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25A-096 (3) ojµ M ra City of Northampton n, s ; E Massachusetts * " rte t . "t '"tt ' DEPARTMENT OF BUILDING INSPECTIONS, ) y ,.. 212 Main Street • Municipal Building ' 1 �`3. � ' Northampton, MA 01060 NW T Property Address: c ; _ _, l)c ' 1''v )ii- AvC Contractor 2: Name: at- ,'' k rn; 1 CO - op i W el' ti d X �; ( r i 'ti E' VI, .Ai14 `_5 City, State: ( f z" 1 t e id : AAA Phone: (q / 2') .?.ii) - _ S'.: c Property Owner , C, y� e/4---y) J - _ 1 1 ,- 6 i _'s, c � (1 t ^ e Name: �'..�t � � �� � . ; � {� -. t ,,{{ Address: (�i ')t �r " ) AVE City, State: AlbrilVinfiny `� , /1/14 C IOC..' (-) I, P a 0 1 611 C.21 1 (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature ,' r '.. -, f ' ( - _ Date 1 The Commonwealth of Massachusetts Department of industrial Accidents a e Office of investigations , A , 600 Washington Street "' - 4 Boston, MA 02111 %,....;;,,,,,, www rnass.govldia Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le;dbly Name ( Hushess /Or C 6 r e t :7 C Address: 33 elf- c t& ((s S. city/state/zip: t1 "t'� %� C--{ es Ph one #: ' (3 — 7 Z- ' � A , r ,.. e ,,fi � ou an employer? Check the appr I •riate boil': Type of project (required): I . ill I am a employer with I t 4. ❑ I am a gener contractor an I employees �fitll and /or part lone). have hired the sub- contractors ❑Nevi construction 2. ❑ I am a sole proprietor or partner- listed on thte attached sheet. 2. ❑ Remodeling ship and have no employees 'These sub- contractors have g. [ Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp. insurance.l r uired. ] 5. [] We are a corporation and its 10.❑ Electrical repairs or additions officers ave exercse teir 11. Plumb' re 3. ❑ I am a homeowner doing all work h id h ❑ � airs or additions P 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. Other (AS (A, ( A.. +1611 comp. insurance required.] 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t 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 name 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. gyp," e_..--, Insurance Company Name: ( W (t1 C i � F ( c & - 1 -'�^•S t/'t^ act,. E,- Z , Policy # or Self -ins. Lic. #: 5 R ki e L, L C 6 U ` (p / Expiration Date: -" [ " 6- I Job Site Address: ,r C _AX.`'1 r7 A' , Cit /State /Zip: � y ir okr n x'11 6 ( Vii' Attach a copy of the workers' compensation 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 v€ ell 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 cer ' under the ' : ' rs 0 ndpet , ties of perjury that the infarrnation provided abo a is true and correct. Signature: ,-■•■■•,- Date: 702 i 1: ` Phone #: "4 (� — 72-"' `� t '" 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 #: '� ✓ e • a/t = Office of Consumer Affairs and Business Regulation ii_ ' ' - _ 10 Park Plaza - Suite 5170 Boston. Massachusetts 02116 Home Improvement Contractor Registration Registration: 165217 Type: Corporation - - Expiration: 1/21/2014 Tr# 220702 CO -OP POWER, INC. PAUL SCHMIDT "" 324 WELLS ST GREENFIELD, MA 01301 - Update Address and return card. Mark reason for change. 0 Address ril Renewal 0 Employment D Lost Card DPS -CA1 C; ECM- 04104- 61 0121 6 ✓m -- .n,.,,,, lh4 v..-i ac4ivaetlo Office of Consumer Affairs & Business Regulation License or registration valid for individul use only —� HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: `t_ Registration: :165217 Type: Office of Consumer Affairs and Business Regulation 4_ Expiration: 1/21/2014 Corporation 10 Park Plaza - Suite 5170 = .= Boston, MA 02116 COP POWER, INc ` e 1 PAUL SCHMIDT ' 324 WELLS ST \r .7__ GREENFIELD, MA 01301 Undersecretary Not v without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License License: CS 103635 - Restricted to: 00 PAUL SCHMIDT ( 24 CHESTNUT ST HATFIELD MA 01038 - _ ��` —--c Expiration: 5/20/2013 C `ummiytiernrr Tr#: 103635 A CERTIFICATE OF LIABILITY INSURANCE 1 2i� o11 D 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). CACT PRODUCER NAME: Shannon Palazzo James J. Dowd & Sons Ins PHONE AC.No. Exf1:413 -538 -7444 FAX No) :413- 536 -6020 14 Bobala Road E-MAIL Holyoke MA 01040 ADDRESSspalazzo(1Owd.COm _., II )JRER(S) AFFORDING COVERAGE NAIC 1$ INSURER Safety Indemnity Com a{anny INSURED COOP INSURER B :Great American Insurance Companies Co Op Power Inc. , INSURER C :U. S. Liability Insurance Company 324 Wells Sire et INSURER D Greenfield MA 01302 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1050225280 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 T YPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR ' INSR WVD POLICY NUMBER (MM/DDfYYYY) (MM/DD/YYYY) C GENERAL UABII.ITY CL1566148 11/8/2011 11/8/2012 EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $100,000 CLAIMS -MADE OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 _ . GENERAL AGGREGATE $2,000,000 GEML AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $2,000,000 PRO- LOC X _ ' $ POLICY IF1 T 1 A AUTOMOBILE LIABILITY COM6212701 3/23/2011 3/23/2012 COML3INEU SINGLE LIMI I (Ea accident) $1,000,000 ANY AUTO BODILY INJURY (Per person) $ A OWNED X SCHEDULED BODILY INJURY (Per accident) $ NON WNED PROPERTY DAMAGE X HIRED AUTOS X -0 AUTOS (Per accident) $1,000,000 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE, _ $ _ EXCESS UAB CLAIMS -MADE AGGREGATE $ DED RETENTION S $ WORKERS COMPENSATION - WC STATU- ' OTH- AND EYIPLDYERS' LIABILITY Y f N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ M OFFICEREMBER EXCLUDED? 1 1 N / A (Mandatory In NHi E.L. DISEASE - EA EMPLOYEE S If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ . B Directors & Officers Liability EPP1117553 3/212011 5/2/2012 1,000,000 5,000 Deductible DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 181, Additional Remarks Schedule, If more space is required) Waiver of Subrogation Applies. CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Honeywell Utility Solutions ACCORDANCE WITH THE POLICY PROVISIONS. 65 Shawmut Road • Suite 4, 2nd Floor AUTHORIZED REPRESENTATIVE r ovoy,,e,". 0 ,., 1 Canton MA 02021 -146 01988 -201D ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD A i ° R°® CERTIFICATE OF LIABILITY INSURANCE 1112 X011 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 Joseph Judd t_t-- r ;` PHONE (413) 625 -6527 FAX (413)625 -T210 Blackmer Insurance Agency Inc. (Alc, N. Fitt: ow. No): 1147 Mohawk Trail ss: joe @biackmers.com d 6 10; INSURER(S) AFFORDING COVERAGE NAIL I Shelburne MA 01370 - 9707 INSU A :Twin City Fire Insurance Co 9459 INSURED D, INS ER E CO-OP POWER, INC A rCe.rc;,,: INS RERC: PC BOX 688 — X0 5 O INSURER C PC Box 688 INSURERE: GREENFIELD MA 01302 INSURER F: COVERAGES CERTIFICATE NUMBER:Master 11 -12 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` SE - ISSUEDD I:RIM Y 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. 1■SR TYPE OF INSURANCE MI ADDL SUER POLICY EFF POLICY EXP UMITS LTR INSIZ WVn POUCYNUMBER (MDDM'YY) (MM!DDtYYYt GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREEMISE(Ea o occurrence) $ CLAIMS -MADE I I OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY S GENERAL AGGREGATE S GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG S _ POLICY Ti P a n LOC S AUTOMOBILE LABILITY COMB LIMB — ANY AUTO BODILY INJURY (Per person) S — ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS NON -OWNED PROPERTY DAMAGE $ _ HIRED AUTOS AUTOS IPereaadent) $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB , CLAIMS -MADE AGGREGATE S DED I RETENTIONS • S A WORKERS COMPENSATION I TORY arcs I 1 T AND EMPLOYERS' LIABILITY ANY PROPRRETORtPARTNER(EXECUTIVE IY(1 N t o EL. EACH ACCIDENT S 1,000,000 OFFICEWMEMBER EXCLUDED? ' D t3wECLC6666 11/1/2011 11/1/2012 (Mandatory In NH) EL. DISEASE - EA EMPLOYEES 1,000,000 Dyes describe under DESCRIPTION OF OPERATIONS below EL. DISEASE- POLICY OMIT S 1, 000, 00D DESCRIPTION OF OPERATIONS ! LOCATIONS! VEHICLES (Attach ACORD ¶07, 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. 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. Honeywell Utility Solutions 65 Shawmut Rd, Ste 4, 2nd Flr Canton, MA 02021 -1461 AUTHORIZED REPRESENTATIVE J Deneauit, CISR /BLAJ ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD r SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ; icensed Construction Supervisor: Name of License Holder : 'aul Schmidt '.4 Chestnut St. latfield, MA 01038 Address`', �. 2S # 103635 U � Exp.5/20/2013 Snature r Telephone )13-772-8898 -Tome Improvement Contractor: 9. Registered Home Improvement Contractor: 'o-op Power Inc. / Paul Schmidt 324 Wells St. Company Name sreenfield, MA 01301 # 165217 Address 1,xp. 1/21/2012 113- 772 -8898 • )aul bcooppower.coop 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 At 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) 1 ' Roofing E Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding [CI] Other [p] Brief Description of Proposed Work: 1/v -ut L. i q-noth , ct. iy IA-1 / ,✓A, -rtj r -3 fi l 3 cs v1/241t iriii r Tt"" (1,6-]4'(5 '"''2 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. 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 I, t C,,, W(j f ( - /2 ti e.11,4 1 . )( VoCA- , as Owner of the subject property r hereby authorize ! A 1. l(,, or ( ° 2 r to ton my beh.lf, i all matters relative to ' f • ! l h% ed b' thi building Permit application. Si , Y. ,iJiatifrA' "irci talc. Dat- I .. I, (, (, l _.-6 -' - n t C , 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 N,am5 / .i __—:,,,,/ //, i ( . _ i i &/),),. ) 0 ) (gnatureof Ownhr,Agent Date .• . Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing 4 Proposed Required by Zoning This column to be filled in by . Building Department 4 Lot Size I I 11 Frontage I 11 I I Setbacks Front 1 1 1 1 1 Side Li R:1 Li 1 R: 1 1 I I 1 Rear 1 1 Building Height I I 1 I ( 1 Bldg. Square Footage I L 1 0% I I 1 I Open Space Footage % (Lot area minus bldg & paved I I _ parking) # of Parking Spaces 1 1 1 1 Fill: (volume & Location) A. Has a Special Permit /Variance /Finding,er been issued for /on the site? NO 0 DON'T KNOW © YES 0 IF YES, date issued: IF YES: Was the permit recorded at the 0 Regis ry of Deeds? NO 0 DON'T KNOW YES O IF YES: enter Book Page and /or Document #111111111111111 B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW le YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained o Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO CY IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, exc ation, 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. t • ft.. Department use only City of Northampton . of Permt: Building Curb Cut/Driveway Permt 212 Main Street Sewer /Septic Availability, 1 Room 100 Water/Well Availability 1 41 .1 6 ? oi 1 orthampton, MA 01060 Two Sets of Structural Plans ,f-- r, - LIE, 3 -58 1240 Fax 413 - 587 -1272 Plot/Site Plans i Nop '' ; Other Specify, , APPLICATION TO MtiSTRUCT, 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 p ( n v94 t 7v4-1: Map 2-,..4 Lot r% ' Unit fifOr M ' f `', 144 A `) (141' ' Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: , y S4V0 t H p c-L cis -'/ot - Name (Print) Current ailing es L. ,. i _ Telephone j �,.(� V) Signature 1,--..._._../ ,- //IV - 1- -— V1 C j`� `( �j 2.2 Authorized Aq ntt: , i//,1-X- - ) r il l C 1 t ��, ":i L v �'(�Yl� lE i Name ( Print)/ e Current Mailing Address: S4g� L C 77 r _sC_ [ nature � T e lephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ] 0 S t5 ; V (a) Building Permit Fee 2. Electrical t L' (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2 + 3+ 4 + 5) ( 0 - r?(7 Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: _ Building Commissioner /Inspector of Buildings Date File # BP- 2012 -1170 APPLICANT /CONTACT PERSON CO -OP POWER INC & NORTHEAST BIO DIESEL ADDRESS/PHONE P 0 BOX 688 GREENFIELD PROPERTY LOCATION 65 SHERMAN AVE MAP 25A PARCEL 096 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid f 9' Building Permit Filled out Fee Paid / Typeof Construction: Insulation New Construction 7 5/1/ Non Structural interior renovations 1 ` Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 oli •.n D- 2 tnature 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. 65 SHERMAN AVE BP- 2012 -1170 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25A - 096 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2012 -1170 Project # JS- 2012- 001999 Est. Cost: $1058.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CO -OP POWER INC & NORTHEAST BIO DIESEL Lot Size(sq. ft.): 7884.36 Owner: SAVOIE KELLY & HELEN SPIEGEL - SAVOIE Zoning: URB(100)/ Applicant: CO -OP POWER INC & NORTHEAST BIO DIESEL AT: 65 SHERMAN AVE Applicant Address: Phone: Insurance: P 0 BOX 688 GREENFIELDMA01302 ISSUED ON:6/28/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:Insulation -Copy of the utility final report required 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 6/28/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner