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' 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 .
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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
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ES E re , F,'E,EATF- Lia SI- ',,itd dAr H,.` / =EE'I REP' ,,,"r_ .'. I.s
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,_ 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
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h ---1 ! nT1iFR T--,AN FJ; f:CC - -
EXCESS • C^ABRELLA LIABILITY — I ! - - -- —...4 A H 7)'- TE!, ;, 1 E 10 0 0 000
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A X ! UfN6684517 04/1 1 I 1000000
C,.F L _ CI- Nar:E 2/09 1 04/12/10 HF :..“E i
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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
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— - - - - - -- - — — -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