24D-121 (3) -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:
PROPERTY LINES SHOWN ARE APPROXIMATE,
A FULL FIELD SURVEY IS REQUIRED TO
ACCURATELY DETERMINE THEIR LOCATION.
NOTE:
SUBJECT TO EASEMENTS AND
RIGHTS OF WAYS OF RECORD.
garage extends 1't over
property line, a full field
survey is required to
accurately determine its
location.
oi garage/
pro)(.nc. dr'oewo
b 119't
garage
O
approx. location of µ
abutters deck &
stairs
n #200 BOOK #206
Z I
L,
95'f
KING STREET ROUTES 5 & 10
SEE: PLAN BOOK 147, PAGES 42--47
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• I\4a/" A.c QQ �. _l_r�9� THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
tN OF mss —MORTGAGE LOAN INSPECTION PLAT—
NORTHAMPTON, MASSACHUSETTS
RAND ALL PREPARED FOR
IZER y VALLEY BUILDING COMPANY, INC.
/35032 SCALE: 1"=30' FEBRUARY 25, 2014
< Sk HAROLD L. EATON AND ASSOCIATES, INC.
SUR REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET — HADLEY — MASSACHUSETTS
LIBERTY MUTUAL FIRE INSURANCE
LI�fCI"ty Mutual. COMPANY
INSURANCE P.O.Box 9090
Dover NN 03821-9090
Telephone: (800)653-7893
Fax:(603)334-8162
Email:IMS®L ibertyMutual.com
May 9,2014
VALLEY CONSTRUCTION COMPANY INC
PO BOX 246
HADLEY MA 01035
RE: WORKERS COMPENSATION INSURANCE
Insured: VALLEY CONSTRUCTION COMPANY INC
Policy Number: WC2-31S-601163-014
Effective Date: January 10,2014
Dear Insured:
This confirms that as of the date of this letter,the above named entity VALLEY CONSTRUCTION COMPANY
INC has a valid workers compensation policy,with coverage for the state of MA,effective from 01/101122014
through 01/1(/2015. The policy number for this coverage is WC2-31S-601163-014.
Sincerely,
Didi Dangas
Commercial Service Operations
cc: MARTIN J CLAYTON INSURANCE AGENCY INC
a
i
1M 00231010 WC2-31S-601163-014 Page 1 of 1
ffice of Consumer Affairs&Business Regulation
r ME IMPROVEMENT CONTRACTOR
q eplotration: 160358 Type:
m ?'? Expiration: '7116/2016 Supplement C•
VALLEY BUILDING COMPANY INC
MATTHEW STONEY
P.O.BOX 246
HADLEY,MA 01035 Undersecretary
The Commonwealth of Massachusetts
Department of Industrial Accidents
a Office of Investigations
W
1 Congress Street, Suite 100
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 I 6. ❑ 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
13.[ Other
employees. [No workers' t� t>ry
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.
lContractors 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: �� � 4-- tt�
City/State/Zip: -'' '�" -,'4k-,
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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certif er a pains a penalties of perjury that the information provided above is true and correct.
Siamat ure: ( Date: `1
Phone# �,1 J'Z - r
e
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
The Commonwealth ofMassachirsetts
�t Department of Industrial Accidents
ter. Office of Investigations
.. r r 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leaibl
Name (Business/Organization/Individual): L IC4
Address: P.6 Ox,
City/State/Zip: Phone#:
Are you an employer?Check the ppropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7: ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑Demolition
working for me in any capacity.n• employees and have workers'.
9. ❑Building addition
[No workers' comp.insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 1.0. Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I L❑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#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 under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#:
Of use on1v. 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 S.Plumbing Inspector
6. Other
Contact Person: Phone#:
Version 1.7 Commercial Building Permit May 15,2000
a
SECTION 10-,STRUCTURAL.PEER REVIEW 4780CM11 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 -OWNERAUTHORIZATIO.N-TO BE:COMPLETED WHEN"
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
(. ^, ('v ................. _. . ......._..__ as Owner of the subject property
hereby authorize
act on my byAt1-f,-i4 all afters relative to work authorized by this building permit application.
Signature bf 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
__.
J'7.. .. _..._.. ..
Print Name
Signature of er/Ag Date
SECTION 12-CONSTRUCTION:SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
_ _ _ _._ _..m._
Name of License Holderlk �ff.._ u �"" ._ .... _ _ ..... ,,. ��,f1 .� 5�
License Number
Address Expiration Date
��
Signatu a 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 bui ing permit.
Signed Affidavit Attached Yes No 0
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 35,000 C.F.OF EKL08ED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
_. _._. ..�., _ ..._, y._-_„ _...-...-_....................,
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
_......_...._ ....._._.. ,. _.. _......_.._..... v...._ . ....._._... _ ._......._. ..._._ .......
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
}
Signature Telephone Expiration Date
, .-e,.
Name Area of Responsibility
I ,
i
_
...........
Address Registration Number
Signature Telephone Expiration Date
_.....
Name Area of Responsibility
Address Registration Number
F
Signature Telephone I Expiration Date
9.3 General Contractor
. . .
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
A_.ddres_s__ _
t7 .57'Y-7711)
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
.o
8. NORTHAMPTON ZONIRG7]
Existing Proposed Required by Zoning .
This column to 5e filled in by
1- I Building Department
Lot Size -�'
Frontage
Setbacks Front
Side L:. ..
Rear
Building Height
Bldg. Square Footage
Open Space Footage _ %
(Lot area minus bldg&paved g J
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Findin ver been issued for/on the site?
NO 0 DONT KNOW YES 0
IF.YES, date issued:
IF YES: Was the permit recorded at the Reg, 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 DONT KNOW C) YES 0
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 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, ex ca tion, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then 2 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 El Existing Ground Sign[I New Signs El Roofing El Change of Use El Other ED
Brief Description ;Enter a brief description here. �� ^ + ,�rJ�✓f
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
FBBusiness ssembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H
High Hazard ❑ - - - - 3A ❑
Institutional El 1-1 El 1-2 ❑ 1-3 El 3B ❑
M Mercantile ❑ 4 El 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)::---1111----'-- ___,_, 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 . ._.. _ _. -.._._.� ., 1St
2nd _.., 2nd _ . ._._... _._.: ._
rd _...._.
3rd 3
th
4th 4
Total Area(sf) Total Proposed New Construction s
Total Height(ft)
---- -_ Total Height ft
7.Water�dpply(M.G.L. c.40,§54) 7.1 Flood_Zone,lnformation: 7.3 Sewage D" posal System:
Public Private ❑ Zone Outside Flood ZoneEy Municipal On site disposal system❑
7,� ° Version 1.7 Commercial Building_Permit May 15,2000
Department u se,onI'
City of Northampton status of Permit
���� uilding Department curb Cutfbni evyay Permit:
212 Main Street sewer/S
epttc Auailabrlity • • • ...;
Room 100 INater/UVell Availability
Electric, Plumbing&Gas Inspeciiop� rtham
North<,mpton, MA C1060 IVV pton, MA 01060 TworSetis of Structuraf•Plans
phone 413-587-1240 Fax 413-587-1272 Plat/site Plans
OtherSpectfy:
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 J 7 . 1 Unit �
G 1� a"l Lot c.n a ) / :ter
A44 G!(; fJ Zone (,r(�� Overlay District
Elm St:District' CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address
Signature /4-/ Telephone mm
2.2 Authorized Agent:
._.. v...._
Name(Print) Current Madmg Address
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
7
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building f1 7-0 . ,, (a) Building Permit Fee
2. Electrical __.,... s (b) Estimated Total Cost of
Construction from- 6
3. Plumbing Building Permitfee
4. Mechanical(HVAC)
5. Fire Protection _..... . ... .:... ..
_- 6. Total=(1 +2+3+4+5) Check Number
This.Section ForOfricial Use Only
Building Permit Number Date=
Issued
Signature:
Building Commissioner/Inspector_of Buildings Date
File#BP-2015-0537
APPLICANT/CONTACT PERSON VALLEY BUILDING COMPANY INC
ADDRESS/PHONE P O BOX 246 HADLEY (413)584-7710
PROPERTY LOCATION 200 KING ST
MAP 24D PARCEL 121 001 ZONE HB(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE ��
ZONING FORM FILLED OUT � J
Fee Paid (
Building Permit Filled out
Fee Paid ,Q
Typeof Construction: INSTALL REPLACEMENT WINDOWS t, v
New Construction
Non Structural interior renovations
Addition to Existing,
Accessory 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
INFQP(IMATION 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
fi eay
Signal fficial 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.
200 KING ST BP-2015-0537
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D- 121 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-2015-0537
Project# JS-2015-001010
Est. Cost: $4800.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY BUILDING COMPANY INC 095905
Lot Size(sq. ft.): 11586.96 Owner: VALLEY BUILDING COMPANY INC
Zoning: HB(100) Applicant. VALLEY BUILDING COMPANY INC
AT. 200 KING ST
Applicant Address: Phone: Insurance:
P O BOX 246 (413) 584-7710 WC
HADLEYMA01035 ISSUED ON.]]/]712014 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