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24D-240 (2) . . The CHIMNEY SYSTEMS 46 Joy St, Chicopee MA 01013 1 - 15 - 10 (413) 594 -8764 DATE SITE ADDRESS: BILLING ADDRESS: NAME Ed Feld Same ADDRESS 97 Cresent St. Northampton, MA 01060 PHONE 584 -9080 Thank you for your interest in THERMOCRETE. We are pleased to submit the following quotation for lining your chimney. SPECIFICATIONS NUMBER OF FLUES TO BE LINED One presently 9 " by 131/2" unlined. LOCATION OF FLUE(S) Center of house to first floor. t DESIRED USE OF FLUE(S) Fireplace ,,, APPROXIMATE SIZE OF FINISHED FLUE(S) 6" by 12" oval cast - in -place liner, OBSERVED CONDITIO OF CHIMNEYS) Poor : inner brickwork is deteriorated throughout chimney; pieces of'bric /mortar'failing out. OTHER SPECIFICATIONS Chimney is approx. 30 feet; firebox opening is 31" by 32" high; . flue is straight no bends; brick missing in smoke chamber wall; damper broken. OTHER WORK TO BE DONE Clean chimney prior to lining process; replace brick in smoke chamber wall; repair damper handle bracket; lay masonry crown & top tile. TOTAL PRICE $ 2750.00 NOTE: Deposit due on day DOWN PAYMENT $ 1000.00 , . ins . BALANCE DUE 1750.00 ° v' DAY OF COMPLETION $ This estimate good for thirty days from above date. If you have questions, or if we can be of any assistance, please do not hesitate to contact us. If you wish to schedule the job, please read the TERMS AND CONDITIONS on the reverse side and sign below. Return the top copy to the address listed below. We will then set a date for beginning your chimney work. Thank you. Approxi , e completion date: / 1 OWNER -, ERMOCRETE CHIMNEY SYSTEMS DATE: ..y N o c , ,2 0/ v DATE: �— '• BY '� �� � BY /trj�� 1 •�s.`�- ){ PETER J. SURER R ® AC OP ID SH B `� INSURANCE BINDER ATE (MM/DD/YYYY) 05/08/2009 THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM. AGENCY COMPANY BINDER# 2445 - Patrons Mutual Insurance Neill & Neill Insurance Agency DATE EFFECTIVE TIME DATE TIME TIME # 662 Riverdale Street X AM X 12:01 AM West Springfield MA 01089 David R. Jarry 05/08/09 12:01 PM 06/08/10 NOON 413 - 732 -4137 FA 413 - 731 -6629 (A/C, No, Ext): (NC, No): THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE AOOVE NAMED COMPANY CODE: SUB CODE: PER EXPIRING POLICY #: AUSN CUSTO THERM -1 DESCRIPTION OF OPERATIONSNEHICLES /PROPERTY (Including Location) CUSTOMER ID; INSURED Thermocrete Chimney Systems Policy Eff Dates: 04/12/09- 04/12/10 Peter J. Burek DBA Chimney Services 46 Joy St. Chicopee MA 01013 COVERAGES LIMITS TYPE OF INSURANCE COVERAGE/FORMS DEDUCTIBLE COINS % AMOUNT PROPERTY CAUSES OF LOSS BASIC BROAD I 1 SPEC GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAGEI X COMMERCIAL GENERAL LIABILITY RENTED PREMISES $ 50,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 R X CTR0001933 PERSONAL & ADV INJURY $ 1,000,000 ,„..1.„ GENERAL AGGREGATE $2,000,000 RETRO DATE FOR CLAIMS MADE PRODUCTS - COMP /OP AGG $ 2,000,000 AUTOMOBILE LIABILITY • COMBINED SINGLE LIMIT $ r ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS • BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ ' -:..4 HIRED AUTOS MEDICAL PAYMENTS $ NON -OWNED AUTOS PERSONAL INJURY PROT $ ' UNINSURED MOTORIST $ j $ AUTO PHYSICAL DAMAGE DEDUCTIBLE ALL VEHICLES SCHEDULED VEHICLES , ACTUAL CASH VALUE COLLISION: STATED AMOUNT $ OTHER THAN COL: OTHER GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: SELF - INSURED RETENTION $ WC STATUTORY LIMITS WORKER'S COMPENSATION E.L. EACH ACCIDENT $ AND EMPLOYER'S LIABILITY E.L. DISEASE - EA EMPLOYEE $ I E.L. DISEASE - POLICY LIMIT $ SPECIAL Policy Period: 04/12/2009 - 04/12/2010 • FEES $ CONDITIONS/ IONS/ TAXES $ COVERAGES ESTIMATED TOTAL PREMIUM $ NAME & ADDRESS MORTGAGEE ADDITIONAL INSURED LOSS PAYEE LOAN # Thermocrete Chimney Systems Peter Burek AUTHORIZED REPRESENTATIVE 46 Joy Street Chicopee MA 01013 David R. Jarry ACORD 75 (2004109) NOTE: IMPORTANT STATE INFORMATION ON REVERSE SIDE © ACORD CORPO TION 1993 -2004 I ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 12/22/2009 PRODUCER (413) 536 -1491 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Metras Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2030 Memorial Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Chicopee • MA 01020- INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: A. I . M. Peter Burek d /b /a Thermocrete Chimney Systems INSURER B: National Grange Mutual 46 Joy Street INSURER C: - INSURER D: Chicopee MA 01013- INSURER E: , COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSRD TYPE OF INSURANCE POLICY NUMBER EFFECTIVE (MM/DDIYYY) P DATE (MM/DD/YY) LIMITS GENERAL LIABILITY / / / / EACH OCCURRENCE $ — COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS MADE I OCCUR / / / / MED EXP (Any one person) $ _ • • PERSONAL & ADV INJURY $ _ / / / / GENERAL AGGREGATE _ $ — GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ — I POLICY I JECT LOC / / / / B AUTOMOBILE LIABILITY M6W55174 01/01/2009 01/01/2010 COMBINED SINGLE LIMIT ' 'S ' _ ANY AUTO (Ea accident) $ ALL OWNED, AUTOS / / / / BODILY INJUR'' X SCHEDULED AUTOS (Per person) $ 100 , 000 5 HIRED AUTOS / / / / BODILY INJURY NON -OWNED AUTOS (Per accident) $ 300,000 — li. / / / / PROPERTY DAMAGE It (Per accident) $ 100,000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY , / / / / EACH OCCURRENCE _ $ I OCCUR I CLAIMS MADE AGGREGATE ^ $ — $ _ I DEDUCTIBLE / / / / $ _ i I RETENTION $ $ A WORKERS COMPENSATION AND VWC6001980012005 12/16/2009 12/16/2010 ITO ST A TU sl IV EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ 1, 000, 000 OFFICER/MEMBER EXCLUDED? / / / / E.L. DISEASE - EA EMPLOYEE $ 1,000,000 It yes, describe under 1 00 000 SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ , , OTHER / / / / / / / / . / / / / DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLESIEXCLUSIONS 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 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Evidence of Insurance FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Brup _ iq tte ACORD 25 (2001/08) © ACORD CORPORATION 1988 Page 1 of 2 INS025 (0108).06 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill). sonotube holes (before pour). a rough building inspection (before work is concealed). insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure . these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper ---- — }its -in- conj unction.to- the_buildingTermi issued,_ and--that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Address of work location The Commonwealth of Massachusetts Department of Industrial Accidents = l� fi Office of Investigations • • 1.� e = '— 600 Washington Street l: _ j Boston, MA 02111 y;. www.mass.gov /dia -Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/PIumb.ers Applicant Information Please Print Legibly Name ( Business /Organization /Individual):' 7`7 2 n o( 7Z ( //liei4'l T r y 17 X Oa E � / Address: ii o S - City /State /Zip: Chi( el:::: OA- ., () / O/3 Pho # �3 ... c{ - �7 Are you an employer? Check the appro box: Type of project (required): / . 1. n I am a employer with 4.. I am a general contractor and I �W 6. ❑New construction employees (full and/or part- time).* have hired the sub- contractors 2. ❑ I am a sole proprietor or partner- listeese d on the attached sheeavet 7. E Remodeling ship' and have no employees loyees Th sub - contractors h8. Derro'uon for me in an capacity. employees and have workers' working Y p ty. 9. Q Building addition [No workers' comp. insurance comp. - insurance_$ required.] 5. I We are a corporation and its 10.0 Electrical repairs or additions 3.0 I- am- a-homeowaer- doing -ll -work _o_ cer Kaye .xe ised.their —1-1-.Q-Plumbing repairs or additions myself [No workers' comp_ - right of exemption per MGL 12.0 Roof repairs insurance required] t c_ 152, §1(4), and we have no . - employees. [No workers' 13.0 Other comp. insurance required.] . *Any 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 bore 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. �, _ r Insurance Co any Name: v ct ® A.dr. tit C--- �K Policy # or Self -ins. Lic. #: VIGI j /q ' Go /- € d - Expiration Date: /?- "/(v /C7 Job Site Address 77 6 _ y mew/ S7 City /State /Zip: s, v • oX1foo 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 51 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: to 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 t if y . a . the pains , d , • ,- „f•; ofperju that the information pr.ovided_above is_true- andcorreat __ Si,... '�� trA►."t'2I railer s ate. -/ 9— j' . ____ Phone #: y ('3 — 1 —F-76- Official use only Do riot write in this area, to be c - i pheted by city or sown officiaL City or Town: Permit/License #__ Issuing Authority (circle one): I. Board of Health 2. Building, Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector _.__ _- 6. Other Y s. Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: /� Not Applicable ❑ Name of License Holder : ?ere 7 C/t C5 s(1 93 /Q License Number ` f J s ( � � D id /3 7 — / — 20/j Address / E xpiration Date Signire elephone 9. Registered, Home Impro rement for „ f. 3 Not Applicable ❑ :..,, s" s 7— //!5-37' Comp. v Name Registration Number 7 -/ �* Address / Expiration Date C4 /( / � Telephone /35 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 ❑ The_ current_ exemption for "homeowners" was extended to include Owner Dwellings of one (1) 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 r iU a n Lour ° . i ' _ .1 . . -- - .-s General..Laws- Annotated. Homeowner Signature r - SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House Addition El Replacement Windows Alteration(s) ❑ Roofing EJ Or Doors 0 Accessory Bldg. ❑ Demolition El New Signs [DJ Decks [Q Siding [D] Other [O1 Brief De -- ipf gn of Prop f ed Work: - ,> �' ' —/ — ./ �� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 64: If: N house and of addition' to existing housing, complete ttie fotlowinc : 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 , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 1, �7tic a.f �.�'. , as Owner /Authorized Agent he y declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed der the pains and penalties of perjury. e 7. E Prin Name 9 Sig . ture of Owne - • ent Date Section 4. ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front _ µ Side Rear _ ..- Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved '- F i parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:;` IF YES: Was the permit recorded at the Registry of Deeds? NO 0 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 0 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 0 IF YES, describe size, type and location: D: ,ore erg any propo" s Ehanges to or addition signs intn3d for the property ? YES 0 NO 0 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 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. ' s p City of Northampton �� f - Building Department Cr[�� prewe y 212 Main Street sws b v , Room 100 • rraltaai� Northampton, MA 01060 Tw©s�"�ctu�afl�Iat t nl 1 9 i" e 413 -587 -1240 Fax 413 -587 -1272 APPUCATION TQ COI4STRU4T, 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 91 Ot "! t O / ' Map Lot Unit W? Zoiie Overlay D Elm St District° CB District SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: • Name (Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Na a (Print)) , Current Mailing Add ess: f _ — 44116 4 1/3 tP7 Signa . e Telephone g / lep SECTION 3 - .ESTIMATED CONSTRUCTION'COSTS. Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant • 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) ehujy V //� , ` /C1 5. Fire Protection /BI t Nr 6. Total = (1 + 2 + 3 + 4 + Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date • File # BP- 2010 -0675 APPLICANT /CONTACT PERSON THERMOCRETE CHIMNEY SYSTEMS ADDRESS /PHONE 46 JOY ST CHICOPEE (413) 594 -8764 PROPERTY LOCATION 97 CRESCENT ST MAP 24D PARCEL 240 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �p Fee Paid O Typeof Construction: RELINE CHIMNEY TO FIREPLACE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 93194 3 sets of Plans / Plot Plan THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I RMATION 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 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. 97 CRESCENT ST BP- 2010 -0675 GIS #: COMMONWEALTH OF MASSACHUSETTS 1ap:Bloek:4D' -<240 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0675 Project # JS- 2010- 000988 Est. Cost: $2750.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: THERMOCRETE CHIMNEY SYSTEMS 93194 Lot Size(sq. ft.): 12109.68 Owner: FELD EDWARD & MERLE L Zoning: URC(100)/ Applicant: THERMOCRETE CHIMNEY SYSTEMS AT: 97 CRESCENT ST Applicant Address: Phone: Insurance: 46 JOY ST (413) 594 -8764 WC CHICOPEEMA01013 ISSUED ON:1/27/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: RELINE CHIMNEY TO FIREPLACE 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 1/27/2010 0:00:00 $25.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo