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25A-185 (34) 05/25/2007 FRI. , 8:17 FAX . .. ., ....... ..._ .. .. _ .. _.._. - ' DATE(MM/DDlYYYY) ACORD �"CERTIRCATE OF LIABILITY INSURANCE' MORRI 1 05/25/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PHILLIPS INSURANCE AGENCY INC HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 97 CENTER STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CHICOPEE MA 01013 Phone:413-594-5984 Fax:413-592-8499 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Continental Casualty Company INSURER B Transportation Insurance Compa Morris Roofing & Sheet Metal wsuRERc Corporation 142 Hancock Street INSURER Springfield MA 01139 INSURER E COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER LILY V POLICY EXPIRATION LIMITS DATE MIDDM!) DATE M/DDfYY) GENERAL LIABILITY EACH CCCURRENCE $1,000,000 A X COMMERCALGENE ALLABILTY 2048605564 05/01/07 05/01/08 PREMISES(Ea cccuremet $100,000 CLAIMS MADE Fx—]OCCLR MED EhP;Any one per=_on) $10,000 X XCU PERSONAL&ADV INJLRY $1,000,000 X Contractural Llab GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPL ES PER. PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE UNIT $1,000,000 B ANY AUTO 1081929625 05/01/07 05/01/08 (Ea accident) X ALL OWNED AUTOS BODILY INJURY $ X SCHEDLLED.AUTCS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNEDAUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ALTO ONLY-EA ACCIDENT $ H ANY AUTO OTHER THAN EA ACC $ ALTO ONLY. AGG $ EXCESSIUMBRELLALIABILITY EA.CHCCCURRENCE $5,000,000 B OCCUR ❑ CLAIMSMADE 2048605645 05/01/07 05/01/08 AGGREGATE $5,000,000 Retained $10,000 DEDUCTIBLE $ RE-ELATION $ $ WORKERS COMPENSATION AND TORY LIMITS X ER B EMPLOYERS'LIABILITY 248605600 05/01/07 05/01/08 EL EACH ACCIDENT $1,000,000 AIJYPP.OPRIETOR/FARTNER/EXECUTIVE . . OFFICERMIEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,0 0 0,0 00 If yes.de=_cribe unde- SPECIAL PROVISIONS below E.L.DISEASE-POLI-Y LIMIT $1,0 00,000 OTHER A DISABILITY BENEFITS STATUTORY LIMITS DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION TOPROVI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL To Provide Proof of Coverage IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AuTH4F4zrD REPRES ATIVE ACORD 25(20011Q8) ©ACORD CORPORATION 198 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 36,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: _- Not Applicable ❑ _ Name(Regis ant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): 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 9.3General Contractor Y "\ ^ a,�r.`scc� �s� S �nr� �— V1/l Not Applicable ❑ Company Name: r(5 Responsible In Charge of Construction 1�j Z /.-{�-..a.-,cn c �c ��' . �. f" �a w►f� D1 1 3 9 Addre 'I 113 478-6�y Signature Telephone 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 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 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 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: C t;T r?S `� tJ 5- 0741197 License Number g9 04 r,r s ; l e li s(`-t A , n.io J 0 6/7/09 Add s Expi ation Date 3 1 - 69Y-3 Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(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 buy ding permit. Signed Affidavit Attached Yes No 0 Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other❑ Brief Description Enter a brief description here. Of Proposed Work: ! � .'� vv to e x s+`. .,c� 0 U,Caav Sr- 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 V 2A ❑ E Educational ❑ 2B ( ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 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 ❑ 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: Proposed Use Group: 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) 1 Sc __ 1 St 2nd 2nd 3rd 3rd 4m _ 4th Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) _ Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system E] 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 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 0 DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES IF YES: enter Book Page, and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES 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 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES NO 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit Ma 15,2000 `City of Northampton tat oPemtit r wilding Department yui[)ri�yPertrlit 212 Main Streeteui/erlpttc A�tllabilify r Room 100 17Vater/Weil Availabtl�ty: .jNo"ampton, MA 01060 wa Sets Of Structural glans 7-"-,Iphon& 413-5 7-1240 Fax 413-587-1272 ?IottS�#e Laos —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 c C C`' ► ` - Map Lot Unit y S_. `�` + �� Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Aqent: Name(Print) /5 /v �r Current Mailing Address: Signature (� (� Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee 7­1 L)c�C�. — 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total= (1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date 1 BP-2007-1273 GIS#: COMMONWEALTH OF MASSACHUSETTS 4010NOWT CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2007-1273 Project# JS-2007-002038 Est.Cost: $45000.00 Fee: $225.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MORRIS ROOFING & SHEET METAL 076497 Lot Size(sq. ft.): 950914.80 Owner: COCA COLA COMPANY THE Zoning: GI Applicant: MORRIS ROOFING & SHEET METAL AT. 45 INDUSTRIAL DR Applicant Address: Phone: Insurance: P O BOX 90178 (413) 478-6943 Workers Compensation SPRINGFIELDMA01139 ISSUED ON:6/29/20070:00.00 TO PERFORM THE FOLLOWING WORK.-INSTALL NEW EPDM ROOF SYSTEM POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 6/29/2007 0:00:00 $225.0011227 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo