24D-119 (5) -NOTE-
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
NOTE:
SUBJECT TO AND TOGETHER WITH
EASEMENTS AND RIGHTS OF WAYS
OF RECORD.
NOTE:
PROPERTY LINES SHOWN ARE APPROXIMATE,
A FULL FIELD SURVEY IS REQUIRED TO
ACCURATELY DETERMINE THEIR LOCATION.
147'±
f'-
�+ W
FI �i
BOOK 8031, PAGE 18
F- 1 N/F CITY OF
approx. location NORTHAMPTON, U
of stairs & deck J SEE: BK. 970,
r PGS. 129-130
i
U
#206 approx. location ;
Jof bit. conc. A
F ; parking i OWNERS
L-1 UNKNOWN
KING STREET ROUTES 5 & 10
SEE: PLAN BOOK 147, PAGES 92-100
TO: EASTHAMPTON SAVINGS BANK AND
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #250167
���� -NOTE-
SURVEYOR-1\aAaASQ '. -.n THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
�- AND DOES NOT CONSTITUTE A PROPERTY SURVEY
tN of -MORTGAGE LOAN INSPECTION PLAT-
NORTHAMPTON, MASSACHUSETTS
RA E.ALL PREPARED FOR
/I ER y VALLEY BUILDING COMPANY, INC.
SCALE: 1"=30' FEBRUARY 25, 2014
HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET — HADLEY — MASSACHUSETTS
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
d 1 Congress Street, Suite 100
4
Boston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Valley Building Company, Inc.
Address: PO Box 246
City/State/Zip: Hadley, MA 01035 Phone #:413-584-7710
Are you an employer? Check the appropriate box: Type of project(required):
1.0 I am a employer with 1-3 4. ❑ I am a general contractor and 1 6. F-1 New construction
employees (full and/or part-time).* have hired the sub-contractors
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.1
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
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.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no j
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: Liberty Mutual Insurance
Policy#or Self-ins. Lic. #:WC2-31 S-601163-014 Expiration Date:01/10/2015
Job Site Address: d e, f2 City/State/Zip: ,1 ' cit�ls
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 u er the pains a penalties of perjury that the information provided above is true and correct.
Si ature: -'' Date:
Phone#• 4-111 . -7
Official 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#:
The Commonwealth of Massachusetts
-x= Department of Industrial Accidents
— � — Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: B ilders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leaibl
Name(Business/Organizadon/Individual):
Address: A 'ZG
City/State/Zip: Phone#:
Are you an employer?Check the approp ate box: 7EDNew ject(required):
I.❑ I am a emnlover with 4. ❑ I am a general contractor and I
employees(full.and/or part-time).* have hued the sub-contractors construction
2.❑ I am a so le proprietor or partner- listed on the attached sheet. deling
ship and have no employees These sub-contractors have . olition
working for me in any capacity. employees and have workers'
9. 0 Building addition
[No workers' comp. insurance comp.insurance.T
required.] 5. F-1 We are a corporation and its 10.❑ Electrical repairs or additions
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.❑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"I 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 fuse
of up to$250.00 a day against the violator. Be advised that a co_py 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: Date:
Phone#:
[Contact only. Do not write in this area, to be completed by city or town offrciat
---
To _ __ _ Permit/License#
thority(circle one):
Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
rson: Phone#:
Versionl.7 Commercial Building Permit May 15, 2000
77,
SECTION 1A-STRUCTURAL.:PEER REVIEW(780 CMR 11001)
Independent Structural Engineering Structural Peer Review Required Yes No 0
SECTION 11 -OWNER'AUTHORIZATION-TO'BE COMPLETED WHEN
OWNERS AGENT OR CONTRA CTO RAP PLIES FOR-BUILDING PERMIT
as Owner of the subject property
hereby authorize.'.... '1 f , ]vw `, a �lr� � l 1 {° ....... . . .___._. . __. ..... _ to
act on my behalf ' all atter lative to work authorized by this building permit
Signature of r Date
I,
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 _.�.-
. _
_.. _.,
Print Name ----�r� P7
Signature wner/A Date
SECTION 12-CONSTRUCTION.SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address __ _. .._ Expiration Date
Signature Telephone
SECTION 13'-WORKERS'COIIAPENSATION INSURANCE AFFJDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affi avit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the btfilding permit.
Signed Affidavit Attached Yes No 0
Version 1.7 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 EKLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant)
nt -. _..,
Registration Number
Address
Expiration Date
Signature Telephone�m
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
[Signature Telephone Expiration Date
�Nae Area of Responsibility
Address µ Re�istrahon Number
r, .
Signature � Telephone � Expiration Date ....M._.....,�. _._._µ,..._ �-....�.._-..,......
_. m..y _ .,..w.._...
_ .
Name Area of Responsibility
Address Registration Number
_...__�._. _.,..
........._...... .. .. .._....
Signature Telephone Expiration Date
_.._ ..._.........
__._._. .
Name Area of Responsibility
Address Registration Number
1
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name.
Responsible In Charge of Construction
Address
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
0
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
r This column to 1 e filled in by
t✓I Building Department
f
Lot Size
Frontage .}
Setbacks Front ��-
}._ .
Side L. R ',`•1 L��.�.._,_. R __..
Rear
Building Height
Bldg. Square Footage f i %
Open Space Footage _ %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
. . __.. _.m.__... ....__W _..
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Findin ever been issued for/on the site?
NO 0 DONT KNOW YES
;IF.YES, date issued:
IF YES: Was the permit recorded at the Regigry of Deeds?
NO 0 DONT KNOW YES
IF YES: enter Book i Page and/or Document#
B. Does the site contain a brook, body of Ywater or wetlands? NO 0 DONT 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:
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, exc tion, 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.
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❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other
Brief Description 'Enter a brief description here.. S
Of Proposed Work:tip[ '��,r M v�- W �Cw✓✓
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
11A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A l u
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ ------ -- 3A ❑
Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 36 ❑
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:.
COMPLETETHIS 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(so
1 St __,...,_... _._.
15t
nd 2nd
2
..._.._.... _.......... ....,,.._....... „_.,...�,„,.. ,.,..,,,_ rd
3rd 3
4ih _._.. __,_... ,._,„.... _ 4th
Total Areas Total Proposed New Construction s
( fl _ p chin
Total Height(ft) j. ,,.._...,
- Total Height ft
7.Water S ply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Di osal System:
Public [ Private ❑ Zone Outside Flood Zone Municipal E On site disposal system❑
Versionl.7 Commercial Building Permit May 15 2000
Department use,only
City of Northampton Status of Permit
16� NOV .LANorthampton,Building Department C&IJ-P f/Dn�ewayPerm�t
212 Main Street SewerJSepticAva�Jabifrty
tectric. PIUm�'�� ROOM 100 WaterM/ell4yallablhty
Nc'thGrnp �:
MA 01060 Two Sets of Structura[Plans ,
phone 413-587-1240 Fax 413-587-1272 Plaftsite 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
< Map (;.lrl (l Lot G tl r Unit
Zone C f Overlay District
--- _
._.... ... ._..��.,...,�.__....,: . �..,.�_,.. ____...,�...,..�....__..�_...-_.,..:. __...._.,_,..._.. : Elm St."District CB District
SECTION 2-.PROPERTY OWNERS HIPJAUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Signature Telephone
2.2 Authorized Agent r i
Name(Print) 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
a
2. Electrical (b).Estimated Total!Cost of
Construction from- 6 _.__
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) _. .._.. _... M,_...._� . .:.:.:___.
5. Fire Protection
6. Total=(1 +2+3+4+5)
Check Number
This.Sectioni Foe Official Use Only.
Building Permit Number Date
Jssued
Signature:
Building Commissioner/Inspector.of Buildings Date
File#BP-2015-0536
APPLICANT/CONTACT PERSON VALLEY BUILDING COMPANY INC
ADDRESS/PHONE P O BOX 246 HADLEY (413)584-7710
PROPERTY LOCATION 206 KING ST
MAP 24D PARCEL 119 001 ZONE HB(100)/URC(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /G o
Fee Paid
Typeof Construction: INSTALL REPLACEMENT WINDOWS
New Construction
Non Structural interior renovations
Addition to Existingp G�
Acclans Structure
Building Plans Included:
Owner/Statement or License 095905
3 sets of Plans/Plot Plan /�
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFqR14ATION 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
e "o e y
�/& 7
Sig] of Buil m ffi cial Date
g
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.
206 KING ST BP-2015-0536
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D- 119 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit# BP-2015-0536
Project# JS-2015-001009
Est.Cost: $3000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY BUILDING COMPANY INC 095905
Lot Size(sq. ft.): 15942.96 Owner: VALLEY BUILDING COMPANY INC
Zoning: HB(100)/URC(0)/ Applicant: VALLEY BUILDING COMPANY INC
AT. 206 KING ST
Applicant Address: Phone: Insurance:
P O BOX 246 (413) 584-7710
HADLEYMA01035 ISSUED ON.•11/17/2014 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL REPLACEMENT WINDOWS-must meet
2009 IECC & stretch code
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 11/17/2014 0:00:00 $55.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner