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24D-172 ACbI' CERTIFICATE OF LIABILITY INSURANCE �TE(M 10/01/2015 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gabdelian Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO BOX 542 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 744 Southbridge Street Auburn MA 01509 INSURERS AFFORDING COVERAGE NAIC S INSURED INSURERA TRAVELERS TOMASZ KARAS INSURER B: AIM KARAS HOME IMPROVEMENTS INSURERC: PLYMOUTH ROCK PO BOX 1 INSURER 0: LULDOW MA 01056 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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. IN MAIL LjW mm TYPE OF INSURANCE POLICY NUMBER "00iff LIMITS A GENERAL LIABLTTY 713343291 680 0511812015 05/18/2016 EACH OCCURRENCE a 1,000,000 COMMERCIAL GENERAL UABILITY E 1 S a ac enoe $ D CLAIMS MADE ® OCCUR MED EXP WV a»Pam) a PERSONAL A ADV INJURY a GENERAL AGGREGATE 3 2,000,000 EWL AGGREGATE LIMIT APPLIE8 PER PRODUCTS-COMPIOP AGO a 1,000,000 POLICY FJPROJECT M LOC C AUTOMOBI.ELIABILITY PRA00001254176 04/01/2015 04/01/2016 COMBINED SINGLE LIMIT ANY AUTO (Em ffl) a ALL OWNED AUTOS BOOI SCHEDULEDAUT03 (per L �RY a 100,000 HIRED AUTOS NON-OWNED AUTOS ( I t) 3 300,000 PROPERTY DAMAGE $ 100,000 (Par mcment) BADE UABIJTY AUTO FONLY--EAACCIDENT S ANYAUTO AUTO VAT EAAGO 3 A ExCE88NMBRELLAL'ARK ITY 78344238 CUP 05/18/2015 05/18/2018 EACH OCCURRENCE s t,G00,0o0 OCCUR CLAIMS MADE AGGREGATE 3 1,000,000 a DEDUCTIBLE a RETENTION a a B 3 LMJABIUTYTIONAND VWC 6011319012010 01/12/2015 01/12/2016 g T LIMITS F1 ER ANY PROPRIETORIPARTNERID(ECUTIVE E.L.EACH ACCIDENT 3 100,000 OFFICERIMEMBER EXCLUDED? IyN aaaBa alder E.I.DISEASE•EA EMPLOYEE 3 500,000 BPEG�IAL PROVISIONS below E.L DISEASE-POLICY LINT a 100,000 , OTHER CARPENTRY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION OATS THEREOF,THE ISSUINO INSURER WALL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 30 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE NSURER,ITS AGENTS OR REPRESENTATIVES. AUTHOROW EP ENTATIVE op ACORD 26(2001!03) ACORD CORPORATION 1958 Massachusetts -Department of Public Safety Board of Building Regulations and Standards r Construction Supenisor Specialty License: CSSL-099719 TOMASZ KARAS P.O.Boa 1 �t Ludlow MA 01056 t ; Expiration Commissioner 01116/2016 C%lP�amrxoiet��e�rll�a�r?Z'��zta�•�ulelfl i Office of Consumer Affairs&Business Regulation �110ME IMPROVEMENT CONTRACTOR egistration: 168951 Type: 'Expiration: 4/27/2017 LLC KARAS HOME IMPROVENTS,LLC. TOMASZ KARAS 1 376 THREE RIVERS RD. WILBRAHAM, MA 01095 Undersecretary CEILING 2"Floor alterations • Remove existing suspended ceiling in the front room 14'x14' • Install 1/2 gypsum • Apply three coats of joint compound • Prime and paint all ceiling Labor $770 Materials $275 Total $1,045 KITCHEN 2"Floor alterations • Remove carpet • Install'/2 gypsum on walls over paneling • Apply three coats of joint compound • Prime and paint • Install linoleum floor • Install kitchen cabinets and counter tops • Install window and base trim • Paint all trim Labor $2,000 Materials $1,600 Total $3,600 DOOR 2"Floor alterations • Remove existing and install new fire rated door 36" Labor $425 Materials $280 Total $705 HAND RAILING • Install a hand railing on rear exterior concrete steps and concrete landing. Labor $120 Materials $150 Total $270 ALL PERMITS AND FEES INCLUDED DUMPSTER o Removal of all trash Included TOTAL JOB: $14,820 Tomasz Kara Yosh Schulman Karas Home Improvements,LLC General Contractactor <J�' ✓� 413-374-8638 Karas Home Improvements, LLC AP General Contractor ffwl�p Tommz Kum P.O.Box 1 Ludlow,MA 01056 CONTRACT Section A:Parties involved: This contract is dated 25a' day of October 2015 between Customer: Yosh Schulman 210 State St. Northampton,MA 01060 AND Karas Home Improvements,LLC General Contractor *P.O.Box 1 Ludlow MA 01056. Telephone: 413-374-8638 Email: KARASGC(&GMAIL.COM Website: KARASGC.COM Section B: Description of work and terms: CEILINGS I"Floor alterations • Remove all existing crown molding • Install 5/8"Fire rated gypsum board on all ls`floor ceilings • Apply three coats of joint compound • Prime and paint all ceilings Labor $6,450 Materials $1,400 Total $7,850 DOOR I"Floor alterations • Remove existing and install new fire rated door 36" • Block existing door way Labor $925 Materials $425 Total $1,350 Rear 9:n�rMcf- a,- ��e�,- al ✓ `1e Sl aca } Te.-^ eA Iris -r-o s fs W �gCcl, feet 12ft 24ft floor FL%jplanner 154 ;Uo 5tk4= 5d v�nq A4/t ICU b�, ! I � m � r�ce `ice j a� i n'}�MeS cen•�- OA I�5 47 S rAitCC e4 G�UN�Y✓ Oft 12ft 24ft floor Uti vanner -.6` /s.� _—.�'•LL,�� — 7-114E AEED 'V&T a&A'YT-'0"A) 7�fE rX' ,,oq Ej 7-Y d'fvi Z'Zer"'ms's (, 9 �"� �i5T,19rJe.�G�S S�resc,JstJ `4J 7-.44E7 ,ass 5sa f �- P. -x- 15° Deed Ref: Book 2S5Z Page_ Z 31 Plan Ref: Please Note:This plan is for mortgage purposes only and is not a complete property survey. It is compiled from deed dimensions, existing plans and other sources of information. This plan is not to be used to establish property lines to erect fen'ces or hedges, etc., and is subject to change as a more accurate survey may disclose. John K. Somers Professional Land Surveyor J,•� 180 Great Plains Road • P.O. Box 1093 Date: -.,�---��1 West Springfield, MA 01090-1093 (413)739-1451 m FAX(413)739-1539 % Scale: jsomerspls@comcast.net City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: SID 61Je 3f. Pim-f'1ctmpAxt� MA 01060 The debris will be transported by: Oieferosk; Rem Lotxv The debris will be received by: Building permit number: Name of Permit Applicant jL� -�.G •-l5 �car�c�s� �,G Date Sign-ature of Permit Applicant City o= Northampton _ k' Massachusetts I y 1 k DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building t.•, =t,: Northampton, MA 01060 h. Sri, INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which The resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two- year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill) sonotube holes (before pour) a rough buildinq inspection (before work is concealed), insulation inspection (if required) and a final building inspection The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be i responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date 4ddress of work location i The Commonwealth ofVlassachusetts Department of Industrial Accidents 1 Office of Investigations 600 Washington Street r Boston, MA 02111 www.mass-gov/dia Workers' Compensation Insurance Affidavit: Builde>rs/Cont>r2cto>rs/1Clectriclans/Plumbe;rs AADtplicant Information Please Print]Legibly Name (Business/Organization/Individual): Y-0 65 HOPE IM NO V E ME�0 S UC Address: P O. ?:z0 X l City/State/Zip: Jf -1,43%0 (� Phone#: IJ/3 ` 3-f 'Y638 Are you an employer? Check the appropriate bog: Type of project(required): 1. I am a employer with i 4, ❑ 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. 0 Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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. tHo meowners 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: CL C 0C`r' Policy#or Self-ins.Lic. #: VO C W11319012-on / 78 3 43.2 ct J 6 YQ Expiration Date: Q�_ //, Job Site Address: J10 5_1 JR& 341 City/State/Zip: PoAQ w f-Ann, HA 0/060 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: 10Ni�tSe �/c2'� Date: Phone#: �/ °" 372 ' 2-563Y Of 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#: SECTION 87 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ Name of License Holder: —liS M A5Z k I G.5 (J`7 ► �/5 License Number P.O. ]-�Ox Address Expiration Date Signature Telephone 9 :RegisferedtHome Improvement"Contractors �_ -_ �.� Not Applicable £ K 600) Pb- Mik T&PROUFMicitTr Ae' Company Name Registration Number � j,ors Ad �'027- l y Address .. ///j Act �i Expiration Date �i_.C.CT t a Acct m MfI 0/0'5-57 Telephone - 7 -& SECTION 10-WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.-.1 52,§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...... £ 11 = HoSne 4wner..Egenpt><on The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780. Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature, i _ I SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House [❑ Addition ❑ Replacement Windows Alteration(s) ® Roofing ❑ Or Doors D 4 Accessory Bldg. ❑ Demoliti n Ne 'Si s Deck [] Siding [0] Other[❑] 4 71 Brief Descript'on roeosed Work: J�J,of -c- C,')t �11 ✓l 5 �� �Ct.� C7(0�15 Alteration of existing bedroom v Yes )o No Adding new bedr m Yes h' No Attached Narrative Renovating unfinished basement Yes _k No Plans Attached Roil -Sheet a-,,4,.-,New.hause artd_oi-addltiorr_to ex stlng housir'q, cotngfete;he fo[lowtnCF: a. Use of building:One Family Two Family art Other b. Number of rooms in each family unit: -3 Number of Bathrooms „z c. Is there a garage attached? D d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of.heating? a Fireplaces or Woodstoves bib Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction A,Cfe,J�a A.5 i. Is construction within 100 ft.of wetlands? Yes 14 No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes )o No. I. Septic Tank City Sewer V Private well City water Supply SECTION 7a-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 I, wi KiS 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 210 54-^+e '5-f 1% 6q6 --,�q-g61C- Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by 0 y ct X%0 _z q; Building Department Lot Size U°_3'ai'` Af rtS Cad 1,1 , A Crt_s , Frontage Setbacks Front Side L. - R:` L: R:F, Rear _i ./VCS C 41W m f Building Height '2-4 Bldg. Square Footage " `""` % Open Space Footage % s, (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 @ DONT KNOW Q YES Q IF YES, date issued:= IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES IF YES: enter Book ` Page; and/or Document#, B. Does the site contain a brook, body of water or wetlands? NO koy DONT KNOW Q YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: s D. Are there any proposed changes to or additions of signs intended for the property? YES 0 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 Q NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. F3eparfinent use only i — ty of Northampton Sfatus,ofPermrt B ilding Department Curb Cutfl7ri�e�iay Perms# _ y � ; 12 Main Street SewerlSegtrcAualraGllrty ff T 2Q��3 Room 100 W... /> e7�Ava�la6ility f G C l ort mpton, MA 01060 Two Sefs of 5tructc�ral Plats -5 -1240 Fax 413-587-1272 Plot/Site Plans - 1 4..D1 .o o ... ::...... . APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE,INFORMATION -`' - Thls secflorrfc be com le ed IA office Property Address: . _ _ _ _ i_:.,i:-�'i_; nl L)210 1V 5fcc�C St `'Map Lot i d�oc��ia vr-��7`c�n MO C�1CX�o El,St Dlstnct .._.:— _=� CB Dlstrtct . SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED:AGENT:•. 2.1 Owner of Record: n Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: --r©m 695 Name(Print) Current Mailing Address: ii>f�0� �;rs> /'/3 3 7-// 96 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 Feb' o U 2. Electrical (b)'Estlmated Total Cost of Construction`from' 6 :: 3. Plumbing Building Permit Fee 1Ei D 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) o��l (, Check Number ThisSection For Official Use Onl Date Building Permit Number: Issued.: Signature: Building Commissioiier/Inspector.of Buildings: Date File#BP-2016-0571 4�1�� 0 APPLICANT/CONTACT PERSON TOMASZ KARAS ADDRESS/PHONE P O BOX 1 LUDLOW01056(413)374-8638 l PROPERTY LOCATION 210 STATE ST �N MAP 24D PARCEL 172 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST l• ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: ADD 2ND KITCHEN TO CONVERT 2 FAMILY �y t New Construction v �x Non Structural interior renovations Addition to Existing Accesso1y Structure I ki WO Building Plans Included: Owner/Statement or License 099719 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: 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 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. 210 STATE ST BP-2016-0571 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24D- 172 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-2016-0571 Project# JS-2016-000955 Est. Cost: $29820.00 Fee: $194.00 PERMISSION IS HEREBY GRANTED TO Const. Class: Contractor: License: Use Group: TOMASZ KARAS 099719 Lot Size(sq.ft.): 9234.72 Owner: SHEILMAN YOSH Zoning URC(100)/ Applicant: TOMASZ KARAS AT. 210 STATE ST Applicant Address: Phone: Insurance: P O BOX 1 (413) 374-8638 WC LUDLOWMA01056 ISSUED ON.111312015 0:00:00 TO PERFORM THE FOLLOWING WORK.-ADD 2ND KITCHEN TO CONVERT 2 FAMILY - *No parking allowed within 5' of the front property line* 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 Sisnature: FeeTvpe: Date Paid: Amount: Building 11/3/2015 0:00:00 $194.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner