43-074 128 DUNPHY DR BP- 2009 -0847
GIS #: COMMONWEALTH OF MASSACHUSETTS
Ma -.Bloc 43 - 074 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category: BUILDING PERMIT
Permit # BP- 2009 -0847
Project # JS- 2009 - 001257
Est. Cost: $5000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 17206.20 O wner: HAYES JOHN C & GA A
7�m,no �R /1 ?7VRJi? T. I AIi 11C1[l +l VA L FY I�v�l� II�IIPRn����.i��ENT INC
_ _ _ _
AT. 128 DUNPHY DR
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584 -7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON.
TO PERFORM THE FOLLOWING WORK .- BUILD BASEMENT REC ROOM
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: -d-f --01 House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation: OK 6 11 30/67 w ls _
Final: Smoke: Final: ® 1-c 3 1)) 10 L0 S
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc Si nature
FeeType• Date Paid: Amount:
Building 4/21/2009 0:00:00 $55.0025486
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
+r
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut /brriveway. Permit
212 Main Street Sewer /Septic Availability
Room 100 Water /Well'Avallability
Northampton, MA 01060 TwdSetsofStrucuraI Plans
phone 413- 587 -1240 Fax 413 - 587.1272 Pibt /Site Pt
Other Speci
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A. ONE OR TWO FAN i lLi ' DWELLING
APR 2 1 LAI
SECTION 1 - SITE INFORMATION' '
This sectim to be completed by office
1.1 Property Address
12 X Map - -- Lot - -Unit ..... Zane _ Overlay District
Elm St. District__.., CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 of Record / 7 �- u /�7
Narne (Print) Currentblin trgss G ��Q
_ �� Telephone Jy �
Sig�iature
2. Authorized Agent Nelson Shifflett
Valley Home Improvement, In C ,, P.O. Box 60627, Florence, M A 0106
Name (Print) Current trailing Address:
�) 5 8 4 -7522 _
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION CO STS
Item Estimated Cost (Dollars) to be official Use Only
completed by permit applicant
1. Building r�� 0 (a) Building Permit Fee
2. Electrical 7 (b) Estimated Total Cost of
- co Construction from 6
3. Plumbing Building Permit Fee
4, Mechanical (HVAC)
5. Fire Protection
6. Total =(I +2+3+4+5) Check Number 2 6 p
This Section For Official Use Onl
Building Permit Number: __ Date Issued:
Signature: Z
Buildirgg Commiss oner /Inspector of Buildings Cat
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front p
_ I C �
Side L: R: L: R:
r
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg & paved
p arkin g)
# of Parking Spaces
Fill:
(volume & Location
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 11 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:
` • P! S� r3E S�RtPT {O ".t OF E= 'R Ot�r•J St '€7 1£'r`AFiK rh <irk AEI � {rc� hl� P
New I{c u.-,e � � Addition � R€pIctErttertt Window" 11 ter�stit�rt(s) I � Rocrtirr} I j
or D oors .. _..._..
Accessory Bcdg. L ' Der nolitior ! Nevi Signs Decks } Siding Other
A-6
tFi ",' rf'.' Ct: -` .. f. r' °��E Y:..., V `�� ..f'.. .,1 £ti'•,. ,Ir..r J ti�f,'ci � ,
t i r s { £tY,�. _�_ / � _, t• r� r,t� : tY£ •�Yk;l:� r..(£�'1r�YyB!E �_j��c E'lr„
63. If New house and or addition to existfn h odsin . the following:
f�
tt d (^ „ ,..,.,, „ ,.x.�r �,• ! -,� ." YtK?.. ..., 'r;t , .. E "�¢7 �,.SI�'�' jY•.:rcks�,k�
.• z!. t
E,-£; .-i L' t _ .. ..w.,.. .. . .... ......
y .w
4
6 :'k�t "� C.t .F,y •r£'r;•ks? :� Cc i ,:r {:ilr� . kac:• : k Y�al "£r t� ��;,�`;c
,� r'���� .- x�slF.Y �.",s t.,e•£i r�:; .° k. I�£r Y ker�E C� .,b o'.,z•.s �, hztYe.`t,? _. Y '• IS:)
a
,
r t <' «st
-`i I ,. k(. ;�. Iv I?£. = `t 1 '•'" 4 >r , }r Fr '.: d.R�EF -:y .... . _..
i
I SECTION 7a • OWNER MITI €DR{ZATION • TO BE COMPLETED MEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
_ _.ULJect p");;:r: f
,Nelson Shiff lett, V a l ley_ Home Improvement,_ . Inc. - !r' A �,r,
r' I,rr •� ^E` ,_ E -3;1, ., '�t - tk.•r- E!l . c „ .=r t!, +:�Y„�r.C.:�y t?[r,. ! .,£r; £1 ; -.�`tr `Y; ,.YE,EI: ;tii;`s.
. N2 .1,S4n�S �`�.�.f,l�'tet., �d3�. �y�Hf�IitQ._._ Iltlp�ClyeStle� ,.t:r.��11G_.,_._.w.�,...m„___, •t {, ;, r;k:e -a fr`,iri'`c:°s"¢lr ! Fr,t;i -t't
4" r- thy, fcner k j,oir , '4[tE
E Nelson Shifflett
° " +
'
'
SECTION 8 - CONSTRUCTION SERVICES
.1 Licp_nsedConstrqction Supervisor: Not Applicable 0
Valley Home Improvement, Inc. License Number
340 Riverside Dr.. e, Northampton MA -01&6-0- 9/22//0
Address Expiration Date
S�g Telephone
Cq�many Name Re Number
340 Riverside Drime-, _V_1 7 10
Address Expiration Date
Northa�ton, M-A 01060 Telephone 584-7522
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 affidavA
will result in the denial of the issuance of the building permit.
`
1 1. - Home Owner Exemption
]I10 Current exemption for "horn no`nurs' was extended to include ooc (l) or two(2) families
and to allow such homeowner to cn-age 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 Homeowne Person (s) who own a parcel of land on which he/she resides or intcnds 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 farin
structures. A person who constructs inore than one home in a two-year period shall not be considered a homeowner.
Such "horricowner" shall submit to the Building Official. on a form acceptable to the Building Official,
responsible for all such work performed under the builldin� perinit.
Asac/in_g yourprcsoncunnthojobsi<oniUherequirodfi
completion uf the work for which this permit isissued.
Also be advised that with relbrence to Chapter 152 (Workers' Compensation) and Chapter | (Liability of Employers tn
Employees for injuries not resulting in Death) ofthe Massachusetts General Laws Annotated, you may lie liable 0nrpersno(x)
you hire io perform work for you under this pxnnd.
The Undersioned "houncowner"certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State n[ Massachusetts General Laws Annotated.
Homeowner Signature _______
44 mid �tmldark
MW
Lwews,t!; CS 60300
Restmledto IG
NELSON A SHIFFLETT
340 RIVERSIDE DR PBX60627
FLORENCE, MA01062
3435
Board of Ruilding Regulaflow, and !aaraclasc#s
License or registration N alid for individul Use oyoN
,I" HOME IMPROVEMENT CONTRACTOR before the expiration (late. If found return to:
Registration: 10 3 Board of Builditig Regulatious and Standards
5 54
One Ashburton I'lave Rm I JO I
Expiration: 7117/2010 Tr# 270246
Type: Private Corporation Boston, Nla. 02 108
VAL LEY HOME IMPROVEMENT fNC.
Ne�soti Sh,fflett
hr'r3srr 331r, ` 060 i;�/z / , / ,"I o (
Net g1latilre
OQ
CCx�J -
$ � �assacflnsetfs
w.t
m DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S CONTENSATION RiSURA.NCE AFF'IDAVTr
' (licensec/permittee}
with a principal place of business residence at:
3 �2/I'f�.5 ! A -ljd`Z ,�/o.�2f�rn/Ji� rs'M (phone #) f �; Z
(strcet/crty!� fP np)
do hereby certify, under the pains and penalties of pedury, that:
W I am an employer providing the following worker's compensation coverage for my
employees working on this job:
ausu aIl ce 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:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy umber) (Expiration Date)
(attach additicaal sheet if necusary to inchtde information pertairdin to all oonhred ra)
() I am a sole proprietor and have no one working for me.
() I am a home owner performing all the work myself.
NOTE: please be aware that while homeowners who employ petsom to do m i+*�a� contraction or repair work on a dwelling of
not mote than three units in winch the homeowner resides or oo the grounds appurtenani thereto are not gatetady oDwakred to be
employas under the worker's .compensation Act (GL152,ss 1(5)), application by a homeowner for a licease or pan d may evidence the
legal status of an employer under the Worker's Compemation Act
I undaYLwd than a copy of this r atemmi may be fcavarciod to the Depertmca2 of Industrial Accidmii Office of Iasoraaca for the
coverage verification and that failure to seen a coverage tinder section 25A of MGL 152 can lead to the i oa of aiminai penalties
coasisting of a fmc of up to 51,500.00 and/or of up to one year and civil pmaltia in the form of a Stop Wort Order and a
fino of 5100.00 a day against tic
Signed this _day of c For dial use caly
Permit Number
` Map# Lot #
Signature of L ermittee
r - - - - -- --------- }-- - - -
—i
I
N i
I I CD CD I !
I ja. —,
CD
CD
I
I : I
(D I
I
(D
C
S -."�� v O I I °
o 0
Z x I I
cr
I I o o —
I I a<
CD
\ �. CD o 2
c cr
cn
CD
C Q CA
v
f� E y
en
Q i l
.v
I cr
---------- - - - - -- - - - -- —
CL
0
r ' --- --- r ------------- -- --- - - ._ _ . -- '
----------
I
I : I cr I I
CD
i :5 I N
CD
( I zy i
i CD �I I
I o NCD I I
N O i N I p
U-1 I 3
ID
1W 0
} o
=r cr N
CD CQ
II f '
(D
1 CD i
I I <
7 c I
- - - - - - - - - - - - - - - - - - - - - -
I i
.ay
(
0-
O