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31B-081 Construction Control Services Affidavit City of Northampton Department of Codes and Inspections Puchalski Municipal Building 212 Main Street Northampton, Massachusetts 01060 Re: Renovations to Mental Health Recovery Services Servicenet 131 King Street Northampton, Massachusetts In accord with the provisions of the Massachusetts State Building Code 780 CMR Eighth Edition, Chapter 1, I certify, that to the best of my knowledge, the plans, computations and specifications prepared by me, have been followed in the construction of this project, and that I have reviewed the shop drawings and other submittals and made periodic inspections and find the work in conformance with my design. 1, as the Affidavited Designer hereby certify that I have on this date June 15, 201 1, inspected the referenced project and that the locus and its structures comply with my plans and specifications and all rules and regulations ofthe Codes ofthe Commonwealth. Therefore, I request a Certificate of Occupancy for this project. 4<,o �, WHITh Fes Entire Project .Y4' No. 8673 Professional Discipline o c, NORTHAMPTON (--)0 .// ad (. 4 0^-) g MASS. c, Signature Reg. ° > • Subscribed and sworn to me before this II day oil.. A . ► 1 ` . . 0 • gilt ► v ( ota s Public) • • ,0. ..•� Qo ^^�� I�" • \,.., • \SSION My Commission Expires 2 ;. i Q '' Q • o y�y : sfilith ft 1' SA gS C N !••• Off;' • • .... • 0 P q R y • pv ••.• I .... r_ r 1 e. t tr ti 44 RE IVED 3 LETTER OF TRANSMITTAL ? O 20 " DEPT op p PROJECT: Renovations to Mental Health -c,oeo Recovery Services ServiceNet 131 King Street Northampton, Massachusetts 01060 DATE: June 15, 2011 TO: Mr. Charles Miller Building Commissioners Office Puchalski Municipal Building 212 Main Street Northampton, Massachusetts 01060 ITEMS: Copies Date Description 1 06/15/11 Control Construction Affidavit - Final Remarks FROM: Architects Inc. 64 Gothic Street, Suite 1 Northampton, Massachusetts 01060 Challenger 1 Whitham, AIA Cc: Tom Gross - ServiceNet ARCHITECTS INC. 64 GOTHIC STREET NORTHAMPTON, MASSACHUSETTS 01060 413.584.7224 € 3 a� I CI s TE3 t Tip a N.ar# ttm fan .g J 0 -- y_ � glRttssttcllusriig �� � III -7 a DEPARTMENT OF BUILDING INSPECTIONS . " 212 Main Street • Municipal Building 'lt, ) � W Northampton, MA 01060 cr V 1'I;( "1 . is Hasbrouck Fax: 413 - 587 -1272 Charles Miller Buildin Commissioner Phone: 413 - 587 -1240 Assistant Commissioner • CONSTRUCTION CONTROL DOCUMENT (For professional Engineers /Architects responsible for Entire Project) Project Title: ,ENo7. M,ll. RECovER Y ,SER /CE5 Date: M4Y `&) 20 Project Location: /3/ /Y /!v9 $T. Map: Parcel: Zone: Scope of Project: / 7EQ /OR ,r i /21/S' TO J OO9 S: / (AT/77. N1 DOOR f /&/ /f/JE$" In accordance with the sixth edition Ma // � sssachusetts State Building Code, 780 CMR Section 116.0: r� ? I, L f///6 �iYJ Mass. Registration # Q ‘ T % , being a registered professional Engineer /Architect hereby CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: k i ENTIRE PROJECT for the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable Laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction documents as submitted for the building permit, and approval for the conformance to the design concept. 2. Review and approval of the quality control procedures for all code - required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with The progress and quality of the work and to determine, in general, if the work is being performed In a matter consistent with the construction documents. I shall submit periodically, in a form acceptable to the building official, a progress report together with pertinent comments. Upon completion of the work, I shall submit to the building official a final report as to the satisfactory completion and readiness of the project for occupancy. Signature and seal of registered design professional, and date: . ARCy ��, W H1 r Fc l , c) No. 8673 V CD NORTHAMPTON 3 MAS??, / (W 4 ' . 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 'Al SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT /— 1ireielld/ / NT— 5 ill .,, ., , as Owner of the subject property hereby authorizerni.e....j / .°-1 .6 to act on my behalf, in .11 matters relative to work authorized by this building permit application._ Signature of Owner Date I '``Z , 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 .------- em # _J / A Print Nam- - _ ..-- ,----- -- ignature of Owner/Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : 17 /c/ 6 j 0 -/-70 91 L-!....!!le.. Nu mbe r 4 277 1 7 -41v-t -r-ec---/V-- re.;11,-4- 4 .0.€4--, , „ __ _______, _ ( i7._ 7 Z Address Expiration Date -r- -Z■•2"--//41.------------- 1 " f ' -. .77._ ..., 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 (A No 0 The Commonwealth of Massachusetts Department of Industrial Accidents • 4 Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): r - Address: / 3 City /State /Zip: 117;/ rr e rr .- I'd Phone #: L// 7 S' = / 7 (7- d Are you an employer? Check the appropriate box: Type of project (required): 1. I am a employer with yo j 4 • ❑ I am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 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.❑ 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. 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 narne 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: / G/J Policy # or Self -ins. Lic. #: (/J 5 7`/ f ) Expiration Date: — Job Site Address: / r/ %,-„,) City /State /Zip: A/6 /�h/ /-', Ui t`6 v Attach a copy of the workers' p ensation 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 certify nder the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: -/ Phone #: G / /f f 7S" o 7 7 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 #: ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYTY) TM 01/10/2011 PRODUCER 413. 586.0111 FAX 413. 586.6481 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Webber & Gri nnel l Ins. Agency, Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 8 North King Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Northampton, MA 01060 INSURERS AFFORDING COVERAGE NAIC # INSURED Servi ceNet , Inc . INSURER A. Philadelphia Indemnity /PA Ins. Meridian Assoc. for Programs & Resources, Inc. INSURER B: Philadelphia Insurance Company 129 King Street INSURER C: MA Healthcare Group /FC Northampton, MA 01060 INSURER D: 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. INSR R NSRC TYPE OF INSURANCE POLICY NUMBER DATE MMIDDF Yrf DATE MMIDD /YYYY LIMITS LT NSRC GENERAL LIABILITY PHPK591482 07/01/2010 07/01/2011 EACH OCCURRENCE $ 1,000,000 DAGE X COMMERCIAL GENERAL LIABILITY PR MISESO(Ea REIN I EL) occurrence) $ 100, 000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 A X Professional PERSONAL & ADV INJURY $ 3,000,000 $1M /$ 3M GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 3,000,000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY PHPK591482 07/01/2010 07/01/2011 COMBINED SINGLE LIMIT X ANY AUTO PHPK592126- MERIDIAN 07/01/2010 07/01/2011 (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY B 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 EA ACC $ OTHER THAN AUTO ONLY AGG $ EXCESS /UMBRELLA LIABILITY PHUB313280 07/01/2010 07/01/2011 EACH OCCURRENCE $ 2,000,000 OCCUR CLAIMS MADE PHUB313538- MERIDIAN 07/01/2010 07/01/2011 AGGREGATE $ 2,000,000 B $ DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION 019003100004111 01/01/2011 01/01/2012 X ORY L MITS X O ER AND EMPLOYERS' LIABILITY Y / N AN YIPRO PRI BO R AR UDEEXECUTIVE E.L. EACH ACCIDENT $ 500, 000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT !SPECIAL PROVISIONS Coverage listed above applies to all locations- including Loc #54- 55 Federal Street, Greenfield, MA 01301 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Department of Health, Bureau of Substance DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Abuse Se rvi es NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn : Erica M Pi edade, Licensing Inspector IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 35 Service Center REPRESENTATIVES. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE Nancy Horan /NANCE 712n i /h., ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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): ,,. J ��^^ `` /�,� 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 RegistraUOn 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 � . " .,_ w ...._..,. ,..... xpiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Addres f‘ f y ignature Telephone Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON. ZONING 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 _, •y - -- parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained ,Date Issued: C. Do any signs exist on the property? YES NO 0 IF YES, describe size, type and location: Co /►r4 Yx' D. Are there any proposed changes to or additions of signs intended for the property ? YES NO a 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 t .4 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations X Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory '/ding ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ IN Brief Description Enter a brief description here. Of Proposed Work: �- A f / // SECTION 5 - USE GROUP AND CONSTRUCTION TYPE J USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business 1 2 A ❑ E Educational ❑ 2B - I ❑ F Factory ❑ F -1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ , 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B El U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: .„ _____,._.. � ..,._ �_.b-._,_ __ ._m„_ 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): _ ._. _______ __ __ ... „ _ , SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) E 1st ..i I I 6...__. _._.... 1sr 2 n d 2nd .....27 7 3 v 3 rd 3 4 Total Area (sf) / L/, y 7‘ 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 "4l Private 0 Zone ,,, Outside Flood Zone Municipal ar On site disposal system Version1.7 Commercial Building Permit May 15, 2000 Ni Department use on itj/ of Northampton Stat44 rm1, s : uilding Department Ourtz uttDnuwayP tf � �` 1 212 Main Street s�erfe tcvailb►Ei . "< Room 100 1laferef AualJabllif}' Northampton, MA 01060 "wo Setsof°StructurafPlans , =a " 6 .$ ,, one 413- 587 -1240 Fax 413- 587 -1272 PIot/5tte Plans Y ©then Speciffy APPLICA • , • 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 Map Lot Unit / 3 /f //v iv Zone Overlay District �-... .. 4a _ Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record U Z ....e!_ Name (Print) Current Mailing Addrec6: Signature Telephone yi' f / 2.2 Authorized Agent: Name (Print) Current Mailing „ddress 1 Signature Telephone a-/, 7 - f"7 f =U L1 s 7 SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical - (b) Estimated Total Cost of V1 S Construction from (6) 3. Plumbing _ - Building Permit Fee 4. Mechanical (HVAC) �.._...,._. ,..._,. __.. 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) / 7i7 U (� Check Number 3� 3 (,/ � This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/lnspector of Buildings Date File # BP- 2011 -0929 APPLICANT /CONTACT PERSON THOMAS GROSS ADDRESS/PHONE 237 Plumtree Rd SUNDERLAND (413 ) 665 8235 3 PROPERTY LOCATION KING ST T6�fc., S a e&' , MAP 31B PARCEL 081 001 01 ZONE GB(100)/ a aICG THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out j �� _ — Fee Paid js Typeof Construction: CONSTRUCT NON - BEARING WALLS New Construction Non Structural interior renovations Addition to Existing, Accessory Structure Building Plans Included: Owner/ Statement or License 059093 3 sets of Plans / Plot Plan THE FOL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 ':nature of Cui ding Of icial 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. 131 KING ST t, BP- 2011 -0929 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B - 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: renovation BUILDING PERMIT Permit # BP- 2011 -0929 Project # JS- 2011- 001512 Est. Cost: $4000.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: THOMAS GROSS 059093 Lot Size(sq. ft.): 24480.72 Owner: Servicenet Inc Zoning: GB(100)/ Applicant: THOMAS GROSS AT: 131 KING ST Applicant Address: Phone: Insurance: 237 Plumtree Rd (413) 665 -8235 Workers Compensation SUNDERLANDMA01375 ISSUED ON:5/17/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT NON - BEARING WALLS 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: ( % 3 - 1( i n Rough Frame: Ok ‘—/ k C Wild Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: hr I/ Final: Smoke: N 1 ve``. 41 (16‹:e i Final: 05 1 / ej/iik THIS PERMIT MAY BE REVOKED BY THE CI : NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND ' _ U : TION Certificate of Occupa "nature: a /,4.. 4.06/4040 FeeType: Date Paid: Amount: Building 5/17/2011 0:00:00 $60.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck – Building Commissioner