24C-084 (2) i ms pan is me propnerary wont prooucr ar vaney name improvement,mc.t vrrr/.iris oenveiea ror me nmirea ano ezausive purpose or suppomng me contract ara or yr i,ano customer agrees mar me eiemenrs or ruts pan snap not oe repuonsneo or presenrea in any
form for the purpose of enabling or supt?orting the work of competing project contractors without the permission of,and compensation paid to,VHl.
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Yaile Dome Im rovement Inc. MASSOSOITST EXISTING SCALE:SEE VIEW SHEET NUMBER
NORTHAMPTON,MA 01062 DATE:11/24/2015
340 Riverside Drive, PO Box 60627, Northampton, MA 01062
Office Phone 413.584.7522 Fax 413.585.0820 GOVERM IPLF CONDTIONS DRAWN BY:S.G. 2
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Yaile Dome Im rovement Inc. MASSOSOITST EXISTING SCALE:SEE VIEW SHEET NUMBER
NORTHAMPTON,MA 01062 DATE:11/24/2015
340 Riverside Drive, PO Box 60627, Northampton, MA 01062
Office Phone 413.584.7522 Fax 413.585.0820 GOVERM IPLF CONDTIONS DRAWN BY:S.G. 2
Find us on the web at: t atw.Valle Homelm rovement.com On
�-*LOOIR PLAN NOTES:
1 ALL EXTERIOR DIMEN510N5 ARE TO THE MAIN Z I
I
Q, E:i E°{OR LAVE°. CIMEN510Sd5 TO OPENINGS AAy TO u
THE FRAMING,ROUGH OPENING. INTERIOR ( Northampton I r I
City of
DIMENSIONS ARE TO THE FINISHED WALL. Buildinn Department
R'
2.GONT?AGTO€SHALL VERIFY ALL GlMcN51GN5 AND I5 ( y p
a RESPONSIBLE FOR ALL DIMEN51ON5(INCLUDING Plan Review
e ROUGH OPENINGS), c°r c
212 Main Street >
EL OTEe: ,- Northampton, MA 01060 �,Uj
N co
y - ♦ .-. - �� / V%e3!'SDO1 `6 1'AEMI"-31 - 1•ivi 7R,7,--,K4',
to
m THE LEAD CARPENTER SHALL FULLY COMPLY WITH THE 2009 / J
z IRC AND ALLADDITIONAL STATE AND LOCAL CODE
REQUIREMENTS. EXT„??5cow
° WRITTEN DIMENSIONS ON THESE DRAWINGS SHALL HAVE -
- -
a PRECEDENCE OVER SCREED DIMENSIONS.THE GENERAL ,�-.i•-�-�, .t,r
E CONTRACTOR SHALL VERIFYAND IS RESPONSIBLE FORALL =
L, DIMENSIONS(INCLUDING ROUGH OPENINGS)AND A °
° CONDITIONS ON THE JOB AND MUST NOTIFY THIS OFFICE OF 1 E11 3 E' i c!T IL
r ®, P i Ems', *s 0 -----—\
ANY VARIATIONS FROM THESE DRAWINGS.
TUB
H THE GENERAL CONTRACTOR IS RESPONSIBLE FOR THE
w DESIGN AND PROPER FUNCTION OF PLUMBING,HVAC AND
2 ELECTRICAL SYSTEMS.THE LEAD CARPENTER OR
SUBCONTRACTOR SHALL NOTIFY THE OFFICE WITHANY
E PLAN CHANGES REQUIRED FOR DESIGN AND FUNCTION OF -- —
o PLUMBING,HVAC AND ELECTRICAL SYSTEMS. E A MI E 0 1"4 6���g�� ` °lam!
}
�
DESIGN CRITERIA: 20091P.CAND IBC ALONG WITH STATE
AND LOCALAMENDMENTS Zy a ---- ----- --- --
j ROOF: SNOW LOAD DETERMINED BY AMENDED I.R.C. E ue,I L 0-n U R,i°' _
RELOCATE FLOOR: 40PSF LL. AND
SOIL: '2,000 PSF ALLOWABLE(ASSUMED). ' ) ti
FROST DEPTH: a
°
i
�� Ti
s TRAM
THIS STRUCTURE SHALL BE ADEQUATELY BRACED FOR WIND
m LOADS UNTIL THE ROOF,FLOOR AND WALLS HAVE BEEN
PERMANENTLY FRAMED TOGETHER AND SHEATHED. 1 I
INTERIOR FINISH NOTES: 1�m E Vi'°+i NI IT TO f �9
d RENDERINGSARE NOT TO SCALE;ALL RENDERINGS ARE �� i N
$p , 1,1 ;11 � '. � tO
y W FOR ARTISTIC DEPICTION ONLY.PLAN UPDATES MAY NOT BE C,9 ' _u I x O
$ a REFLECTED IN RENDERINGS.RENDERINGS SHALL NOT BE "Y'
o USED FOR CONSTRUCTION. O well
c SEE FINISH PLANS &SCHEDULE FOR SPEC'S
o
Z
? o EXTERIOR FINISH NOTES:
NEN FIXTURE
----- — — ---- ------ �1r�d LINT EN C3 OEE-T ITH �' �L'li;J 0 FO
m RENDERINGS ARE NOT TO SCALE;ALL RENDERINGS ARE
FOR ARTISTIC DEPICTION ONLY.PLAN UPDATES MAY NOT BE W
o REFLECTED IN RENDERINGS.RENDERINGS SHALL NOT BE = I zi _
m.y USED FOR CONSTRUCTION. _____ _ __,__-___�_ __ 0
w -- fw
SEE FINISH AND PLANS&SCHEDULE FOR SPEC'S N E TILE FLOOR y � v
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The Commonwealth of AAIassachusetts
Department of Industrial Accidents
6 t— Office of Investigations
=, � 1. 600 Washington Street
7�—
Boston, MA 02111
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): mQY b\.sYw)C`.'n4- , —Tn
Address:
City/State/Zip: Y DI '(l l f: , `(lam Z;IVhone:#: L�`� � .
Are you an employer? Check the appropriate box: Type of project(required):
1. I am a employer with �9 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. r-1 New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
working or me in an capacity. employees and have workers'
g Y P h'• 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.+
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.E]Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.❑ Other
comp, insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
+Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:_ be,..,�G1 C C1`X�{Z C ►'CJ.J
1'alicy#or Self-ins. L1c.#: �C.�C Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form_of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify � the pains a d penalti perjury that the information provided above is true and correct
Si nature: p -' : "�' Date:
4
Phone#:
I i Official use only. Do not write in this area, to be completed by city or town official
B
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
s
'Is:s I-wl-,t
t
MOT0< x cc of i...'4 k, ..dn'.t.,'a ASK ,.$', d Bul"' lslt,'b,,,, e . .,
it, Park Plaza - Swe 5 171)
Won Masoldin eu, 1)
T-;f ,
d.
P t, ba, aF,
F LORE
xe3'r.n X
Lily of Tlortl_Za.mpton 212 IMain Street, Northampton, MA 01060
Solid Waste Disposal Afflda dt
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: � Ca � yee -
The debris will be transported by: ` ro'f
The debris will be received by:
AA , rwj—Lntg
Building permit_number:
Marne of Permit Applicanfi Ou
--
l
Gate Signature of Permit Applicant
SECTION B-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: 1 Not Applicable ❑
Name of License Holder:� f11 l���tVV1�t t'1 (�,,�� ��
License Number
2_6 T2
Address Expiration Date
SEA--1 153a Sign Te ephone
9.Registered Norte Improvement Contractor Not Applicable ❑
Company Flame Registration Number
Address rr Expiration Date
Telephone )C1V` _T D�D
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....... No...... ❑
11 do e Owner Exefilptl6n
The current exemption for"hameoumers"was extended to include 0irmer-occu pledl Dwellings atone(1) or two(2)families
and to allow such homeowner to engage an individual for hue who does not possess a license,ur a Jded that the owrber acts
as suuoerAsor.C_'R 380• Sixth Ednt?on Section
Defirit:ion 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 verson who constructs more than one borne in a two-year nerlod shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official, on a form acceptable to the Building Offlcial9 that he/she shall be
responsible for all such work.rnerformed under the bu?tldfn6 hermit.
As acting Construction Sunenisor our presence,on the job site thrill be Yetlirireri fi•nm time to+ ,A a�. a.�C
} .. _ . _.. aa;id, 5 1
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 niay be Hable 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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New douse ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0) Decks Siding[®] Other[d]
Brief Description of Proposed
Work: 9-MOID EL cIr— SEC. 6 rcon
Alteration of existing bedroom Yes No Adding new bedroom Yes N
Attached Narrative Renovating unfinished basement Yes _ No
Plans Attached Roll -Sheet 1\11
6a.If New house and or addition to existjng�� got r bjete th6 foil w�6
a. Use of building :One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. 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 T aril: City Sewer Private well City water Supply
SECTIO+N'?a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, o L� ►� �" I � �r as Owner of the subject
property
hereby authorize
to act on rnpo f, ' II tive to work autho ed by this building permit application.
Signature of weer Date
as OwnerlAuthofted
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
i and belief. -
Signed under the Pins and penaliles of pet-jury.
j
i Print Name
I y
I signature or Owner/Agent Date
Section 4. ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
et ac cs Front
Side L::.... R: L.- R
Rear
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 0 DONT KNOW 0 YES 0
:.............. .........;
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book Page: and/or Document#
B. Does the site contain a brook, body of water or.wetlands? NO 0 DONT KNOW 0 YES 0
W YES, has a permit been or need to be obtained from the Conservation Commission?
Reeds to be obtained Obtained � , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
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:
-.. Ut Ili liiG Vli'1�-U..l.UC4 G Ids.:' U . t. ,:- ,-:r i_': •i!� ,.,-.'_;,:.:i. :1. :i:.: .,�� �,: i QliiG vi I:�ft[i�IC Ut G l.�il�liUll i./I C111
that wiff disturb over 1 acre? YES K!0 ,0
IF YES,then a Northampton Storm Water Management Permit from the DPIAI is required.
• Department use only
City of Northampton Status of Permit:
g Department Curb Cut/Drive. way Permit
,- 12 Main Street Sewer/Septic Availability
�R n Room 100 WaterMell Availability -
� JAN ' 5 201Ao rt-tam pton, MA 01060 Two Sets of Structural Plans
_� phone 413- 87- 240 Fax 413-587-1272 Plot/Site Plans
C 'INS oth fy
er
Sped
.
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Prop rty..Address:
/� This section to be completed by office
t l(,S zl s®l v rF''e V flap Lot Unit
Zone Overlay District
Elm 5t.District Ca District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
21 Owner of Record:
Name Current Mailing Address:
tot 1- 331:-,- (owl4
Telephone
gnature
2.2 Authorized Acient:
i Q (OoloaA
Name(Print) Current Mailing Address:
LA I b- C6001A cc�-2-2—
Signat vf Telephone
SECTION 3-ESTOMATED CONST€UC—TiON CO-STS
item Estimated Cost Poliars)to be Official Use Only
completed by ermit applicant
1. Building 1 (F3, so o (a)Building Permit Fee
2. Electrical 000 (b)Estimated Total Cost of
Construction from (6)
i 3. Plumbing 1 ,COQ Bw*; n Ferixtpr Fee I
I
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+ 3+4+5) aq,Doe Check Number
This Section For Official Use Only
Building Permit Nurnber: Date Issued:
I
Building Commissionerlinspector of Buildings Date
File# BP-2016-0866
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE01062(413)584-7522
PROPERTY LOCATION 17 MASSASOIT ST
MAP 24C PARCEL 084 001 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
Fee Paid
Typeof Construction: REMODEL 2ND FLR BATH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans included:
Owner/ tatement or License 077279
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR ION PRESENTED:
pproved 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
Demolition Delay
Signature of Buil mg Wficial 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.
17 MASSASOIT ST BP-2016-0866
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C-084 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-2016-0866
Project# JS-2016-001459
Est. Cost: $24000.00
Fee: $156.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 7492.32 Owner: GOVER JENNIFER
Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT. 17 MASSASOIT ST
Applicant Address: Phone: Insurance:
P O BOX 60627 (413584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.11612016 0:00:00
TO PERFORM THE FOLLOWING WORK.REMODEL 2ND FLR BATH
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 Occupant Signature:
FeeType• Date Paid: Amount:
Building 1/6/2016 0:00:00 $156.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner