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N - -BYOI 06) IL p W J pr a' LL ?t%; r �igbd�y °ke zk. r M#' ed�� i 4�Sy =�YM w w U z o w ui o Uw z U) --- - } �w w w n- 0 o ° 00 w ww ( a� Zlo'l i g - LL F o w n L w oQ � w U k' LL .�Y uJ ' � z o 0za J N U- C) T pd QD II! w Q oo LL = Z �i W J Yd W J ' W- U. ,u r Dv I—VT : . -NOTE- THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. BUILDING LOCATION ACCURACY IS NOT GUARANTEED S �5 dv� t+- i TO: FLORENCE SAVINGS BANK & LAWYERS TITLE INSURANCE CORPORATION TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES, EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY # 250167 —NOTE- SURVEYOR: �T• __ THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY OF _MORTGAGE LOAN N INSPECTION PLAT— NORTHAMPTON, MASSACHUSETTS RAN PREPARED FOR 0 IZ. y ROBERT M.J. & IRENE CLOUTIER #35032 SCALE: 1 "=30 ' AUGUST 10 , 1998 �Q HAROLD L. EATON AND ASSOCIATES, INC. suRVE'�° REGISTERED PROFESSIONAL LAND SURVEYORS 235 RUSSELL STREET - HADLEY - MASSACHUSETTS 41t1AMP�. goo o Fg GZt7 of Xvirt1jaill full Z - 9 B �asaxchnsctls m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, Nelson A. Shifflett / Valley Home Improvement, Inc. (LccnseeJpermittee) with a principal place of business/residence at: 320 Riverside Drive, Northampton, MA 01060 (phone4) (413) 584-7522 do hereby certify, under the pains and penalties of perjury, that: M I am an employer providing the following workers compensation coverage for my employees working on this icb: Travelers Insurance Co. UB88SD9983 2/1/01 (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 workers 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 duct if necessary to include information pertaining to all coairacwrs) ( ) 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 whilo homeowners who crrplay p=ons to do maim— -tc r construction or repair work on a dwelling of not mote than throe units in which the homeowner resides or on the sxouuds appurtenant tharcto are Dot geoc ally oonsidered to be employes under the worker's compc os4on Act(GL 152,ss 1(5)),application by a homeowner for a Neese or permd may evidcnoe the legal status of an employer under the Worker's compensation Act. I undersuad that a copy of this&a I emeat may be forwrudbd to rho Departmood of Industrial A.=daa&Office of Inauanoa for the coverage vaificatioa and that failure to sect=coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties contisting of a fine of up to S 1,500.00 mxdlor irmpriso�of up to one year and civil penalties in the form of a Stop Work Order and a fro of 5100.00 a day agairui me Signed this , day of 2000 =MapF# Lot r" /V Signature of Li ertni tee tar 16 00 10: 53a p. 4 A• T� SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed C4ns3[ttion SS/uRServisor: �y Not Applicable ❑ Narne of license Holder "C A/ -S i / �� _ )1 � License Number 61'<ez i:1y-s e , �'d ,v/ `�0�3 � ql�U Address ---' '– Expiration Date Signature Telephone ;9 Fitsr`ttb` tlx�ttirPli�rl}t� 'olfi§iNft�t=Ci � to"rss ?'r r�, ,, ,<< v: r,: Not Aop;icaole C Company Name Registration Number 3Z0 lel�llle,-'Y14: �,er y� _ _ �I;Mao Address Expiration Dale 67O6Qreleptione SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G,L.x.152,§25C(6)) Workers Compensation: Insurance affidavit must be completed and submitted with this aoplicat on. failure to provide this af`idav - will result n the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... L1 J N5 i, The cw-tent exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)£unilies and to allow such homeowner to engigot an individual for hire who does not possess a license, provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 1083.5.1. Deilnition of Homeowner: Person(s)who own a parcel of land on which he/she resi&s or uitends to reside,on which there is,or is ititendcd to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person Nyho constructs more than one home in a two-year period shall not be considered a homeowner. Such"I ionic own er"shall submit to the Building Official,on a form acceptable to the Building Official,that be/she shall be responsible for all such work performed under the huildinp-permit, As acting Construction Supervisor your presence on theob site will be required `.rout 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 1-53 (Liability of Employers to Employees for injuries net resulting in Death)of the Massachusetts General Laws Annotated, you may be liable for persons) you hire to perform,,york for you under this pen-nit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the Stat:Building Code.,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature__ — _ •�tyar 16 UU 1U: 53a p. 3 SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House O A. ' on ' Replacement Windows Alterations) R ofing ❑ O ' iv'�14 Or Doors 0 /llD J J. Accessory Bldg. ❑ Demolition❑ New Signs [ j Decks [ ) Siding[ J Other[ J Brief Description of Proposed Wor'K: --./ /'�` L — -- — Alteration of existing bedroom NO Adding new bedroom_ Yes e<No Attached Narrative Renovating unfinished basement, Yeso Plans Attached Roil n- Sheetp--C;, 6a 1f1V+3siullt(is�is+b' !atr�df flia�t.t ?(r# itl. g"#ttri5rtg�.'�tt�iD :Iin. iu LCIYyiC: a. Use of building. One Family- t--' Two Family Other b. Number of rooms in each family unit: 17 Number of Bathrooms c. Is there a garage attached?4- d. Proposed Square footage of new construction. J Dimensions — e. Number of stories? f. Method of heating? /U / Fireplaces or`,Noodstoves Number of each g. Energy Conservation Compliance. ``' �� Mascheck Energy Compliance form attached? I h. Type of construction_ i. Is construction within 100 ft.of wetlands? Yes 10. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade. k. Will building conform to the Building and Zoning regulations? _ Yes No . I. Septic Tank City Sewer Private well City water Supp.y SECTION 7a-OWNER AuTHORIZAT'ION --TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FQR_BUILDING'PERMIT as Owner of the subject property hereby authorize – / 1� _ � to act on my behalf, in all rs rel i to work authorized by tnis budding permit application. Signature of Owner Date 'D O , A�`` l /vGS(` �v s/✓ �/�����/ s Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, tc the best of my knowledge and belief. Signed under the pains and penalties of rjury. Print Name ec2l�vl') �q- Signature of Owner/Agent Date far lG GU 10: S2a p• 2 erode A'jj e)(eep f' g 0/�C a '6 ' x /y ' 'Oec_4 4s . ate -V M /n/--//O/V"" Section 4, ALL INFORMATION MUST BE COMPLETED, or PER HT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be tilled in by Building Department Q Lot Size �Q�0&1f) Frontage _ /Q9 , s d' Setbacks Front ?D Side L: _R:�.5 L:_ CC + R: ��, �J Rear 5W, o Building Height �:J1 �� � _ av � 35- Bldg.Square Footage LS 7o Open Space Footage I % tLot arkin ea minus bldg 8 paved + 7 8 r3© —7 7 12 U/ r �87 ✓7 6 O a of Parking Spaces a Fill.. volume do 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 1,-� 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 _ t,�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:_ a= Q tyof Northamptonf '' ui.iding Department � 212 Mai n Street P `� ^ 1CtS°FCS Room 100 Northampton, MA 01062 .; Jj rM� a a�iu.R one 413-5871240 Fax 413587.12.71.- �yl:'� i i•rid+ s C��t t r kah 4_4 ut'k APPLICATION TO CONSTRUCT. ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING j /V/ SECTION I-SITE INFORMATION / . 11k,114-d- 1,1urlxAddrs -- This�ec314T1'ttibe oot►rpteteti b Office, 0/U Zone Yetlay'Drstr4ct: --- _Vrn t iRpAirt CB'DastnGt_ _.' SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Nam Print; Curren;Mailin d e Telephone o S natur �Gr 2 — 6 AY 2.2 Authorized went: � LL y j /V, Name(Print) Current Mail Ing Address: - N��A — Signatu a Telephone LION 3•ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Buildings/Orel (a)Building Permit Fee 2 Electrical (b)(b)Estimated Total Cost of Construction from E 3. Plumbing i coo Building Permit Fee 4. Mechanical (HVAC) / 5. Fire Protection 1 C� a 6. Total =(1 +2 +3+ 4 +5) I AL CCU Check Number / )7S' This Soction For Official Use Only Building Permit Num Date Issued: Signature: Loop Buil ing Commissioner/In ector of Buildings Date + W� File#BP-2000-0957 APPLICANT/CONTACT PERSON Valley Home Improvement,Inc ADDRESS/PHONE P O Box 60627 (413)584-7522 PROPERTY LOCATION 40 HICKORY DR MAP 29 PARCEL 018 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Z/ `5- / S — Typeof Construction: REMODEL KITCHEN&BATH&ADD 8 X 14 DECK New Construction Non Structural interior renovations Addition to Existing Accessojy Structure Building Plans Included: Owner/Statement or License 060300 3 sets of Plans/Plot Plan THVOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § _w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § w/ZONING BOARD OF APPEALS 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 Com ' on Permit from CB Architecture Committee L acv Signature of Building O cial Dat 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. f ;; �, �, rt �� �,. -�<' 40 HICKORY DR BP-2000-0957 GIS#: COMMONWEALTH OF MASSACHUSETTS Mgp:Block:29-018 CITY OF NORTHAMPTON Lot:-001 Permit: Buildin Category: alteration-addition BUILDING PERMIT Permit# BP-2000-0957 Project# JS-2000-1750 Est.Cost:$35000.00 Fee:$175.00 PERMISSION IS HEREB Y GRANTED TO: Const.Class: Contractor: License: Use Group: Valley Home Improvement, Inc 060300 Lot Size(sg.ft.): 14941 .08 Owner: KEEFE JAMES&YVONNE Zoning:URA Applicant. Valley Home Improvement, Inc AT: 40 HICKORY DR Applicant Address: Phone: Insurance: P O Box 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON.518100 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN & BATH & ADD 8 X 14 DECK POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: �i�A'�+� Footings: Rough;a (�A� �RVAS Rough: $AA House# Foundation-/,/, a� ]`d Final: OO r�3'"' /`OCR �0 6 � 8 Final: ���� Rough Frame: ok 6 6 Gas Fire Denartment Fireplace/Chimney:A)p-n-e— 'am— Rough: -" Oil: Insulation: Final: Smoke: Final: 151w' THIS PERMIT MAY BE REVOKED BY THE CITY OF RTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc nature.� S� . Fee Tyne: Receipt No: Date Paid: Check No: Amount: Building 5/8/00 0:00:00 11895 $175.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo