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31D-010 (21)
MCCONNELL HALL BP-2017-1161 GIS*: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 31D-010 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2017-1161 Project# JS-2017-001962 Est.Cost: $115000.00 Fee: $805.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Siae(sq.R): 30492.00 Owner: SMITH COLLEGE OFFICE OF TREASURER Zoning: EU(192)/RR(186)/WP(I86)/URC(6)I Applicant: KEITER BUILDERS AT: MCCONNELL HALL Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 0 WC FLORENCEMA01062 ISSUED ON:5/1/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:COMBINE 2 CLASSROOMS INTO A SINGLE CLASSROOM 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: OI: 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 5/1/2017 0:00:00 $805.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2017-1161 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE (413)586-8600 0 PROPERTY LOCATION MCCONNELL HALL MAP 3ID PARCEL 010 001 ZONE EU(192)/RR(186)/WP(186)/URC(6)/ THIS SECTION FOR OFFICIAL USE ONLY: e PERMIT APPLICATION CHECKLIST (( (( ENCLOSED REQUIRED AAdl; ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ‘20 Fee Paid Tvoeof Construction: COMBINE 2 CLASSROOMS INTO A SINGLE CLASSROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 102457 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFpRMATION PRESENTED: 1../ 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 ¢111 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. Vcrsioni.7 Commercial Buiidin• Permit May 15.2000 Department use only pPK 1 7 '-t-- City of Northampton Status of Permit { _Budding Department Curb Cut/Driveway Permit _ _ _. -- 2i2Main Street Sewer/Septic Availability WaterNVell Availability Northampton, MA 01060 Two Sets of Stoicism!Plans phone 413-587-1240 Fax 413-587-1272 PIoeSite Plans Other Specify APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE E/�ORR.TWO FAMILY DDDW/EE,WNN,G �y SECTION I-SITE INFORMATION (2 ` &d ( 2v rV."- 1.1 Property Address: This section to be completed� by office McConnell Hall- Rooms 203&204 Man 3(j) Lot 0(V Unit 44 College Lane Zane overlay District Northampton,MA 01060 Elm St,Dlrttrkt CB Dlatrlct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT y.t Owner of Record: 040 til _ Name(Pani)'`Ri teuat�-'iCe`''��a' •4"t t COLL'�i Current Malting Address.KiOl.T p tM o O1aS Signature ' k 1tlf`L'y Srt .t,,.,r Telephone y"t 4P) 2.2 Authorized lti nt: lKerter Builders,Inc. 35 Main pS�qtggggss. Florence,MA 01062 Name(Piing Curer 58bg-6611U Signature At President,KBI Tekphone RECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Buiding (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of 6-3, COO Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) ie r UU U 5. Fire Protection — 8" 05- 6. Total=(1 +2+3+4 +5) ) / Si coo Check Number 696.-7.7J Thin Section For Official Use Only Butioing Permit Number Date Issued Signature: Building Commissionernmpector of Buildings Date Version 1.7 Commercial Building Permit May 15,2000 SECTION CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,900 CUBIC FEET OF ENCLOSED SPACE interior Alterations ✓ Existing Wall Signs Demolition Repairs Additions Accessory Building Exterior Alteration Existing Ground$I n New Signs RoofIngg Change of Use Other Brief Description COMEINETWO CLASSROOMS INTOASINGLE LARGE CLASSROOM Of Proposed Work: SECTION 5 USE GROUP AND CONSTRUCTION TYPE See attached control docs USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 ❑ A-2 ❑ A.3 ❑ IA 0 A-4 ❑ A-5 0 18 0 B Business 0 2A 0 E Educational ❑ 2B 0 F Factory 0 F-1 ❑ F-2 ❑ 2C 0 H High Hazard 0 3A 0 I Institutional 0 1.1 ❑ 1-2 0 14 0 3B 0 M Mercantile 0 4 ❑ R Residential 0 R-1 ❑ R-2 0 R-3 0 5A ❑ S Storage ❑ S-1 0 S-2 ❑ _ 5B 0 U Utility ❑ Specify: M Mixed Use a Specify: $ Special Use ❑ Specify: COMPLEtb 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 8 WILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) in 1° 2n° 3'u 4°i 4m Total Area(at) Total Proposed New Construction(si) Total Height(h) Total Height ft 7.Water Supply(M.G.L.o.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public 0 Private 0 Zone Outside Flood Zone Municipal ❑ On site disposal system , Version I.7 Commercial Building Permit May I5,2000 8. NORTHAMPTON ZONING 111111111 Existing ® Required by pya Zoning This column m bc MIN In by Building 1111111.111111.11.11 1111111111_-- Setbacks Front Man `.tide Rear ! aim _ llllllll� Open Space Footage -�--__ (Le(arca minus bldg I paved kimi main_ gala 111111.11111111111.111111111111 A. Has a Special Permit/Variance/Finding/�'� ever been issued for/on the site? V NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW O YES 0 IF YES: enter Book Page and/or Document ft B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW © YES Q 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 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 IF YES, describe size, type and Location: E. V>SIt the construction activity disturb(clearing,grading,excavation,or Ring)over t acre or is it part of a common pian that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Per ll from the DPW Is required. 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 78D CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: 1,-.4VP-Pr ITer* --,Not Applicable El -• Name(Registrant): [MA-6e 3 S r� I M --Fk1^tt 4A1 Qd I -e / tm A._ Registration Number Address 41.3. -17-51111 e V n— �4Expiration Date Signe Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility , _ i Address Registration Number I Signature Telephone Expiration Date L Name Area of Responsibility i Address __ ( Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility __i 1 i Address Registration Number _ L Signature Telephone Expiration Date 9.3 General Contractor Keiter Builders,Inc Not Applicable Company Name: IScott Kerter Responsible In Charge of Construction 1Main St Florence MAA tl ss / / - it � .4 E eek 1 4135868600 ' • (sygnange / Telephone Version l.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Stmcturat Engineering Structural Peer Review Required Yes O No 0 SECTION 11 •OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1:704PCIA�} c ri .\ ,as Owner of the subject property Keiter Builders,Inc. hereby authorize Io act on my behalf,in all matters relative to work authorized by this building permit application. ?rz�n Ste-, ref (ton Slgnatureo Owner Date Keiter Builders,Inc i, ,as Owner/Authorized Agent hereby declare that the statements end Infomraiion on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Scott Keiter pamrie President,KBI 04.11.16 Signature of OwnwJAgera Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction S petvisor: Not Applicable Scott Keiter CS-102457 Nome or License Holder: License Number 51 A Hatfield Street Northampton,MA 01062 06/20/2018 ess Expiration Date President,K81 413-586-8600 Signawre Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a.15Z g 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 Q No 0 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, $54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150k Address of the work: 44 College Lane The debris will be transported by: Keiter Builders,Inc. The debris will be received by: Valley Recycling Building permit number: Name of Permit Applicant Keifer Builder, Inc 04.11.17ftKiii President,I:BI Date Signature of Permit Applicant err Department of Industrial Accidents _[4111=-t =mac= of Investigations =: 1 Congress Street,Suite 100 "1,„-thW Boston,MA021142017 www.ntass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Keiter Builders, Inc. Name(BusinessOrganizationfndividuai}: Address:35 Main Street City/StatetZip:Florence, MA 01062 Phone if:413-586-8600 Are you an employer?Check the appropriate box: Type of project(required): I. 0 I am a employer with 18 4. ❑ I am a general contractor and 1 employees(full and/or part-time)." have hired the sub-contractors 6. ®New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ID Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9 0 Building addition [No workers' comp. insurance comp. insurance. required.] 5. Q We arc a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.® Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] r c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] "Any applicant that checks box M I must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tcontmcmrs that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not(hose entities have employees. If the subcontractors(rave emptoyets,they must ptavide their workers'camp polity number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Arbella Protection Insurance Company Name: _ Policy#or Self-ins. Lia #:9i 2744061$ Expiration Date:6/1117 44 College Lane Northampton, MA Job Site Address: Ciry/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 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 DR for insurance coverage verification. • I do hereby rfify under the pains and penalties of popsy that the information provided above is true and correct. /j� 04.11.17 Signature '"^�- President,K81 Date: Phone#: 413586-8600 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License I Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone t: 'i`n d CERTIFICATE OF LIABILITY INSURANCE s7/lsy2N16n THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS ND 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 tNSURER(S}, AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder ban ADDITIONAL INSURED,the pollcy(les) must be endorsed, I/SUBROGATION IS WAIVED,subject to the terns 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 endoreement(e). PRODUCER r Cynthia Henderson, CISR Webber s Oriaaail P." (413}586-0211 Yo-f.Hoy u H1]loa e-Hl rutty. e North King Street RRchendersonewebberandgrinnell.cots MIMESIS) I e COVERAGE NAGS Northampton MA 01060 M9urcnsArbella Protection 41360 iHeURED MWRER a: Keiter Builders, Inc. RmnRER C: Attn: Scott Ke/ter NEMER O: 35 Main street IN6IRERE: Florence MK 01062 PNIMER E: COVERAGES CERTIFICATE HUMBER3taster Erp 2017 REVISION NUMBER: THIS i5 TO CERTIFY THAT THE FOUCEES OF INSURANCE LISTED BELOW HAVE SEEK ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWTHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 10 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS MD CONDITIONS OF SUCH �,PPOLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, URI OPE OFMWRAI CE hMpYNp POL(nYNWaER (PoL IM ES Lain 1 E COMI@RUALGFNERALLMEnJrY t,tn OCCURRENCE 1,000,000 OmMr;e TOReY/6O A CLNM9MwE XOCCUR MtEMSES Ea eoannrca1 100,000 QOoo66]96 6/3/201 6/1/]a1T MEO EYP(Nry.wgnw0 5,000 PERSOWL6AW WARY 1,000,000 GEN.AGGREGATE HMT APPOSE PER GENERAL AGGREGATE 9,OOO r000 X POLICY �¢ �.-_. '.ECF ..,:LOC MiWUCTS-COMP/OPAGG 2,000,000 DTtER. ..._ AUTOMOBILES/AMITY COMMMED SINGLE that 1,000,000 ta.ate4M) A _ ANY AUTO BODILY INJURY 1P. ri pel OAREDALL E 6ACUYNS011 LEO 10300]9]15161 611/]010 6/1/1011 HOOILYR1NRY eMpNnO —AUTOSE KREDAUEOS Z N°H. O PROPERTY CvENIE INRO6 11Ne=N.Yi MOON PARNAM 5,000 I UWNEIJA LIAS _ OCCUR EACH OCCURRENCE E 5,000,000 A EXCESS LIAR CLNMSNADE AGGREGATE S 5,000,000 DEO X 1I INTENTIONS 10,000 6600064199 5!1/1016 6I1H617 More 0 S —,xmXERSCOgEtnattt jMore INES X Rift ANY mWHIETOWT'ARIXER/EXECIITNE , OFFKERNEMSER EXCLUDED? NIN/A ELEMNACPOEM f 1,000,000 A (Mndmoo N MI - 9137440615 6/11/2016 6/11/2017 E,L.rESEASE-EA EMPLOYEE S 1 000 000 DER�xoXPoGvONMFF PnONOF OPEMT011}pekw EL MSEnSE-vq]GY.etli f 1.000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORN 101,*/1IIMM R.mmt,Sch.UM,may ea Nash*/II mem*peals HAMRA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Informational Purposes THE EXPIRATION DATE THEREOF, NOTICe WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE C Henderson, CISR/CIN '4. R -� - 0198&2014 ACORD CORPORATION. All rights reserved. ACORD 25(201401) The ACORN name and logoare registered marks of ACORD IN5r10Sm,m+, Initial Construction Control Document �f To be submitted with the building permit application by a ggg Registered Design Professional for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Physics Lab Renovations, McConnell Hall, April 10,2017 Property Address: Smith College,Northampton, MA Project: Check(x) one or both as applicable: -New construction x Existing Construction Project description: Combine two classrooms to a single large classroom for"dry physics lab". h Laura Fitch, MA Registration Number: 8835 Expiration date: 8/17,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': x Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17.as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official. I shall submit field/progress reports(see item 3.) together with pertinent comments, in a form acceptable to the building official. Upon completion of the work. I shall submit to the building official a `Final Construction Control Document'. Enter in the space to the right a"wet"or electronicuu. signature and seal: 779^n mer xl Phone number: 413-549-5799 M=,;{ Email: Ifitch@krausfitch.com • Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate wih an 'C'project design plans.computations and specifications that you prepared or directly supervised. If'other.is chosen. provide a description. Version 06_11_2013 ally PO Box 130424 Roseville,MN 55113-0004 April 12, 2017 Larry F. Eldridge, Jr 54 CHARTER OAK DR FEEDING HILLS, MA 01030 Re: Larry F. Eldridge, Jr, Case#: 17-30209 Account No.: XXXXXXXX2036 Vehicle: 2013 CADILLAC ATS VIN: 1G6AH5S30D0123808 Dear Larry F. Eldridge, Jr: Please see the enclosed. M Xiong Bankruptcy Agent Ally Bank 800-495-1578 CC ROMILDA R ELDRIDGE Court of MA JONATHAN R GOLDSMITH DENISE M PAPPALARDO Enclosure SAM Proof OfClalm(MX) Debtor 1 Larry F.Eldridge,Jr Debtor 2 (amuse n frim United States Bankruptcy Court for the: District of Maas ehnsett5(State) Case number 17-30209 Official Form 410 Proof of Claim 04/16 Read the Instructions before fining out this form. This form is for making a claim for payment in a bankruptcy case.Do not use this form to make a request for payment of an administrative expense.Make such a request according to 11 U.S.C.§503. Filers must leave out or redact information tat is entitled on privacy on this form or on any attached documents.Attach redacted copies of any documents that support the claim,such as promissory notes,purchase orders,invoices, itemized statements of running accounts,contracts,judgments, mortgages,and security agreements.Do not send original documents;they may be destroyed after scanning. If the documents are not available, explain in an attachment. A person who tiles a fraudulent claim could be lined up to$500,000, imprisoned for up to 5 years,or both- 18 U.S.C.§§152,157,and 3571. Fill in all the Information about the claim as of the date the case was filed.That date is on the notice of bankruptcy(Form 309)that you received. Fiel 1 Identify the Claim 1. Who is the current Ally Bank creditor? Name of cisditor(the person or entity to be paid for this claim) Other names the creditor used with the debtor 2 Has this claim been No acquired from someone else? ❑ Yes. From whom? 3. Where should notices Where should notices to the creditor be sent? Where should payments to the creditor be sent? (it and payments to the different) creditor to be sent? Federal Rule of Ally Bank PAYMENT PROCESSING CENTER Bankruptcy Procedure Name Name (FRBP)2002(g) PO Box 130424 P.O. Box 76367 Number Street Number Street Roseville MN 55113-0004 Phoenix AZ 85062-8367 City State Zip Code City State Zip Code Contact phone M-495-1573 Contact phone 80n-495-1578 Contact email NIA Contact email NWA Uniform claim identifier for electronic payments in chapter 13(if you use one): 4 Does this claim amend ❑ No one already filed? ❑ Yes. Claim number on court claims registry(if known) Filed on MM t DO t YYYY 5. Do you know if anyone 17 No else has filed a proof of claim for this claim? ❑ Yes. Who made the earlier filing? Official Form 410 Proof of Claim Page 1 Part a. Give Information About the Claim as of the Date the Case Was Filed 6. Do you have any number ❑ No you use to identify the Yes. Last 4 digits of the debtors account or debtor? ❑ 9i any number you use to identify the debtor'.2036 7 How much is the claim? $20 459/1 • Does this amount include Interest or other charges? •Claimant Reserves Right ioAmanmts Clan ❑ No ❑J Yes.Attach statement itemizing interest,fees,expenses,or other charges required by Bankruptcy Rule 3001(c)(2)(A). 8 What is the basis of the Examples: Goods sold,money loaned, lease, services performed,personal injury or wrongful death,or credit card. claim? Attach redacted copies of any documents supporting the claim required by Bankruptcy Rule 3001(c). Limit disclosing information that is entitled to privacy,such as health care information. Automobile Financing 9 Is all or part of the claim 0 No secured? ❑J Yes. The claim is secured by a lien on property. Nature of property: 9 Real estate.If the claim is secured by the debtor's principal residence,file a Mortgage Proof of Claim Attachment(Official Form 410-A)with this Proof of Claim. Q Motor Vehicle ❑ Other Describe: 2013 CA),OILLAC ATS VIN'.1O6AH5S30D0123EO$ Basis for perfection: certificate of Titlefl ien Notice Attach redacted copies of documents,if any,that show evidence 01 perfection of a security interest(for example.a mortgage,lien,certificate of title.financing statement.or other document that shows the lien has been filed or recorded) Value of the property: $70 459.71 'Fully secured because acquired wlhin 910 days of pHition. Amount of the claim that is secured: 570.459.71 Amount of the claim that is unsecured: $0.00 (The sum of the secured and unsecured amounts should match the amount in fine 71 Amount necessary to cure any default as of the date of the petition: $0.00 Annual Interest Rate(when case was filed)5 44!•May not reflect ate entitled to under In re Till ❑ Fixed 9 Variable 10 Is the claim based on a 0 No lease? 9 Yes. Amount necessary to cure any default as of the date of the petition. $ 11. Is the claim subject to a Q No right of setoff? 9 Yes. Identify the property: Official Form 410 Proof of Claim Page 2 12 Is all or part of the claim 23 No entitled to priority under ❑ yes. Check all that apply Amount entitled to priority 11 U.S.0§507(a)7 A claim may be partly ❑ Domestic support obligations(including alimony and child support)under priority and partly 11 U-S.C. §507(a)(1)(A)or(a)(1)(B). $ nonpriority. For example, in some categories,the ❑ Up to$2850.00-of deposits toward purchase,lease,or rental of property or law limits the amount services for personal,family,or household use. 11 U.S.C.§507(a)(7). entitled to priority. ❑ Wages,salaries,or commissions(up to$12,850.00")earned within 180 days before the bankruptcy petition is filed or the debtor's business ends,whichever is $ earlier.11 U S.C. §507(8)(4). ❑ Taxes or penallties owed to governmental units. 11 U S.C.§507(a)(8). $ ❑ Contributions to an employee benefit plan. 11 U.S.C_ §507(a)(5). $ ❑ Other.Specify subsection of 11 U.S.C.§507(a)( )that applies. $ "Amounts are subject to adjustment on 04/0112019 and every 0 years after that for cases begun on or after the dale of adjustment. Pat 3. Sign Below The person completing Check the appropriate box: this proof of claim must sign and date it. ❑ I am the creditor. FRBP 9011(b). 0 I am the creditors attorney or authorized agent. If you file this claim 0 I am the trustee,or the debtor,or their authorized agent. Bankruptcy Rule 3004. electronically,FRBP ❑ I am a guarantor,surety,endorser.or other codebtor. Bankruptcy Rule 3005. 5005(a)(2)authorizes courts to establish local rules I understand that an authorized signature on this Proof of Claim serves as an acknowledgment that when calculating the specifying what a signature amount of the claim,the creditor gave the debtor credit for any payments received toward the debt. is I have examined the information in this Proof of Claim and have a reasonable belief that the information is true A person who files a and correct. fraudulent claim could be fined up to$500.000, I declare under penalty of perjury that the foregoing is true and correct. imprisoned for up toy Executed on date 04/12/2017 years or both. MM 1001 vvvr 18 U.S.C.§§152,157,and 3571. Mayhoua Xiong Signature Print the name of the person who Is completing and signing this claim: Name Mayhoua Zona First name Middle name Last name Title Bankruptcy Agent Company Ally Servicing LLC Identify the corporate servicer as the company if the authorized agent is a servicer. Address 4000 Lexington Ave. N.Suite 100 Number Street Shoreview MN 55126 City State Zip Code Contact phone 800-495-1578 Email N/A Official Form 410 Proof of Claim Page 3 CERTIFICATE OF SERVICE I,the undersigned,declare as follows. 1 am over the age of 18}cars and not party to this action_ My business address is PO Box 130424,Roseville,MN 55111 I am readily familiar with the business practices of my employer for the collection and processing of documents and correspondence for mailing with the United States Postal Service and those correspondence and documents arc deposited with the United States Postal Service that same day,or within one business day,in the ordinary course of bust ness. On April 12,2017.1 served the following document: • Proof of Claim with all Exhibits and Attachments in the method or methods described below and if served via U S.Mail,by placing copies of said documents in sealed envelopes and addressed as follows: Non-Filing Co-Debtor Debtor Attorney ROMI IDA R ELDRIDGE Larry F.Eldridge.Jr JONATHAN R GOLDSMITH 54 CHARTER OAK DR 54 CHARTER OAK DR Served Electronically FEEDING HILTS,MA 01030-2036 FEEDING HILLS,MA 01030 Trustee DENISE M PAPPALARDO Served Flecironically I then placed said envelopes for collection and mailing at my employer's office following ordinary business practices,addressed to the partics so designated above. I declare under penalty of perjury that the foregoing is true and correct. Executed on April 12,2017,at Shoreview,Minnesota. Signed. /s/ Mayhoua Xiang Bankruptcy Agent Ally Servicing LLC PO Box 130424 Roseville,MN 55113 800-495-1578 Fax. 651-367-2005 Official Form 410 Proof of Claim Page 4 United States Bankruptcy Court for the District of Massachusetts In Re Parrs F.Eldridge,Jr Case No 17-30209—Chapter 13 Vehicle 2013 CADILLAC ATS VIN: 1(16AHSS30D0123808 Itemization of"Other Charges'—Proof of Claim Dated April 12,2017 The claim of Ally Bank includes the following other charges in addition to the principal amount of 520,438.69. 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AllyElectronic Title Document • ELT*MA Title# : BR979178 Title Type : Issue Date : 00/00/0000 Lie/Tag/Control # : VIN: 1G6AH5S30D0123808 Vehicle Info: 2013 CADI ATS Brand code: 00 Clear Odometer Reading: Date: 00/00/0000 Status: Owner information Owner Information: ROMILDA R ELDRIDGE Co-Owner: LARRY F ELDRIDGE JR Third Owner: Owner Address: 54 CHARTER OAK DR FEEDING HILLS, MA 010302036 Lienholder information Lienholder: ALLY FINANCIAL PO BOX 8138 COCKEYS V I LLE, MD 210300000 2nd Lienholder Name: ELT Sent Date: 12/02/2016 Lien Type: Owner Driver License#: MA PDP Doc Ref 50000078135 / 00283 04/12/2017 08:19:01 Account r � ally PO Box 130424 Roseville,MN 55113-0004 April 12, 2017 ROMILDA R ELDRIDGE 54 CHARTER OAK DR FEEDING HILLS, MA 01030-2036 Re: Larry F. Eldridge, Jr, Case#: 17-30209 Account No.: XXXXXXXX2036 Vehicle: 2013 CADILLAC ATS VIN: 1G6AH5S30D0123808 Dear ROMILDA R ELDRIDGE: Please see the enclosed. M Xiong Bankruptcy Agent Ally Bank 800-495-1578 CC Larry F. Eldridge, Jr Court of MA JONATHAN R GOLDSMITH DENISE M PAPPALARDO Enclosure SAM ProofefOalm{MX) Fin in this information to identify your case: Debtor 1 Larry F. Eldridge,Jr Debtor 2 54 .0 firm United States Bankruptcy Court for the District of f�1 sath r,gf s tsutet Case number 17-90209 Official Form 410 Proof of Claim 04/16 Read the instructions before filling out this form. This form is for making a claim for payment in a bankruptcy case.Do not use this form to make a request for payment of an administrative expense.Make such a request according to 11 U.S.C.§$03. Filers must leave out or redact information that is entitled on privacy on this form or on any attached documents.Attach redacted copies of any documents that support the claim,such as promissory notes,purchase orders,invoices,itemized statements of running accounts,contracts,judgments, mortgages,and security agreements.Do not send original documents;they may be destroyed after scanning. If the documents are not available, explain in an attachment. A person who files a fraudulent claim could be fined up to$500,000,imprisoned for up to 5 years,or both. 18 U.S.C.§§152, 157,and 3571. Fill in all the Information about the claim as of the date the case was filed.That date Is on the notice of bankruptcy(Form 309)that you received. ®Identify the Claim 1. Who is the current Ally Bank creditor? Name of the creditor the person or entity to be paid for this claim) Other names the creditor used with the debtor 2. Has this claim been El No ^_ acquired from someone else? ❑ Yes. From whom? 3 Where should notices Where should notices to the creditor be sent? Where should payments to the creditor be sent? (if and payments to the different) creditor to be sent? Federal Rule of Ally Bank PAYMENT PROCESSING CENTER Bankruptcy Procedure Name Name (FRBP)2002(g) PO Box 130424 P.O.Box 78367 Number Street Number Street Roseville MN 55113-0004 Phoenix AZ 85062-8367 City State Zip Cede City State Zip Code Contact phone $00495-1528 Contact phone 800-493_757$ Contact email NfA Contact email WA Uniform claim identifier for electronic payments in chapter 13(if you use one)'. 4. Does this claim amend No one already filed? ❑ Yes. Claim number on court claims registry(if known) Filed on MM t DD t YYYY 5. Do you know if anyone j No else has filed a proof of claim for this claim? 0 Yes. Who made the earlier filing? Official Form 410 Proof of Claim Page 1 Part 2 Give Information About the Claim as of the Date the Case Was Filed 6. Do you have any number ❑ No you use to identify the 0 Yes. Last 4 digits of the debtor's account or any number you use to identify the debtor 2Q36 debtor? 7. How much is the claim? $20.46A.71 ' Does this amount Include interest or other charges? •Clamant Rare.Rpm 10 Amerm its Claim ❑ No 0 Yes.Attach statement itemizing interest,tees.expenses,or other charges required by Bankruptcy Rule 3001(c)(2)(A). 8. What is the basis of the Examples.Goods saiki money loaned,lease,services performed,personal injury or wrongful death,or credit card. claim? Attach redacted copies of any documents supporting the claim required by Bankruptcy Rule 3001(c), Limit disclosing information that is entitled to privacy,such as health care information, Automobile Financing 9 Is all or part of the claim ❑ No secured? 0 Yes. The claim is secured by a lien on property. Nature of property: ❑ Real estate.If the claim is secured by the debtors principal residence,Me a Mortgage Proof of Claim Attachme-^.tNOffidai Form 410A)with anis Proof of Ciaim. 0 Motor Vehicle ❑ Other Describe: 2013.GADII I A4 A[n VIN rt5B30D0123808 Basis for perfection: C hficdte of Title/Lien Notire Attach redacted mores of documents,If any,that show evidence of perfection of a security interest(for example,a mortgage,lien,Certificate of title,financing statement,or other document that shows the lien has been filed or recorded.) Value of the property: $20 459.71 'rally secured because acquired within 910 days 01 caution. Amount of the claim that Is secured: $2Q459 11. Amount of the claim that is unsecured: 10.00 tree sum of the secmet and unsecured amounts should match the amount in line 7.) Amount necessary to cure any default as of the date of the petition: $0 00 Annual Interest Rate(when case was filed)5 44V. 'May not reflect rate entned to under In re nit ❑ Fixed O Variable 10.Is the claim based on a 0 No lease? ❑ Yes. Amount necessary to cure any default as of the date of the petition. $ 11.Is the claim subject to a 0 No right of setoff? ❑ Yes. Identify the property: ............. ........ Official Form 410 Proof of Claim Page 2 12.Is ail or part of the claim No entitled to priority under ❑ Yes. Check all that apply: Amount entitled to priority 11 U.S.0§507(a)? A claim may be partly ❑ Oornostc support obligations(including alimony and child support)under priority and partly 11 U.S.C.§507(a)(1)(A)or(a)(i)(B). $ nonpriority. For example, in some categories,the ❑ Up to$2,850.00"of deposits toward purchase,lease,or rental of property or law limbs the amount services for personal,family,or household use.11 U.S.C.§507(a)(7). $ entitled to priority. ❑ Wages,salaries.or commissions(up to$12,850-00M earned within 180 days before the bankruptcy petition is filed or the debtor's business ends,whichever is $ earlier. 11 U.S.C,§507(a)(4) ❑ Taxes or penalities owed to governmental units. 11 U.S.C.§507(a)(8). $ • Contributions to an employee benefit plan. II U.S.C. §507(a)(5). $ ❑ Other.Specify subsection of 11 V.S.C.§507(a)( )that applies. $ •Amounts are subject t0 adjustment on Mor/m9 and every 3 years after that for cases hegun on or atter the date of atlrystment. Put 3Sign Below The person completing Check the appropriate box.' this proof of claim must sign and date it. ❑ I am the creditor. FRBP 9011(b). El I am the creditors attorney or authorized agent. If you file this claim 9 I am the trustee,or the debtor,or their authorized agent. Bankruptcy Rule 3004. electronically,FRBP ❑ I am a guarantor,surety,endorser,or other codebtor. Bankruptcy Rule 3005. 5005062)authorizes courts to establish local rules I understand that an authorized signature on this Proof of Claim serves as an acknowledgment that when calculating the specifying what a signature amount of the claim,the creditor gave the debtor credit for any payments received toward the debt. is I have examined the information in this Proof of Claim and have a reasonable belief that the information is true A person who files a and correct. fraudulent claim could be fined up to$500.000, i declare under penalty of perjury that the foregoing is true and correct. Imprisoned for up toy Executed on date 04/12/2017 years or both. mmt De Year 18 U.S.C.§§152,157,and 3571, fa/Mayhoua Xionq signature Print the name of the person who is completing and signing this claim: Name M,ayhoua Xiong First name Middle name Last name Title Bankruptcy Agent Company Aly Servidng LLC Identity the corporate servicer as the company if the authorized agent is a servicer. Address 4000 Lexington Ave.N.Suite 100 Number Street Shoreview MN 55126 City State Zip Code Contact phone 8o0-4954578 Email N/A Official Form 410 Proof of Claim Page 3 CERTIFICATE OF SERVICE L.the undersigned,declare as fellows. I am over the age of 18 years and not party to this action. My business address is PO Box 130424,Roseville,MN 55113. 1 am readily familiar with the business practices of my employer for the collection and processing of documents and correspondence for mailing with the United States Postal Service and those correspondence and documents are deposited with the United States Postal Service that same day,or within one business day,in the ordinary course of business. On April 12.2017,1 served the following document • Proof of Claim with all Exhibits and Attachments in the method or methods described below and if served via U.S.Mail,by placing copies of said documents in sealed envelopes and addressed as follows: Non-Filing Co-Debtor Debtor Attorney ROMILDA R ELDRIDGE Larry F.Eldridue.Jr JONATHAN R GOLDSMITH 54 CHARTER OAK DR 54 CHARTER OAK DR Served Electronically FEEDING HILLS-MA 01030-2036 FEEDING HILLS,MA 01030 Trustee DENISE M PAPPALARDO Served Electronically 1 then placed said envelopes for collection and mailing at my employers office following ordinary business practices,addressed to the parties so designated above. I declare under penalty ofperjury that the foregoing is true and correct. Executed on April 12.2017.at Shoreview,Minnesota. Signed- is/ Mayhoua Xiong Bankruptcy Agent Ally Servicing I_I,C PO Box 130424 Rosevdle,MN 55113 800-495-1598 Fax. 651-367-2005 Official Form 410 Proof of Claim Page 4 United States Bankruptcy Court for the District of Massachusetts In Re_ Larry F.Eldridge,Jr Case No 17-30209—Chapter 13 Vehicle:2013 CADILLAC ATS VIN. IC6AH5S30D0123808 Itemization of"Other Charges"—Proof of Claim Dated April 12,2017 The claim of Ally Bank includes the following other charges in addition to the principal amount of 520,438 69: Accrued Finance Charges $21 02 Total. $21.02 x]c 'memo mivvwli -V ']�""1"1"."1"1""""""":""1" /Tva . ,..a..a. 3-10010, ��yp� --V 1 �Y nt/SI%[;/!/x' �i..-......4,-.c.;......1,7,7,..±.I/WA�/ [' as Wp ii pIAI MA w4x Wm OPWla1.10090•psytwneAl4Ulwunn0A114114.1 pun GNy not put FI 401 I1.sI6 SM • 9410•05 not MINIM WWI,'"All69w0 8910 nuuq 141 Ola1Zr MA .++.A 4 wu aau,.'rwapm wI4 xpun'urou 05 TYni9 r pr,i.)-.Y+p w.w9r1 wl(w'tri 441,wwr I, wO+.M w!w lnl aw uwM Y w w0419-u. 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AHyElectronic Title Document • ELT*MA Title# : BR979178 Title Type : Issue Date : 00/00/0000 Lic/Tag/Control # : VIN: 1G6AH5S30D0123808 Vehicle Info: 2013 CADI ATS Brand code: 00 Clear Odometer Reading: Date: 00/00/0000 Status: Owner information Owner Information: ROMILDA R ELDRIDGE Co-Owner: LARRY F ELDRIDGE JR Third Owner: Owner Address: 54 CHARTER OAK DR FEEDING HILLS, MA 010302036 Lienholder information Lienholder: ALLY FINANCIAL PO BOX 8138 COCKEYSVILLE, MD 210300000 2nd Lienholder Name: ELT Sent Date: 12/02/2016 Lien Type: Owner Driver License#: MA PDP Doc Ref: 50000078135 / 00283 04/12/2017 08:19:01 Account