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18D-025 3861378 ACORO" CERTIFICATE OF LIABILITY INSURANCE Date(mm/tld/yy) 10/3/2008 Producer THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Krauter&Company LLC 225 Franklin Street, 26th Floor COVERAGE AFFORDED BY THE POLICIES BELOW. Boston MA 02110 INSURERS AFFORDING COVERAGE 617 217-2100 INSURER Indian Harbor Insurance Company www.krautergroup.com INSURER United States Fire Insurance Co. Insured INSURER Commerce and Industry Ins. Co Woods Restoration Services, LLC INSURER AIG Casualty Company 398 Stamm Road Newington CT 06111 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. POLICY POLICY INSR EFFECTIVE EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE DATE LIMITS GENERAL LIABILITY EACH OCCURRENCE $ TO-7-TO-0 A COMMERCIAL GENERAL LIAB ESGO023278-01 6/7/2008 6/7/2009 FIRE DAMAGE(Any one fire) $ 100,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1 000 000 GENERAL AGGREGATE $ 2 000 000 GEN'L AGG LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2 000 000 POLICY ROJECT n LOC $ AUTOMOBILE LIABILITY B ANY AUTO 133726015-8 6/7/2008 617/2009 COMBINED SINGLE LIMIT $ 1,000 000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ Comp./Coll. PROPERTY DAMAGE Ded:$1,000 (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC$ AUTO ONLY: AGG$ EXCESS LIABILITY EACH OCCURRENCE $ 10,000,000 C OCCUR F�CLAIMS MADE BE 1222901 6/7/2008 6/7/2009 AGGREGATE $ 10,000,000 DEDUCTIBLE $ RETENTION$ 10,000 $ WORKERS'COMPENSATION& STATUTORY LIMIT THEIR_ D EMPLOYERS' LIABILITY 531-57-40 6/7/2008 6/7/2009 EL EACH ACCIDENT $ 1,000,000 Employer's EL DISEASE-EA EMPLOYEE $ 1,000,000 Liability EL DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION F ERATIONS L TI A N VEHI LES EX LU I N ADDED BY ENDORSEMENT PE IAL PROVISI N CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE The City of Northamption EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE- 212 Main Street SENTATIVES. *10 Days for Non-Payment of Premium Northampton MA 01060 AUTHORIZED REPRESENTATIVE Lori MacDonald ACORD 25-S(7/97) ®ACORD CORPORATION 1988 Board of Building Regula ions and Standards One Ashburton Place - Room 1301 �• Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration 153051 Type Ltd Liability Corporation Expiration: 10/26/2008 Tr# 253097 WOODS RESTORATION SERVICES PHILIP WOODS 398 STAMM ROAD NEWINGTON, CT 06111 Update.address and return card. Clark reason for change. .address Renewal Employment Lost Card 0PS-CA1 C, 50M-05!06-PC8490 �=iz �Q'rrUY,ri,��,2c:�;;�ii ��✓�,cY�tJaci:iw�•.G Board of Building Regulations and Standards Construction Supervisor License License: CS 94977 Birthdate: 2/9/1966 Expiration: 2/9/2010 Restriction: 00 JAMES MACRAE 398 STAMM ROAD NEWINGTON,CT 06111 / — Commissioner Xe &MM"Wwald W,4e& Board of Building Regulat ons and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Construction Supervisor License License CS: 94977 Restriction: 00 Birthdate: 2/9/1966 Expiration: 2/9/2010 JAMES MACRAE 398 STAMM ROAD ---- _ NEWINGTON, CT 06111 Update Address and return card. Mark reason for change. DPS-CAI A 50n61-o5W Pc&90 Address Renewal Lost Card The Commonwealth of Massachusetts t = = Department of Industrial Accidents Office of Investigations -r 600 Washington Street Boston, MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Le6ibly Name (Bu sin ess/Organization/Indi vi dual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Ty pe of project(required): 1.[1 I am a employer with 4. F-] I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp. insurance.+ d. re uire 5. ❑ We are a corporation and its 10.7 Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.7 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ 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: Policy#or Self-ins.Lic. #: Expiration Date: Job 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify,and pena 'es of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use onlh. Do not write in this area, to be completed by city or town offciaL 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#: , Version 1.7 Conunercial Buildin.-Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No O SECTION 11 -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 __�._...... ...... .... ...r_ _. ._._.. �c � y U, C?� Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder GtM�, ��c+u� License Number A dress Expiration 52 -_00 . Sig Telephone SECTION 13-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 0 i f Version].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 Architect: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number 9 Telephone Expiration Signature xpiration 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 P h' Address Registration Number T Signature Telephone I Expiration Date 9.3 General Contractor y woo iztz5v6rga: ._ `�,5 LJ—C— Not Applicable ❑ Company Name. onsible In charge of Construction iY Address —, Signatur Telephone r Versionl.7 Commercial Building Permit May 15,2000 S. 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 (2r YES 0 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 011/ DONT KNOW 0 YES 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 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,exca)WIon, 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. Version 1.7 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❑ dditions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Y Change of Use❑ Other❑ Brief Description Enter a brief description here. Of Proposed Work: 1` /"t L�rf`, ..fim. f�4 i\.L/( ... .! ..G. s ...._,ti .. C�'U� 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 ❑ 18 ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I" ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 313 ❑ 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) 1st Z! G4 .�� r7- 2nd .,. __... __.... 2n° 3rd 3rd 4m _ 4u, 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❑ Version 1.7 Commercial Building Permit May 15,2000 Department use only Qty`of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit - L�Qa 212,Main Street Sewer/Septic Availability 01 Room 100 Water/Well Availability. Northairnptor� MA 01060 Two Sets of Structural Plans phone"41MO-1 240�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: frC/i Wo A t r- s Map Lot Unit %� .�4,,"� P 7 G A N A ©j 0 � Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: od 7d.-_ .C�'C?C �c�ixt tca�_.da�. ..p+° ,. wllher�t,�wtA {em ulc �4 �K . {�. Name(Print) Current Mailing Address: u Signature ) `- `�—��� .._ Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS" Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building cy, y w (a)Building Permit Fee co 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 Commissionerlinspector of Buildings Date BP-2009-0379 CIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:roofing BUILDING PERMIT Permit# BP-2009-0379 Project# JS-2009-000515 Est.Cost: $8500.00 Fee:$55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JAMES MACRAE 153051 Lot Size(sq. ft.): 220413.60 Owner: LAUREL RIDGE REALTY ASSOCIATES LIMITED PARTNERSHIP C/O KONOVER Zoning: SR/URC(100 /L Applicant: JAMES MACRAE AT. 312 HATFIELD ST - BLDG 2 Applicant Address: Phone: Insurance: 398 STAMM RD (860) 523-0027 WC NEWINGTONCT06111 ISSUED ON.10/7/2008 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE & REPLACE LEFT & REAR ROOF ONLY 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 10/7/2008 0:00:00 $55.0044192 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 312 HATFIELD ST-BLDG 2 BP-2009-0379 GIs#: COMMONWEALTH OF MASSACHUSETTS Map-Block: 18-025 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:roofing BUILDING PERMIT Permit# BP-2009-0379 Project# JS-2009-000515 Est.Cost: $8500.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin: JAMES MACRAE 153051 Lot Size(sa.ft.): 220413.60 Owner: LAUREL RIDGE REALTY ASSOCIATES LIMITED PARTNERSHIP C/O ]CONOVER Zoning:_SR/UR ,(091irRi Applicant: JAMES MACRAE AT. 31 (EL`U ST - 8�uv 2 Applicant Address: Phone: Insurance: 398 STAMM RD (860) 523-0027 WC NEWINGTONCT06111 ISSUED ON:101712008 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE & REPLACE LEFT & REAR ROOF ONLY POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: ..Service: Meter`t Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: l c sz at cn Final: Smoke: Final:(J�/� /�'�1'4 ,� THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIO . Of Certificate of Occu anc Signature: ---~` FeeType: "' Date Paid: Amount: - Building 10/7/2008 0:00:00 $55.0044192 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo