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17A-006 jite elf - / iy / / 4 ° 4 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 M —5 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 165217 Type: Corporation Expiration: 1/21/2014 Tr# 220702 CO -OP POWER, INC. PAUL SCHMIDT 324 WELLS ST GREENFIELD, MA 01301 Update Address and return card. Mark reason for change. 0 Address E Renewal 0 Employment 0 Lost Card DPS -CA1 is 50M- x4;04- G101216 ?fie o/ ✓ #aaaaduuaelta Office of Consumer Affairs & Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration. 165217 Type: Office of Consumer Affairs and Business Regulation Expiration 11 Corporation 10 Park Plaza - Suite 5170 Boston, MA 02116 CO .P POWER, IN - , PAUL SCHMIDT 324 WELLS ST , GREENFIELD, MA 01301 Undersecretary Not v without signature Massachusetts - Department of Public Safer% w t1 Board of Building Regulations and Standards / Construction Supervisor License License: CS 103635 Restricted to: 00 PAUL SCHMIDT 24 CHESTNUT ST HATFIELD, MA 01038 Expiration: 5/20/2013 C Tr#: 103635 The Commonwealth of lifassachusetts . w 4 Department of Industrial Accidents -== "t Office of Investigations . � w 600 Washington Street °; im + -- , .g Boston, MA 02111 �� r. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): C 6 (f?"Lt/6^ ., - it C. Address: ' tf o+! &t (S S City /State/Zip: : Yt- - (-{" i'Iione 44: ( .--- -1 7. 2- Are ou an employer? Check the appr i +rate box; Type of project (required): 1 1. am a employer with t t 4 . 0 I am a general contractor and I employees (full and/or part - time). �' have hired the sub-contractors '5 New construction 2.0 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' 9. ❑ Building addition [No workers' comp. insurance comp. mstrrance.l required.] 5. 0 We are a corporation and its 10. ❑ 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' comp. right of exemption per MOL 12.0 Roof repairs _ insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13 . (a Other inV (A, t GL. OY� comp. insurance required.] ' *Any applicant that checks box #1 must also fill out the section beiow 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. lithe 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 ielformatlon. • � „ k , � Insurance Company Name: t W fr C t j / F (E" -�' ��S t 't^ Gc C Policy # or Self -ins. Lie. #: 0 rY G I__ C. & 8 47 Expiration Date: 14 - i - .2- 6-1 2- -- 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 VIOL c. 152 can lead to the imposition of criminal penalties of a tine up to $1,500.00 anrt /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. I do hereby cer • under the ' s , rnd p - , Ides of perjury that the information provided abo e is true and correct. Signature: ' Date: i II Phone #: f g - q"7 2- 6 1 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 #: City of Northampton 4 \S.. zie / ' 7 Massachusetts * c , . w ga " < " . 1 DEPARTMENT OF BUILDING INSPECTIONS I. lF �1 212 Main Street • Municipal Building � ��"' \ Northampton, MA 01060 St iY 3 ") .\ Property Address: Z 7 it-wig-,u: - L4- 6 WC 72 -- Contractor Name 1 019 7' Address: �Z t/ ln/M c 5'r. City, State: el P1 1-1,9 Pt A" (3,i > a Phone: \ .. LI (3 ) 37, - tb b g b Property Owner Name: ,_"L 'l4' l/ you X Address: ' X -rvt,ry City, State: 1, L , - 1WM t r (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have provided the property owner with a co- s .f this affidavit. Z Contractor signature P /s 4 Date 1 /01/ Z AC o CERTIFICATE OF LIABILITY INSURANCE 1 �i 2 E(NIMMD _�- 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 NAME: Shannon Pala77c James J. Dowd & Sons Ins ( r PHONE . ExtI:413- 538 -7444 (Am No):413- 536 -6020 14 Bobala Road E-MAIL Holyoke MA 01040 ADDRESSS... • • • • ■ ..0. INSURER(S) AFFORDING COVERAGE NAIC 1I INSURER A Safety Indemnity Company INSURED COOP INSURER :Great American Insurance Companies Co Op Power, Inc. INSURER C:U. S. Liability Insurance Company 324 Wells Street Greenfield MA 01302 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1050225280 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. NCTWITHSTANDINC ANY RECUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED CR 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR ' IN$5 M/ WVD POLICY NUMBER (MM/DDTYYYYI (MDD/WYY) C GENERAL UABIUTY L1566148 11/6/2011 11/6 /2012 EACH OCCURRENCE $1,000,000 DAMAGE 70 RENTED X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $100,000 CLAIMS -MADE OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENII AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $2,000,000 POLICY IF T X LOC A AUTOMOBILE LIABILITY COM6212701 3/23/2011 3/23/2012 ( E a ac identl GLE LIMl I (Eaeccident) $1,000,000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED X SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON -OWNED PROPERTY DAMAGE $1,000,000 AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE . $ EXCESS UAB CLAIMS -MADE AGGREGATE $ _ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY I• / N I TORY LIMITS FR ANY PROPRIETOR/PARTNER/EXECUTNE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ( N / A (Mandatory M MH) E.L. DISEASE - EA EMPLOYEE $ If yes destxibe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Directors & Officers Liability EPP1117553 5(22011 52/2012 1,000.000 5.000 Deductible DESCRIPTION OF OPERATIONS 1 LDCATIDNS ( VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Waiver of Subrogation Applies. CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Honeywell Utility Solutions ACCORDANCE WITH THE POLICY PROVISIONS. 65 Shawmut Road Suite 4, 2nd Floor AUTHORIZED REPRESENTATIVE Canton MA 02021 -1461 r ow. 4.,. (31913B-201D ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ACQ CERTIFICATE OF LIABILITY INSURANCE DATE (MIWODI 1 Y) 1... 11/29/2011 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: 0 the certificate holder is an ADDITIONAL INSURED, the poiicy(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 N ca TACT Joseph Judd Blackmer Insurance Agency Inc. Ma rc o No ,Pxn: (913) 625-6527 No: (412) 625 -6210 1147 Mohawk Trail ADDRESS: j oe @blacimrers.com INSURERS) AFFORDING COVERAGE HAIL it Shelburne MA 01370 -9707 INSURERA:Twin City Fire Insurance Co 29459 INSURED INSURER B : CO -OP POWER, INC. INSURER C : PO BOX 688 INSURER DI PC BOX 688 INSURER E : GREENFIELD MA 01302 INSURER F: COVERAGES CERTIFICATE NUMBER:Mster 11 -12 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 CONDT7ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY t3E ISSUED MAY-PERTAIN, .THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN 1I5 SUBJECT TO ALL THE TERNS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I LSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POUCY EXP Vn LIMITS INSR W POLICY NUMBER (MMIDDNYn (M ► YYwootYr GENERAL LIABILITY EACH OCCURRENCE 5 COMMERCIAL GENERAL LIABILITY p M SES (ERENTED o T rrenix $ CLAIMS -MADE n OCCUR MED EXP (Any one person) $ _ PERSONAL & ADV INJURY 5 GENERAL AGGREGATE 5 GEM. AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG 5 7 POLICY n iF a P1 LOC _ S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY (Per person) S — AUTOS N � _ AUTOS BODILY INJURY (Per accident) S NON -OWNED PROPERTY DAMAGE 5 ` HIRED AUTOS AUTOS fPer aeadenfl S UMBREUA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE S DED l RETENTIONS S A WORKERS COMPENSATION ( TfSR y 1 A A T 7 U S I I T . AND EMPLOYERS' LIABILITY ANY PROPRIETORfPARTNERIEXECUTIVE Y / N EL. EACH ACCIDENT 5 1,000,000 OFFICER'MEMBER EXCLUDED? n NIA 11/1/2011 11/1/2012 (Mandatory in NH) 0@SSECT,C6666 EL DISEASE - EA EMPLOYEE 5 1,000,000 U yes, describe under DESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedute, II more spate is required) Operations usual to energy efficiency services - energy audits, air sealing, insulation and solar hot water system installation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Honeywell Utility Solutions ACCORDANCE WITH THE POLICY PROVISIONS. 65 Shawmut Rd, Ste 4, 2nd Fir Canton, MA 02021-1461 AUTHORIZED REPRESENTATIVE f- J Deneault, CISR /BLAJ ACORD 25 (2D10105) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD co -Op r 14 POWER BUILDING COMMUNITY -OWNED SUSTAINABLE ENERGY Affidavit of Waste Disposal 1, Paul Schmidt Energy Efficiency Program Director of Co -op Power certify that Co- op Power will remove all waste from the job site located at:_ rwcv Lat- lk f / L 'rl v 1 F it At, c INU-) c (,5 6 2 _ Owner Name Street Address Town /State/Zip Waste will be disposed of at our dumpster at our facility in Hatfield, MA. Our removal service is Waste Management. a_ Paul Schmidt Date • Co -op Power, 324 Wells St., Greenfield, MA 01301 or Mailing Address: Box 688, Greenfield, MA 01302 ph: 413.772.8898 or 877.266.7543, fax: 413.517.0300, info @cooppower.coop, www.cooppower.coop SECTION 8 - CONSTRUCTION SERVICES _,icensed Construction Supervisor: 8.1 Licensed Construction Supervisor: 'aul Schmidt Name of License Holder : )4 Chestnut St. _ -latfield, MA 01038 # 103635 U Address � xp. 5/20/2013 tP 4 143-772-8898 Signature 11 Cr■ � Tel pho -Tome Improvement Contractor: "-o -op Power Inc. / Paul Schmidt 9 Re! istered Home Im rovement Contractor: 324 Wells St. Jreenfield, MA 01301 _ Company Narlte # 165217 �xp. 1/21/2012 Address i 113- 772 -8898 i u ' )aul @cooppower.coop 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 8 No ❑ 11. Home Owner Exemption The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (I) 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 as 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 in a two -year period shall not 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 under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be 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, you may be 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 Pri-H 1,r wan SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [O] Other [0] Brief Descrip ion of Propose Work: 1 iv k t kT) r r -- 3. S (ift j tvt" ( i ' tr / 14 i hv 0/ LI' ''rrit Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - 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. 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, /3 L F i to D P . z,, > ` i- tc c ' Y- , as Owner of the subject property hereby authorize t, k 1 ( —v to act on my behalf, in all atters relative to work authori ed by this buildin permit application. Signature o Owner 1 Date 3 L SUM VIP ✓ , 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 th- rains . nd pe alties of perjury. . ' iiii Print Na l e ' IV ui l. Signature of i • sent Date I L Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information 1 Existing Proposed Required by.Zoning This column to be filled in by Building DepaEtment , Lot Size 1 I 1 I I Frontage I I I 1 I I Setbacks Front I ( I I I Side L:I 1 R:1 1 L:I 1 R:I I I 1 I Rear 1 I 1 I Building Height Bldg. Square Footage ( % I I Open Space Footage % (Lot area minus bldg & paved 1 I I 1 I I I 1 I I parking) # of Parking Spaces I 1 Fill: (volume & Location) A. Has a Special Permit /Variance /Finding e er been issued for /on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Regi try of Deeds? NO O DON'T KNOW YES O IF YES: enter Book Page and /or Document # r B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , 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 - O NO C', IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, exc ation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only RECEIVED City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit APR - g 2012 212 Main Street Sewer /Septic Availability Room 100 W ater/Well Availability N I rthampton, MA 01060 Two Sets of Structural Plans DEPT OF BUILDING INSP ONS NORTHAMPTON, M ` '. - ' - 587 -1240 Fax 413- 587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office Z 3 1- t v o Map Lot Unit f 1 / 0 " - 1 - 4 ° M A d 10 2- Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: / ( - r e D P 3 L- tc,/r 77! t>) c.' CC- / Name (Print) Current Mailing Address: Telephone / 3 si G~ � f A, . _.. ° �ts .4. r b -1 1 s� ° 2 2.2 Authorized Agent: Gilt. id( t t 4 ( ("tit, f'! , $ T . & ) Pr/ n'1 a (.30 i Na - (Print) Current Mailing Address: ) 43-2 Signature Telephone g SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building - I 21 16' ov (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) 2- ( Check Number 3/99 9 This Section For Official Use Only Date Building Permit Number: Issued: Signature: ,A O� 9 Building Commissioner /Inspector of Buildings Date 23 LEENO TER BP- 2012 -0877 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A - 006 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit # BP- 2012 -0877 Project # JS- 2012 - 001543 Est. Cost: $2126.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq. ft.): 13503.60 Owner: LEROUX ALFRED P & GAIL B Zoning: RI(100)/URA(100)/WSP(100)/ Applicant: PAUL SCHMIDT AT: 23 LEENO TER Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247 -5739 WC HATFIELDMA01038 ISSUED ON:4/10/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATE WALLS 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 4/10/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner