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R Q � L 'fgas�p` O h � � E� L Fl i O R E N N 'o C') > R C E R C Q C L o r-- _5 � R c�c3 O cn An n rn a) W L Cn L � d up a o � 0 � O 06 o ° w LO Y W M <y o Q Q Z O� ~W ? QX� 0� _JJm 0 Z a. = o CERTIFICATE OF LIABILITY INSURANCE OP ID S DATE(MMIDDIYYYY) WILL-12 d 07/16/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Kinney Pike/Brat*?eboro ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 225 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. 0. Box 430 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Brattleboro VT 05302-0430 Phone: 802-254-2366 Fax:802-254-6132 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Acadia Insurance William G. Walker & Co, Inc. INSURER B: - - ----- - --- 759 Brattleboro Road INSURER C: PO BOX 47 INSURER D: Hinsdale NH 03451-0047 __.. INSURER E: COVERAGES 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 CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRW_D POLICY EFFECTIVE POLICY EXPIRATION ----- -- LTR IINSRO TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIDDIYY LIMITS GENERAL LIABILITY ECCURRENCE $ 1000000 270-RENTED-- A X COMMERCIAL GENERAL LIABILITY CPA180057211 07/15/03 07/15/04 Eaoccurence $250000 CLAIMS MADE a OCCUR P(Any one person) $5000 NALSADVINJURY $ 1000000____ GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 1 $2000000 POLICY F—] PRO- ( LOC I - JECT I I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A ANYAUTO CAA180057311 07/15/03 07/15/04 (Ea accident) i ALL OWNED AUTOS BODILY INJURY $ rXXX SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-_EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FI CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under -- SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER A Property Section CPA180057211 07/15/03 07/15/04 Leased A lEguipment Floater CPA180057211 07/15/03 07/15/04 Equipment 5000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION C0144,fAl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION The Commonwealth of DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Massachusetts - Dept of NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO$0 SHALL Industrial Accidents IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 600 Washington Street Boston MA 02111 REPRESENTATIVES. j AUTHORIZED REPRESENTATIV ACORD 25(2001108) c ACORD CORPORATION 1988 i 4,001 CERTIFICATE OF LIABILITY INSURANCE OP ID S DATE(MM/DD/YYYY) WILL-12 02120/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Kinney Pike/Brattleboro ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 225 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P. O. Box 430 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Brattleboro VT 05302-0430 Phone: 802-254-2366 Fax:802-254-6132 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Acadia Insurance INSURER B: INSURER C: — ---- — --- ---__.--- ---- William G. Walker Co Inc. 759 Brattleboro Road PO BOX 47 IN D: Hinsdale NH 03451-0047 SURER E: COVERAGES 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 CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR. TYPE OF INSURANCE DATE MM/DD/YY DATE MM/DDIYY GENERAL LIABILITY EACH OCCURRENCE ! $ 1000000 A OMMERCIAL GENERAL LIABILITY CPA180057211 07/15/03 07/15/04 PREMISES ERao�cc rence)I $250000 CLAIMS MADE lI OCCUR MED EXP(Any one person) 1 $5000 j PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 POLICY JECT 71 LOC ��--- ~_ COMBINED SINGLE LIMIT i $ 1000000 A ANY AUTO CAA180057311 07/15/03 07/15/04 (Ea accident) AUTOMOBILE LIABILITY ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS ! (Per person) $ X HIRED AUTOS BODILY INJURY Is i X NON-OWNED AUTOS (Per accident) I PROPERTY DAMAGE j (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ N EA ANY AUTO OTHER THAN ANY $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ i RETENTION $ $ WORKERS COMPENSATION AND OR LIMIT TH- EMPLOYERS'LIABILITY TORY LIMITS ER E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ j H yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER I A Property Section CPA180057211 07/15/03 07/15/041 Leased A Equipment Floater CPA180057211 07/15/03 07/15/04 Equipment 5000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ROOFING CERTIFICATE HOLDER CANCELLATION BOLMOKE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Ken Boudo 68 Gilrain Terrace IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Florence MA 01062 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE (41f h ACORD 25(2001/08) © CORD CORPORATION 1988 %.ueni*. au114 VVILVVALZ f4C4Dr. CERTIFICATE OF LIABILITY INSURANCE 02/24/04DnYYY> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Sheppard Riley Coughlin ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 99 High Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Boston, MA 02110-2320 617 348-1900 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Liberty Mutual Insurance Company William Walker&Co., Inc. INSURER B: 759 Brattleboro Road INSURER C: P. 0. Box 47 INSURER D: Hinsdale, NH 03451 INSURER E: COVERAGES 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 CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR DATE MM/DD/YY DATE MM/DD/YY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PR I $ CLAIMS MADE F]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY 7 PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FI CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WC A WORKERS COMPENSATION AND WC731S346893383 09/21/03 09/21/04 X ORSTATU- WITS FR EMPLOYERS'LIABILITY NH Employees E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE - OFFICER/MEMBER EXCLUDED? Benefits E.L.DISEASE.EA EMPLOYEE $1,000,000 If yes,AL P be under State of Hire E.L.DISEASE-POLICY LIMIT 1$1,000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS This policy covers those employees leased by William Walker&Company, Inc. through Surge Resources, Inc., Londonderry NH CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Ken Boudo DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL I In DAYS WRITTEN 68 Gilrain Terrace NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Florence,MA 01062 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S72523/M67553 JMM © ACORD CORPORATION 1988 Q-Kn�A�p (rzty of Xart4ttlllptan • � Z I �d358[}�liSttt4 6 DEPARTMENT OF BUILDITjG INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to act as his/her construction super,• sor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location 01`N � .• 6 hlcesRtf�ttsrtls - __ DLPARTMENIT OI' BUILDD] G INSPL:CTIONS 212 A'lctin Strcet ' Municipal 73ui1(ling NTorthampton, Mrtss. 01060 WOM ER'S COSTPENSA`ZTOIN INSURANCE A: FIIDAVIT Wth a principal place of busmess/residcuce t: �Ph 33 do hereby cer & miVei thc palls ,!rid pen:itic:; ni r_;rjury :ha: lX I am zin employer providing the iollo' hn; '•:Ort;CT"S coil pc:)Snort GOti`C.; for my employees worldrlg on Leis job: C � (Insu-a ie Cocap m) (PcLic:NtL-,i ber) -- (ExT Mtn Date) j I `m a sole proprietor, g,entra± Iona nc_or ni hon eovvoe: (ci:ele Oct) and gave hired t.lie Conti-actors WeA bNow who haw th v,Orkevs Gomynskon r,0!iwer (Z`mme of Conanaor) (111SJ^IlC I CIP.^;::i'T:�G(! f N113I tYi) iT?;? uC% Datcl oNalm of Contr aa-j _ (11is� rice Com?_::v/Pc.?ic:Numb--r) (Ex i o a Date) In, .,nc t=;�i : tr'oGc: Nun�rX r) Z. D ) Same of Contractor � �tr-, ,.,:•- =.x-;r,:no� 1;ate' (Name of Contrlctor) — - (Ins muic: Comrz-n'['olic;r Numr r} 111Cjm(',' a:,,Q have 110 OI:C ••'Urwiif` 10f ill _ l ain a honic oW!1Gr i)C!:C`1111Iif� 1(l i!. �'•'_:._, iii`, 11� NO'IT: )ICZSZ be nt.-a;c d:>_.St:ilc Fri<-ty tiara t crpl lr- v c m cr:Zpair.— ,cl! Doc uxYC ilt p Lhroo ni+i i tt4 dt'he a;'` :J_ • ter_ I Lhcc o c t trt Ccxtzll:i c;r.:';(cd - c a hotnco,,-cr for a lieu cr :r ri:::- r c rr Tagil Llsm of an cmployar un,'cr L`za Wcvi cr:Co -tw—anon!.ct I u--�d---slrnd thst s copy of tEi.cIatc:s c"y ho fa-v,—IS J to ttn L` jS Lar-,!of Lr i&L=iJ/kccid z:y Circa of::atr�.a for llx mvczxSe veriCir_tioa and that fe.ilurc to z--C'-=c 2 S A of MCt L.151 can ic_d to the irnj>asi.tial c; 00as00 Kit rur_of up to S 1,SMOO u:td'rr oC up to cn:}- r.-.I civil pcmltia in do Itxzn cf a Sic", rr oC S 1 Qo.o(}a day a 7ain:.i T -. . F x dq;a utr[s1 um ally Pcr;nit Numtx:r +6 a SEGTi0N.8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone �'--�'-^rnr-.enr rte:[ z, rtra..e.. „a. :..^:s^acar�_e�t+a°.R%a.�a,•- 'w�T� �a_.d � _ °y k 5 zse., Re i tere�Aao�elrn c vemen.a.Contracto:>.x - a- - ,, Not Applicable ❑ C-ompgny Name Registration Number 0 & k >1F Hl',-)auIE �Jp ON, I a li � Address Expi tar ion Date Telephon C SECTION 10 YVORKERS',C,OMPENSATION INSURANCE AFFfDAVIT(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 building permit. Signed Affidavit Attached Yes....... No...... ❑ -,&Pk � a `� ��mptip n 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 far 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 SECTIO F PROPOSED WORK check all applicable) ; »i ";Y' b? „'i,�u.,.r-:w.:s•� ;,�:•; � '�», '?mil;- f - .,i},r:t ,•s-r:>' .. New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ) Brief Description of Proposed Work: n S VQ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll D - Sheet 0 I.fi Newouse ndorr,a��;i#ion toexlstin li usin`` co"in` 'iefethe followin 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. Mascheck 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 SECTlOTT7 OWNERAUTfORIZATION TO BE'COMPLETED WHEN OWNEf�SAGENT OR CONTRACTOR APPLIES f0R BUILDING RERMIT= .. i, I� Ybt ►. [J� � �1� �`1JDfJ/J �D �/�O as Owner of the subject property hereby authorize PQ_ P1 OX to ac or, my behalf, in I matters relative to work authorized by th ss buil ng permit application. Signature of Owner Date '� Q l�atz G as Owner/Authorized Agent hereby declare that the stat4ments 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 Nam Signature of Owner/Agent Date VqW Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF 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 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES 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 No IF YES, describe size, type and location: City of Northampton at Building Department r> ' 212 Main Street Room 100aer - `. Northampton, MA 01060 _ phone 413.587.1240 Fax 413-587-1272 P os�t P r3 Qther�,S�aeo � ,� APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION ,� This section totbe comp eted)`y""IofficeaT 1.1 Property Address: �� =b i'0'� (0 AN— y + d Zone. -= ` _ ' - Over.1Nstrict; t Di '�it*s "Elmt Di tncY' � � �z BD s ict $ECTI.ON:2- PROPERTY OWNERSHIP/.AUTHORIZED AGENT 2.1 Owner of Record: &Iro O(.,R r1 o _160t)I-)a , l�r� 1�) b u i o ��t;h Ct (��- � ✓�Vt 'L2 r�7� Name(Prin ) / Curr�n Maina Address:�J 'f. . 1 ��/�—k� /t� Telephone Signature 2.2 Authorized Agent: U�i!I►Ct, �p l(,�zIk�r� �- c GEC �b X �l'7 f s&&- f� o3y:� N I e(Print) Current Mailing Address: Signature Telephone SECTION°3 ESTIMATEb CONSTRUCTION COSTS, Item Estimated Cost(Dollars)to be Official Use'Only cQ pleted by ermit applicant 1. r /,) (a) Building Permit Fee 2. Electrical I "( (b) :Estimated Total Cost.of i`oii Errs 3. Plumbing Building Permit Fee 4. Mechanical (HVAC 5. Fire Protection 6. Total =(1 + 2 + 3 + 4 + 5) C 1 Check Number This Section For Official Use Only BuildingPermit Number: Date "ssued: Signature: Building Commissioner/Inspector of Buildings Date 6 ILRAIN TERR BP-2004-0892 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-499 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A) Cate oa: BUILDING PERMIT Permit# BP-2004-0892 Project# IS-2004-1329 Est.Cost: $13941.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WILLIAM G WALKER & CO 130327 Lot Size(g.ft.): 36721.08 Owner: BOUDO KENNETH G&DONNALEE A Zoning:URA Applicant: WILLIAM G WALKER & CO AT. 68 GILRAIN TERR Applicant Address: Phone: Insurance: P O BOX 47 (603)336-5539 Workers Compensation HINSDALENHO3451 ISSUED ON.3118104 0:00.00 TO PERFORM THE FOLLOWING WORK.INSTALL STANDING SEAM METAL 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 VIOLATIO F ANY OF ITS RULES AND REGULATIONS. f OCCU anc Si nature: Certificate o p y - FeeType• Receipt No: Date Paid: Check No: Amount: Building 3/18/04 0:00:00 2792 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo