38B-171 (3) NNI II
MAROTTA KITCHEN REM 3/8" = 1 `-�- �- - _____ ' �.
Andernsen C 24 casement window
-
___I. €,Iiminate cased opening k
f ` �` -- - -- k � a �_» - i P . 11 s
i r '., -t ( �� , apron front sink �� i
1 ,
Honed granite tops subject to allowance
It
fir
ar
G . / install owners tale
O" � I floor �
1/ — a
Cust P or Natural Summit Woodworks Cabinets
n 4 ci Cr1 n-30.,
Iji
I ii
�
)-- —
�
I
-. ownd raft ds g - nge •
1 -- --
_
exposed sheetrock wra pped beam microwave location to follow �,
1 _ i _ i full htg cabinet 1
1 \ 1 desk cab / wall cab above
•
— _ _ enlarge cased opening
OR „ttA�fp�_
% (0 , lassaChnsetts AIL
' ► ° - DEPARTMENT OF BUILDING LNSPECTIONS = `
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 �,~ •'�� �
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, /1l 2 L-s o kr SW /1: l/ /1. y /7 /L ,1-; v›- Arts 7 i, 2 _ — ,i 1 L
(li censee/permi ttee)
with a principal place of business/residence at:
3 fo /l///ie -$ Lb el .1 -11/Z ,r/o, 2 777/7/ ii”, (phone #) 58 ` 7 zz
(street/city!s-ta °rip) ef/oh O
do hereby certify, under the pains and penalties of perjury, that:
(A I am an employer providing the following worker's compensation coverage for my
employees working on this job:
%iL /CL. ss _2-7/5. G'D. 6 765 / z,/ / //v
(Insurance 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)
(Ihsurance C ompany/Policy Number) (Expiration (Name of Contractor) iration Date )
(attach additional sheet if necessary to iochuile information pertaining to all cc edora)
( ) 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 persons to do maintenance, construction or repair work on a dwelling of
not more than throe units in which the homeowner resides or on the grounds apis uteosnt thereto are not generally considered to be
employers under the worker's ration Ad (GL152,3s 1(5)), application by a homeowner fora license or permit may evidence the
legal status of an employer under the Worlceu's Compemation Acs.
I understand that a copy of this ratement may be forwarded to the Department of Industrial Accidents' Office of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of 5100.00 a day against me.
Signed this /3 day of / 4 ) T F a
f Permit Number
' ./ ✓'` Map# Lot #
Signature of LIZ. _- • erm.ittee
s„ NI.ts«.tahusctts - llc°I artment ;tf Public N:tlel{
BoArd of I3tttktin2 Rel.tillations ,Anal " tand,ird.
...: ::3n tr &cit$`rr *`a ,px s r L t" cease
Lu t CS 60300
Restr{a ted to. 1G
t SO
stot
NELSON A SHIFFLETT
340 RIVERSIDE DR 1X60627 Iltli,
FLORENCE, MA 01062
r:-2-. -'' , - � 1 %,..f Ats�rr € rata' 3435
r =>71`£itdb 3 „fiYu! P �,�•�.••» Y 4�'"t' 3435
`, ! . >i, ,-,,,,,,e;
F ,ae rs% , i i7:, ,,,,, lien, ±r
Itsarti or finals ing Regulations and Standards License or re ;istrmioo sf alid for indiN acid use oni,
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to
t ‘ Registration: it7 °r Berard of Building Itegulations and Standards
o
�'` Expirations /17;;�71D Tr# 21024.6 f /iteAshburttttt Place lttn I301
Type: Private C: orporat on Boston, 1a. ft? 1#74
VALLEY HOME IMPROVEMENT INC.
N Noe a rt; il en MA E1 =`.F0 - Adminisnatm r Not sali =leitbout signature
r �
w '
SECTION 8 - CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable D
Name of License Holder : Nelson Shif f let _ — 060300
Valley Home Improvement, Inc.
License Number
340 Riverside Drive, Northampton, MA 01.0.61] 9/22//
Address Expiration Date
584 - 7522
Signature Telephone
ir
P--
0. Register. Home Improvement Contractor: « Not Applicable ❑
Valley. Home Improvement, Inc... 105543
Company Name Registration Number
340 Riverside Drive ._..__,.._ 7117/10
Address Expiration Date
Northamp MA 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 affidavit
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes X 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 he
responsible for all such work performed under the building permit.
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, von 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
•• 'rstiori 5. DESCRIPTION OF PROPOSED WORK cchttck all inzpfishls
Ninv HcLf:4.t ACditiort I Replacement iliinchw.f. Aiter..ftion(t)
b,// Rooting r
Dr Doors ::
Accessory J Demlitier New Signs J Decks 1 Sidirg '1 Other
fan Id c.T/uh..0
Y e';
* Lir Lti..[V tif
ror
62.1f New house and or addition to existing housing. complete the following:
Cr m
Cy ra■rn.,1•
t
70
2 F _ „.„ „ „ Ei a:Lci.cc?
1,11, ;;A:' 100 yt
::ty f,fn to ;t:t:
1,1,
SECTION 7a - OWNER AUTNORIZATION TO DE COMPLETED WHEN
1 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
/72 /LC/Z7 ), r/VS /P7/4 , att, t-c uLt
Nelson Shiflett, Valley Home Improvement, Inc .
;dr ,ttlfh(vwet,,.. Vaf, ,:t:Tirlif-,°,11(,)
/Akif44, Ake/4
S a:Jr? 0) ChNlef
..Nelson_Shi.tf..tet.t,_Valley_Home_„Improxement._Inc . /AulnCr'1240,:1 Af:f7r,t
dt '24c 1.r1 t1tI i0r ,if;!1:l'Citic7 !rt.: 1 ,^1t ,. ..; IJ U it'y
1,r ewler ce ne. bci k.
tci c: t 0r an L tin o'
Nelson Shif f let t
I-
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 — j r
Setbacks Front �!
:
Side L: R: R.
4
Rear I
Building Height
4 -
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 / i DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO i../" 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 pro erty ?YES _
No
IF YES, describe size, type and location:
•
i '
F------ geprtn use arl '' 1
City of Northampton Status of Per it:
Building Department Curb Cut /Dri ✓ev9 y Permit
r ,
212 Main Street Sewer /Septic Availa i: r ., -,,,,%.
Room 100 Water /Well #vatiabili
Northampton, MA 01060 TWo Sets o Stru t ural Plans i L i
e`n
phone 413-587-1240 Fax 413-587-1272 Plot /Site F „ f ‘ _
C t rpe ,. .,
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A- 3NEORTWO FAMILY DWELLING
APR 7 1 2":
SECTION 1 SITE INFORMATION d J c
J ■
1.1 Property Address;
This section to be completed by office
'
rMap Lot ,�_ Unit
/ 2 /5 //./1/1/ �..
it/ ()/e /7 7 f/2' /1.7./f z) /6 C (> Zone _ Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
7 kJ r r/r r L is / /II/ (//14,1_,.- Mir' /7 /7//7 /-1 e i A! ` ' ..
Name (Prix • Cur t? ailin re • ,- jZ1� (A c,
4(1/1 d- 2 �` r / �
T et epho ne G ,
Signature c 7 ` 3 4 70 2
2.2 Authorized Agent: Nelson Shifflett
Valley Home Improvement. Inc,. P.O. Box 60627, Florence, MA 01062
Name (Print) Current Mailing Address:
f
/ ' . ,I A 584 -7522
Signature ,I Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant _
1. Building )/ (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
ctO d Construction from (6)
3. Plumbing 3S—DJ Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) ,3Oev a Check Number 1.5 I 15 6,00
This Section For Official Use Only
Building Permit Number: i Date Issue _-
', c,. __
Signature: —% ,'
2a'c�
Building Commission %lnsp t6r of Buildings Gate _
17 MADISON AVE BP- 2009 -0846
GIS #: COMMONWEALTH OF MASSACHUSETTS
Ma_ 714 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- 2009 -0846
Project # JS- 2008 - 001274
Est. Cost: $30000.00
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC
Lot Size(sq. ft.): 8232.84 Owner: MAROTTA MICHAEL & MICHELLE
Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 17 MADISON AVE
Applicant Address: Phone: Insurance:
P 0 Box 60627 (413) 584 -7522
FLORENCEMA01062 ISSUED ON:4/21/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: REMODEL EXISTING KITCHEN
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 4/21/2009 0:00:00 $0.0025486 I6
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo