24D-087 (6) AC'oRID0 CERTIFICATE OF LIABILITY INSURANCE DATE 1201 YYYj
��. 11/03!2014
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.
OfIPOi=TANT: It the certificate holster is an ADDITIONAL INSURED,the poiieviiesi must be endorsed. if SUBROGATION IS WAIVED.subiect to i
u..;,j„utb>w. . l:i of zhe r..u_l' � a.d ssar_nntr:m _e,ta,d.,;;eT'mrl-a F-Qi'v'-z T5C.--u",.
I 'White.§tihinvillp Inn Anr-.y 1nr I '`: i y {;�,g,f?- (413}538-5293 r N� (413}538-b970
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South Hadley P.4A 01075-0789
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A.I.M.Mutual Insurance Company � � ---
INSURE
Selkirks Family Chimney Cleaning LLC INSURERS;INSURER C
272 Fes-rton Street i
South Hadley, MA 01075 INSURER D `- ------ �-
I INSURER E:
INSURER F,
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER.,
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AUTOMOBILE LIABILITY ( I COMBINED SINGLE LIMIT
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AUT05 AUTOS 9001LY INJURY{Per accident)
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I AUTOS t(Per accidenti $ _-----
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DESCRIPTION Or OPERATIONS!LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required)
CERTIFICATE HOLDER CANCELLATION
Town of Granby
10-B W.State St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Granby,MA 01033 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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Client#: 18316 SELWAI
ACORD�I CERTIFICATE OF LIABILITY INSURANCE 1013112014
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 C-OVEPAGE AFFORDED BY THE Pr)L1,C1E'-`
--,N-7H 1 S CE.Tl FICAT F OF 1�1 S UR AN Cr 7,1017 S NOT CO-NS— V.7 Z! A 'CON'TRACT TLiE ISSUI'Na^1N5!J1r-=RfS`.Al'UTHORiZED
-r--P-T'?'F-SFNTATIVF OR PROr)tlrFR AND THE f-FRTIf-IrATF Iini r)Fr,
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h, of the ooiicv, r"uiTc� .n,cndr)rsemcnt.A staterri,' t on this cortif cay.does no! ulhii-
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1 J�4 Lamb 15trpci
i Box 789
I Sr,ufh Vlaflev, MA 01(1755
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CEPTIF!CATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
F- Town of Gran'y- THE EXPIRATION DATE 1HEREOF, NOTICE BE DELIVERED IN
e"Building losp ctor ACCORDANCE IMTH THE POLICY PRO*,A'SiONS,
iri-B West State Street
Granby, MA 01033 AUTHGRiZED RLPRZ3ENTAT;',T
J
-HON.Aii rights reserved,
ivl 1988-2010 ACORD CORPORA
ACORD 25(2010105) 1 Oi 1 The ACORD name and logo are registered marks of ACORD
*S,i764i!Mi7640 c Ewl
City of Northampton
•�'°� Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building yetis, `ta
Northampton, MA 01060 '6�• _,i`
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET,CORN, STRAW OR SIMILAR STOVES,OR FIREPLACE INSERTS
Permit Fee: $25.00 Check# 11 .0
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: - '+"' ��%�y�tif S EL --1 r'_' K_
Address: c µi 0 -"- SG t, uGllr�.0, Telephone: 35"� �
c it K5
2. Owner of Property: lz_-_'4a
Address: r�'_ YV m Telephone: jG' c/C
3. Status of Applicant:_Owner _Contractor
4. Type or Brand of Stove: w''�V L , 6'C7
If applicant is not the homeowner: Z
Construction Supervisor's License Number S S Expiration Date
Home Improvement Contractor Registration Number Expiration Date
All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
s. Certification: I hereby certify that the information contained herein is true d accurate to the best
of my knowledge.DATE: APPLICANT'S SIGNATURE 44'_'4_
DATE: s / ��f HOMEOWNER'S SIGNATURE
t
APPROVED
DATE: BUILDING OFFICIAL
50 NORTH ST BP-2015-0673
G1S#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D-087 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: woodstove BUILDING PERMIT
Permit# BP-2015-0673
Project# JS-2015-001287
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WAYNE SELKIRK 159582
Lot Size(sg. ft.): 7927.92 Owner: STABILE JOHN T&PAMELA C C/O BRIGITTE M PAROT
Zoning: URC(101)/ Applicant: WAYNE SELKIRK
AT. 50 NORTH ST
Applicant Address: Phone: Insurance:
272 NEWTON ST (413) 455-9965 Workers Compensation
SOUTH HADLEYMA01075 ISSUED ON.1211612014 0:00:00
TO PERFORM THE FOLLOWING WORK.JOTUL F100 WOODSTOVE
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 12/16/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner