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23B-046 (5)
r,vv r��4M , CERTIFICATE OF LIABILITY INSURANCE 1 2i2si2oi2 ) 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 NAME: Webber & Grinnell Ins. Agency, Inc. PHONE , ) : 413.586.0111 �a : 413.586.6481 8 North King Street ADDRESS: Northampton, MA 01060 CUSTOMER ID #: 00005609 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER Firemen's Ins /Acadia Young Roofing Co Inc INSURER B : Star/TPA PO Box 60056 INSURER C : Florence, MA 01062 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: PDF 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 W POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR VD (MM /DD/YYYY) (MM /DD /YYYY) GENERAL LIABILITY CPA004804022 01/01/2012 01/01/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PR E S (RENTED $ 250,000 PREMISES (Ea occurrence) CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5 , 000 A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENII AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 ICI POLICY PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON -OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION NWCC46396716 01/01/2012 01/01/2013 X WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER B A N YIP ROPRIETO R PARTN ER/EXECUTIVE N N /A E.L. EACH ACCIDENT $ 500,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City Of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 212 Main St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Northampton, MA. 01060 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Jenna Rodrigue, CISR /JER © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD .eContr. Supervisors Lie. No. 011878 Plockkt Tel. 413-584-1367 o C l)0 0 G o INC4 413- 586 -9167 Fax 413- 585 -0226 P.O. BOX 60056 FLORENCE MA 01062 -0056 Customer : Cooley Dickinson Hospital Date: 9/15/1 1 Address: 30 Locust St. Northampton, MA. 01060 Job Location Original Building with slate. SPECIFICATIONS: 1. Remove all the existing slate down to the decking. 2. Apply ice and water shield back six feet to all roof edges and three feet wide in the valleys. 3. Apply roof wrap to all remaining roof areas. 4. Line the existing gutters with .060 EPDM. 5. Install .032 gauge aluminum valleys. 6. Install a 30 year Architect shingle. 7. Install four inch round aluminum down pipes. 8. The work area will be pipe staged to protect the public and meet O.S.H.A. regulations. 9. Remove all our roofing debris from the job site and dispose of in a legal land fill. All material is guaranteed to be as specified. Any alterations or deviation from above Specitioations wivotving extra costs will be executed only upon written orders, and will become an eudra charge over and above the eatbate. Al agreemetn9 wntingent upon insurance. ac or decays pai wi our a d rel. O t carry Ore and other nece2a inaurenoe. Al A axounts not paid witl>Ft 30 days are subject to a late charge of t tl2 96 IV Per month on the unpaid b alanoe. In the event that legal action Is Instituted to collect Authorized an sorts due uder n thi �reement, the undersigned agrees to pay all costs Incurred inoludii rea sorm ble attorn teas. Signature I * icha Youn dent Acceptance of Proposal -The above prices ,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature r gnl ar to do the work as specified. Payment will be made as outlined above. I ' Acceptance Date of Acceptance Zi • Z1I -ra' CCC7 roc• 17 T4-, -- i1 i TJCnu 1 T \J' 1 T \J^1 T i — inner, ir••.^rn DTI _rte CT 1 1v0. U11878 Pla,a4ae Tel. 413-584-136'7 YOUNG ? t OPING CO v Mac. 413 -586 -9167 Fax 413 - 585 -0226 P.O. BOX 60056 FLORENCE MA O10620056 Customer : Cooley Dickinson Hospital. Date: 9/18/11 Address: Locust St. Northampton, MA. 01060 Job Location Elevator Shaft on Administration Building. SPECIFICATIONS: 1. Clean the loose gravel on the elevator roof and 2'x6' side roof. 2. Apply 1/2 nch fiberboard insulation over the two roof areas. 3. Install Carlisle's .060 gauge reinforced mechanically attached roofing system. (Adhere the membrane to the parapet wall and caps.) 4. Flash all walls, edges, and roof penetrations with an approved Carlisle detail. 5. Install wood nailer to the parapet cap and 1/2 inch CDX plywood to the walls. 6. Install 16 oz. copper edge metal. M material is gyuaranteed to be as epecINed. An afleratlons or de in m above ap e db cattons Invotvkg extra cost wiN be exe c uted only upon wrltten orders, and will become en extra charge over and above the estimate. AN agreements contingent upon stokes, accidents or delays beyond our control Owner to cony lire and other necessary Insurance. AN a ocounts not paid within 30 days are subject to a tate charge of 1 1/2 % "KC, a due Und is ague t, the nderer t sgned agrees i ail co to i c I a Authorized including reasonable attorney's tees Signature Richard Yo ' Pr silent • Acceptance of Proposal -The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature I..�� to do the work as specified. Payment will be made as outlined above. 1 — Date of Acceptance 2,1 1 1 ( i TM' J CC 710r' r Ycrsionl.7 Commercial Building Permit May 15, 2000 i $ECT1O[!} It "tttUC'C.0RAL-':1 EEfP }PEV1EIW(790'cMit:41U :'{ ):. ;.: ;';'_" . Independent Structural Engineering Structural Peer Review Required Yes 0 No di I • • SECTION 11 = OWNERAUTHORIZATION . - WHEN..:... OWNER8: A (�FNOR T';CONTRAO 'A TQRPPLIES-FOR RUILDINO:PERIVUT' ::';,_. ° . . •:::..••• :-.:.-v„; .... . t _ -• , as Owner of the subject property ' hereby authorize to act on my behalf, In matters relative to work authorized by this building permit applicatioLT Signature of Owner Date • I, ,, as Owner /Authorized. Agent hereby declare that the statements end Information on the foregoing application are true and accurate, to the best of my knowledge end belief. 5 ! ned under the: r Jijs /pe of uerju1N. _ --- --- - -- --- --- Print Name / • : ' ,,� a l 4 1 1a- (_ _____ l Signature . i Agent Date • SECTION.12:1 CONSTRUCTION 11101V1 1101V10E3': -:i' 0 .. •1sadC,st ...... Not Applicable ❑ Items of License Hoiden: ----- l License Number r. o, of (.00 , re ic.e #4- 46. .,_..l_�__ c- Address Expiration Data 7 764...efr....._ I LI c 3-58k{— r%7 si . Telephone .SECTION WioitKERS: CD1 MIItN5ATION- INSUkANCE AFFIDAVIT .(M.G.L 52 :;c. § 25CI6)) ' °. • ` ::. Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached Yes 0 No • • . d • Yorelon1.7 Commercial Building Potmit May 15, ZODU BEGnfN '8- F'RDFEtialUNAL- pESION'RND GdNSTRUGTION.$ERViCES = FOR 'DIJ!CDIN05 AND; 3TIIUGTURES.3l)BJECT TO _ • CONBRD T CUNTR t. U R tl tlUANT TO:T5DiGMR lie (CGNTAININti ]VIURI: 7HAN'aMIOO C FIIVF ENCLU8ED BFAGE) 5.1 Registered Architect: I • I i Not Applicable 0 Name (Replsirent): Registration Number . Address , 1 1 Expiration Dale Bigneture Telephone A2 Registered Professional Engineer(s): Name Area of Responsibility • Address I I Repislretton Number Signature Telephone Expiration Date C 1 r' - I Name Area of Responelblllly , 1 I I -1 . Andress Registration Number 11 1 BlBnetute Telephone Expiration Data • I II 1 . Nems Area or Responsibility L -" ..' _Li T . 1 Addlees Regishanon Number I I I 8tgnetna • Telephone Expiration Veto 1 I1 Name Area of Responsibility L I Registration Number 1 Address I 1 l - Telephone Explrellbn Data Signature 9.3 (loners! Contractor Not Applicable ❑ Company Nom m e : �-- ---- -- –. –� Reeponslble In Merge of Cvnetruoeon Address 1 1 • Telephone.. . • Signature • . E i . . • 1. .• . ' . Yerakm1.7 Commercial Building Permit May 15, 21100 Fe ,11 .,:14Ht§)ii:Zok t iliv, iiswAtAilawm,•;i7s4z.....a.: . Existing Propooed Required by Zoning ThIs column to be tilled in by Building Deportment - • . Lot Size 1 11 , . . . FICIAIRB 1 1 L_ .._1 11MINININNE . • . setbacke Eiggi L—J ak L:1---1. it:L-1 1,:=1 id 1 =1 ED =I 1 1 1 i .. Building Height ED ED =I . • , Bldg. Square Footage it] I ED S =1 1 1--1 CT3 Open Spree _Footage % (Let ores mint bidg & paved 1 i 1, 1 L....1 L—.1 = . Perking .. ' # Of Forking Spaces 1 1 1=1 1:=1 Fill: ' - . (volume &Location) • ' A. Has a Special Permit/Yariance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 . IF YES, date Issued: I 1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES; enter Book 1 1 Pager and/r Document 13. Does the site contain a brook, body of water or wetlands? NO 0 DoNT KNOW • YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 - Obtained 0 , Date Issued: r .- .1 C. Do any signs exist on the property? YES .. IF YES, describe size, type and location: f -----------"------" 1 .. 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: 1 , E, VW(' thg Constructlan activIty disturb (clearing, grading, excavation, or filling) over 1 acre or Is It part of a common plan thgt will disturb over 1 acre YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW le required. • ' ., .. . .. .. „, • Yelsionl.7 Commercial Building Permit May 15, 2000 . • SECTION 4: ,CONSTRUCTION SERVICES FO "PROJECTS LESS THAN • 35,000. • • CUBIC 'FEET DKI=NCLO$ED SPACE . • Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Oround Sign ❑ New Slgne ❑ Roofing.” Change of Use ❑ Other ❑ SrIef Dasoriptlon Enter a brief description here. 5-ee, 0. ,i ec k j fO S . Of Proposed Work: ll . : •l3ECT1UN =:UBE GROUP ANU: Ct7N5TRUCTION TYYPE. j USE GROUP (Check as applicable) 1 CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ . A -2 ❑ A -3 ❑ 1A ❑ A-4 ❑ A -5 ❑ _ 18 ❑ B Business M 2A ❑ E Educational ❑ 28 ❑ F Factory • ❑ F -1 ❑ F -2 ❑ 2C ❑ ,H High Hazard ❑ 3A ❑ 1 Institutional ❑ _ 1-1 ❑ I -z ❑ I -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A 0 S Storage ❑ 8 -1 ❑ 8 -2 ❑ 5B ❑ 11 Utility ❑ Specify: __ i - 1 M Mixed Use ❑ Specify: I - J • • s Special Use ❑ Specify: r COM! LL` "SEGT IF EXISTJNO BUILt INO UNLEROOINCltiENOYATIbNS; ADDITIONS ANfb /OI# CF4A.NOE "IN USE Existing Use Group: 1 1 Proposed Usa Group: I ^-- `— I ExIslInp Hazard Index T80 CMR 34):[ . 1 Proposed Hazard Index T80 GMIZ 34): SECTION e•BInLDINO "I etc3NTAND AREA.. : : J BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION ;` t�j %t . •, kICI : i WSE: Ory G Y�,'. ,r ., ...,!...;..,,T C 4 4 U' ,'�l `f i ° t,: k J r oe . , Floor Area per Floor (ef) f l ii , ", f.1 - � � y, j f, t l ' ` {� �' ' � ' 1. i'i i I , i i ; .J ., .,,•' 'J .1f, : .',,,f,;1.:.- ;'' :`::..:.; ' 1� I 1 : 4. .. . :..7'r .ir . k . X,•�� ,^! �tiH�x':. _ ; ':.:..; ;. :: , ! d.• .ra j,.,. ; { - .. :..: .11, :,:i-%'.,.. n . } fr I 3 ;tr' r- ;;;lit.'.14iS lrrd:rr',.:•'7,: :. a:. :;;;:.:_.1:, et 1 •,f - , ::�r „:�N�i� >• " * ?s�3,.[:r'• 'a:.Y..!.'L.y ."• 4'1 I :!t-e r'd +ii7:9F4': 1 .. - f y7 , P - . Am s Total Propose N ew C onstruction (sl) , :' ; :.:.:7 ; ; ..s.- 'y�i ..,•,'• •');,' Of) f) L_ ::; { {. i { :: ” >.'... Tots 1 - ' � y ?: ;i u. t • . . . I , .1, Total Height ft ':r, _ y t i l, f . : {" . _ .. =' , y , Total Height (ft) . 7. Water Supply(M.O.L. c. 40, g 54) 7.1 Flood Zone {nfonnatlon: 7.3 Sewage Disposal'System: Public 0 Private ❑ 1 Zone J Outside Flood Zone❑ Municipal ❑ On site disposal system❑ • • y iR sags i 1 . , fel 290 - Version1.7 Commercial Buildin: Penult Ma 15 2000 . ' ---. • City of Northampton Building Department 212 Main Street Room 100 - Northampton, MA 01060 .. , • phone 413-587-1240 Fax 413-587-1272 • • APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY 6UILDING OTHER THAN A ONE OR TWO FAMILY DWELLING . .:SECTION •p: 60* itlerEfOMA'1 . •• • : .:: :. : 1.1 prose& Address: 40 .t 4F AATI) ,1 , 0!g ,., 0 , t1 9i. 1 1ti , . 0 .0$ 6 00 1 tited . .li . Y..:::: : : 1 Ai ff - 0 C,001q bictiy)&m 1 . . ohs ;1611, 3o to ut St ....$t- „--iew ,- ,,,.„--,•;---?, • ; ”, - - -.' 1,-.1,,1•:_01.1.,tir-Nr.,,§fivs,5s. :. oati_ ..,;(5 AI a r4-h4 r 1 Ipioni A - 419 - U060 o*k-- liv , _ SEGTION 2 .i::PF0411ER:ttOVilVEhijiiIP/AUTlitirilititi.Adettt,.: • .: ..,•.. :i .. j:: ' -. U: ........ ..:!i . :::: ...;.: -,..: ' : -: ' :: . -, : • . ..: .. ....::: --. .. ' : .. — :. .. .: . . . . ..., . . . LIOWElerofileCord . . , . \----° - 1 1___Ii C .,_ IL...1 tk" -. ---.1 Name (Print) Current Melling Address: — --- 6g0-?3t . • _ I Signature Telephone tiO ,! '!Elt ' . • .1 .0- '0656 itore4ep Aw j e- - . . ( Name (Print) Current Mallin9 Address: f . / , / I 1 /13 - A- y 4.% 7 • J Telephone .. r : - TIO la ' .1 . .I i • i i " Ct 0 CI • • I .... . . . .... . .... Item Estimated Coat (Dollars) to be . - . Official Use Only.:.*: : • . :. completed by permit applicant • , : ,, -. • : • •• . :- .. ,..-. • . . .. :.: . ... ::: .. .......• 1. Building ( i - - - , 9 - - 5 - - - 1 . (a) Building permit Feel:. !.., - ..:.:::-...... ..... :. :... : ...... ; ..... ..,. i 2., Electrical (p).Estirriated Total Cot OE.: :-.. ',,,.:::.; . :, J. -: . .::.. - . .. :..:,. • .:71 - ristrif&tidr.i:frOtTi 3. Plumbing 1 1 ;13011ding Fel.: i.......-.:• :.:•.,.. : ::: 4. Mechanical (HVAC) :-•:::::.;.::::...:..:..:::::::::,,,::::::-....,::,:,:.:;:: ...,...:-..::..:•.. :•: . : . ,,,.,..;::•.,,• 41 g. . 5. Fire Protection L • • 4111 - f . 7 .:: All/ irAIIMIll 0. Total=(1+2+3+4+5) 0 • I i 1 dhi.OckitinAoh.-41 ... , ..-Awillimi i . . .... . . - ....!.,.:...." •••f•••:::-.. ... .....•.....-4..... this50010.riFor041claltlie.0.1111Y• ;" .. . ,...:: . : .. : . : ........... ... :::: . : ; . ::: . :.: • •• • •,.. • • • . BuildingrerniltNunItit :. • . Date :. Issueri • ....: -: : :: -;-;::: ...... :::: . :::: . ...;- tlialetuferf ;:.: :::..... . ir , f . i..•::.....! . .,.. ..! :-.. : .. . : ,.. ... .;.:: ;:, ... : . :i . i .. ..:..:,, . , . " :.: ...:*- : f. r '...:: F. : . : ... :: . i : • - i . :-.... .•.:' • ::........: :::. :: :::: ;:• .. ...i-:;; :::. :::: .. ":: • .. • IffuildIng'Cbm(nRilltifjellIni*torpf Buildings : . . • ...;... . .;.: b&9. . .,... :. .. ,.... .:,... ,.. .. .„.... ... . .. , .:, ....... . .. • - - - - ', - ....': '-'•'.-,:vi--i'wge.44:1144iliiiiitiNifigiMediiii4 File # BP- 2012 -0753 APPLICANT /CONTACT PERSON YOUNG ROOFING CO INC ADDRESS /PHONE P 0 Box 60056 FLORENCE (413) 584 -1367 PROPERTY LOCATION 30 LOCUST ST MAP 23B PARCEL 046 001 ZONE M(99)/URB(1) / /WP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out d �y� [ 99 Fee Paid / Typeof Construction: REPLACE SLATE ROOF ON ORIGINAL BLDG, REPLACE ROOF ON ELEVATOR SHAFT ON ADMIN BLDG New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 011878 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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 2V 1 Z 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. • 30 LOCUST ST BP- 2012 -0753 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23B - 046 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- 2012 -0753 Project # JS- 2012 - 001331 Est. Cost: $108000.00 Fee: $648.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: YOUNG ROOFING CO INC 011878 Lot Size(sq. ft.): 1325051.64 Owner: COOLEY DICKINSON HOSPITAL Zoning: M(99)/URB(1) / /WP Applicant: YOUNG ROOFING CO INC AT: 30 LOCUST ST Applicant Address: Phone: Insurance: P 0 Box 60056 (413) 584 -1367 Workers Compensation FLORENCEMA01062 ISSUED ON:3/5/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE SLATE ROOF ON ORIGINAL BLDG, REPLACE ROOF ON ELEVATOR SHAFT ON ADMIN BLDG 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 3/5/2012 0:00:00 $648.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner