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23A-107 ® DATE (MMIDDIYYY Y) ACO CE 'TIFICATE OF LIABILITY INSURANCE 6/22/2011 i . THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS i 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 CONTACT Jeanne Deneault CISR NAME: Blackmer Insurance Agency Inc. PH F,xtl: (413) 625 -6527 (A/c, N FAX ( 625 8210 1147 Mohawk Trail. E -MAIL jeanne@blackmers . com ADDRESS: _ INSURER(S) AFFORDING COVERAGE NAIC it Shelburne MA 01370 -9707 INSURERA:Landmark American Ins Co INSURED INSURER B Max Specialty Insurance Co - op Power, Inc INSURER :Twin City Fire Insurance Co 29459 324 Wells St INSURER D : PO Box 688 INSURER E : Greenfield MA 01301 INSURER F : COVERAGES CERTIFICATE NUMBER:CL1162200869 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INGR VD ID POLICY NUMBER (MM!DDIYYYY) (MM01YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 100,00D A CLAIMS - MADE X I OCCUR X LSA086972 00 11/8/201+ 11/8/201 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 _ X POLICY [ PRO- LOC _ $ J Ff:T AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea aceidenn ANY AUTO BODILY INJURY (Per person) $ ALL OWNGD SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE AUTOS (Per accident) $ HIRED AUTOS S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1,000,000 DED RETENTION$ RENEWAL MAX113100056487 6/2/2011 6/2/2012 $ WORKERS COMPENSATION WC STATU- )0TH - C AND EMPLOYERS' LIABILITY x TORY I IMITS FR N ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? 0 8WECLC6866 11/1/2011 11/1/20 (Mandatory in NH) 4 E.L. DISEASE - EA EMPLOYEE $ 1, 0 00 ,000 I) yes. describe under DESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 10i, Additional Remarks Schedule, if more space is required) Operations usual to energy efficiency services - energy audits, air sealing, insulation, and solar hot water system installation. Center for Ecological Technology is listed as an additional insured. Co -op Power acknowledges that they have contractually waived (as allowed by the ISO C00001 10/01 policy) all rights of recovery against CET or National Grid or Western Massachusetts Electric Company or Berkshire Gas Company or any of their affiliates for any loss or damage covered by said. policy, Certificate issued subject to the terms, conditions, exclusions, and endorsements attached thereto. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Center for Ecological Technology ACCORDANCE WITH THE POLICY PROVISIONS. 112 Elm St. Pittsfield, MA 01201 AUTNDRI �arry J Ju Aoct xe . BL ACORD 25 (2010/05) © 1958 -2010 ACORD CORPORATION. All rights reserved. TAIennc rnn,n,. , n4 TL.., nrn rsr'1 .. ,.... ,......+ L.......... _.......i...,.,r ...,....,... s nrnon SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: :able ❑ Licensed Construction Supervisor: Name of License Holder Paul Schmidt mber 24 Chestnut St. Addr Hatfield, MA 01038 I +ate # U Exp. CS 5/20/20 3 Signature Telephone 413 - 772 -8898 9. Registered Home Improvement Contractor: Home Improvement Contractor: licable ❑ Co -op Power Inc. / Paul Schmidt Company Name 324 Wells St. ':tion Number Greenfield, MA 01301 Address 11165217 fi Date Exp. 1/21/2012 413 - 772 -8898 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 building 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 ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [Q Siding [0] Other [0] Brief Work Desaiption of Proposed v! r'l,� f - r,l r 1 [ _ i . 1 / J ' • A I G f " J Alteration of existing bedroom Yes No Adding new bedroom Yes � No , ✓ ✓✓ /' ' Attached Narrative Renovating unfinished basement Yes • No Plans Attached Roll - Sheet ea. 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 l L 1r''' c - �i ��� , as Owner of the subject ty proper . J hereby authorize i' % L' 1 !' �. > / . to act • . - behalf, in all to wo . - • by � is bui • permit a • • nation. `li a ' (1 22%0) Signet - of Owner r Date I 0314 5'' / i$i 1 , as Owner/Authorized prized Agent hereby declare that the statements a irifomtation on the foregoing application are true and accurate, to the of my knowledge and belief. Signed under the pains and penalties of perjury. jZ »i j Print ovtinertz A gent4— i / Signature , 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 e been issued for /on the site? NO O DON'T KNOW YES 0 IF YES, date issued:' IF YES: Was the permit recorded at the Regis of Deeds? NO 0 DON'T KNOW YES O IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained Q , Date Issued: C. Do any signs exist on the property? YES O NO 0 Do-- J /CI 0 w 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: 0-en f K^'r --.d E. Will the construction activity disturb (clearing, grading, ex vation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. i z a • — — Department use only r R ECEIVED ity 1 Northampton staff of Pamir uik ing Department Curb CutiptivewaY .t INOV 2 ( 2011 212 Main Street SeweriSeptid Avaitai744 Room 100 Water ell Availability N hampton, MA 01060 Two Sets of S i+ at P lans DEPT OF Bunn' l�h i AI-58T-1240 Fax 413 -587 -1272 Pan a Plans NORTHAMPT Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office ) 57 1 Map Lot Unit \ �CS > Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: > Na j ;,• 'I r % "' II Current Mailing Address: � ! Telephone 9 .5 - 2. Authorized A� n C Jy tj C /S ,Si' N A Name (Print) Current Mailing Address: J • 1<' Signature 4/1 Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical 300 E Estimated Total (b) stt cited ota Cost o f Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection // ��/ 6: Total = (1 + 2 + 3 +4 +5) tJ( Check Number (94J� it6S This Section For Official Use Only ``��` Building Permit Number Date Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2012 -0516 APPLICANT /CONTACT PERSON PAUL SCHMIDT ADDRESS/PHONE 24 CHESTNUT ST HATFIELD (413) 247 -5739 PROPERTY LOCATION 137 SOUTH MAIN ST MAP 23A PARCEL 107 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 4.55- Fee Paid Typeof Construction: INSTALL WALL INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 103635 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF91 AATION PRESENTED: !!// 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 Di y 0"; /A>V-- Signature of Building f icia 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. 137 SOUTH MAIN ST BP- 2012 -0516 GIS #: , COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A -107 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit # BP- 2012 -0516 Project # JS- 2012- 000865 Est. Cost: $4800.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq. ft.): 12371 .04 Owner: CLAWSEN GREGORY & KARLA Zoning: URB(100)/ Applicant: PAUL SCHMIDT AT: 137 SOUTH MAIN ST Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247 -5739 WC HATFIELDMA01038 ISSUED ON:11/30/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL WALL INSULATION 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 11/30/2011 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner