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reoove unused chimney CE .
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repair roof leak
1 infill and refinish floor
N. new sheetrock throughout
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rebuild bead bd. pantry cabs. relocate fridge V3 -
bead bd. end panel )'
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new sink base and
convert surface to recessed and // s drop in sink
add two rec. on three way switches
---i / 24" cab for future dishwasher
- /
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existing overhead light to remain
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[ (-- Insulate knee walls and flat ceiling
I - \--- refinish floor ,\
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\ counter over under counter laundry
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15" + cab.
rebuild bead bd. storage
7 new partition
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24"gas range ' wall cabs / bead board
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nutone vent
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-$ 18" cab. slide outs
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"' DEPARTMENT OF BUILDING INSPEClTIONS
212 Main Street • Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION [NSURANCE A e i`.LDAVIT
I, Nelson Shifflett - Valley Home Improvement Inc .
(lic.°nseeipermittee)
with a principal place of business/residence at:
340 Riverside Drive, Northampton, MA 01060 (phone#) 584-7522
(s-ter-ott/c.ty s..u.^": 71)
do hereby certify, under the pains and penalties of per-jury, the_:
( I am nn employe: providing the following workers compensation coverage
employees working on this job:
Acadia Insurance Co . 0109302-12 2/1/07
(Insurance Company) (Pctic;Number) (`., iration
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's com ensation policies:
(Name of Contactor) (Insurance Corcoa-y/Po?icv Nnm::c;) (E..L-aac is:c.
(Name of Cont actor) (Insurance ComcauyfPoiicy Number) (Expir:0on Dare
(Name of Coacac:or) (Insurance Company/Policy N,urbz) ( pilmncn Dare)
(Name of Contractor) (Insurance Company/Policy Number) (Expiation Date)
(attach additional sheet ifneoeaary to include information pertaining 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:plr...se be aware that while homeowners who employ pas=to do maintenance,c nstrunioa er r^,air work on a dwell:cg of
not more than three units in which the homeowner resides or on the Bounds appurtenant theetn art not generally coardered to be
e loyr:s under the wod a compensation Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the
legal crania of an employee under the Worirds Compensation Act.
I undo-rand that a copy of this ztatcmrat may be forwarded to the Dopertznaa ofrna.,{rial Aocdoda'OfEoo of Iaauvnce for the
coverage verification and that failure to segue coverage under section 25A of MGL 152 can lead to the imposition of criminal prsfacs
comis<ing 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 Ordc and a
fine of S100.00 a day against toe.
Signed this / o f day of rc/, ,)lk9, For departmental use only
Permit Number
_SECTION 8 -CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Nelson Shiff let t 060300
Valley Home Improvement, Inc. License Number
340 Riverside Drive. Northampton, MA oiogn 9/22/08
Address Expiration Date
584-7522
Signatur � Telephone
asot
9. Registered ome Improvement Contractor:. Not Applicable ❑
Valley Home Improvement, Inc_ 105543
Company Name Registration Number
340 Riverside Drive 7/17/08
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. F ailure to provide this affidavit
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes ISI 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
'ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ J Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑ / •
Accessory Bldg. ❑ Demolition❑ New Signs [ J Decks [ i Siding[ i Other [1✓
Brief Description of Proposed Work: Aerzcfc I 'ad`�0 (/1 L.•%�j /20" ,L . A 1T°S�/Ml( ��.)-
J
f� /� a� s
Alteration of existing bedroom Yes No Ad :ing new bedroom c,!es%" No �J ��
Attached Narrative - Renovating unfinished basement Yes No
Hans Attached Roll _ - Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of dui ding One Family Two Family I, Other
5. Number of rooms in each family unit: Y . Number of Bathrooms
c. is there a garage attached? /i.,/
c. Prop sec Souare footage of new corstruction. 424 Dir ens:c
e. Num.oer of stories!
Menccd of ,-eating' 1=# Fir c'aces or `lVcoasto'ves Number of each
g. Energy 'Conservation Compliance. 71) 71 i'- ascneCh Energy Ocmpilance form attacnec
g i
Type of construction X r v� /
�`
. is cons: on within 100 ft. of wetlands? Yes Is construction 'NI:fun 100 yr. `lecdo.a . Yes
Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulatic-s? Yes No .
i. Septic Tank City Sewer Private well City water Supply
i
SECTION 7a - OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. kt/:// Z9 U*/)/ C. as Owner of the subject proper.,
hereby authorize Nelson Shifflett, Valley Home Improvement, Inc. to act on
my be If, in all tters lative t% ��'r' authorized by this bui ding permit applic bon.
Z00)6
Signature of Owner Dated
I. Nelson Shifflett Valle c •. - i, • • - rr - . • , as Owner/Authorized Agent
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 perj _
Nelson Shifflett /297a47
Print Name
1 ,
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 f
Building Height '
Bldg. Square Footage 1 /o
ee��ti
Open Space Footage ,.1 1 %
(Lot area minus bldg&paved
parking)
of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Findin ever been issued for/on the site?
NO 1/ 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 IV. 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:
`' ' ; Department use only
V-' '�7\‘‘City of Northampton Status of F41, -4
` Building Department Curb Cut/l 'I7?'"'' t
212 Main Street Sewer/Septi ar' tit jr t '-7'� -t
_, , _ i c Room 100 Water/WeII Avat a%lrty R
"'" a Northampton, MA 01060 Twa'Sets of.�A u�,al Plans
p neA413-5'87-1240 Fax 413 587 1272 Plot/Site P" j7 e ` < "
p
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
y93 S mq W�j Map Lot Unit
/f �/ "/�/;( Zone Overlay District
/42�(f °LC I%
Elm St. District CB District.
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
} 2.1 Owner of Record:
1,0;11:1Mid av ' 4 - A,61,. i y i. Ja94-,\,,-.) 6-)-7
Name(Prin ) r► Curren ai mg Add ss
.c A Telephone
Signature
2.2 Authorized Agent: Nelson Shi f f lett
Valley Home Improvement, Inc . P.O. Box 60627, Florence, MA 01062
Name,,(Print) Current Mailing Address:
U``\ t-L1 A N\ W u�'vF LL ` 584-7522
Signature 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 J (b) Estimated Total Cost of 1 �71J
())61'4.3-3 Construction from(6) / ->"
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection / 6 cel/ 7 may)
6. Total = (1 + 2 + 3 + 4 + 5) t)j se)a) Check Number Y �7
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2007-0257
APPLICANT/CONTACT PERSON Valley Home Improvement,Inc
ADDRESS/PHONE P 0 Box 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 143 SOUTH MAIN ST
MAP 23A PARCEL 105 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out e9/� 9r/ 011//7
Fee Paid
Typeof Construction: REMODEL 2ND FLR LIVING ROOM&KITCHEN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 060300
3 sets of Plans/Plot Plan
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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 Co • ion
/Vi L00 -
Signature of Building Officia 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.
143 SOUTH MAIN ST BP-2007-0257
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A- 105 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2007-0257
Project# JS-2007-000392
Est. Cost: $23500.00
Fee: $117.50 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group:- Valley Home Improvement, Inc 060300
Lot Size(sq. ft.): 7710.12 Owner: BOUTELLE ANN E
zonina: URB Applicant: Valley Home Improvement. Inc
Al:
143SO_SOUTH MAIN ST
Applicant Address: Phone: insurance:
P O Box 60627 (413) 584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON:9/7/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL 2ND FLR LIVING ROOM & 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:
L) _
Rough/ Rough: /6 3/V 6 p i House# Foundation:
Driveway Final:
�,� 4Final:
�' Prn° Rough Frame: O1/. , fr _ ( 'J
Gas: Fire Department Fireplace/Chimney:
Rough:j D "V)6 Oil: Insulation:
Final: op S/fir c /E_ f Smpke: Final: p 3 V(S10`'o (-4-U r5
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
0
Certificate of Occupancy- - O Signature:
FeeTe: Date Paid: Amount:
Building 9/7/2006 0:00:00 $117.5021496
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo