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38A-107 (18)
Subcontractor WC Poi# Ins Co Eastfield Glass WC8713327 Peerless Grimaldi 9113701109 Arbella Hurley & David WMZ8005601012009 AIM Mutual Pilgrim Interior 468120870108-MA CA Insurance Soup to Nuts UB1B54882612 Travelers Universal WC8565060 Peerless Warehouse Mech MCC2000316012012 MA Employers Ins The Commonwealth of Massachusetts Department of Industrial Accidents 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):Five Star Building Corp. Address: 123 Union Street, Ste 200 City/State/Zip:Easthampton, MA 01027 Phone #: 413-527-4060 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ® I am a general contractor and I employees(full and/or part-time).* have hired the sub contractors 6. II] construction 2.E I am a sole proprietor or partner- listed on the attached sheet. 7. K Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. n We are a corporation and its 10.0 Electrical repairs or additions 3.n I am a homeowner doing all work officers have exercised their 11.E Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.17 Roof repairs insurance required.] t c. 152. §1(4), and we have no employees. [No workers' 13.E 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: General Casualty Co of WI Policy# or Self-ins. Lic. #:CWC 0820373 Expiration Date:05/09/2014 Job Site Address: Baystate Hospital, 759 Chestnut St City/State/Zip:Springfield, 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. :e advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance co ;rage verification. I do hereby certify under the pain: and •• a ties of perjury that the information provided above is true and correct. Signature:Kevin Perrier Date:NOV. 7,2013 Phone#: 413.527.4060 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#: MAY-08-2013 13:44 FINCK & PERRAS 1 413 627 6970 P.003 A 2LLM CERTIFIC;R I t ur LIPbiLi I '1 JI'4 Urci�w�.c OS/U3/1U13 PRODUCER (413)527-5520 FAX (413)527-5970 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fi nck & Perras Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 6 Campus Lane ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton, MA 01027 INSURERS AFFORDING COVERAGE NAIC Ik INSURED Five Star Buy •a ng orp INSURER a General Casualty 24414 17 East Street INSURER B: Easthampton, MA 01027 INSURER C; INSURER 0: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY RECUIREMENT,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, IN SR AMYL• TYPE OF INSURANCE POLICY NUMBER PO ICY EFFECTIVE POLICY EX•�RAT:ON LIMITS • OENERALUABILITY CC10394412 05/09 201 05/09/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILfIY CCT0394412 05/09/2012 05/09/2013 DAMAGETORENTED S F I,p�CPC I oer,,..,��1 100,000 1 CLAIMS MADE '. ' ' OCCUR MED EXP(Any on.person) 5 10,000 A PERSONAL a AOV INJURY 3 1,000,000 GENERAL AGGREGATE $ 2,000,000 CEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGO 3 2,000,000 1-1 POLICY Teo OC _ n AUTOMOBILE LIABILITY CBA0820374 05/09/2013 05/09/2014 COMBINED SINGLE LIMIT ANY CBA0820374 05/09/2012 05/09/2013 (E"u10dOO $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS IPorperson) S A X HIRCD AUTOS BODILY INJURY s X NON-OWNED AUTOS (Per ecbldent) PROPERTY DAMAGE 3 (Per acadonl) I GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 6 H ANY AUTO _ OTHER THAN EA ACC 5 AUTO ONLY: AGO 6 EXOESSAJMSRELLALIABILITY CCU0394412 05/09/2013 05/09/2014 GACHOCCURRENCE $ 9,000,000 -X-1 OCCUR ( CLAIMS MADE CCU0394412 05/09/2013 05/09/2014 AGGREGATE $ 9,000,000 A $ DEDUCTIBLE 5 —RETENTION $ $ WORKERS COMPENSATION AND CWC0820373 05/09/2013 05/09/2014 X I WCSTATU- _ R EMPLOYERS'UABILITY CWC0820373 05/09/2012 05/09/2013 E.L.EACHACCIDENY 3 11000,000 A OFFICERT EMBER EXCLUDED? CU7NE E,L.DISEASE•EA EMPLOYED,$ 1,000,000 If yos,describe Under SPECIAL PROVISIONS below C.L.DISEASE-POLICY LIMIT_S 1,000,000 OTHER DESCR1IPTIO Cl'OPERATIONS I LOCATIONS/VEHICLES)EXCLUSIONS ADDED BY ENDORSEMENT)SPECIAL PROVISION$ Proof of coverage CERTIFICATE HOLDER ANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES ES CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL BUGH NOTICE SHALL IMPOSE NO OBUGATON OR LIABILITY OF ANY KIN.. ,.ON THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED SENT TVE ACORD 25(2001/08) OACORD CORPORATION 1988 . . ::::::::.:::iii::•:':::•?:::::::g.g5.'-giLl-,W,/0;;.::: •••••:::••:,:::•::::::::::::::::,...:.,.:,, ,, , "" - c LC) :::.::::::::.•-•:.•:-.7:.:.:::•:.:::.:::.: ::: ,,,,-;;;Ai;' ••: ......•....:....::;:'::::'::;;;;.... ..::,•;-j:,,,7..Z,;;;.:f,Y"^ ..' . 0 ir"' -.....i. . .:'::,:•:•:•:•.::::.5fii'is,:1•;q9.,>•:•;;I: .-..'.: >1 (/4) .....:.-:::::-•:•.:..::::::::.....:r.::-::::.:::,.:•: .::•:.....: •.... 0 tr.) T:$ txi 5 :-..::....,.W........__:.:.4..._,....-.'::-,....,.4,.:,i..,;..:,:..:i..._--sL...:..:.=:.=:::.:,•:,.:...:..:.:..:.i1 ..1,... (e) ....... >< .• ••••••••••••••••••••---, 0 cl •....::.,..,•:,....,::::::::.:.:.,,:.:.:,:.::::: ill 1.9 +0 . ..0 (I) "CS CL 4- rks \I.A \I .. N i 0 • ,,,.. () 4-0 C C 0 ''l 4S• ,.., ,,,........0:.,-,,,3„,....,....„ r"' a) ._ 0 cr) ., ,,,s,,.......,. . ..-.,,:.,, . ,,,,A,..0,-Lge , E Vii ' ......i 111111M .6r. ,,,,,,:k.rA1V• , •.• 'I,' 75.0 •/".". 4-,re'Q:: . ... ":a' 1....t. v..:.,•• ,,:::,•,-. L. 0) (I) C? ..--t ,,,,T.J.:. -,-.,,,.:: .......,,•...-- - .-,-k a) • \ 0 -fek, . , kk . r 0 N 11 (1) V) I NOM 4= :I 1: (1) **i 13 , c tego Fail 0 ,..... ,,„„j 1 v U 411 Elmo 11)411 V) 13 l'et (Xi tg 2 o Fial (1) ds* City of Northampton Massachusetts tkt *;_ DEPARTMENT OF' BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 NS or Louis Hasbrouck Fax: 413-587-1272 Chuck Miller Building Commissioner Phone: 413-587-1240 Assistant Commissioner CONSTRUCTION CONTROL DOCUMENT (For professional Engineers/Architects responsible for Entire Project) Project Title: Ll B5RT"( ML UAL/NORTt1ptMP TON Date: I I I - 2O13 11131/50 38A-107"661D, / Project Location: I VILLAGt; HILL) 5 U ITE 1O 3 Map: Parcel: _Zone: E v Scope of Project: IaretejOR ebN4TRUCTION jNGI,UPES PAATt11ONS CLEGtRACAL,CEtL1N66, FINI51415S AND L)FE 5RPCTY IN Ac MUL11-Te9ANT o F ce BUILDING. In accordance with the Eighth edition Massachusetts State Building Code, 780 CM Section 10/.6: �1 _ I, KK N1' rt\ /vR�__ �i __Mass. Registration # 3) 114 I4 Being a registered professional Engineer{ArchitecAhereby CERTIFIES that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: h(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 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 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 -al of R. stered Professional 44 as, 4 fic, %: \ ,/,4 4°' ' ! �� No.31714 m PHH ADcLPHtA l� �AnG PENNSYL MA '�►cn 1,6t Day of NONE DEN 2011_ (seal) 4,OF Vip• .t` • Version1.7 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 0 SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Liberty Mutual Insurance/Molly Louden as Owner of the subject property hereby authorize Five Star Building Corp to act on my behalf,in all matters r lative to work authorized by this building permit application. 0111 ,,,� � 111 Kl /3 Signaof• + Date l Five Star Building Corp 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- .of perjury. Kevin Perrier A Print Name 112 I J Signature of Owner/Agent Date SECTION 12-CONSTR TIO ♦SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:Kevin Perrier-Five Star Building Corp MA CS 085319 License Number 123 Union Stra t, ite 200, Easthampton,MA 01/13/2015 Address Expiration Date (413) 527-4060 Signature I Telephone SECTION 13- •RKE'S'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 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 Ar chitect: " Not Applicable KC -H s Tj .i p R. i 31714 Name(Registrant): Registration Number Urti 2 !i SG ' HILMX l ! ' )901 1 08/31/2014 Add .s / f1 (215)922-7066 Expiration Date Si•nature Telephone 9.2 Registered Professional Engineer(s): I T 441.0Ail /5d t [�{/+r r I Jl6t ti -•_ #lfi - i , u,y ~ 4 Name / 4 etlIV ti 0 1044 Area of Responsibility 10 fo f4LL5 ._121 , v t f 116/ ' 5 4 itl& Address Registration Number ,s----- 247'41/4 /114/1 4- 30-Jy Signature Telephone Expiration Date Name Area of Responsibility Y fibs bs b!!- ?t t YThav,v-n4 # l' o locg 241-6M C It Addre 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 Five Star Building Corp Not Applicable 0 Company Name: Kevin Perrier Responsible in Cha a of Construction 123 UnioP S t, Suite 200,Easthampton,MA 01027 Addresa� f �/ U (413) 527-4060 Signature tl 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 parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT 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 C 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 ® , Date Issued: C. Do any signs exist on the property? YES ® NO Q IF YES, describe size, type and location: Monument-Corner of Prince and Village Hill D. Are there any proposed changes to or additions of signs intended for the property? YES i© NO Q 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 ® NO 0 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 GI Existing Wall Signs ❑ Demolition GI Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Tenant build out-partitions, electrical, HVAC,plumbing, ceiling, flinishes and life safety. Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ( ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business 0 2A ❑ E Educational ❑ 2B I 12 F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I-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 l ❑ 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: Business Proposed Use Group: Business 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) 8,224 1st 3,106` 2°d 8,224 2' . ...._ 3rd 3rd 4th Total Area(sf) 16,448 Total Proposed New Construction(sf) 3,106 Total Height(ft) 40' r --- Total Height ft NO (u i1 EI r E_ 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 p Municipal i4 On site disposal system 0 \ \\D\-. NOV —7 2013 '1 t,,,_ city of Noithversaionintp.t7oCnommercial Buildina Permit May 15,2000 Fec“,r,c r - , - Department use only Status of Permit: __ • Building Department curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 WaterlWell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans - - , - Other Specify 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 This section to be completed by office 1.1 Property Address: 11 Village Hill; Suite 103 Map 3g k Lot \t Unit Northampton,MA 01060 Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Liberty Mutual Insurance,Molly Loudon 175 Berkeley St., #07N,Boston,MA 02116 Name(Print) Current Mailing Address: (857)244-2777 Signature ° A/ALA. t..."._.i. /L- Telephone F 2.2 Authorized Agent: Kenneth M.Bere . 211 South 12th Street,Philadelphia,PA 19107 _ . Name(Print) Current Mailing Address: ..... / . (215) 922-7066 / Id 4.- ' Signature a.— ...f 4 AL Al_■, Telephone SECTION 3-ESTIMATED CONSTRUCTle N 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 $53,493.00 Construction from(6) 3. Plumbing - $38,167.00 Building Permit Fee 4. Mechanical(HVAC) $59,813.00 5. Fire Prote•i'on $ Jct. 1 l"a,7 6. Tota -iie 2+3+4+6) IP, 2,62. 951.00 Check Number y-Nlc,a q 1)0 ( 1./1-1C) i This Section For Official Use Only 0 rfil.tit Permit Number Date Issued Signatur Building Commissioner/Inspector of Buildings Date 09P1214 .----pcmo fairivo4cie AND FL-Af, /1/ 7/i) File#BP-2014-0612 APPLICANT/CONTACT PERSON FIVE STAR BUILDING CORP ADDRESS/PHONE 17 EAST ST EASTHAMPTON (413)587-4060 0 PROPERTY LOCATION 11 VILLAGE HILL RD MAP 38A PARCEL 107 001 ZONE PV(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out qiev 4s-4s-77,4A, Fee Paid Typeof Construction: CONSTRUCT PARTITIONS FOR TENANT BUILDOUT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 085319 / 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: tV 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 .y /I IV,3 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. 11 VILLAGE HILL RD-SUITE 103 BP-2014-0612 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38A- 107 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-2014-0612 Project# JS-2014-001032 Est. Cost: $262951.00 Fee: $1577.40 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: FIVE STAR BUILDING CORP 085319 Lot Size(sq.ft.): 38027.88 Owner: LIBERTY MUTUAL INSURANCE Zoning:PV(100)/ Applicant: FIVE STAR BUILDING CORP AT: 11 VILLAGE HILL RD - SUITE 103 Applicant Address: Phone: Insurance: 17 EAST ST (413) 587-4060 () WC EASTHAMPTONMA01027 ISSUED ON:11/18/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT PARTITIONS FOR TENANT BUILDOUT 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 11/18/2013 0:00:00 $1577.40 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner