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30C-035 (3) ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YVYY) 06/01/2012 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. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms 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 endorsement(s). PRODUCER 413 - 566-0028 413 - 566 -0090 CONTACT Richard R. Green Insurance As encv, Inc. Richard R. Green Insurance Agency, Inc. N o EA): 413-566-0028 iaaNO): 566 -0090 32 Somers Rd. nouRess: richardgreenins @charter.net PRODUCER CUSTOMER ID 0: Hampden. MA 01036 INSURER(S) AFFORDING COVERAGE NAIC INSURED INSURER A: Patrons Mutual Patrick Kubala INSURERS: Commerce Insurance dba Patrick Kubala Home Improvements INSURER C: Utica National 5 Pell Street INSUIUSZD: Ludlow, MA 01056 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDmONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADM SUBR POUCY EFF POUCY EXP LTR TYPE OF INSURANCE , INSR WVD POUCY NUMBER (MM/DDIYYYY) (MMIDDIYYW) LIMITS GENERAL UABIIJTY EACH OCCURRENCE $ 1 .000.000 A J COMMERCIAL GENERAL LIABILITY PRREMIISES (Ea $ 50.000 CLAIMS-MADE [j OCCUR MED EXP (Any one person) S 5.000 CTR0012081 05/05/2012 05/05/2013 PERSONAL & ADV INJURY $ 1.000.000 GENERAL AGGREGATE $ 2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 2.000.000 71 POLICY I I Ff: n LOC 5 AUTOMOBILE UABIUTY COMBINED SINGLE UMIT (Ea accident) ANY AUTO BODILY INJURY (Per person) $ 100,000 B ALL OWNED AUTOS BBMJ33 06/01/2012 06/01/2013 BODILY INJURY (Per accident) 5 300,000 • SCHEDULED AUTOS PROPERTY DAMAGE $ 100,000 • HIRED AUTOS (Per accident) • NON.OWNED AUTOS UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS -MADE AGGREGATE 5 DEDUCTIBLE _ S _ RETENTION $ 5 WORKERS COMPENSATION I TORY LIMPS I I ER AND EMPLOYERS' LIABILITY C OFFICER/MEMBER EXCLUOED4 ECUTIVE (� N / A 4364592 10/27/2011 10/27/2012 E.L EACH ACCIDENT s 100,000 ( In NH) I , I E.L DISEASE - EA EMPLOYEE 5100,000 _ I D t ESCRI IP PTIION OF ORATIONS below E.L. DISEASE - POUCY OMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, W more space is required) Subject to policy terms and conditions. The owner is excluded from the Workers Compensation policy as a sole proprietor. CERTIFICATE HOLDER CANCELLATION For Insured's Records Only SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE For Insured's Records Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. For Insured's Records Only For Insured's Records Only AUTHORIZED REPRESENTATIVE For Insured's Records Only For Insured's Records Only ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD O , _op...., ,,,,,, egefola A7,46ez :,...,-,-„,„___, • Office of Consumer Affairs and usiness Regulation - --,... -1- ----: :, - -_-_ - _!1 - - 10 Park Plaza - Suite 5170 ,..,.. Boston, Ma.s.sachu.setts Q2116 Home Improvement ctotractor Registration — - Registration: 150118 _ Type: Individual ,., ; : =..... .- :: z:Z: Expiration: 3/7/2014 Tr# 221970 PATRICK KUBALA 1:,,-1-,_.-=--_,....---?..,,,, :,.. ,‘ if '. ..-,,,,....,......., :, , ..- - , PATRICK KUBALA ,-...- ,,....-:,--_-: -:-...__—_: ... ‘,.- --- -..._--- -- .-5.„.. - .._:-=- --, 98 DUXBURY LANE ......, : LONGMEADOW, Wk 01 1 06 Update Address and return card. Mark reason for change. -..:',Z7----.7 S•ii. — 7-- 0 Address El Renewal 0 Employment 0 Lost Card DPS-CA1 6 5011-04/04-6101216 — _ Offictriegt t7rdiallagi _License or registration valid for individul use only - . _ ., HOME IMPROVEMENT CONTRACTOR efore the expiration date. If found return to i -_ -V . := Rellisirafio" n:,..41-190118 .. ....- Type: Office of Consumer Affairs and Business Regulation 10 , P ti ark , plaza 5170 ..... -1 Expirationly_ 12014 Individual r — AI 111411 PATRICK i LONGMEADOW, htirkl:W:;-,1 Undersecretary V IN , M„. without signature . . ... \ •Z alliiiallM61,000•All.. IMM.11ra. 11.•■■•••••• ■■••• . rona.•••.• •■••■■•••.....: - :,,,j+ IM:iii)S, liVI:NIWL ''::' f : i ,,, E 14I-C I! T1 Board4 Baal* ReMilatipas and Staadanis • ..,:- . ... '"•,-.-- ' Ccinstruction Supenrisor License HOME MORE) , ilCONTRACFOR 44i ire. It - 1 4t- Licesetel CS 100114 RT -;: -.';?. - -. , 5:‘• - -7, AI" IX* -,-, --- V., —.... .. PATRICK tisi; - .. ,3 4 :::::.•:.:: : .,;, :-.- v-:;: - .;:,-, # 98 EL89301MLANE1 pAmocKEIBALAikaiE nifeROVEktENTS LONMENAK *01106 .-.*11-=' - - LIC. / REG NQ....-.---,-..---''ffECTIVgiti ---R EXPIRES .. .. - - ' Hic .' /2012 _ Expiration SS2013 Tr.,: 1194. -Ceseniiuioner -,.. ■ - ...we- CERTIFIED INSTALLER - r LEVEL: RI_C-I INSTALL i i.- L" -- 4 - .,. ;,, _ S=:r• mi ttib.... _JA #700002175 Expinss: 08/01/14 Kubala, P-atrick Sponsored By: Aschdectural Testing, fill Dembuty Lane Inc. --....... aisames•Itma■abe Minn _____PATRICK KUBALA HOME IMPROVEMENTS All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by Provisions of Chapter 142A MA HIC #150118 of the general laws, must be registered with the Commonwealth of Massachusetts. 5 Pell Street Ludlow, MA 01056 Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 413 - 589 -1010 02108 (617) 727 -8598 Submitted To: .Rs2pil /704 �' / ']'� .r,t go ,c-zrp,ice_ Job Name: / /,..). i G - '_l.� gcx,Pj. -,- 474 © / Z_ Job location: -5;1 Phone y // - 7 ?5 . ,o, / Estimator: / its- 7( We hereby submit specifications and estimates for work to be performed and materials to be used: ( ..,_-1.11 Qemp R, /)p - Pr.7i' -P'- & i4 2%cl� ail =�t - fwn 5'h , ins - 4 -.f X' c *- 444 , .tom s - bc ,ot c, �/ n `'i .th'k_ _i/L'm)m 2 - 1 ( 1 _ - A RC. (ACe ee i S +� f otf ec C,r 4 -ids -4, 0 , . . '1-.6. ._ -7 a / /-Pi' . G'. /7' Ir f AS. ,r ** P 7 V"---- WORK SCHEDULE 1 10. ., it ilia " Contractor will n. ., the work or order the materials before the third day following ollowing the signing of this agreement, unless specified he n. Contras will being the work on or abou'� . Baring delay caused by circumstances beyond the contractor's control. The work will be completed date). The owner hereby ackno I . ges and agrees that scheduling dates are approximate and that such delays that are not avoidable by the Contractor inclu ng but not limit strikes, Acts of God, shortages of materials, accidents, and all other delays beyond the its control, shall not be considered as violations of this Agreement. WARRANTY The contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of o 5 following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the C tractor, its subcontractors, employees or agents, is discovered after completion of any job, including clean up, the Contractor shall at its own expense, forthwith remedy, repair, correct, replace or cause to be remedied, repaired or replaced, such damage or such defect in materials and workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed - upon work. We Propose hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: ( 1 j/ / 2D ,„ sh .6;5,4, / YEA Gt€4 ‘,..-- dollars ($ v 7 7 ° ). Pa nt to be aA jot's: / %( . t )upon signing contract, 2/4I5 (j( 9 7 t 2 PATRICK KUBALA HOME IMRPOVEMENTS -- % ( " '' ) upon completion of 5 PELL STREET 3 % ,#-1s upon completion of / Z. "I/ LUDLOW, MA 01056 413 ( t S $ ) shall be made forthwith upon MA HIC 150118 completion of work under this contract. /,. /� Notice: No agreement for home improvement contracting work shall require a down payment Salesperson" /� fje (advance deposit) of more than one -third the total contract price or the total amount of all deposits or payments which the contractor must make, in advance, to order and/or otherwise Authorized Signature: obtain delivery of special order materials and equipment, which ever amount is greater Acceptance of Proposal: I have read both sides of this document and accept the prices, specifications and conditions stated. I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You the buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See notice of cancellation form for an explanation of this right. Please refer to the Notice of Cancellation that accompanies this contract; contents of which are referred to above and incorporated herein by reference. /# 5/ t4(0 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES s Signature r Date 1 7/0 ). Signature Date v r.j PI -J r ' J AFFIDAVIT In accordance with the provisions of MGL c 40, §54, I acknowledge, as a condition of the Building permit, all debris resulting from construction activity ._ governed by this Building Permit shall be disposed of at r 10 ( \�`a� Man Q� •••��� Q 1j� j'q a�p/'p Q Q y!/ -3�- c S { `- f �I � a.9 a �+•� • iunt; a l cL U t of d I {. \--i (NAME OF FACILITY) a properly licensed solid waste facility as defined by MGL C 111, §150A. 09. 10 . 12- Date S t une o Permit Applicant • • PRINT OR TYPE THE FOLLOWING INFORMATION: • • , labi -C 4- - .i - VCOU 1 neTrVerfUtr (NAME OF PERMIT APPLICANT) G k • (TYPE OF MA ERIA TO BE DISPOSED OF) • ■ ank...:<<.fAlt >MiSY . ' _V"4- (PROPER ' G DR -• S) I E'± •r The Commonwealth of Massachusetts Print Form # : =s: Department of Industrial Accidents W _ 1 � . Office of Investigations - 1 Congress Street, Suite 100 . - r Boston MA 02114 -2017 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organizati on/Individual): Patrick Kubala Home Improvements Address:5 Pell Street City /State /Zip:Ludlow, MA 01056 Phone # 589 -1010 Are you an employer? Check the appropriate box: Type of project (required): 1. 0 1 am a employer with 4 4. ❑ 1 am a general contractor and I employees (full and /or part- time).* have hired the sub - contractors 6. El New construction 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working or me in acit employees and have workers' g any capacity. y . 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: 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. t Homeowners 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: Utica National Policy # or Self -ins. Lic. #:4364592 Expiration Date: Job Site Address. L . d. City /State /Zip: /IAA OI 0 to2 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 certif u / er a pains and penalties of perjury that the information provided above is true and correct Signature: i Date] qi ib i 1 Phone #:(41 5 - 1010 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 #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder ' Pa+v - 1CK )(Da lc- /001 License Nu ber s-t-_ Lud l cyw, AM 0 1.0510 q a ( 3 Addres Expiration Date , )9 IDIo /S in a Telephon 9. Registered Home Improvement Contractor: Not Applicable ❑ K t )alt. L- 14-D,rvue INonvrivt.e.A4s 1st) I f Company Name Registrati n N ber 6 1 s- L--IOl/mo "7 ( LI Address Expirati Dat Telephonk S %9 ( bib SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the build' g permit. Signed Affidavit Attached Yes No ❑ 11, - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing IV( Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [0 Siding [D] Other [0] Brief scri )ion of Propose ( ropose _ (^ / _ (` ork: \ a � Q Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a, If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, Cl +- In C4 V U tO O, t O_ , 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. Print Narrfe `' / k' . b 1 Z Lure o f 0 er/Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R:. Rear Building Height Bldg. 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 DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES IF YES: enter Book Page, and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 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 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. RECEIV 1 Department use only C ity of Northampton S tatus of Permit: Building Department Curb Cut/Driveway Permit 1 A 1012 212 Main Street Sewer/Septic Availability Room 100 Nater/Well Availability pEPS .OF B��� INGINE � Tlotrs orthampton, MA 01060 Two Sets of Structural Plans phone 413 587 - 1240 Fax 413 587 - 1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address �, j� This section to be completed by office L.t l 4 - f lore P�� ►cL 1 �d• Map Lot Unit DY JAc - 1‘44 0 1 0 fo 2 Zone Overlay District EIm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: d ose.i)vl , •.„ , ,_G LA_, Name (Print) urr nt Mailin Address: 413�5.3�— 0052 Telephone Signature 2.2 Authorized Agent: f t vloalo` p-ett I.)d low , gins Name - ri -t) Current Mailing Address: c+1 s<&9 -t 0 10 S'■ • -ture elephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 4 (a) Building Permit Fee • p 0 �I'� 1 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) C< . Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date 464 FLORENCE RD BP- 2013 -0296 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30C - 035 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit # BP- 2013 -0296 Project # JS- 2013- 000484 Est. Cost: $8874.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PATRICK KUBALA 100114 Lot Size(sq. ft.): 71438.40 Owner: HOLIK JOSEPH L Zoning: SR(100)/ Applicant: PATRICK KUBALA AT: 464 FLORENCE RD Applicant Address: Phone: Insurance: 5 PELL ST (413) 589 -1010 WC LU DLOW MA01056 ISSUED ON: 9/14/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE PORTION OF ROOF 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 9/14/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner