32A-118 (3) M orke-f J-f
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 -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, , 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
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: p 1/ Not Applicable ❑
Name of License Holder: ��`d V t A&vr''6 L 10371d
License Number
U� vtrs,}�.
Address Expiration Date
Signature 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 0 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 36,000 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
Signature Telephone Expiration 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
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name:
Act)_ OiAovr-k(.
Responsible In Charge of Construction
Address 0,7
Signature Telephone
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C�MPANY `�
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&Gas InspeC W15 /3O�ZOZS n,MA 01060
I am writing on behalf of Valley Building Company, Inc., which owns the property located at 98 Market Street
in Northampton. Valley Building Company, Inc. has a current permit out, for work to be completed, at 98
Market Street in Apartment 3. This will includes the creation of a back stairwell off the existing porch, and a
dormer, as per plans submitted. While all else will remain the same on our permit application, our CSL will be
changing from Matt Stone to Chad O'Rourke. The HIC and all other information will remain the same, including
the oversight by the registered engineer on the plans.This project has only entered the demolition phase to-
date, so a framing inspection will still be needed when ready.
We have included a new signature page, with the CSL information, for Chad O'Rourke, to replace Matt Stone,
on our permit.
If you have any further questions or concerns, please do let us know.
Thank you,
Pe er A. lina
"From our Home Page to Your Next.Horne'... www.ValleyBuildingCoxom
Y.O.Box 246• ROUtC 9- 1 ladlcy,�Nfassachusctts 01035
Tel:413.584.7710• Fax:413.825.0219• I?mail:info(vallcybuildingco.com