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17A-159 (2) 7 __.---_-,_ -LY fie i7i)f o/ - w4i,lcrcA/tex;e1(3 ,c _i�i ` r , Office of Consumer Affairs and Business Regulation -fib= 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 151246 Type: Ltd Liability Corpor Expiration: 5/23/2014 Tr# 224564 ACE FIRE & WATER RESTORATION GARY BRUNELLE 18 ELIZABETH ST. W. SPRINGFIELD, MA 01089 Update Address and return card. Mark reason for change. SCA 1 Cc 20M -05/11 ❑ Address 0 Renewal 0 Employment ❑ Lost Card c2 92e aorrai omoea 4 c a4Jack4Jee Office of Consumer Affairs & Business Regulation License or registration valid for individul use only 1 :lit.= — • ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to •' t. t Office of Co nsumer Affairs and Business Regulation mew 151246 Type: g lk -1! G xpiration: 5/23/2014 Ltd Liability Corpci 10 Park Plaza -Suite 5170 f� Boston, MA 02116 ACE FIRE & WATER.RESTORATION GARY BRUNELLE ' � 18 ELIZABETH ST.. �' " % W. SPRINGFIELD, MA 01089 Undersecretary Not valid 71 out signature •t Ala.- ichusctts - Department of Public Safct� i Board of Building Net:ulations and Standard• Construction Supervisor License License: CS 74416 GARY W BRUNELLE § 125 CREST LN f' GRANVILLE, MA 01034 �--e..- —y - Expiration: 9/18/2012 ( o0nnmiaiuMCI Tr#: 2422 Ace Fire & Water Restoration, Ius i u 18 Elizabeth Street d CONTRACTOR AGREEMENT AND West Springfield, MA 01089 DIRECT PAYMENT REQUEST Phone: (413) 750 -5200 ACE - , , TER Home Improvement Contractor License #151246 RESTORATION, INC. GENERAL CONJRACIORS Insured Name & Loss Address: Billing Address If Different: ...IL kgeft L P. ,c �i / i..,Ali/ . - /a Insurance Co , .I. • .9 • � Insurance Adjuster: - SPT/Yj/.t11 •--- J, /1S (1C)i-S) Contractor and Owner agree as follows: 1. Scooe of Work: The Contractor shall famish all of the materials and perform all of the work necessary to retum the property located at 14.Y C/CIX to pre -loss condition, in accordance with the final agreed upon specifications between Contractor, Owner and Owner's insurer, which shall become part of this Agreement 2. Time of u b jaoletior: The work to be performed under this Contract shall be commenced approximately on lb Z' ) 31i / and shall be substantially completed on or before . Contractor shall not be responsible for any delays beyond its control, including without limitation, change orders, any delays caused by Owners) or their insura camer or adjuster, inaccessibility to the property, unavailability of materials, any acts of god, and/or any strikes. 3. Contract Price: The Owner shall pay the Contractor for the material and labor to be performed under this Contract the sum of: as set forth in the final agreed upon specifications, subject to additions and deductions pursuant to authorized change order(s). It is understood that this estimate is subject to the approval of the adjuster or a representative of the insurance carder and may be modified. 4. Proare Payments: Payments of the Contract Price shall be paid as follows: The aforesaid payment schedule may be modified upon receipt of the approval from the insurance company or adjuster. 5. Insurance: Owner hereby assigns to Contractor all of his or her right, title and interest in and to a portion of all insurance benefits or proceeds to which Owner may be entitled, and assigns any and all claims which Owner may have against any insurer, to the extent of the amount of the bill for professional services rendered to Owner and /or Owner's property referenced above; and Owner hereby grants a lien to Contractor on any insurance benefits or proceeds that may be due Owner. Owner further acknowledges and agrees that said assignment may not be revoked retroactively, and may only be revoked by giving a written notice by Certified Mail or hand - delivered to Contractor, effective after date of receipt of said written notice by Contractor. Owner hereby authorizes and directs the payment of such insurance benefits or proceeds directly to Contractor and directs the above referenced insurance company to pay to Contractor such sums as may be due upon receipt of a statement for services rendered. Owner understands that he or she is primarily responsible for the payment of services rendered by Contractor and the authorization contained herein in no way releases Owner from personal responsibility to pay for such charges. Owner hereby requests and authorizes his or her insurance company to furnish Contractor with any and all information, including without limitation, payment information and estimates with regard to work required to preserve and protect the personal and/or real property which Owner owns, controls or leases. All deductibles are due upon executing this Contract. All betterments from the insurance carrier and/or any services not covered by insurance shall be due and payable by Owner at the completion of services rendered. 6. Change Orders: Any alteration or deviation from the above scope of work will be executed only upon written order for same, signed by Owner and Contractor, and if there is any charge for such alteration or deviation, the additional charge will be added to the contract price of this Contract 7. Necessary Wor All necessary work, not covered by insurance company, that is required to be performed for the completion of the original contract, shall become the responsibility of the homeowner. 8. Default Payments are due within 30 days of invoice. If payment is not made when due, Contractor, at its option, may suspend work on the project until such time as all payments due have been made and may take steps to secure a lien upon Owner's property pursuant to Mass. General Laws Chapter 254. If payment is not received within 30 days of invoice, a delinquent payment penalty wit be charged at the annual rate of 18 %. In the event the account is referred to an attorney for collection, Owner is responsible to pay reasonable attorneys fees to Contractor's attorney, and court costs, in the event a suit is filed. 9. Any individual or entity shall be entitled to rely on the original or any photocopy of this document as if it were the original. 10. General Provisions: a. All work shall be completed in a good workmanlike manner and in compliance with all building codes and other applicable laws. b. To the extent required by law, all work shall be performed by individuals duly licensed and authorized by law to perform said work. All contractors and subcontractors must be registered by the administrator of the Board of Regulations and Standards. c. Contractor may at its discretion, engage subcontractors to perfomr work hereunder. d. Contractor warrants it is adequately insured for injury to its employees and others incurring loss or injury as a result of the acts of Contractor or its employees or subcontractors. e. Contractor shall obtain all permits necessary for the work to be performed. In the event Owner obtains their own permits, Owner shall be excluded from the Residential Contractor's Guaranty Fund pursuant to Mass.Gen.taws Chapter 142A. f. Contractor shall not be liable for any delay due to circumstances beyond its control, including without limitation, strikes, casualty, or general unavailability of materials. Contractor shall not be liable for consequential and/or collateral damages. g. Contractor warrants all work for a period of 12 months following completion. h. This Agreement shall be govemed by the laws of the Commonwealth of Massachusetts and the parties hereto hereby agree to submit ro the jurisdiction of the courts located within the Commonwealth of Massachusetts for any controversies arising out of this Agreement i. Owner has the right to cancel this Agreement within three business days of executing this Agreement provided Owner notifies Contractor by midnight of the third business day of such cancellation. j Intending to be legally bound and acknowledging receipt of a copy of this executed Agreement, we sign this ay of �iQG Do not sign thi contract if there are any blank spaces. Uf Signature r JiAt ce 4 t..cu'Yt AFWRI Representative -me . i Print Name ( `1\ Al C e ( CO Y c,Yj l Fed ID# 204384724 l_ Title Date Date WHITE- FILE COPY YELLOW - OFFICE COPY PINK- CUSTOMER COPY ACEFI -1 OP ID: DA ' `1 ° RO CERTIFICATE OF LIABILITY INSURANCE DA 08/14/12 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 413 - 781 -7000 CONTACT Haberman Insurance Group Inc PHON Linda Klein 95F Ashley Avenue 413 - 733 -9545 PHO , Ext): 413- 781 -7000 FAX 413 No): 413 - 733 -9545 West Springfield, MA 01089 E -MAIL Kevin Mayo ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :American Safety Insurance INSURED ACE Fire & Water Restoration INSURER B Safety Indemnity 33618 18 Elizabeth Street West Springfield, MA 01089 INSURER C :Associated Industries of 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. I L T R TYPE OF INSURANCE I POLICY EFF POLICY EXP INSR WVD POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY ENV0237101103 09/21/11 09/21/12 DAMAGE TO PREMISES (Ea occurrence ) $ 50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 X POLICY .197 PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) _ $ B ANY AUTO 6213867 07/01/12 07/01/13 BODILY INJURY (Per person) $ ALL OWNED x SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X W NON -ONED PROPERTY DAMAGE $ AUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESSLIAB CLAIMS -MADE ENUO237121103 09/21/11 09/21/12 AGGREGATE $ 1,000,000 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION WC STATU- X OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER Y / N C ANY PROPRIETOR /PARTNER /EXECUTIVE VWC6014477012012 07/01/12 07/01/13 E.L. EACH ACCIDENT $ 1,000,000 OFFICER /MEMBER EXCLUDED? N N 1 A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Contractor ENV0237101103 09/21/11 09/21/12 Ea Occur 1,000,000 Pollution Liab Ded 5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION TOWONOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street Northampton, MA 01060 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD To : 14137505201 11/17/2011 08:48 1f905 P.003/003 The Commonwealth of Massachusetts . -72k- 1 ::e rir i iel qi •""d.. IESiPit::.: ACCit of S in ..,__..=.... ' - t t= t- Office of investigations • �, i `� • 3 i 500 Washington Street Boston, MA 02111 . `. mis . }vlvw.niassgov /din Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information. - Q Please Print Legibly Name (BusinessfOtganization !Individual): - 4 [(` • l-( # t4.) c ?1 ce Aes F o9 V i(A, • � - /. • Address: l e 41; ? F h • ¢t`2 S(. . • City /State /Zip: Wti d Si)rin t t , X / 'ti7 0/ Phone. #: - • - - • Are you an employer? Check #hi kppropriate box: _ Type of project (required): 1- a m a e m p l o y e r w i t h 7 ( " ) 4..0 I am a general contractor and I employees (full and/or part trine).* have hired the sub - contractors 6. New construction 2- t 1 as a 'sole proprietor a: pa-?ner- - listed on the:attached sheet 7 0 Remodeling ship and have no employees - These sub - contractors have •8. [j Demolition - worldn forme in any ca aci . employees and have workers' g Y P $ • 9. 0 Building addition [No workers' comp. insurance com ice• 10_ Electrical repairs or addrhons required.] S. We are a Corporation and its eP • 3.0 I am a homeowner doing all work officers have exercised their - - 11.0 Plumbing repairs or additions • myself. [No workers' eoiatp.. . right of exemption per IyIGL • 12. ]j Roo re insurance required.] 1 c. 152, §1(4), ancl. we have no • - emploYees. -('No workers' 13.0 Other . • - .- - .comp, insurance required] ... . * Any applicant that checks box #1 muse also fill out the section below shovring their woikeds' comprusatian policyinformatioa. . - t Homeowners who snbrriit #his affidavit indicating they are doing all work. and. then hire outside contractors must submit a new affidavit indicating such. 3 Contractors that check this box must attached an additional sheet showing the name ofthe.sub- cojitractors and state whether or not those a itities have - . employees. If the sub-contractors have employees, they must provide their workers' comp. policy number. • . z _. ..... . /gm an employer that is providing workers' compensation i nsuranc e fy my employees .Below is the policy and job site • informations. - t fr, - • insurance Compaany.Name: G l . . / . - - _ • - e , .. --),„, • Policy # or Self-ins. Lic. #: V - w . tfp / `7 / • _ i ration Date ate: / //' . lob Site Address: . - City /State/Zip: 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 maybe forwarded to the Office of . Investigations of the DIA for insurance coverage verification. • • - I do hereb certify under the pains•and penalties ofpeijury that the information provided above is true and correct. Signature: Date: _ - _ Phone #: • j� pl f � i Official use only. .Do not write in tl fr area, to be completed by city or torn official t 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 #: i SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : (//412/ c3j,i./j p ( 4/1/& ✓ /// License Numb / r fll2 /1.e/A -Yr 9 - /2' 20/2- Address /�� �d- Expiration Date �. S 1 � E / C' / / . Signature Telephone ����JJJJ Li/3... lv go 9. ReAistered Home Improvement Co tractor: Not Applicable ❑ /lee - Q 2 /5 /,2ij Com an Name Registration Number d E Im6e1A.L5/ .5 2o)/7 Addre s 4-1 Expiration Date / ` (1 n� /C1 Ha_ 6/0� Telephone 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 ❑ 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) n Roofing l i Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [Q Siding [D] Other [Iiit Brief Description of Pro bsed Work: KCS1W Cl) tYcti? Alteration of existing bedroom Yes V No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes N 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 , 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 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information 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 # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW GK YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book t Page' and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ( DON'T 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 0 , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: axe cg3)5, ?ess 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: E. Will the construction activity disturb (clearing, grading, ;x avation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO I I IF YES, then a Northampton Storm Water Management Permit from the DPW is required. ► 4 Departmen Ilse = , s , ... R EC - City of Northampton Status of Permit ' B uilding Department Curb'C.ti/Dm/ewayPeanit f 212 Main Street Sewer ; o va abdlty J 1 6 2012 1 Room 100 Water/WelMAvailabd y`` 1 i I rthampton, MA 01060 Two sets of Structural Plans D phon 41 - 587 -1240 Fax 413- 587 -1272 Plot/ Site Plans' _..._ Other Specify, APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Address: This section to be completed by office 7�p/3 f cX ./'/n i/ Map Lot Unit .7 /c1'enee, Ha.... Zone OverlayDistric# Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: e rr( ` q er�t e ; -/ I/3 rn hence /r /. Na me ( int) ( Current Mailing Address: Telephone Signature 2.2 Authorized Agent: psi ` i / t') 2 X' - '// ' z /1 &IL sr Name (Print) Current Mailin. IP Address: 1 Signature Telephone SECTION 3 - E (MATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee / ODD- 2. Electrical (b) Estimated Total Cost of 10 Dom. Construction from (6) /6/, DDU Building Permit Fee 3. Plumbing j 4. Mechanical (HVAC) //), l)0 5. Fire Protection 6. Total= (1 +2 +3 +4 +5) /SO,O CO - Check Number z - i ox. q)6-61 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File # BP- 2013 -0178 APPLICANT /CONTACT PERSON ACE FIRE & WATER RESTORATION INC ADDRESS /PHONE 18 ELIZABETH ST WEST SPRINGFIELD (413) 750 -5200 PROPERTY LOCATION 43 FOX FARMS RD MAP 17A PARCEL 159 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT ds1Z° Fee Paid �t1 Building Permit Filled out 2.912 `L'° „�� j Fee Paid ��((JJ ' v Tvpeof Construction: FIRE RESTORATION ° J d CJ New Construction // �� L / ' PI Non Structural interior renovations nl� Addition to Existing J l Accessory Structure Building Plans Included: Owner/ Statement or License 074416 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO3MATION 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 Dem•l "o D- ay /dg zill/7 7 1 Signature of Building • fficial 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. 43 FOX FARMS RD BP-2013-0178 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A - 159 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 -0178 Project # JS- 2013- 000291 Est. Cost: $150000.00 Fee: $900.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ACE FIRE & WATER RESTORATION INC 074416 Lot Size(sq. ft.): 27007.20 Owner: GRANT GERALD S & BERNICE B Zoning: URA(100)/ Applicant: ACE FIRE & WATER RESTORATION INC AT: 43 FOX FARMS RD Applicant Address: Phone: Insurance: 18 ELIZABETH ST (413) 750 -5200 Workers Compensation WEST SPRINGFIELDMA01089 ISSUED ON:8/20/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: FIRE RESTORATION - MUST BE CURRENT BUILDING CODE 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 8/20/2012 0:00:00 $900.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner