32A-048 (5) 65 MARKET ST BP-2017-1111
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32A-048 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-2017-1111
Project# JS-2017-001892
Est.Cost:$80500.00
Fee: $523.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY BUILDING COMPANY INC 095905
Lot Size(s0. ft.): 20429.64 Owner: MARKET STREET RENTALS LLC
Zoning: URC(100)/ Applicant: VALLEY BUILDING COMPANY INC
AT: 65 MARKET ST
Applicant Address: Phone: Insurance:
P O BOX 246 (413) 584-7710 WC
HAD LEYMA01035 ISSUED ON:4/5/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:INTERIOR AND EXTERIOR RENO
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 4/5/2017 0:00:00 $523.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck- Building Commissioner
File#BP-2017-1111
APPLICANT/CONTACT PERSON VALLEY BUILDING COMPANY INC
ADDRESS/PHONE P O BOX 246 HADLEY (413)584-7710
PROPERTY LOCATION 65 MARKET ST
MAP 32A PARCEL 048 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT /j/j
Fee Paid C3$
Building Permit Filled out
Fee Paid
Typeof Construction: INTERIOR AND EXTERIOR RENO
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
INFORMATION PRESENTED:
'flpproved 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 Variances
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 CR Architecture Committee
_ Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition D- .y
/ s
Sign of Building i wial 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.
t*Ds'pyIniontuse only
City of Northampton static§tWS f t"" c^ *a '"
Building Department � 'c , + '3; ,t.t4 - :
212 Main Street
Room 100 ri7 ° 6, k
Northampton, MA 01060 T1` fs tfD ,
phone 413-587-1240 Fax 413-587-1272 P ` 4
+: R asx s
APPLICATION TO CONSTRUCT,ALTER,REHAIR,IRENOVATE ORDEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION i APR - 4 2011
1.1 Property Address: I. __ --_ Tide+ction to be completed by office
6S Ma-h�} ✓`1-/ce-1 -- R Lot Unit
/`/t 010d0 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
U1- R,,.4- / L t C PC. AJ/a- ai< Pe, , Ciozr
Nameurrintir Current Mailing Address:
C`Id�^')y_ t - 5Th-17/d
/C/�� Telephone
Signature
2.2 Authorized Agent:
L./CI He- 6..,,}(ac};o.. (o in z 'PO - Nix -Thr, N,d4, Mk cloizf
Name(Print) Current Mailing Address:
f.� Lit 3- YPH- 7710
Signature �f Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 57 OG i (a)Building Permit Fee
2. Electricalt'occ, (b)Estimated Total Cost of
Construction from(6)
3. Plumbing CCL Building Permit Fee
4. Mechanical(HVAC) 6, SULK
S. Fire Protection
41(
6. Total=(1 +2+3+4+5) $G/5-60 Check Number 67/(9 ,,�a
This Section For Official Use Only
Building Permit Number. Date
Issued:
Signature:Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING ML Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size d11,M3u ^nw._. i I _. _. . 1
Frontage /07• r1 _,r-m.4._ 1 ' _1
Setbacks Front -?347_ --I L
i
Side L L R:;.77'.- L:. 1 11
Rear 1 12f-
Building Height -d $,
Bldg.Square Footage 17(0 t 6 4;2X'
Open Space Footage _._ %
(Lot area minus bldg&paved , .
parking)
#of Parking Spaces 'Id 6^^-e+ i
Fill: - I
(volume&Location) . ._. _ _.. -
A. Has a Special Permit/Variance/Fin�di7n( ver been issued for/on the site?
NO O DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Reg' ry of Deeds?
NO O DONT KNOW YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0/ DONT KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO V
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 V
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,exc ation,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 a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[l Siding[E77J Other[62f
Brief Description of Proposed y
Work: FT,„I rx„i' fi-II fn,.,..+-,n jn}ri-isr 6 Ark-,,t1i,JSL-, 0.- der S- p4,-.5,-,. fry
Alteration of existing bedroom / Yes No Adding new bedroom ✓ Yes No /
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Roll -Sheet
ea.If New house and or addition to existing housing, complete the following:
a. Use of building:One Family Two Family k7 Other
b. Number of rooms in each family unit: L1 . `I Number of Bathrooms /f /
c. Is there a garage attached? IC,)
d. Proposed Square footage of new construction. 11,A Dimensions
e. Number of stories? r)-
f. Method of heating? /'I.n: .: 'i,4- , Lic,, Fireplaces or Woodstoves No Number of each /
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction /
i. Is construction within 100 ft.of wetlands? Yes ,../ 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 No.
I. Septic Tank City Sewer ✓ Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION•TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, pr4-r( A. Kjnar O-,; MarYsr k-. }- Q, },(- BGG ,as Owner of the subject
property
hereby authorize Urr t(e (ti+n,c4 f (o,
to act on my beha ' . atters relate to work authorized by this building permit application.
f cl_ y. ao/7
Signature of Ow • / Date
I, I declaet- the state �[:r •as best of my orized
knowledge
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.
e-1-7r- A (,•%r:r , Ir/
Print Name
--------I few `I-1'1-)v,7
Signature f er/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supe
rvisor: Not Applicable 0
/4
Name of License Holder: �-Pike(A/ -) C7- G 'SG c
License Number
2,7' (/C^,-1> 1274) 7 cc,-I'a 1-1.121MA 6' 1t
Address Expiration Date
Signore i Telephone
y IIT ?JG' 7741}
9. Registered oma Improvement Contractor: Not Applicable 0
O01Iif) 6, ;141,c, (c. ire) Cf
Company Name Registration Number
PG Rox d ti,-, N,41 , /✓iP 7-/4
Address
6,72r))/6„.......,./
l//���i �� Expiration Date
`,_ Telephone Lin)'5 r7-771r.
SECTION 10-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 buildii g permit.
Signed Affidavit Attached Yes 1W No 0
11. - Home Owner Exemption
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 buildingpermit
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 A//A
—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
goo 4 fence
stock
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wire fence
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chain link/ r O
fence w'
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NOTE: , oo
PROPERTY LINES SHOWN ARE ti
0 �0
APPROXIMATE, A FULL FIELD SURVEY IS v 0-n
REQUIRED TO ACCURATELY DETERMINE n' le LO
THEIR LOCATION. m� 95.
m °a
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D 1 RO h ` N-C -, 1
0' II •I' '
° % MARKET STREET
TO: EASTHAMPTON SAVINGS BANK
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
MONUMENTAT1ON 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
R f. —AGEE—
SURVEYOR: THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
ie or µms\ —MORTGAGE LOAN INSPECTION PLAT—
NORTHAMPTON, MASSACHUSETTS
RANDALL y\ PREPARED FOR
IZER o 63 MKT REALTY, LLC
As5oa2 SCALE: 1"=50' JANUARY 24, 2017
\ q �/ HAROLD L. EATON AND ASSOCIATES, INC.
----, REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL SWEET — HADLEY — MASSACHUSETTS
Northampton, MA : Residential Property Record Card
[Back to Search Resulty) [Start a New Search ][Helo wRh Printinq
Search For Properties
Parcel ID Name Street Name
MARKET ST V Search Reset
Parcel ID Card Map-Block-Lot Location Zoning State Class Acres
32A-048-001 2 63 MARKET ST 109-n/a 0.469
65
Owner Information
63 Mkt Realty LIc
11 Ballard St
Easthampton MA 01027
Deed Information
Book/Page: 11290/246
Sale Date: 2013/04/23
Dwelling Information
Living Units: 6
Style: Conventional
Story Height: 2
Exterior Wall: Frame
Attic Living: None
Basement: Full
Year Built: 1920
Ground Floor Area: 880
Unfinished BSMT Area: 0
Fin BSMT Living: 0
Tot Living Area: 1760
Rec Room: 0 x 0
Tot Rooms: 8
Bedrooms: 4
Full Baths: 2
Descriptor/Area
22 A:2Fr/B
880 spit
B:OFP
50 rift
40 2Fr/B
880
n
B 5
Notice
The information delivered through this on-line database is provided In the spirit of open access to government information and is
intended as an enhanced service and convenience for citizens of Northampton, NIA.
The providers of this database: CLT, Big Room Studios, and Northampton, MA assume no liability for any error or omission in the
information provided here.
Currently All Values Are Finalized For Fiscal Yr 2017.
Comments regarding this service should be directed to:isaraflnlanorthamotonassessor.us
u9Qanm
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 160358
Type: Private Corporation
Expiration: 7/16/201B Ira 919291
VALLEY BUILDING COMPANY INC
PETER GELINAS -- - -
P.O. BOX 246
HADLEY, MA 01035 -------- - -
Update Address and return card.Mark reason for change.
scni cun+oLi 'J Address Renewal Employment ! Last Card
usi
Office nfConsumer Affaim&Business Regulation License or registration valid for individual use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 160358 Type: Office of Consumer Affairs and Business Regulation
/ {• Expiration: 7/16/2018Private Corporation10 Park Plaza-Suite 5170
Boston,MA 02 116
VALLEY BUILDING COMPANY INC
PETER GELINAS
8 BAYBERRY LN
HADLEY,MA 01035
UndersccretanNot wag3without signature
6.
V. Massachusetts Department of Public Safely
Board of Building Regulations and Standards
License' CS-095905
Construction Supervisor
MATTHEW J STONE
373 GRANBY RD
SOUTH HADLEY MA' 010/0
(�--n Expiration
Commissioner 0&0S@018
Q Assessment and Sales Report
Address: 63 Market St, Northampton,MA 01060-3231
Map Ref.: M:032A B:0048 L:0001 Zoning: URC
Owner 1: 63 Mkt Realty Uc
Owner 2:
Owner Address: 11 Ballard St,Easthampton,MA 01027-1145
Use: Residential-Multiple Bldgs Style:
Levels: 0 Lot Size: 0.47 Acres(20930 sgft.)
Year Built: Total Area: 0 sqft.
Total Rooms: 0 Living Area: 0 sqft.
Bedrooms: 0 First Floor Area: 0 sqft.
Full Baths: 0 Addl Floor Area: 0 sqft.
Half Baths: 0 Attic Area: 0 sqft.
Roof Type: Finished Basement: 0 sqft.
Heat Type: Basement: 0 sqft.
Fuel Type: Basement Type:
Exterior: Attached Garage: 0
Foundation: Other Garage: 0
Air Conditioned: No Fireplaces: 0
Condition:
Last Sale Date: 5/9/2007 Last Sale Price: $0
Last Sale Book: 9123 Last Sale Page: 340
Map Ref.: M:032A B:0048 L:0001 Tax Rate(Res): 16.16
Land Value: $133,700 Tax Rate(Comm): 16.16
Building Value: $264,800 Tax Rate(Ind): 16.16
Misc Improvements: $0 Fiscal Year: 2016
Total Value: $398,500 Estimated Tax: $6,939.76
The information in the Public Record is set forth verbatim as received by MLS PIN from third parties,without verification or change.
MLS PIN Is not responsible for the accuracy or completeness of this information.
1X The Commonwealth of Massachusetts
Department ofIndustrial Accidents
_ i Eft Office of Investigations
,li 1 Congress Street, Suite 100
Boston,MA 02114-2017
+ t„e7 se www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): U ilo.) (6n '4-Re :t" (a-
Address: -T 0 I, C =4L11
City/State/Zip: HA ti Ir /W 010 3 s Phone#: it( ; -SGI- 77 (a
Are an employer?Check the appropriate box: Type of project(required):
I.CJ I am a employer with �, 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. Q 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.:
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I1.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] t c. 152,§1(4),and we have no
employees. [No workers' 13.0 Other
comp.insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their worker'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 subcontractor and state whether or not those entities have
employees. If the subcontractors 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 andJob site
information. +
Insurance Company Name: C;(srr4J .,+•n I —
Policy#or Self-ins. Lia#: WC a- 31 S_ /n,;C j r �l7 Expiration Date: /- vc I t
Job Site Address: 64 -CS A1,rl ,F �}rq+ City/State/Zip: l/(Icr /.. . -pk- M4
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 cerafy the pal
and penalties of perjury that the Information provided above is true and correct
Signature: r Date: 3-a?-J6 l7
Phone#: Mi3 T'i- 77(0
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 S.Plumbing Inspector
6.Other
Contact Person: Phone#:
WORKERS COMPENSATION AND EMPLOYERS LIABILITY
INSURANCE POLICY b,av Liberty Mutual.
INSURANCE
AR INFORMATION PAGE
116 Berkeley Suet B7ebn.MA 02116
Issued by LIBERTY MUTUAL FIRE INSURANCE 16586
Policy Number WC2-31S-601163-017 Issuing Office 016C
RENEWAL OF: WC2-318-601163-016 Issue Date 01-06-17
Account Number 1-601163 Sub Account 0000
1. Insured and Mailing Address
VALLEY CONSTRUCTION COMPANY INC
RISK ID 000994581
PO BOX 246
HADLEY,MA 01035
Status 03 — CORPORATION
Other workplaces not shown above: SEE ITEM 4. PREMIUM- EXTENSION OF INFORMATION PAGE
1 Policy Period:The policy period is from 01-10-2017 to 01-10-2018 12:01 A.M. standard time at the
Insured's mailing address.
3 Coverage
A. %brkers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states
listed here: MA
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits
of our liability under Part Two are:
Bodily Injury by Accident $ 500, 000 each accident
Bodily Injury by Disease $ 500,000 pokey lint
Bodily injury by Disease $ 500, 000 each employee
C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here:
SEE END WC 20 03 06B
D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE
4. Premium: The premium for this policy will be determined by our tvbnuals of Rules, Classifications, Rates and
Rating Plans. All information required below is subject to verification and change by audit.
Code Premium Basis Total Rate per$100 Estimated Annual
Classifications Number Estimated Annual Remuneration of Remuneration Premium
See Extension of Information Page
•
Mnimum Premum $ 500 (MA) Total Estimated Annual Premium $ 4, 522
Premium will be baled ANNUAL
•
Producer 0004-026083 i _ ti
MARTIN J CLAYTON INSURANCE AGENCY I I
INC
1649 NORTHAMPTON ST 4 JAW 1 7 2017 t
P 0 BOX 989 1111
i. v f 4
WC 000001 A 01987 National Council on Compensation Insurance,inc. WC 000001B(CA)
Ed. 07/01/2011 All Rights Reserved Page lot 1
•
e Bot enm
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 ail 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: KJ -CC Aar-I're e k
The debris will be transported by: Amlicrr-' Tr,
The debris will be received by: A Ml , ;a- 7r.,
Building permit number:
Name of Permit Applicant .A/ID Con)}r,ci,•_ C6- (Lc,
'> -
Date Signature of Permit Applicant
3040DC 3040DC 3035DC /1
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3068 _ _ _ 3040DC 3040DC _ N
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,1 LIVING AREA
405 sq ft
City of Northampton .--4! M Iv,- I r, ,
Building Department eti<G `,dr.
Plan Review
212 Main Street
Northampton, MA 01060
2035DC 2040DC
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LIVING AREA
405 sq ft
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