Loading...
24B-081 • .. Massachusetts - Department of Public Safety • Board of Buildino Regulations and Standards Construction Supervisor License License: CS 80749 • JAMES E BEST ' Q :x 4 SIMONDS FARM RD :"- BILLERICA, MA 01862 Expiration: 5/24/2013 Commissioner Tr#: 14707 • Accuw CERTIFICATE OF LIABILITY INSURANCE pa ge 1 of 1 r 01;13;20 2 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 CONTACT NAM F Willis of Pennsylvania, Inc. PHONE FAX c/o 26 Century Blvd. (NC NO FXT) 877 945 - 7378 (Am NO)' 810 257 - 2465 P. O. Box 305191 E - MAIL AnnRFCS certificates@willis.com Nashville, TN 37230 -5191 INSURER(S)AFFORDING COVERAGE NAIC # INSURER A: Arch Insurance Company 11150 -001 INSURED Centimark Corporation INSURER B: American Guarantee & Liability Insurance 26247 -001 12 Grandview Circle INSURER C: Canonsburg, PA 15317 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 17330093 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 ADD'L SUBR P OLICY NUMBER POLICY EFF POLICY EXP LIMITS I TR )NSRr WVn (MM /nnI(YYY) (MM /M/YYYY) A GENERAL LIABILITY 11PKG2382905 5/1/2011 5/1/2012 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DA PREMISES (Ea occurence) $ 300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X Contractual Liability PERSONAL &ADVINJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GENLAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4,000,000 7 POLICY X P IFC O .T X LOC $ A AUTOMOBILE LIABILITY MA 11CAB2383105 5/1/2011 5/1/2012 Ea accident) COMBINEDS $ INGLELIMIT 2,000,000 ( A X ANY AUTO AOS 11PKG2382905 5/1/2011 5/1/2012 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON -OWNED PROPERTY DAMAGE AUTOS (Per accident) $ X Coll.d:S x Com.Ded $ e De lf Insured elf f Insu ed B X UMBRELLA LIAB X OCCUR AUC930387909 5/1/2011 5/1/2012 EACH OCCURRENCE $ 10, 000, 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10, 000, 000 DED RETENTION $ $ A WORKERS COMPENSATION 11WCl2382805 5/1/2011 5/1/2012 X WCSTATU- c) - AND EMPLOYERS' LIABILITY TORY I IMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? IM andatorylanen E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,0 0 0 , 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach Acord 101, Additonal Remarks Schedule, if more space is required) Division /Location: Rocky Hill / 1100 Workers' Compensation Policy #11WCl2382805 (AOS = All Other States except OH, WA, ND, and WY which are insured through state funds). Job # 2600067417 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Papa Gino' s AUTHORIZED REPRE ENTATIVE Attn: Brian Wilde 301 King St. 1 Northampton, MA 01060 - A Co11:3602606 Tp1:1255163 Cert:1733003 ©1988 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Satellite Dishes Satellite dishes may need to be moved during roof construction. CentiMark will coordinate this effort on your behalf with your satellite company and they can bill you directly for re- calibration. Nightly Tie - In's Depending on new roof system being installed, temporary water cut -offs are to be constructed at the end of each working day to protect the newly installed roof system and building interior. Clean Up All work premises will be cleaned daily during the construction process and at the completion of the project. Job Acceptance and Punch List Conduct a post job walk through for final sign - off of our job completion form. Warranty Upon purchase of the roofing system, you become entitled to receive the benefits of single source responsibility through CentillMark's comprehensive written warranty. This warranty protects your roof against defects in materials or workmanship. If your roof leaks at any time during the warranty period, we will provide complete warranty service. Quote Name Section Name Length TPO Recover Main Twernty (20) CentiMark Corporation disclaims any and all responsibility for pre - existing conditions including, but not limited to: structural damage or deficiencies, clogged drains, mold growth, excessive standing water, removal of hazardous material or other hidden deficiencies such as; damaged or leaking skylights, HVAC units /conduits, electrical or gas lines. This proposal does not cover, and in no case shall CentiMark be liable for, the removal of or damage to, HVAC units /conduits, gas lines, water lines, electric lines, or conduits, whether located above, below, or in the roof system, lightning protection systems, landscaping, communication cable, communication devices, or other devices, including recalibration of satellites. It is the building owner's financial obligation to provide corrective measures. Recommended Accessory Options to Consider: Upgraded TPO Membrane Furnish and install an upgraded 80 mil TPO membrane that will improve long term roofing performance and add strength in high traffic areas for an investment of $1.00 per square foot. Preventive Maintenance Program Provide Preventive Maintenance Program for an investment of $320.00 per semi annual visit. A minimum investment of $640.00 is required. CentiMark Confidential Mechanical attachment of the membrane shall be done utilizing a 1" wide polymer batten bar or 2 3/8" round seam plates and FM Global (FM) approved fasteners. Maximum spacing 6" on center. The thermoplastic membrane seams will be overlapped a minimum of 5 ", then hot air welded together. Weld width shall be a minimum of 1.5" in width for automatic machine welding. Weld width shall be 2" in width for hand welding. Upon completion of welding, each seam shall be probed to ensure proper securement. HVAC, Curbed Penetrations and Other Air Handling Unit Details Furnish and install at the base of the unit 2 3/8" round seam plates to the field membrane. Adhere a second piece of thermoplastic membrane to the curb with bonding adhesive and install prefabricated universal corners for reinforcement. Fumish and install a 30" wide TPO protective mat at rooftop access points. Pipes Less Than 6" In Diameter Furnish and install new prefabricated thermoplastic pipe boot secured at the top with a stainless steel screw type clamp fully adhered to the field sheet. Stacks Greater Than 6" In Diameter Furnish and install a 60 mil, non - reinforced thermoplastic flashing, where applicable. Miscellaneous Projections Furnish and install thelinoplastic flashings to the roof projections. Upon completion of welding, each seam shall be probed to ensure proper securement. Furnish and install new white 24 gauge TPO coated metal pitch pan(s) and/or ChemCurb(s). New pitch pan(s) and/or ChemCurb(s) shall be installed utilizing mechanical fasteners and/or adhesives and topped with sealant. Furnish and install TPO uncured flashing to meet the dimensions of the pitch pan(s). Furnish and install protective mat or membrane under existing rooftop satellite dishes. Sheet Metal Accessories: Furnish and install new 24 gauge white thermoplastic coated metal gravel stop /drip edge with continuous cleat where not behind the front signage. Furnish and install our 6" laminated TPO cover strip to the prepared existing metal edging behind the front signage in conjunction with our primer washing and adhesive promoter to bond directly to the existing metal edge. Standard Operating Procedures: Employee Professionalism All work shall be perfoinied in a safe, professional manner in compliance with Centimark policy. Permits CentiMark will supply the necessary permits for the project. Permits During permitting, the municipality may require the services of a certified professional. Any fees related to obtaining permit approval are not included in CentiMark's proposal. CentiMark Confidential 4444 Construction tion p cifi tion 1 ►► Papa Ginos - 0109 - Northampton 301 King St Northampton, MA 01060 Specifications For CentiMark TPO Mechanically Fastened System Sections included: Main Project Preparation: Perform a pre -job meeting to determine jobsite logistics and safety requirements. Safety Related Furnish and install proper safety equipment in accordance with Centimark's written safety program. Furnish and install warning lines to identified areas associated with ground related roofing activities. Store roofing materials in accordance with good roofing practices. Material placement will be to distribute weight loads throughout the entire roof area. Surface Preparation: CentiMark will removed the membrane between the seams to expose the underlying insulation. Core cuts will be performed to identify potential areas of wet insulation. Remove areas identified as wet down to the structural deck and fill void with rigid insulation to level at a cost of $1.75 per inch of thicknessper square foot. In the area of removal, the deck will be inspected and if it is not capable of providing a acceptable substrate for the installation of the new roof it will be replaced at a unit cost of $6.95 per square foot. Areas of removal will be approved by an Owner's representative. Remove and dispose of existing pitch pan(s) as needed. Remove existing exposed perimeter metal edge and dispose of debris. Remove existing wall flashings to a workable surface and dispose of debris. Insulation Attachment: Furnish and install a 4 mil polyethylene vapor /air barrier over the roof membrane surface. Furnish and install a total of approximately 752 sq ft of tapered insulation between the front two scuppers and the back to scuppers as separate systems to improve drainage. (see drawing) System Application: Furnish and install CentiMark 60 mil reinforced, TPO roof membrane. Position the TPO membrane over the prepared substrate and allow the membrane sufficient time to "relax" prior to installation. Install the new TPO membrane over the prepared surface by utilizing mechanical fasteners on 6 foot centers. CentiMark Confidential JAN/05/2012/TH 03:45 PM FAX No, P. 002 7 1` t P CENTJMARJ SAIJES AGRFEMEN'I, 12 (.rand% ictt Circle -- (anuu. hurlg. I'.\ 1 53174533 . 1. 724.74; -7777 Job Number: Reference Number: Name: Papa Gino'9 inc. ,11)13 1.1)4 11 iu� Address: 600 Providence Highway ` Name: Gtoo' 0109 Y Address: 301 KtnB Street _ State; Dedham City: Nort am_pron MA Zip: 0202 -- - 6 ____ State. _ MA --- -- _--- Canhtet: Bryan v---7'i—tae _010 Phone: 413 -586 -7237 06 ____ Phone. 781 944.6606 Building(s)/Section(s): Main " "'--- iimm..........ineramematimemmum—miins , Per Proposal Dated: 12-5-2011 And/or as follows: Purchase Price: 529,620.00 Warranty to be issued in the name of Purchase PO #: 1 Centimark Sales Rep: Jason M. Grieco 2_ - - Office Location: 1100 Warranty Length/Yrs: 20 Years Phone: 800.990 - 0706 Payment Tennis: Net 30 Initial acknowledgement of Payment Telrras: Bank Name: Account #: Address: _ Contact: . Phone; City: • . Trade References; 1. Trade ,12,efereace: Phone: Address: City: _ State: Zip 2. Trade Reference: Phone: Address: City: _ State: _ Zip 3. Trade Reference: Phone: Address: City: State: Zip . — By my signature below, I certify that I have authority to bind the purchaser and have had the opportunity to review the ternas of this Agreement, including those set forth on the second page. On behalf of the Purchaser, I understand and accept said terms and agree to be bound thereby; and acknowledge that a sample copy of the warranty has been provided for my review. I also authorize the release of credit information to Centimark Corporation. • t1. • . . . r e. i 1.011. A g+ , ved and accepted by Purchaser Printed Name and Title Data garner TO 1117 TERMS AN C p CONnMoNs OF 51? ONA PACE —"— J INITIAL PAGE 1 . • Versionl.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 11 - 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 , 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 Name Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applica le ❑ License Number .. 5 ,.(1'1Q.!r _.... ...""■ ,,..,,... V__..__ _13 er .�.L.�n Address / Expiration Da e Signature Telephone SECTION 13 - 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 0 No 0 Versionl.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable Name (Registrant): Registration Number Address .._ Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor I / I A/ r1C,,, Lob ,_ Not Applicable ❑ Company Name: Responsible In Charge of Construction Address l 'Do • IO • p7 Signatur, r Telephone Versionl .7 Commercial Building Permit May 15, 2000 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size ___ _____.._...._..._.... . Frontage Setbacks Front Side L: -_ -. -. R: P., Rear Building Height Bldg. Square Footage oho Open Space Footage % o (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 Q DON'T KNOW C YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES Q IF YES: enter Book Page and /or Document # i E B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained , Date Issued C. Do any signs exist on the property? YES NO Q 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 Q NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repair Additions I:1 Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing's Change of Use ❑ Other ❑ Brief Description Enter a brief description here �Z- fi t `n '�yQ -�"�' , � ° Of Proposed Work : , 'Z _( (\- f(,- -1 '\y V:� �� , -Y.l ..- rY �52fti orp-cs SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 CI A-2 ❑ A -3 ❑ 1A � A -4 ❑ A -5 ❑ 1 B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile Cl 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 El 5A ❑ S Storage Cl S -1 ❑ S -2 ❑ 5B ❑ U Utility ❑ Specify: I M Mixed Use ❑ Specify. S Special Use ❑ Specify: COMPLETE 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): ,_v _, __ SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) _..,... 1 st 1 , 2 n d 2nd 3r 3rd 4 t r 4 th Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private El Zone _ 1 Outside Flood Zone❑ Municipal 0 On site disposal system❑ if Version!.7 Commercial Building Permit May 15, 2000 Department use only RECEIVED City of Northampton Status of Permit: 1 Building Department Curb Cut/Driveway Permit JAN 1 92012 212 Main Street SewerfSepticAva €lability Room 100 Water /Well Availability f I NSc'n0 orthampton, MA 01060 Two Sets Structural o auIu NO ructural Plans ■ . Ma pE �e::. - 587 - 1240 Fax 413 587 - 1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office o .... _ �\ S Map Lot Unit q 0r FA / ril C Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Current Mailing Address: - q '' -- e,,c...,0 C Signature h� 86 2.2 Authorized Agent: ! 1 1 Name 1 b "�t4eQ� ,r," -�, 1- 6 (Print) Current Mailing Address . � �� - ( • /�I v rJ • `1.. O . c7..Ld. _ ......_.....__.....' Signature � ._., 0� D " V Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building c9 Col <I� °'' (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) ... _� -.... _ .r 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection ... . .... .. .. ... .. 6. Total = (1 + 2 + 3 + 4 + 5) (Qp� o‘ Check Number ! rj 4 , � v Ammap i i This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2012 -0665 APPLICANT /CONTACT PERSON CENTIMARK INC ADDRESS/PHONE 51 BELAMOSE AVE ROCKY HILL (860) 256 -6601 0 PROPERTY LOCATION 301 KING ST MAP 24B PARCEL 081 001 ZONE HB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST — ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out t t/ �� q � � / p Fee Paid /L7lo y a �' Typeof Construction: REPLACE MEMBRANE ROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License CS080749 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION 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 Delay 1/23/f 2- 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. 301 KING ST BP -2012 -0665 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24B - 081 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 PER1VMIT Peimit # BP -2012 -0665 Project # JS- 2012 - 001154 Est. Cost: $29620.00 Fee: $180.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CENTIMARK INC CS080749 Lot Size(sq. ft.): 37722.96 Owner: GUARINO RALPH J TRUSTEE MAIL TO: PAPA GINO'S INC Zoning: HB(100)/ Applicant: CENTIMARK INC AT: 301 KING ST Applicant Address: Phone: Insurance: 51 BELAMOSE AVE (860) 256 - 6601 0 ROCKY HILLCT06067 ISSUED ON:1/23/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE MEMBRANE 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 1/23/2012 0:00:00 $180.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner