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18D-060 (2) j.. / \�\ i \� ��� `f 1', 10 Jul 2012 10:46AM CROCKER BUILDING Co 14137376861 p.l City of Northampton r .� Y , i Massachusetts M t;� k 1 ' ‘,.•..,.' ( D AR3' 1T OP BUILDING IMPACTIONS 212 !lain Street • Municipal Building ' te, .� Northampton, !A 01060 + :e. 0 INSPECTOR Louis Hasbrouck Fax: 413 -587 -1272 Chuck Miller Building Commissioner Phone: 413-587-124.0 Assistant Commissioner CONSTRUCTION CONTROL DOCUMENT (For professional EnglnoorwArchttocts rssponsibts for Entity Project) Project Title: fit9LI t31Z -ii 10 /164, 'A 5' Date: 7. 10- t Z Project Location: 155 1 i AL, 1 V� Map: Parcel: Zone: Scope of Project: WrI r n r r i.1 0Voltnr,i4 In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 107.6: t, rot;,L\ .)(A 'i y,i42 fie Mass. Registration # (P Being a registered professional Engineer /Architect hereby CERTIFIES that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: IA 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 10,7.6.2.2: 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 became 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 Professional /""rye „.p.----- 1,,l !� 4,... WILLIAM A. TERRY . ,9 ` � ff Notary Public Pi1�.6512 r `C) Day of y,G 2q Commonwealth of Massachuse j c NO. �L'LC G '�_ n: E My Commission Expires 4": � ' t -p i` /.;. (seal) V6 r , il 1 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -067805 ' 1, WILLIAM D CROQ'KE' ,)' 36 SPRINGFIELD ST' i * WILBRAHAM 14fA 011 " "" Expiration Commissioner 04/19/2014 The Commonwealth of Massachusetts Print For { _ Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 ft 0 Boston, MA 02114 -2017 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information Please Print LeEibly Name ( Business /Organization/Individual): 'Lt?Q (L) � c ,m4 Q,„ C .,y Address: t eaL - 1 - 14 c.1s.teN c City /State /Zip: G'wsc.e \_ NV; oktOy Phone #: it ) ) 7. 7803 Are you an employer? Check the appropriate box: Type of project (required): 1. a I am a employer with / g' 4. ❑ I am a general contractor and 1 6. New construction employees (full and /or part- time).* have hired the sub - contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. KRemodelin ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. 111 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. ❑ 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. 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. Insurance Company Name: Lt.'6tAT Policy # or Self -ins. Lic. #: 31S - 3 $ V 9 (,t -- O t a Expiration Date: 3 /St/ 13 Job Site Address: 1 S City /State /Zip: kicsMewrb%.. MA 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 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 hereb certir the pains penalties of perjury that the information provided above is true and correct. l ti-S Date :_°' D/ Signature: -- Phone #: ('f3) 237-76)63 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 #: From:Monique Schetzel FaxID: Date:6/28/2012 09:32 AM Page: 1 of 1 ------"1 CROCK -1 OP ID: MS ' `' �O /? ° CERTIFICATE OF LIABILITY INSURANCE DATE 06128 DIYYYY) 06128/12 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 PHILLIPS INSURANCE AGENCY INC 413 - 594 - 5984 NAM Patricia Mahoney FAX IAIC 97 CENTER STREET 413 - 592 -8499 , No, Ext1: 594 -5984 (Are, No): 413- 592 -8499 CHICOPEE, MA01013 EMAIL att sinsu ran ce.com Chris Rivers ADDRESS: Ff YAP hi IIi P INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Selective Insurance 12572 INSURED Crocker Building Company Inc INSURER B: Liberty Mutual Insurance Co Mr. Seth Crocker INSURER C : 186 Stafford St — Springfield, MA 01104 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMJDDIYYYY) (MMIDOIVYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY S1888087 04/01/12 04/01113 RREM lETC REM PREMISES (Ea occurrence) LD $ 100,000 CLAIMS -MADE [ X I OCCUR 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 I POLICY X JECT LOO $ I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ A � ANYAUTO A9092137 04/01112 04101113 BODILY INJURY (Per person) $ - ALL OWNED X SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED PROPERTY DAMAGE $ Included X HIRED AUTOS X AUTOS (Per accident) X UMBRELLA LIAB X OCiOUR EACH OCCURRENCE $ 5,000,000 A - EXCESS LIAB , CLAIMS -MADE S1888087 04/01112 04/01/13 AGGREGATE $ 5,000,000 DED RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER B ANY PROPEIETORfPARTNER/EXECUTIVE Y N Nl A WC531S385691012 04/01112 04/01/13 EL EACH ACCIDENT $ 500,000 OFFICEPIMEMBER EXCLUDED 500,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under 500,000 DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ A Rented /Leased Equi S1888087 04/01/12 04101113 Rented Eq 200,000 I DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Renovations for Pioneer Valley Books, Former Tiger Press Building 155 Industrial drive Northampton, MA. CERTIFICATE HOLDER CANCELLATION CITYOFN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Northampton Louis Hasbrowck Building Comm AUTHORIZED REPRESENTATIVE 125 Northampton, Locust Street No MA 01060 (9.3--4_,#.0.4 //1,1 f i ) ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 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 01 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 I, ��__ 1.. _ .. _,� ��. • , 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 penalti s o erjury. 7 ,% �.. f ...9t --, Cr 'Z4L (L Print Name a 7714.2Ot Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ `William Crocker Jr. CS- 067805 Name of License Holder : License Number 36 Springfield St & /&c►dA" ,t'ta OKA c p 04/19/2014 Address Expiration Date (413) 737 -7803 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: ;Bernard M Schenkelberg Not Applicable 0 ,�.�_...u. 6542 Name (Registrant) Bernard M Schenkelberg Registration Number Address 014•2. tskotvwstlrk �� Su.�G :08/31/2012 pr %M°. dA%°l (413) 739-0162 Expiration Date G% � Telephone 9.2 Registered Pra�Fe�onal En ineer(s): 9 N/A 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 Crocker Buinding Company Inc. Not Applicable ❑ Company Name: =William Crocker Jr. Responsible In Charge of Construction ;186 Stafford St Addre ,. (413) 737 -7803 Signature Telephone Versionl.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 104108.40 same • g as Frontage ex same 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) NIA A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 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 ®i NO 0 IF YES, describe size, type and location: Owner intends to install. Type unknown at this time 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 Q 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 !7 Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Renovation of interior office and break -room. Install partition wall, enlarge break room, new Of Proposed Work: (paint and flooring, Install (4) exterior windows. SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business 0 2A ❑ E Educational ❑ 2B 1 ❑ F Factory ® F -1 ® F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I 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 I ❑ U Utility ❑ Specify: 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 ,Fl ' Proposed Use Group: F -1 Existing Hazard Index 780 CMR 34) :. a - ■ /F k Proposed Hazard Index 780 CMR 34): Nl SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Area per Floor (sf) 1 st 1st E X vs •-•5 .!Jo C4 2 nd 2 �d 3r 3 rd 4 m Total Area (sf) Total Proposed New Construction (sf) 0 Total Height (ft) o ) o Total Height ft 0 "c?, 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public p Private ❑ Zone Outside Flood Zone❑ Municipal A On site disposal system❑ Versionl.7 Commercial Building Permit May 15, 2000 t�artaiten ,�u�e �a � RED,` rp -' City of Northampton --- Building Department G # Otrt DrWeu ay Pelt JUL Q , 212 Main Stree ; ew erl pt�cAva ability �� WICK w �J� Room 100 Water/Well Av r 1 x ���k �--- -� _ __ Northampton MA 01060wa 8e ofStrucfiallarl z �� f� DEFT. OF BUILD ,, , i ... t kxF "y r r 41 NORnaAMPieN, MA bile 413-587-1240 Fax 413- 587 -1272 Pietist* #plan Other a ect y 4 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 1 ,155 Industrial Drive e�e a._.. Map / Lot e,, 0 Unit ;Northampton MA, 01060 Zone Overlay District ...__ Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Pioneer Valley Books 31 Hidden Meadow Road Name (Print) Current Mailing Address: 413 548-9042 Signature Telephone r � 2.2 Authorized Agent: William Crocker Jr 186 Stafford St Name (Print) Current Mailing Address: (413) 737- 7803���� Signature ",�f Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building $96,500.00; (a) Building Permit Fee 2. Electrical $8,000.00 (b) Estimated Total Cost of Construction from (6) . __. .a._ -_ .• .R ..- 3. Plumbing 00 Building Permit Fee $3,500.' 4. Mechanical (HVAC) 5. Fire Protection $7,000.00` _ 6. Total = (1 + 2 + 3 + 4 + 5) Check Number 36361 t 4 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0035 APPLICANT /CONTACT PERSON CROCKER BUILDING CO INC ADDRESS /PHONE 186 STAFFORD ST SPRINGFIELD (413) 737 -7803 PROPERTY LOCATION 155 INDUSTRIAL DR MAP 18D PARCEL 060 001 ZONE GI(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out / .q�] Fee Paid Cv �.T T Typeof Construction: RENOVATE INTERIOR OFFICE & ENLARGE BREAK ROOM & 4 EXTERIOR WINDOWS --. tis New Construction C 1 )40( Non Structural interior renovations vm/ y Addition to Existing t 1 Accessory Structure pn 61(5 Building Plans Included: , . I / C° ^ e J.; 3 Owner/ Statement or License 067805 lo ` /� , •'7 _ 3 sets of Plot Plan THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I ORMATION 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 14 itio�: %e der v: IV 44101 2 ----/./------ Signature : 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. 155 INDUSTRIAL DR BP- 2013 -0035 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18D - 060 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- 2013 -0035 Project # JS- 2013- 000050 Est. Cost: $115000.00 Fee: $690.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CROCKER BUILDING CO INC 067805 Lot Size(sq. ft.): 104108.40 Owner: DUFRESNE ROBERT Zoning: GI(100)/ Applicant: CROCKER BUILDING CO INC AT: 155 INDUSTRIAL DR Applicant Address: Phone: Insurance: 186 STAFFORD ST (413) 737 -7803 Workers Compensation SPRINGFIELDMA01104 ISSUED ON:7/16/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: RENOVATE INTERIOR OFFICE & ENLARGE BREAK ROOM & 4 EXTERIOR WINDOWS - SPRINGKLER ASBUILTS REQUIRED BEFORE FINAL INSP 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 7/16/2012 0:00:00 $690.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner