/081 of 7 012681 CMF 0 ACORD CORPORATION 1988 • ✓fie anvntrnurieala er ,gz.ac�rwella Board of Building Rcgulatio s and Standards Construction Supervisor License License: CS 15825 Expiration: 3/4/2010 Tr# 17697 ll Restriction: 00 RICHARD E ZAPERT 11 COOK RD SOUTHAMPTON, MA 01073 Commissioner • ( ' I . 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 0 No Q SECTION 11 OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ( I, 6!ne v' eve t,0' t I Cs , as Owner of the subject property hereby authorize , AP1 c ._ 5 w" ei c10 - T to act on my be If, in all matters relat e to ' "w irk by this building permit application. ,, / `.2i -ice 1 c'tti e / - t; ifs / _— /. �� is Signature o wner Date y a, c , 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 /o vi J S ay C 4 if Print Name'` X 0/2 /0 Signatur of Owner /Age 7 7--""<- ! / Date SECTION 12 - CONSTRUCT SERVICES 10.1 Licensed Construction Supervisor: Not Ap I=1 Name of License Holder : 4/ a i C, 7 Gi/'";'/z_T J `J l License Num er c ---c/L- '44 ei-N-r V ) '1 Al 3iii to dress . Expiration Date 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 No 0 � &(/ a l I e 0 A/ce fp,' ,,, -de ,,,e ,,, i S , -I G Dr, c . L \j 5ay � r SI`l�'�t• ►7�> P b 7 , "I^ ' . -e L T 0612)' ' Versionl.7 Commercial Building Permit May 15, 2000 k 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 J I t CU J Vic . Not Applicable ❑ Company Name: :Tok .5 a Responsible In Charge of Const ction n� 6c x 7 11 7 A )) v7 GS 11 C_ r e6 o9� Address /'.7. � - , (O.) ( 647-3'33 Signatur y,,,,,,,,,,----.--, Telephone (6-(l1)06) ?7/ 70 0' t 1 Versionl.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Pxoposed R 'red by Zoning 1 J + L a � column to be filled m by �� �� ( ding Department Lot Size Frontage Setbacks Front Side L:'' R. L R: Rear Building Height 7y Bldg. Square Footage % x Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces F ill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW YES Q IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES l NO q) 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 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15, 2 • R SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ad Existing Wall Signs ❑ Demolition 4,Ikepairs.0 Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ R g [3 Change of Use ❑ Other ❑ Brief Description Enter a brief description here. Coves In ' 11 C i ..1 " ''' ( 'y/C Of Proposed Work: A 4,1 rt 0 64' c P s J Jci c e 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 )4 2A ❑ E Educational ❑ _ 2B 1 ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B I S M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ,A S -2 ❑ 5B I ❑ - [ 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) 151 151 2nd 2 nd 3 d 3rd 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 ❑ Zone Outside Flood Zone0 Municipal ❑ On site disposal system El t A Versionl.7 Commerc ; Permit Ma 15, 2000 Department use only City of Northampton \) , - atu , Permit: Building Department , ' , Driveway Perm - JAN 212 Main Street ./ r� epticAvailability �� R oom 100 ` ` Wate Ava Northampton, M 1 . /. Two Sets of Structural Plans � phone - 413 - 587 - 1240 .FeX, - 4. ' . - 5872 Plot/Site Plans J r Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE; C4ANGE 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 1 d . 9 / U, /6,-)i) ` ,31- Map Lot Unit A v)-N ' ./14:1'1 ,4 Zone Overlay District _ T Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Ownef of Record: Lei 1e. ,%I e v l w 'i ( 1 I t'r . 3) Cie 4 S C.it I l i), - I6+-i../1( 479 OJ) Name (Print) - Curre t Ma iling Address: ` 1r 3) .�yt7 - 5.560 Signature ,9� /.� ` fi / J �eTelephone 2.2 Auth Agent: Name (Print) - Current Mailing Address: Signature , •- - Telephon t (i) ( �' 3 1t /'3 ,G) �/ -C�LY7 r SECTION 3 -'ES7 , ATED CONS TRUQTI0N COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 4 (a) Building Permit Fee 2. Electrical 4 ) Uo47 c 4 % (b) Estimated Total Cost of Construction from (6) 3. Plumbing /9 `'`-J Building Permit Fee 4. Mechanical (HVAC) �U G i � ' 5. Fire Protection ( P-1/4) ' iL 6. Total = (1 + 2 + 3 + 4 + 5) 7 1 v�cJ rte, ~ ^ Check Number w) U i 0 Building Permit Number This Se ction For Official Use Only Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2011 -0621 APPLICANT /CONTACT PERSON SIFCO INC ADDRESS /PHONE P 0 BOX 787 WINDSOR (860) 688 -3331 PROPERTY LOCATION 24 NORTH KING ST MAP 18D PARCEL 066 000 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 7 �c �1 L� n Fee Paid W� Typeof Construction: CONSTRUCT NEW OFFICES & H/C RESTROOM - ENTERPRISE RENT -A -CAR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 15825 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 2 --/i 0 Signature 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. 24 NORTH KING ST BP-2011-0621 GIS #: - COMMONWEALTH OF MASSACHUSETTS 18D -066 CITY OF NORTHAMPTON Lot: -000 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 -0621 Project # JS- 2011- 000957 Est. Cost: $35000.00 Fee: $210.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SIFCO INC 15825 Lot Size(sq. ft.): Owner: WICKLES EDWARD J & GENEVIEVE F CIO WICKLES FAMILY TRUST Zoning: Applicant: SIFCO INC AT: 24 NORTH KING ST Applicant Address: Phone: I nsurance: P 0 BOX 787 (860) 688 -3331 WC WINDSORCT06095 ISSUED ON:1/13/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT NEW OFFICES & H/C RESTROOM - ENTERPRISE RENT -A -CAR 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 1/13/2011 0:00:00 $210.00 212 Main Street, Phone (413) 587 - 1240, Fax: (413) 587 - 1272 Louis Hasbrouck — Building Commissioner