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M 7 - f� � E � Af CERTIFICATE OF LIABILITY INSURANCE 19iioi�ox�� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CODERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOE$ NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTI'tU 'G A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE,OR PRODUCER,AND THE CEI;-IIMATE HOLDEE. IMPORTANT: If the ceR e holder is an ADDITIONAL INSURED,the poky(les)must be endorsed, If SUBROGATION IS WAIVED, subject to tbo terms and conditions of the policy,certain policies may rbqulre an endorsement A stawment on tbls cartiflcate does not Confer dghta to the oartificate holder in IWu of such ondorsemont(s)• PRODUCER XIQU0 Kirtq A Cashman Inc. FnoNE (413)384-5IS10 (413)884-9322 176 King 0t eat INBURB AFFAAMNCCOV NAIO* Northwwpton MA 01060 INSORERAMBrcharit:s jiligurazice INSURSO II(aupgot a: L & L Fence Conpany' INSUIUM C! 45 State Road PWREft D: _ M UREIR S: Whate1y KA• 01093 INSgfin F: COVERAGE& CERTIFICATE NUMBER-CLI491C 00545 REVISION IN M ER: tHIS IS TO ceATIFY THAT THE POLICIES OF INSURANCE L16TED BELOW HAVE 1569H ISSUED TO THE e4wRGO NAMED ABOVE FOR THE POLICY PERIOD INDICATED- NOTWITHSTANDING ANY A9QUNRIiMiNT,TERM OR C-ONOITIOV CF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI: CERTIFICATE MAY BE ISSUEO CR MAY PERTAIN.THE INEUPANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUSJEGT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUGH POLIGEw,LIMITS SHOWN IVAY HttVE BEEN RECUCED BY PAID CLAIMS. I TYPE OFWOURANCE r2LICY NI:Ma ut POLICY aw LIAaT$ GLEN IRALLMAUTY Factl Ol:O 2 000,0 I ERCIAL 61MMIAL LASILnY ,t $ 5:)0'0 ) A CLAWIt-L&%DR OCCUR 2059&31 8/34/2014 /1412016 hED= AtMtrne S 3,0 1 PGRSONAL b ADV INJURY B 2,000,0 ) ---- - GEN&PAL AcIrAWA.TE S 4,000,0 D CSTTL AGGREGATE LIMIT APPLES PER: PRODUC're- VnP A93 3 4,000,c D - FOMY r i Lac AU1011110 N.G UAN&ITY 1,009,c A ANY AUTO s00L.Y INJURY(F4r wwr1) 8 __ ALL D r---I SC 06UU� /90/2014 �/3012015 eWLYNJRY(P...; %) $ x O ..... WWI)AUTOS � S Unlns:roe mCQVd lil i11iM1 3 .'rt0 X uBIeRBLJLA LIM H RRENCE 3 1,000,C ) A EXCESS LIAR 01,A1M$-MA0R AGORESAIIi 3 X 10000 CUa91A4C9t3 /l4/2o1n /14/7015 y A ryORKQt9 COIIIFL"NSATWN WC STATU} ITN• AN.EMPLOYERS'I-AMITY �pgrIVCIiTIVE Y© NJA a oa c 1 yO1�jRL � 9097462 /34/2014 /14/2015 O .Aprr��pppp NyN� E.L.OISEABE-EA EMPLOYE t, 500,C 7 1DESCrmPT16N OAPERAT)ONE tobw P.L DISEASE-POLICY LIMIT S 5O0 C . --T I I I i.- DEK MFTIOROFOF @RATIOR51LOCATWN7IVEMCLE6(ARMsA1CORD101,0.600ntlRW4ft&Nk16lb.IIMW609UYtrigW10d) CERTIRCATE HOLDER CANCELLATION S11001.0 ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED 9EFORI THE EXPIRATION RATE THEREOF, NOTICE WILL BE DEUVEIWo N ACCORDANCE WITH THE Y x,=-�s AVTNORRCDRCARLELNTATNE �`� AGORD 25(2010104) 41988„ 010 A(LORO CC)RPORATION. All rights 1'esero I NS025 01=o Dl The ACORD name and logo are regMered marks of ACORD EO/Ee 39Jd 3DN3d-1QN`-I THV999ETV 812 :60 bTf3�180,'6[ FROM :7rtG 4Z UPRIGHTS BM<S FrtX t•Q. :l ti3 6a?87 SGp. P18 2014 O4:12RM F2 versio 11�7 CozAlt6nial 8uiiditt Permit idly 15,2000 SEGTlON I0.STRUCTURAL PEA FWVIEW(780 PAR 14014). n _ Indepar�:ent Sty aural Bn mwodng Stru wel peEr F aviewRequ0l-d Yes C) No j Stct TION 1't•OWNIRAUTHORIZA'n N-ro �''W CVJW tS AGENT OR coNTRACTOR A PPLISS F t 06"Mikil * M17 -- _j,�..� _ .max= ✓ n' "al as Owner of the Subject prope'v hereby authors:..., ,.,,. I - � �... ''-u1 {:s�•?��-�----•-- r'- - -- j act on my oehalf•in all tr/.apttets roklive io work authoi zed by t;is b,nlding permit volicofiori at Omler Data oc OvTw)Aathokoz Agen;tioroby oeclar+e fret t"stakt"nts and nform;ticn on the foregoing application are trim and accul. te,n the boat of",Y knowledge and beifot. ufg"le�tU'4�t �R201CLand,,,�natp,q ,f,�s� ... ..._., ..... . ,, ... _. .. .............7 Sgnat{re of O nmeriA gerd " k*DSW -- SFeCTION 12.CONQT(RIJCTK)N BERVICAS i 1 7 L t�iont3unonlsor NotAppllcable ZI i Addrsws r� " t-.,1+ Ct° { 1 t __ _ _�.. iSsrRirotlan0at6� �{gntaUare TGrrpt{oru'] 1 ! SECTION 13•WO aRS'COMPENSATION INiSURI kNCE AFFIDAVIT(MAL'.a;162,$25C(6)� Workers Compvr^.at w Insuronca atfidovlt must be o irrAleted and submitted with this 6pplicotlon.FaoLno to profte ois oBidavt wig result in the denial of the inuance or tr,a bddlng pt mA, 8"d Affidvvd Attached YeQ Na U/T.09 =9Vd �;:hd.�d-h[hdt'-1 T86 999Th 80' :60 hTOZ/BO/FO FRCM :'MG AND UPF?103FITS E00K5 FAX NO, Sep. 05 2014 04:05FV PI Versio,11.7 Conriom'jaf Build:,%PoWit May 11,2000 SEMON 9�FWFESSONAL DESION AND 004161 MUCTION SIAMMS 00k pUll'nimr.*mumwv)W4 SUBJECT TO r,ONSTRUCTIONCONTROL-PURWANTT07SOCI�Rilg(=N'rAINING MORP,17MANM006-C.I':C*&4cLoit6sp-4091 9.1 Not ApPlIcable ........... --------- f-----------...... Expiregem Date Marne Fleas of Respimabbty "tv Name area Of fttp"INAY .............. Name Area of RmporUblgty Qdf"% ±on Number Evrabon 099 Nmio Am*of ftspwSiblitf S49rat" Commy Nam; to "Ponside in Chilli of biWft-dIbn Addmr,s ;�&5 Uj tl LJ THP999ETV Be :so tIGz1q0,esj2 Version 1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be tilled in by Building Department Lot Size Frontage Setbacks Front Side L:_ R: L: R: _ Rear < .; Building Height 1. Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces � a4\ Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO C) DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T 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 0 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: Y, t• <, c`��5. 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 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 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 W Brief Description Enter a brief description here. / Of Proposed Work: It K tt° a «�( 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 2A ❑ E Educational ❑ 2B I ❑ 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 UILDING 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(so 1 St 1 St 2nd 2nd 3rd 3rd 4th 4th Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) Total Height ft 7.Water upply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private ❑ I Zone Outside Flood Zon Municipal On site disposal system[:] Version 1.7 Commercial Building Permit May 15,2000 Department use only City of Northampton Status of Permit: Building Department Curb CuttOriveway Permit - a 212 Main Street Sewer/Septic Availability -- - Room 100 Water/ Well Avallability orthampton, MA 01060 Two Sets of Structural Plans Nor r L R c --n J13-587-1240 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 1.1 Property Address: This section to be completed by office 4_ (,- jt'1 r'\'o { '5f,r-e e{ Map Lot Unit + C" 4'\cc-k" Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: _ 16\_ "f & tn",r}rt{ SA "Ak\ A)IN, C'l G'F" Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: + Name(Print) Current Mailing Address: _ Signature It Telephone A L3- 9E ':l J SECTION 3= STIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com feted by ermit applicant 1. Building ,! (a) Building Permit Fee 1-Zn CA 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total =0 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-0295 APPLICANT/CONTACT PERSON FOUR MARKET STREET LLC C/O JANET GEZORK ADDRESS/PHONE 26 MARKET ST NORTHAMPTON (413)586-9231 Q PROPERTY LOCATION 4 MARKET ST MAP 32A PARCEL 100 001 ZONE CB(99)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid - Building Permit Filled out — Fee Paid Typeof Construction: ERECT 8 FT FENCE New Construction Non Structural interior renovations Addition to Existing- Accessory Structure Building Plans Included• Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: pproved 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 o ' D Sig ure o wild' g O icial 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. 4 MARKET ST BP-2015-0295 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A- 100 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categoa: FENCE BUILDING PERMIT Permit# BP-2015-0295 Project# JS-2015-000426 Est. Cost: $850.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. A.): 3484.80 Owner: FOUR MARKET STREET LLC C/O JANET GEZORK Zoning: CB(99)/ Applicant: FOUR MARKET STREET LLC C/O JANET GEZORK AT.• 4 MARKET ST Applicant Address: Phone: Insurance: 26 MARKET ST (413) 586-9231 O NORTHAMPTON MAO 1060 ISSUED ON:911712014 0:00:00 T TO PERFORM THE FOLLOWING WORK.-ERECT 8 FT FENCE 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 9/17/2014 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner