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17C-220 (6) R.C.1 ROOFING 40 MAINE AVE, P,0. Box 309 EASTHAMPTON, MA 0027-0309 ((==ES TZ MA TE-,)D,) PHONE (413)627- 477 S low FAX (4-13)527'4WS ---- -, . 3VNE 3, 2co.3 ewt* kTT'W '10" 1 ha K.'NQ STRYlt-T Job LoG*W,At 40 OVENCE Ull" 15-17 NCRiX HAPTI STRECT FLOP.facs' HA —401haft'. (40) 504-7:329 F -Ap .............. Amu., ..Oft...,..... lt%,-PON 00.01%a I il�* k.W oov Yp f1A.dd. K"N 61 kv;4 3AI"u A m&Wu%d i.;cow'Rjt�noN L�,,c�4se#0744,u �suftwel" MCI�kivopl li 114wFoww"e. �.v a*o, IlUK _r Y P iY it` ; ' ,..� 9 B �lasattcl+asstti' DEPARTMENT OF BUILDING INSPECTIONS 212'Main Street a Municipal Building ' Northampton, Mass. 01060 WORRER'S COMPENSATION INSURANCE AFFIDAVIT (1i r=M* ) with a principal place of business/residence at: Z46 fna0rtti . wit- � � a��.,a\c�� �\a• 0A0Mhone# 1'u ( •ty/staW2ip) do hereby certify, under the pains and penalties of perjury, that: (VK1 am an employer providing the following worker's compensation coverage for my employees working on this job: 6)C\31 S•31T IS-611 10-5-0� ansumace Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below who have the following worker's compensation policies: _ t R; (Name of Contractor) (insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/PaUcy Number) (Expiradon Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additioml shod ifaw=uy to ind. 6&cmatioa pertaining to au oodraclocs) ( ) I am a sole proprietor and have no one working for me. ( ) I am a homeowner performing all the work myself. NOTE:please be aware tilt vrhilo bomoownea who employ pc=m to do maiamsaoe,coosuvwoa•ar r cPair wort:on a&XIling of nog an"than tbroe units is which the hoamwocr raida or m the grounds VVAdeoLaiberoto an oot geoerally 000sidcmd to be c*oY=uada the worker's compeasatim Act(GL152 fs 1(5)),applimtioa by a homeowoir for a Gant•a permit nay evWc=the Iega1 status of an employw under the Wockar's C,oaVpozWm Alt I understand that a oopy of this suLecocat array be forwarded to the DcpacCnaos of Induatriel AoeidaW OXoe of 1—iry w fa dw eovcrago Wrificd1w*ad that failure to&•nine coverage under soctim 25A of MOL 152 an lad to the inlpo oar of aimiasl peaaltia oomistiag of a fine ofup to S I,300.00 sadly impeisoamwt of tip to ooe yt sad Civil penalties is the form of a Stop Walt Older and a ter»of 5100.00 a day against tae For drat use coty Permit Number Map# Lot# Version 1.7 Commercial Building Permit May 15,2000 G ! 4*ifr` Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ s a s r e I, '18M Ow SS d SP1WLC'& 'No—t , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative tow k authZded by this building permit application. aLa0-ho-d 9 13103 Signature of Owner Date I, r' ����F _ K �_ —C' . 9�4:Lk n , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing applicati re true and accurate, to the best of my knowledge and belief. signed under the pains and penalties of perjury. r Print Name Signature of Owner/Agent Date 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: � \ )� \\S��� o-1 Ll S� a1-4 License Number ,A() '5- O� �- O Jf Address Expiration Date Signature Telephone SET C6 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...... ❑ Version 1.7 Commercial Building Permit May 15,2000 f 9.1 Registered Architect: Not Applicable Name(Registrant): Registration Number Address Expiration Date Signature Telephone 92 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 lY Company Name: Responsible In Charge of Construction ' Address Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 7. Water Supply(M.G.L c.40, §54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ 1 Zone: Outside Flood Zone ❑ Municipal ❑On site disposals stem ❑ S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L R• L• R: Rear Building Height Bldg.Square Footage % Open Space Footage % (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 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 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_ No IF YES, describe size, type and location: ' Version 1.7 Commercial Building Permit May 15,2000 Interior Alterations Existing Wall Signs Existing EPIgns Additions ❑ FRool'!ng ❑ ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ .] ❑ Accessory Building[ ] Repairs [ ] ish - ES 4SE T 0 S G pU USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 213 ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1.1 ❑ 1.2 ❑ 1.3 ❑ 3B ❑ 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: ri .® Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): $4CT O 6 BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(so 1:t 1st 2nd 2 nd 3rd 3rd 4th 4 th Total Area (sf) Total Proposed New Construction(s f) Total Height(ft) Total Height ft-------------------- ,i - 1 EI ��?#aY�x'�ii^a75$fbsf64�sc?iet,l�J� -. City of Northampton <� paf? r t Building Dep6rtmeht t 212 Main Street ..m 100 ortham ptbn, MA 01060 .X*) NA114 . . . . . . 7 <r'{F ® '��� a°® °Yn�71 `�A°►A.,r + Nr'�/� 1 i�®.�Y�iid3a���,��R"r ,�,��```^! + . . � a ® ��� 111 ��® & 0!1'��dk3�dl�Fdl"1►E.ari® � • IIIF • � . • ° °° n P Us—a te, g g� �a 2. Electrical .�•* -+ 1 F 4 4. Mechanical(HVAC) 5. Fire Protection • • t ^r m.-; '� � n^�v —r �,«�..w,�'.;r °4T�^a«^�,^'.+ �,_ 1 "v'."".."`^"'x.'' F� -.+rx._^.•r-^ '4!. P r 1.Y-0 4� -...J..::.�� �T � � �Yle��"l 1Aii. � S d� f, f,i.Y si}+�swi.•�T.� t] h�b%�i '. }�y�, �`'« myyww F j 4wk 'k r ct f K, Z, ark`,.?. .�.a Y`�� «� a s...� 4v k S '�`'��, b r+'i1 � i .••f d r yr } i ;;y pg��'1'��[d y.�...�.. +( jpy p}�y^'� .fir �e A�q• ,J,y„raisb �»'�.: tr I7.NORTH MAPLE ST BP-2004-0254 GIs#: COMMONWEALTH OF MASSACHUSETTS Mpp:BBlock: 17C-22P CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0254 Project# JS-2004-0374 Est.Cost:$10000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RCI ROOFING 074334 Lot Size(sg. ft.): 10410.84 Owner: VALLEY PROGRAMS INC Zoning: GB Applicant: RCI ROOFING AT. 17 NORTH MAPLE ST Applicant Address: Phone: Insurance: P 0 BOX 309 (413) 527-4775 Workers Compensation EASTHAM PTON MAO 1027-0309 ISSUED ON:915103 0:00:00 TO PERFORM THE FOLLOWING WORK.REMOVE EXISTING SLATE - INSTALL NEW ASPHALT SHINGLES POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Foy;;"alas: 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 Ci"l'� OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 9/5/03 0:_' ): ?„ 4451 $50.00 212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo