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31B-005 (4) i ,v.,,. - nx : Al �. �.._o... „lo a r...y r oyc c V, ._ 1....a.c.4-,4,....av ,h v ,..-. •- m. - ayc.c v, _ ' Ac9RfJ CERTIFICATE OF LIABILITY INSURANCE OP ID DS CATE,kl?,ODhYYY) , iak„r,.'".' AMER1 -3 02/26/10 1 ' 7 ' -_' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMIA.TION J Raymond Lussier Ins Agcy Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 181 Park Avenue . Suite 8 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO SOX 499 ALTER THE CO' /ERAGE - AFFORDED BY THE POLICIES BELOW. . West Springfield MA 01090 -0499 Phone: 413 -737 -5359 Fax :413- 732-2027 ; INSURERS AFFORDING COVERAGE NAIC INSURED REP Hanover Insurance Company . t — 22-9 1 Iri._i>ei-E Granite State Ins Co i American Masonry, Inc ; II' c_ - - Fr:C 119 Dupuis Road r - - - - — Holyoke hA 01040 f "" _PLR `, - _ -- -__ - - --1 COVERAGES TH_ ),I„IEF ..F HP,' k L STED EEL. He .E IEEE ,_UF. nE1HE li kl.'k . ?:.FC E FE_F r E PJLI E -.L, f JCl'ATED N_E- PAT- d!TANDING •- fN PE 7, FFPIE1 T? Cf. cr CdT,CNOF dd f,r:•.7_.4.'THEA C -v ✓Fd /V! PCPS(TT s, i -iB( i THE! E :,IFiC' TE W EF - IJED OR PEP ?,1!, THE =CFr" '_ Ei THE OL c_CPIEED -∎_ E, i I . -. P_ TTr,xL THE TE=:MS E C LU;C ..p LCP,OiT : SUCH ES E re , F,'E,EATF- Lia SI- ',,itd dAr H,.` / =EE'I REP' ,,,"r_ .'. I.s MR' ?DL' Ci__.___—__—__.__—._____—__ ___7___— __— .— __-- ._�_— .__ —___._ 1 POL'CYEF:ECTI`.'E' T CTEICY ERF`FfFATJFET ! ,_ INSRC1 TIFF OF INSURAN•_E POLICY NUMBER `- I DATE (kPlii.7.D` °'(7Y) CATE (MMIDDIYYYYj I LIMITS L . GENERAL uAai Ln ' ! I E H X R LACE _ i 1000000 A I I;,_Ii FEEPLLI r TY ! OHN5693407 -OS C!4 /12/09 04,12/10 Eg E e) ? 300000 _ LAMc �,c , ! I PF • r Epp, Ohe( r: r I 'k _ 15000 1 I_ >' Business Owners ! N L s 1000000 ., r d FP_A E - E 11 2000000 RE; „T , PP „ PE: PR,D!l T” cr.c!F f - - ' 1E2000000 : AUT MOBILE LI,.EILm' I ! I r r I r I u,ir I 1000000 A ' I -w 1 ABN6960587 -08 : 2/12/10 1 02/12/11 L f 1 ! 1 1 i HELD L r, T 1 i L! If•ULR° 1 If ' r ...Fi c n I _.. 1 __.. FF PERT' E∎M ; E I'1 1 I (P, 3ai7ert; 1 1 j —__ — — I . GARAGE LIABILIT7 —�— I AL: :, n• , _ ■,; ACG DE-!T I r - --. — h ---1 ! nT1iFR T--,AN FJ; f:CC - - EXCESS • C^ABRELLA LIABILITY — I ! - - -- —...4 A H 7)'- TE!, ;, 1 E 10 0 0 000 E A X ! UfN6684517 04/1 1 I 1000000 C,.F L _ CI- Nar:E 2/09 1 04/12/10 HF :..“E i 1- ; , ucr aL I h j T $1000D ! I - - i — - N CRRERS OMPENSATION T -- APIDPioPL Y RS Lrh BLint f , N ! ! I �T:Ri I �I. _ 1 —y k�_ B , J 1 PRCPRE F <.Fr EFrtirJ:TVP r - ! WC007426278 ! 04/09/09 ! 04/09/10 EL - ACHFr IDE\T i 100000 FF1 F Wi:Ed DEPE =! E,; I f — —._— (Polanaaiurq - - - i EL !EE." E EL - .E. i'i 100000 ..—_ r yes. u -s;. to Lrlder f __ — r - - --- .. « _ Pr oel I_dNsb brq E cv _lulT t 500000 OTHER .� —. —.—. �..�.__ �! — r — 1 I — - - - - - -- - — — -L- -- - -- __ CE'SCRIpri =•P4 of opeRQT,ONS ! LOCATIONS i VEHICLES i EKCL'_ S.O NG ADDED Fs i' ENDQRSEME■:: i SPECIAL PR VISIONS CLARKE SCHOOL FOR THE DEAF IS LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER _ CANCELLATION SHCULD ANY OF THE ABO` +E DESCRIBED POLICIES BE CANCELLED BEFGRE THE E }PIRATION CLARKES CATE THEREOF. THE ISSUING INSURER WILL ENDEAv OR TO MAIL 20 OAYS WRITTEN. NOTICE TG THE CERTIFICATE HOLDER !-LAMED TO THE LEFT, BUT FAILURE Ti) DO GO SHALL :?POSE NC OBLIGATION OP LIABILITY OF ,1,iY KiNC UPON THE INSURER, "S AGENTS OR CLARKE SCHOOL FOR THE DEAF REPRESENTATIVES. 46 ROUND HILL - — - -- - - L NORTHAMPTON MA. 01050 HO - =_D �EFae�-NrA r 1/ dwil�/ �� S I — ACORD 25 (2009/01) QD 198: •2009 AC'' 0 CORPORATION. All rights reserved. 40 The ACORD name aria kiwi are registered marks of ACORD Lu A v g ,liro I� ) • INDEPENDENT SCHOOLS COMPENSATION CORPORATION NCCI CARRIER CODE NO. WC 00 00 01A WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE 1. The Insured: Clarke School for the Deaf Policy No. WC 000998 -9 Renewal of: WC 000998-8 Individual Partnership Mailing address: 47 Round Hill Road X ton, MA 01060 Corporation or Northampton, Federal Employers I.D.# 04 Inter /Intrastate Risk I.D. # 24528 Other I.D. # Other workplaces not shown above: See Schedule 2. The policy period is from 01/01/2009 12:01 a.m. to 01/01/2010 12:01 a.m. standard time at the Insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 500, 0 0 0 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 5 0 0 , 0 0 0 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06 A D. This policy includes these endorsements and schedules: See Schedule 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rate Per Code Total Estimated $100 of Estimated Classification No. Annual Remuneration Remuneration Annual Premium See Item 4. Extension WC 00 00 O1A Total Estimated Annual Premium $ 37, 750 Deposit Premium $ 37, 750 Minimum Premium $ 291 (MA) 9101 Expense Constant $ 338 MA - DIA Assessment 0.061 3,032.00 Premium Adjustment Period: Annual Countersigned by: Servicing Office: INDEPENDENT SCHOOLS COMPENSATION CORPORATION Date: Producer: Hub International New England Copyright 1987 National Council on Compensation Insurance. Original 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 600 Washington Street Boston, MA 02111 Tel. # 617 -727 -4900 ext 406 or 1- 877 - MASSAFE Fax # 617 -727 -7749 Revised 4 -24 -07 www.mass.gov/dia The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations t ((j= 600 Washington Street Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information �+ Please Print Legibly UI Name ( Business /Organization /Individual): o. r'ke w /I ocJ / 4 r t e -, e af — Address: (1 0 c , i d , // Rd City /State /Zip: /Qf d � Am irk- a /4 0 Phone #: S'S'T ' J Y'Sc) Are you an employer? Check the appropriate box: Type of project (required): 1. am a employer with /6; o 4. ❑ I am a general contractor and I _ employees (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 ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.t _ 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 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. tHo meowners 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: J' i e, e/►cSe/i SCAOcJfS CO fry P-ASa)tcYl Grr Policy # or Self -ins. Lic. #: (N C 6 0 0 9 9 Expiration Date: —7 /i l/ o Job Site Address: R.3 130 u n ( ,L // City /State /Zip: /V 4 fh 1a /'1� 4 --- d / 0-61 G 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 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 certify ui er / the pains and penalties of perjury that the information provided above is true and correct. Signature: l�C.�/,t Date: 3 /c 21 / `/ Phone #: N (3 $ Pis 0 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 #: Letter of Transmittal - -- The Berkshire Design To: Clarke School Group, Inc. Attn: John Scott Project: Parsons House wall reconstruction Northampton, MA Date: 02/23/10 Copies Date Description 1 02/10/10 Stamped and signed plans For your: Information Review & Comment Approval X As Requested Remarks: Landscape Architecture John: Enclosed is the set of stamped and signed plans that you requested. Civil Engineering Please let me know if you have any questions or if you need anything else. Planning Land Surveying d C6176 h) 411/1 Chris Wall 4 Allen Place Northampton, Massachusetts 0 1060 Telephone (413) 582 -7000 Facsimile (413) 582 -7005 E -mail bdg @berkshiredesign.com Version1.7 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 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Steven BaliCki , as Owner of the subject property hereby authorize John Scott to act on my be ' 1 ` all matters relative to work authorized by this building permit application. �, 03/16/2010 Signature of • Ti' Date Steven Balicki , 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. A Print Name lc A t ' 03/16/2010 Signature of Owne • 1 Date SECTION 12 - C ■ ~ - UCTION SERVICES 10.1 Licensed Co = uction Supervisor: Not Applicable 0 Name of License Holder : John Scott CS 78899 License Number 11 Hunt Rd. Hawley a.01339 03/18/2011 Address ' ' Expiration Date k.._ (413) 339 -5508 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 budding permit. Signed Affidavit Attached Yes 0 No Version1.7 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 o Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Richard Klein design Name Area of Responsibility 4 Allen Place, Northampton, Ma. 01060 688 Address Registration Number (413) 582-7000 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 Not Applicable 0 Company Name: Responsible In Charge of Construction Address Signature Telephone Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height BIdg. 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 0 DONT KNOW 0 YES 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 O DONT KNOW ® YES 0 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 ® NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended 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 O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 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 ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other 1:21' Brief Description Enter a brief description here. Of Proposed Work: j ) / Rep rr 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 ❑ 1 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) 1St 1st 2 nd 2 nd 3rd 3 rd 4th 4th 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 is Private ❑ Zone Outside Flood Zone p Municipal p On site disposal system❑ Version1.7 Commercial Buildin &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 83 Roundhill Rd.. Map Lot Unit Northampton Ma. Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Clarke School 47 Roundhill Rd.Northampton, Ma. 01060 Name (Print) Current Mailing Address: (413) 582 -1111 Signature Telephone 2.2 Authorized Agent: Steven Balicki 47 Roundhill Rd. Northampton, Ma. 01060 Name (Print) Current Mailing Address: (413) 582 -1111 Signature Telephone SECTION 3 - ESTIMATE NSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building $78,000.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) $78,000.00 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 +2 +3 +4 +5) Check Number 63 ,,c1 0 1 This Section For Official Use Only Building Permit Number Date Issued Signature: Budding Commissioner /Inspector of Buildings Date • File # BP- 2010 -0846 APPLICANT /CONTACT PERSON JOHN SCOTT ADDRESS /PHONE 11 HUNT RD HAWLEY (413) 339 -5508 () PROPERTY LOCATION 83 ROUND HILL RD MAP 31B PARCEL 005 001 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 Fee Paid /6k33 66 1 Typeof Construction: WALL REPAIR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 078899 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQgMATION PRESENTED: I 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 /1"--1-"J SOAO Signature of Building O ficial 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. 83 ROUND HILL RD BP-2010-0846 GIS #: COMMONWEALTH OF MASSACHUSETTS 3113 - 005 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 -0846 Project # JS- 2010- 001255 Est. Cost: $78000.00 Fee: $468.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOHN SCOTT 078899 Lot Size(sq. ft.): 62290.80 Owner: CLARKE SCHOOL FOR THE DEAF PARSONS HOUSE Zoning: URC(100)/ Applicant: JOHN SCOTT AT: 83 ROUND HILL RD Applicant Address: Phone: Insurance: 11 HUNT RD (413) 339 -5508 0 WC HAWLEYMA01339 - ISSUED ON:3/31/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:WALL REPAIR 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 3/31/2010 0:00:00 $468.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo