25A-046 (28) o b
0
s
w
CID
csz
NOTE:IN ORDER THAT THIS APPLICATION MAYBE ACCEPTED,THE DATA CALLED FOR BELOW MUST BE SO SET FORTH THAT
WE CAN DETERMINE FROM THE APPLICATION AND THE ACCOMPANYING PLANS WHAT THE EXISTING CONDITIONS ARE AND
WHAT THE FUTURE CONDITIONS WILL BE.
Plans,in duplicate,must be filed with this application before permit will be granted,one of which,upon issuance
of the permit shall be kept at the site during the progress of the work.
New............ .❑
Addition......., '
No ...........-D, Zone..... .:...., Type , Map.. Parcel..:.1.!R.......... Alterations ❑
Q-jNN'IP�.
Repair............❑
1997 g. CITY OF NORTHAMPTON Demolition....❑
MASSACHUSETTS
Application forotherthan a Dwelling Permit
(To be filled out in ink OR on a typewriter)
To the Building Inspector: Die �. 19 ....
Application for a permit is hereby made according to the fol owing:
1. Location, Street and No.... 1.........I�A1 t.4 ........ .............................................................
2. Nearest cross street... . Lot No....................
/u. ... ...... ...... ` ... .... ....... . .... ............... .....
... .... ....
3. Owner's name. .0?1 sf .S.o!"1........rS�.4�.... .. .0... .. Address ..i;1.... .... �?�!..... ...........
4. Architect's name [ Z 0. r1!t�..f4.1'`.... ...........4 ddress .�a r (
5. Buildcr's name Y.r'.. !rl..l{t t... ....
�:�. . Address
. . .. ......................... ... ............ . . ......
6. Use of building, Present... ....... Proposed ....... .......... .....................................................
7. Building fronts on how many Stregts?...........Q r-4..............................................................................................
8. Is b ildipg�in fire district?....... ( ..:..................................................................................................... ..
� ��{ 1.... ...
buildm Width in ft. .� .....G..Q............ Height in ft...
L►.
9. Size o g, .......... ..2'........., Length m ft. g � .......-.....
10. Distance of building from Street Line-2:1-J..., left lot line 30_1.47 right lot line..&..1.., rear lot line.1..75
11. Type of construction(check one): 1-A.......... 1-B .......... 1-C .......... II.......... III.......... IV.......... V A
Stories B 1 2 3 4 5 6 7 Roof
Story heights in ft.
Thickn's of walls in ins. ytt
Material of walls
Material of floor/roof
Design live load
Design dead load
Occupancy or Use
No.of persons/families
No.of stairs
nn� 1
12. Soil under footing is.....t11.1l1� 1 Yt., '1,1f?i�! ......................................``....,............................................
13. Depth of footing below grade....`. . .Cl').1:h. ft. Will piles be used?....... ................
4
14. Area of entire building(Present plus new) .........A 5.1?...................................................................... sq.ft. p
p 1� � Q g..T:1./w.4!G�.11�. . sE�Ik4.sl v
15. Type of roof flat.... .......... Ached. �- �.. Material of roof coverin
16. No.of elevators/. . ..�N, Method of heattng�IAr4System A01.14 IAA.A..:........... Fuel ...... '
17. Are live loads 1fo on`6rawings? •Are all other structural conditions noted on drawings?.....
18. Building(will be)(is)equipped with sprinklers?.............M-0........... With sprinkler alarm?....P.v.:................
19. Is building to be used as a factory,workshop or mercantile or other establishment employing 10 or more persons?
Y"•. ..............................................................................................................................................
20. Is building to be used as an office building,dormitory,hotel,family hotel,apartment or boarding house,lodging
house or tenement house having 8 or more rooms above the second story?........... .U......................................
21. How many exits(per floor)to street? ......................................................................................................................
22. Is building a"Place of assembly"as defined by the General Laws? ..N.A...........................................................
23. Will building conform to the General Laws? ..... Building and Zoning Ordinances?.. ...............
24. If a garage,distance from nearest building? N` /4-. ...:
25. If an addition,alteration or demolition,when was building erected?..... ../..1G4/.... .............i.......1..�
26. Estimated costs:
rsigned certifies that the above statements are true to the best
General$..... .......... o i wl ge and belief.
Plumbing......... ,�.t?'Q�.:..........
.. ...1........... ...:......................................
Gas Piping....................................... Signature�of�owner,architect or engineer
Sprinklers........................................ ITTEN DISCRIPTION OF WORK TO BE DONE
Heating..........ft 0 Q.vv ... (Use blank half of reverse side,if necessary)
Electric..........0 ?..�..dQ J............. ...............................................................................................................
Other.................... .........
Total$..... �.V U'U...........
[7/Vst>cl C'(_ 0 AJ P61P
CERTIFICATION
I, Susan E. Shaw, Secretary of The Coca-Cola Company, do hereby certify
that the following individual has been elected and is now acting as an
officer of said corporation in the capacity set forth beside bi.s Maine:
Dallas A, Hurston Assistant Vice President
(Signature)
I do further certify that such officer's signature appearing above is his
genuine signature.
IN I� NESS WHEREOF, I have subscribed my name as Secretary and
have caused the corporate seal of said corporation to be hereunto affixed
this 9th day of Septe nber, 1996.
Sus . E. Shaw
Secretary
----------------------------------------------------------------------
hTTr S he '-i is>R�RLL r.,.; :�_.�—_��_,r,�„_�- : p�i,a�_� r '_ir 16 P. 03.
Enjoy
C"-O�Wo
MEMORANDUM
February 25, 1997
NiEMO TO: Dallas A. Hurston
FROM: James E. Chestnut
SUBJECT: Delegation of Authority - Summary Review Comm ttee Consent -
F'ebruary 19, 1997
1. Pursuant to resolutions adopted by consent action of the Summary Review
Committee of the Board of Directors of The Coca-Cola Company (tile "Company"),
dated February 19, 1997, the Summary Review Committee authorized me to tape c-rtain
actions with respect to the following matter:
Land exchange with the Northampton Montessori Society, Inc. in Northampton,
Massachusetts
2. I hereby delegate to you, pursuant to the resolutions of the Summary Review
Committee., a copy of which is attached, the authority to execute, in the name and on
behalf of the Company and under its corporate seal or otherwise, deliver and fie any
agreement, instrument, certificate or other document, or any amendment or supplement
thereto, that you may deem necessary in connection with the foregoing.
4
J. E. C.
n
t?rxrzx
CC 1179 jAv Wtg.dN
ATT'r vHEF'F'ARD":F'EHLL -:1r F. )2 F t°�i- +
CERTInCATE OF SECRETARY
THE UNDERSIGNED, as Secretary of The Coca-Cola Company, a Delaware
corporation (the "Company"), does hereby certify as follows:
1. That the Board of Directors of the Company, acting by and through its
Summary Review Committete, duly approved the exchange of a 13,000 square foot (more or
less) parcel of real property located at its production facility in Northampton, ?Massachusetts,
adjacent to the property of the Northampton Montessori Society, Inc. ("NMS"), for a 10,000
square foot parcel of real property located it: Northampton, Massachussetts owned by NMS by
Resolution of the Summary Review Committee on February 19, 1997 (the "Resolution"); and
2. In the Resolution, the Board of Directors of the Company, acting by and
through the Summary Review Conlinittee, authorized the Chief Executive Officer, the
President and/or any Executive or Senior Vice President and/or any Vice President of the
Company or such other person o. persons as the Chief Financial Officer may appoint to
execute such documents as may be necessary, convenient or appropriate in order to carry out
the referenced sale; and
3. James E. Chestnut as Senior Vice President and Chief Firarcia'_ Officer of the
Company has duly delegated authority to consummate the referenced sale transaction and
execute all necessary documents to Dallas A. Hurston as Assistant Vice President of the
Company; and
4. The Resolution has not been modifaed or rescinded and remains in effect.
Dated this day of e_ ,J , 19.7
THE COCA-COLA COMPANY,
a Delaware corporation
By: i
/ Susan E. Shaw, Secretary
STATE OF GEORGIA
COUNTY OF FULTON
Sworn to and subscribed before me this G day of ?'all-'11 , , , 1947, by
� AUJ as Secretary of The Coca-Cola Company, a Delawar ation, She
is personally known to me.
vite
Notary Public
H7'' SHE;_ FuFI FEELL F- . 4?�- t a r,1_; +; 1_ P.04
RESOLVED, that the Company be, and it hereby is, authorized to exchange a 13,000
square foot parcel of real property located at its production facility in Northampton,
Massachusetts, adjacent to the property of the Northampton Montessori Society, Inc.
for a 10,000 square foot parcel of real property located in Northampton,
Massachusetts owned by NMS, all to be upon such specific terms and conditions as may
be approved by the Chief Executive Officer of the Company or such other person or
persons as the Chief Executive Officer may design'=ate; and
FURTHER RESOLVED, that the Chief Executive Officer of die Company or such other
person or persons as he may designate Ln writing be, avd each of thern hereby is,
authorized to take any x d all action (including without limitation, the borrowing of funds
or the issuance of guarantees by or on behalf of the Company) that such pe�;on deems
necessary, convenient or appropriate in order to carry out the intent and purpose of the
preceding resolution and to effectuate the transactions contemplated thereby, including
but not limited to the authorization and approval of an increase or degrease in the
aggregate con-sideration for, and a modification to the basic form or structure o, the
transactions described above; and
FURTHER RESOLVED, that any elected or appointed o{`l'icer of the Company, or such
other person or persons as the Chief Executive Officer, the President or the Chief
Financial Officer may designate in writing, be, and each of them hereby is, -authorized to
execute, in the name and on behalf of the Company and under its corporate s" or
otherwise, deliver and file any agreement, instrument, certificate or other document, or
any amendment or supplement thereto, and to take any other action that such person may
deem necessary, convenient or appropriatL in order to carry out the intent and purpose of
the preceding resolutions and to effectuate the transactions contemplated thereby.
R T T'("S SHEFFhRN REHLL r a . 813-5 ,t ':a ? P-Ia�_a 'i7 13 i F.
{ being along said land of the Commonwealth of
Massachusetts , Department of Environmental
Management) .
Containing 10 , 000 square feet of lard , more or
less .
Being all and the same parcel shown and described as "PARCEL All
on a plan of land entitled " PLAN CF LAND Ih NORTHAMPTON ,
MASSACHUSETTS PREPARED FOR The Coca-Cola Company" , dated
08/30/95,, prepared by Alrtter Huntley , Jr - & Associates , Inc . ,
r9c9rded in the Hampshire County Registry of Deeds in Plan Book
Page .
Being a portion of the premises conveyed by dead of Ralph H.
Thompson and Mary M. Thompson to the Northampton Montessori Society ,
inc . dated August 23 , 1990 , recorded in said Registry in Book 36121
Page 290 .
IN WITNESS WHEREOF , the said NORTHAMPTON MONTESSORI
SOCIETY', INC . has caused its corporate saal to be hereto af! Jxed
and these presents to be signed , acknowledged and delivered in its
game and behalf by Robert K . Brick , its President , and Herbert
Mayer, Jr . , Its Treasurer, hereto duly authorized , as of the Fifth
day of September in the year one thousand nine hundred ninety-six.
In the presence of : NORTHAMPTON MONTESSORI SOCIETY, INC.
j�D
By:
(Rohe t K. Brick)--P e ident
Sy:
(Herber Mayer , . ) " re carer
COMMONWEA%TH OF MASSACHUSETTS
Hampshire , ss . October 17 , 1996
Then personally appeared the above named Robert K. Brick and
Herbert Mayer , Jr . , 'president and Treasurer , respectively , as
aforesaid , and acknowledged the foregoing instrument to be the free
act and deed Of the NORTHAMPTON MONTESSOR OCIETY, C. before
me
-Ja et M. Shepp rd) Notary Public
My commission expires : September 11, 1998
.
PTT-r`,:� S H E RF�R 1 RE P,L L 1C, P
7,
X N 0 W A L L Ef N T H E S E P R E S E N T S
That the NORTHAMPTON SOCIETY , INC . , a Massachusetts
corporation duly established by law, whose mail address is 51 Bates
Street, Northampton, MA 01060 ,
for consideratioh paid , and in full consideration of a deed of even
date from the Grantee herein to the Grantor herein of real estate
having an agreed upon value of $50 ,012. 84 ,
grants to THE COCA-COLA COMPANY , a Delaware corporation duly
established by law , whose mail address is I Coca-Cola Plaza ,
Atlanta, CA 30313 ,
�
WITH QUITCLAIM COTENANTS
Z That certain tract or parcel of land situate off the North-
easterly sideline of Bates Street in Northampton , Hampshire County,
0 Massachusetts , bounded and described as follows :
is
04
Beginning at an iron rod set at the most Easterly corner of
rZ
X; other land of the Northampton Montessori Society, Inc . , shown as
"PARCEL D" on the plan of land hereinafter referred to, and at land
of the Commonwealth of Massachusetts , Department of Environmental.
Management , said iron rod being located N . 52 ' 58 ' 07" E. 292 .36
feet, as measured along the boundary line between said other land of
T shown as "PARCEL D" and
(V the Northampton Montessori Society , Inc ,
�4 said land of the Commonwealth of fi,assachusetts , Department of
.0
Environmental Management , from a point on Said Northeasterly
sideline of Bates Street, the same being the Most Southerly corner
<V of the parcel hereby conveyed, and thence running
N. 37 " 01 ' 53" W. along said other land of the Northampton
LW Montessori Society, Inc . shown as said "PARCEL D"
115 . 57 feet to an iron rod set at other land of
The Coca-Cola Company , shown as "PARCEL B" and
"PARCEL C11 on said plan; thence running
V)
N. 86' 421 21" E. along said other land of The Coca-Cola Company
Tj shown as said "PARCEL V 193 . 24 feet to an iron
4
ro rod set at said land of the Commonwealth of
.0 Massachusetts , Department of Environmental
Management; thence continuing
�4
4J thence running
U) N. 86" 421 21" E. 14 .86 feet to an iron pipe;
S. 52" 581 07" W. 173 . 05 feet to the iron rod set at the place of
beginning ( the last two courses and distances
PTT Y'S M-q C
The above described parcel is conveyed SUBJECT TO:
I . The rights and easements conveyed by deed of National Can
Corporation to Massachusetts Electric 'Company and New England
Telephone And Telegraph Company, dated May 15 , 198n , recorded in
said Registry in Book 2162 , Page 298; and
2 . Terms and conditions of the City of Northampton ,
Massachusetts , Northampton Industrial Park, Redevelopment Plan, Code
No . 303 , recorded on March 22 , 1973 in Book 1692 , Page 22181 as
affected by instruments recorded in said Registry in Book 1975 , Page
187 , Book 20-118 , Page 51 Book 2636 , Page 9 , Book 2656 , Page 227, Book
2656 , Page 233 , Bock 2700 , Page 176 , Book 3159, Page 169 , Book 3649 ,
Page 33 , Book 3890 , Page 142, Book 4106 , Page 217 and Book 425-11, Page
48 .
Being a portion of the premises conveyed by deed of Mid
Atlantic Canners Association, inc . to The Coca-Cola Company, dated
October 10 , 1994 , recorded in said Registry in Book 4571 , Pace 177 :
IN WITNESS WHEREOF , the said THE COCA-'COLA COMPANY has
caused its corporate seal to be hereto affixed and these presents to
4
be si nedl acknowledged and delivered in its name and h 1
bed-:
r its
PdRa—i J ,
duly authorized, this 4-4 day of Z �-j-/cmbcr in the year
one thousand nine hundred ninet7:six. I
In the presence of: THE COCA-COLA COMPANY
By,
DALLAS A.FJRSTON
STATE OF GEORGIA
Fulton , sa . C�Ae V Y N e,r 5 1996
Then personally appeared the above named_X,:)u_�LS
61 sos4.
Le as aforesaid , and
acknowledged the foregoin4 ingtrume.rit to be the free act and dead of
THE COCA-COLA COMPu'jy, before me
"9r V'E) Notary Public
My commission expires :
ATTr'
" } 4 I °, DT '" S
K N 0 W A L L M E N B Y i..H E
. 'a E�{ P R E S
That THE COCA-COLA COi�iPA aV-�r `3a L' Pl.aware corporation d,.il
established by law , whose na+�. 7 add-,zryS-3 " 1-s 1 Coca-Cola Plana ,
Atlanta, GA 30313
for consideration paid , and to the Grantor herein foa deed el es t-- " _
date from the Grante_
having an agreed upon value of $50 ,012 .84 ,
grants to NORTHAMPTON MONTESSORI SOCIETY, INC . , a Massachuset 5 ts
corporation duly established by law, whose mail address is y
Bates
Street, Northampton, MA 01060 ,
CD WITH QUITCLAIM C01,7ENAANTS
That certain tract or parcel of land situate on the c.orth�-
easterly sideline of Industrial Drive in Northampton , Hamps:,ir_ e
AU
County, Massachusetts , bounded and described as follows :
Beginning at a bound on said Nort'.easterly si-reline Of
Industrial. Drive at other land of the Nerthampto Mc.�tsscrz
z society , inc . , shovr n as " PARCEL D" on the plan of land her iinnfter
referred to, and at other land of The Coca-Cola Company, shown as
v "PARCEL C"' on said plan , the same being the most Westerly corner of
the parcel hereby conveyed, and thence running
N. 63° 32 ' 25" E. 127 .10 feet to an Iron rod; thence running
N . 810 31 ' 36 " E. 156 .61 feet to an iron rod; thence running
0 S. 370 01 ' 53" E. 77 . 13 feet to an iron rod set at other land ob
'o The Coca-Cola Company , shown as " PARCEL A" on
said plan , and at said other land of the
a., Northampton Montessori Society , inc . shown as
0) said " PARCEL D " ( the last three cou-ses and
distances being along said other land of The
Z Coca.-Cola Company shown as said "PARCEL C" ) ,#
o thence running
Z
S . 860 42 ' 21" W, along said other land of the lhorthampton
` Montessori Society, Inc. shown as said "PARCEL L"
v 315 . 66 feet to the bound at the place of
� beginning.
ro
F4 Containing 13 , 196 square feet of land, more or
,J less.
a�
Being all and the same parcel shown and described as F-PARCEL B"
N on a plan of land entitled " PLAN OF LAND IN NORTHAMPTON ,
MASSACHUSETTS. PREPARED FOR The Coca.-Cola Company " , dated
08/30/95 , prepared by Almer Huntley , Jr . & Associates ,, Inc . ,
recorded in the Hampsh ire' County Registry of Deeds in Plan Book
Page
AT T Y'S SHEPPARD&REALL Fax:4 May S '97 10 57 P. 01
GUh
'WAY 1 4 1997
x r:
j
5-MAY-1 991 10:07:45 Ha,npsnira Canty Registry of Deeds r2Ca; N 02245
Marianne L. Don:nla. Ragistar of Degas
33 King Street
Northampton, MA 01050-32ie
Name: BO�EN S :IEaE. Addr: 40 CENTER CTREcT
`IURTHAMPTON, MA 01040 OGu
Re.-nf;t Type: OR
Payment
Total Pape:: COS? Pees Taxes
Fee:
Tax: $ 45?.56 Cneck: 240.00 b 4:0.35
$ 0.04 Cnarge: $ 0.30
Charge Code:
Comment. 0CA. COLA COMPANY
JMEN1i 9700u9G82 to 970,-.-09099 -
M,v' Co^sides$ Record ee Exci7e TcR
------- __ •_----'S C;- --------- .... .......: ,.. 5-MA. I,.•+. _..4: „ �,;� 02^ =LA�;!vl:i' �0 ti;
,72 0001 OO�J_ 0.04 ,;0 -,,, / �7 r, .4, 7 n0 „r, k ?1 P`_
.. . IO.OG O.Ov .,� 5 :S. .9: .. 3 C. 9/ ,. C 111.1;0 8 IN;:
M:.. G01 OC:i ).00 1C.,, 0.40 ..00 5-MAY-1917 09:43 9/4003084 OR /;1C1!0'
0,00 10.00 O.C' 0 9 S 4 r. 09OrS5 OR
r . _ :4 0001 0041 0.00 10.00 0.:0 O.vO :-MA'f-:35i 09:se 9"00090e6 ^R /510% 01v_ r
0001 OOOi 0.00 10,00 O.OG 0.00 5-MAY-1997 09:46 970009467 OR r-si:++'; :44
C 0001 0001 0.00 10.00 0.00 0.00 5-MAY-1991 0 9:46 97LC09088 CR ;510`,'4149
JA 040: 0001 0.00 10,00 0,00 0.40 5-MAY-1991 09:41 970G090;9 OR is 07;d1i
04 4001 0001 0.00 10.00 0,00 0.00 -MR'r-1997 09;4' 91001'5090 v'r', 1'Si07a"0��
0001 0001 0:00 10.00 0.00 0.00 5-MAY-1997 09:48 970')09091 0R (5"0',01F')
0001 0" i 00 1.,4% 0.00 0.00 5-MAY-1997 09:48 9700^U 909'2 OR /510,';9'
h _: ;1 0001 04 0.00 10,00 Q,00 O.Ov^ 5-MA j AT 09:44 970019093 OR 1: _
MISS 004 01:01 0001 0.00 10,00 C.00 0.00 -1997 09:45 3/0009094 OR iElr,
MISS 0 '? 0401 0001 0.00 10,00 0100 0.00 5-MAY-1997 09::0 p7,3 n4'3)9' '`•' i,'; I^II
0000 50012.84 25,00 230.28 PAID 0.04 5-MAY-1997 4,;: R 15107l01;1 i, i
DEED 006 0';01 0000 5001-2,84 2.'."' 230.28 ?AID 0.00 5-MAY-2491 __ ^01 9 09% OR '25'247 Oi23 '":
MG 004 0001 U00 0.0^ 0.04 0.00 5'MAY-: :0 9::....':s OR 15101!018';
MIS3 0 0 i 00•^.1 :',i10 0.00 0.00 5-'!A"-i=.Z L w. OR /5101(01'3"s
DATE,M
-
ACORD, CRRTIFICA_T_E `:OFaLIA51UT Y �I NSURANCE NI,�OlYY)
PRODUCER (413)586-0111 FAX (413)586-648i__"
413)586-6481 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
oodward & Grinnell Ins. Agcy. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
8 N KING ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
NORTHAMPTON, MA 01060 COMPANIES AFFORDING COVERAGE
COMPANY Travelers Insurance Company
Attn: Phyllis Cameron Ext: A
INSURED
Wright Builders Inc COMPANY
115 Industrial Dr B
Northampton, MA 01060 COMPANY
C
-----... - ------ _.-
COMPANY
D
COVERAGES
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR!. DATE(MWDD/YY) DATE(MMIDDIYY) j
GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000
X COMMERCIAL GENERAL LIABILITY PRODUCTS COMP/OP AGG $ 2,000,000
CLAIMS MADE X ! OCCUR PERSONAL&ADV INJURY $ 1,000,000
A DC0346R2868 03/01/1997 03/01/1998 --
X OWNER'S&CONTRACTOR'S PROT! EACH OCCURRENCE S 1,000,000
FIRE DAMAGE(Any one fire) $ 100,000
__..
MED EXP(Any one person) $ 5,000
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
X !ANY AUTO 1,000,000
ALL OWNED AUTOS
BODILY INJURY
(Per person) $
A X SCHEDULED AUTOS DAO810346R2881 03/01/1997 03/01/1998 -- --- -- - - -.___. .-__
X HIRED AUTOS BODILY INJURY $
X NON-OWNED AUTOS (Per accCent)
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY
EACH ACCIDENT-( $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $ 1,000,000
A X UMBRELLA FORM DCUP346R2868 03/01/1997 03/01/1998 AGGREGATE S
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND TORY LIMITS ER
EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 100,000
A .. UB346R2936 03/10/1997 03/01/1998 -THE PROPRIETOR! X INCL EL DISEASE POLICY LIMIT $ 500,000
000
PARTNERS/EXECUTIVE
..
OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE" $ 100,000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/SPECIAL ITEMS
LANKET ADDITIONAL INSURED ENDORSEMENT APPLIES
CERTIFICATE'HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
CF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
ALj ED 5WPRESENTATIVE
ACORD 25-S 1195 f % CACORD CORPORATION 198
��t1AMP� tr
a 0 Crl �
q ZIIZITIt�7IIIt af
: + PPO d' assacfinsrffs ��
v DEPAR.i vfEIN Or BUILDLNG INSPECTIONS €
212 Main Street + Municipal Building 'o
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
with a principal place of business/residence at:
lv (phone-,)_
do hereby certify, under :he pains and peaa?tes of perjury, that:
( ) I am an employer prcviding the followi-Cz workez✓s compensation cove.'-age for my
employees working on t?di5 job:
q3�\-,k—t( ��'�, 'I
(I==nce Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner(crcle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (insurance Company/Po icy Numbc.) (Exxpiradon Date)
(Name of Contractor) (Insurance Co=aa/Policv Number) (Expiration Date)
(Name of Contractor) (Insurance Co;-l,any/Policy Number) (Expiradon Date)
(Name of Contractor) Gnsurance Coz „any/Policy Number) (Expirdon Date)
(at2ac$additional shed if nee e:ssry to include infonnatioa p to all .ors)
( ) I am a sole proprietor and have no one woricing for me.
( ) I am a home owner performing all the work myself.
NOTE:plrse be aware that Y&Ha hoa=wncrs who a a:piay pcs-as to eio=&izt_ __�o=s:r ctioa or rtpa r work en a dwelling of
not mote than t ea traits in wbieh the homeowner resides or on t5e g-,va&apputteasui Ihetc a are mot generally coardasd to be
employes tinder the worker's o=p=siion Act(GL152,ss 1(5)�apv U=ion by a homcow=for a GC=se or pest m;ay evi&=the
lepal sutua of an employer under the Worker's Cou>amation Art
I undm-a=d Thai a of thin ctazmeui may be forwarded to tSc Depert nccd of Inrfrrst iel Aradmt3 Office of Irauxnce for the
covaa30 vc ifl and that aaU=to soaue average Linder scrvx 25A of MGL 152 can aced to the impost Ca of cri=i u peaa -
s o up 01,500.00 sadlor imprisons of up to cne yew and evil perut ijs io the form of a Stop W cri;CT&--and a
fim of 5l a y tae
y of 14 For d use rely
Permit Number
Map'# Lot n
Si of Li ermine-
R O V E FILE # 962138
APR I $ 1997
APPLIC CONTACT PERSON:
4-- A: , SPAONE: d!c
PROPERTY LOCATION: Vr/
MAP 2?Sf9 PARCEL: ZONE
THIS SECTION FOR.�OFFICIAL VSE ONLY:
PERMIT APPLICATION CHEC CLIST
ENCLOSED REQUIRED DATE
PTYUrlinE Permit Filled nyit
iYt �Zu
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION-
Approved as presented/based on information presented
Denied as presented:
Special Pit and/or Site Plan Required under: § 0
Y PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under.§ w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
'!Permit frop ConservatioZ n
�8
Signature of Building InWor Date
NOTE:Issuanoa of a zoning permit does not relieve an appiloant's burden to oompty with nll
zoning requirements and obtain nil required permits from the board of Heealth, Conservation
Commission, Department of Publlo Works and other applioable permit granting nuthoritl--
10. Do any signs e)ost on the property? YES NO
IF YES,describe size,type and location: �h�eC lt'd0�/'EJ� SIS/1 /-S OC4 14 el
Lr r7 7�- a U'
Are there any proposed changes to or additions of signs intended for the property?YES NO_�
IF YES,describe size,type and location:
21. ALL INFORMATION MUST BE COMPLETED, or. PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
Thia —1— to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage Z�iO �
Setbacks 3°
- side L:9fI /-R:�`I�'`� L: '�'`l- R: f/-
- rear 1,l q ��.5 1 f-
Building height Z� ZZ{
Bldg Square footage y5gg 2 z
%Open Space:
'(Lot area minus bldg Do 07 ��> °Jv
&paved parking) (J /�J
# pf Parking Spaces
f of Loading Docks
Fill: � D
.4voZ-ume-4 location)
13 . Certification: I hereby certify that the information contained herein
_ G is true and accurate to the best of my know dge
1
DATE: APPLICANT's SIGNATURE
NOTE: lssu nce of a zoning permit does not relieve an app ant's burdecomply witi},.+pii
zoning requirements and obtain all required permits from a Board oT th. conservation
Commission. Department of Public Works and other applicable permit authorities.
FILE #
Lery
APR 81991 1
VIN ( 41gQ
File No
9� 0)i t
-``- ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: &Or&m /U/) �o/1 ��5�// �vCi �z, / In e -
Address: Z3a ley SVree-14 Telephone:
2. Owner of Property: /Y4rfhu?n p/Un /%,I f e:5Scr i cS0 Ci e IV , /n C'_ .
Address: `i / S �frf�� Telephone: ��/ 3 � 96 Y536
3
3. Status of Applicant: _Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 51 aQ 74e5 Y74ree°
Parcel Id: Zoning Map# 264 Parcel#' District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property fig"
6. Description of Proposed UserVllork/Project/Occupabon: (Use additional sheets if necessary):
�/ oel 5 7� d!3 ' Sr c ►, he,, 3Go0 �S4z'a'- 7`2e7� �i 2 �IOpOSeO�
0&'71in house -
�-Q 7o.c -f'
7. Attached Plans: �Sketch Plan de Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Varian c indi ver been issued for/on the site?
NO DON'T KNOW YES IF YES,date issued:'/'/7&
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO_�" DON'T KNOW YES
S,has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained C ��/ 7,date issued:
(FORM CONTINUES ON OTHER SIDE)
r� s FILE # C; 1,3
` MAY 1 41997 p
APPLICANT/CONTACT PERSON:
, .RE MONE• 11,5 �
PROPERTY LOCATION:
MAP ,An!2 PARCEL: - ZONE
THIS SECTION FOR-OFFICIAL USE ONLY. /a 7
PERIYIIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FRIED OUT
Rnilding Permit Filled nilt
Fe
' oI
Building Plan-, Tnrhided-
THEWLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presented/based on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §_
PLANNING BOARD ZONIN
Received &Recorded at Registry of Deeds
Finding Required under:§ w/ZONINI
Received&Recorded at Registry of Deeds j
Variance Required under: § w/ZONI
Received&Recorded at Registry of Deeds /
Other Permits Required: �'�.
Curb Cut from DPW Water Availabilit
Septic Approval-Bd of Health Well Water PotaMuiy-no meann
r n a ' n
Signature of Building Inspector Date"
NOTE:Issuanoe of a zoning permit does not relieve an applioant's burden to oompty with all
zoning requirements and obtain ail required permits from the Board of Health, Conservation
Commission, 17epartment of Pubiio Works and other applioable permit granting authorities.
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