31A-149 (2) < 8'-6" > 1.<._ 8' -5"
I II I - x'
f -I 1I •
CO
new wood p osts `Y'
Irm
411, _ *
.1- IIIIIIIIs
/ _
28 door to match.
Eat
refinish sheetrock ceiling `
g '
co
1
, s s 4., '; 4 e 1 t, , aru, , s �X t J ,, ,. c i f `,- WA! ' ° "I; *� = #w iZ c s , "*.. � # a
Wolf/ David alum porch enclosure. New wood posts and door surround
-- N e o 1ywood alum. pane :s wi full removable screens .-
p 3-( - ) ....___'
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ig o pen below ®► ® ' " F adjus shelves 4t new close u 8 " 4 d r= wer (van ` - - - : 0" rece , sed me • cab'ab y ° . _ ..„
_ _ _ _ _ _ _ _ _ r:
x3 R 1 _ -
ontinuous granitiogp /4" b.s 1i u
er r �� deck/ pencil drawer / s
new insulation, sh- etrock, trim th • ughout. heat lamp 1
door to rema n. \
f,3 f
I new tile floor R
e new vinyl window M..
. '_
". OO toto drake toilet 4
—
0" Max Intuition - , ?,ower „ „ —
. — —
leer door. I —
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_________________
_ _______ _________________ _
4e;.- 6 1)--
,SttAM
E xt Ml N�irilla ll point %%t: 4S4
4 B assaChnsetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street Municipal Building
Northampton, Mass. 01060 ~ " '
WORKER'S COMPENSATION INSURANCE Al'IW)AVIT
/Vizso/kr Sff /GP !/ (/ #L141, c
(licenset&permittee)
with a principal place of business/residence at:
3 'f o t o 1/Z45 i .6 2 � 11 dt/D, -12f iii ; "I (phone) 58 e/- / ZZ
(tit - mt/cityistat e/xip) Dune o
do hereby certify, under the pains and penalties of perjury, that:
I am an employer providing the following worker's compensation coverage for my
employees working on this job:
Acadia Insurance Company WCA5029908 2/1/2013
(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)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional scut if necessary to include information penalising to all contractors)
( ) 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 bomeowners wow employ persons to do maintenance, construction or repair work on a dwelling of
not mare than throe units in which the homeowner resides or cc the grounds appurtenant thereto are act generally considered to be
e rnployers under the worker's coarpensation Act (GL152,ss1(5)), application by a homeowner fora lionise or permit may evidence the
legal status of an employer under the Wortcor'a Compensation Act
I understand that a copy of this statement may be forwarded to the Department of Industrial Accidents' Office of rasuranae for the
coverage veri&catioe and that failure to secure coverage under section. 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a &ne 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
fun of 5100.00 a day against tux.
Signed this - ✓ SI day of 20j2_ F use only
Permit Number
/a1 IMF /9'1" Map# Lot #
Signature of LL • ermittee
.., \ Office. of. Consumer Affairs & Business Regulation License or registration valid for individul use only .. ,
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
- Registration: - Type: Office of Consumer Affairs and Business Regulation
^ 7/17 /2012 Private Corporation 10 Park Plaza - Suite 5170
•>. � ..s : = - = = `--__ - Boston, MA 02116
VALLEY HOME IMPROVEM %
LL INC.
Nelson Shifflett ,r
340 RiversideDr /
Northampton, MA 01060;_ ::::-.".-,...,-.,...• ` Undersecretary N'; slid without signature
Nlasachusetts - Department of Public Safet■
Board of Building Regulations and Standard
+ ___.v Construction Supervisor License
One- and Two- Family Dwellings
License: CS 60300
NELSON A SHIFFLETT ` ,
340 RIVERSIDE DR PBX60627 z'
FLORENCE, MA 01062
°%. ---'''� Expiration: 9/22/2012
( ommisiuuer Tr#: 2383 i
SECTION 8 - CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Nelson Shif f Lett 060300
Valley Home Improvement, Inc.
License Number
340 Riverside Dri k • . • . u4. I 4 . 1 9 / 2 2/1 2 .
Address Expiration Date
584 - 7522
Signature Telephone
9. Resister H'• m• rove -n. antra •r Not Applicable ❑
Valley Home Improvement, 'Inc. 105543
Company Name Registration Number
340 Riverside Drive 7117/12.
Address Expiration Date
Northampton, 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 Jgl No ❑
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 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, 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
f
r,c(s K h k III li bl )
Now House 1.! I Addition U Replacement Windows ! Alteration(s) I: Roofinc 0
Or Doors :.:
= Accessory Bldg. 'D ' DemolitionO New Signs : j Decks ': ) Siding f j Otherd
. ;
..,
3'1c' Dcw1..1. oft r.; Pr,-; pc .,c(,': .. gaVja ,gAt — Pre Mr e fd-AA scrc 4 ,..21- it-pasts, r-c- a#06 / Q ,e, elastk
7
ri. ",:e ^ her:tc;cm _`0, _ (.<< Ar:1 np, nEty:
ttal NartAr.z Fe c), ,lifill;ht tAsvrtiert le', 1...-
Fly- -.. ...,t!..a:t1<:.: oi,
63.1f New house and or addition to existing housing. complete the following:
kr7:',€ .. ot ouilcal : C 7 am 1 Tw3 7 .3m4ly C..1t
0 r...xtVZIEti i':' iC; 1 ear-.11'at +;n:, %tynnify ot Eiath
,-.,. k, Ye :: 0 ....L
J r rf.):„ Flc;i..irt; feCtAF: . c:! 01 tt..(vc ; t:t.tct :Jo
7,7 No :',f ,, ...! ,- ; ,- 1 ,,, !=,, , 7 1 . ) ifi
4 , Vcr.r of heating f it: c', ur ° Kute,— uf cocti
. Et E ' :y Oc7St Cor la iVchcck Enc-gy Cornlr-Ai:e form a:tz'cl cc.?
zt cc !,11untfen
. cc . *11..,:,:bc!i w.thi i IOU 1 '.4 wnGs? _ Yes ' Is c:Jitstruct:, whir 100 yi . 1:;Iplii is 1
of :feint n! ceil(ir t Dr rfeloo/ °r~tchcto va6f
k 'h idvq; :".0,' frm to 'A:u. ButIctrtp, ;ild ?rnv,p 1 yes
— Cy Sewet It , j , - - 1 , , t we __ Co,y ' S y
1 SECTION 7a - OWNER AUTHORIZATION • TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 f , , , as Owner d t. subject prDpEtty
li,, , Nelson., Shi Iflett., Valley Home Improvement, . Inc. . „ . to azt on
my ...fl „it --zil' ,..'.., r ....',-Alo.." t ':',.0 ,:ta:tho t' L
__
: t
4 A...../
- 47 ,
S3..ur of O'er
. Neloon_Skifileft..__Salley_liame—Iraproyerzent....__Inc . , :V; Ycrter/AtiMrc7P.1 AEent
decine ...taterric , ....trIci wfotreilti e the fortlifair p, a upl'cdtkg t t RI t'ut and mg„.&.:r4.1.r.:% l;) ',11. t„, el try
{..rce..1.".:Cge End belief.
,
t.O
Nelson Sitif flet t- _____ _.._
.__ , ,
, i-t Nxr,:t
_____72 • / - --
, __....
......:
--__
.,k
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
Side L: R: L: R:
Rear /0
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 -7' DON'T KNOW YES
IF YES, date issued:
IF YES: Was the rmit 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:
64,-,1 J (i..=: C /L) c-
P cg 3 ( 1 - 0 ) 3 A .6gY - --- ti Department use only
�� \ City of Northampton Status of Permt
20 \ \ Building Department Curb Cut /Dri eway P unit
wG 212 Main Street Sewer /Septic Ayail a
�. Room 100 Wal r /Well Ava
�, ;'PN_ . - -�''-- Northampton, MA 01060 Trio Setsof St4ctural Ptans ;
°� � °;tH p h one 413- 587 -1240 Fax 413. 587.1272 Plot�Slte P0 e
Other Specifyt
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING I
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
/.5 /fia t/A) ilC0I -C7-. Map Lot Unit
Ve) v rt /hIp ix4,-/ • Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name ► ra r Current Mailing Address:
/ a 1 v Telephone
Sig
2.2 Authorized Agent: Nelson Shifflett
Valley Home Improvement, Inc. P.O. Box 60627, Florence, MA 01062
Name (Print) Current Mailing Address:
'7 4 584 -7522 _ _�.
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building /50°d (a) Building Permit Fee
2. Electrical '--1200 (b) Estimated Total Cost of
Construction from (6)
3. Plumbing i0 �(9 Building Permit Fee
i
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) (. aoo Check Number 3 (2 /3s) 1/ t)
This Section For Official Use Only
Building Permit Number: Date Issued: _
Signature: _.�
Building Commissioner /Inspector of Buildings Date I
File # BP- 2013 -0149
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413) 584 -7522
PROPERTY LOCATION 15 MAYNARD RD
MAP 31A PARCEL 149 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out per/ S \
Fee Paid v e eIsa)
Typeof Construction: REMODEL BATH,REPLACE PORCH SCREENS & POSTS,RECONFIGURE CLOSET
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 060300
3 sets of Plans / ' • Plan
THE FOL E WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO :: 1 ATION PRESENTED:
Approved 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 Variance*
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 CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
: olition - .:
e of B: ilding 0 icial 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.
15 MAYNARD RD BP- 2013 -0149
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A -149 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- 2013 -0149
Project # JS- 2013 - 000246
Est. Cost: $30000.00
Fee: $180.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 060300
Lot Size(sq. ft.): 10628.64 Owner: DAVID JUSTIN & JUDITH WOLF
Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 15 MAYNARD RD
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584 -7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:8/13/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: REMODEL BATH,REPLACE PORCH SCREENS &
POSTS,RECONFIGURE CLOSET
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 8/13/2012 0:00:00 $180.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner