24C-083 (7) •
'111
' - BP-2005-0933
1s#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2005-0933
Project# JS-2005-1304
Est.Cost: $20000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Valley Home Improvement, Inc 060300
Lot Size(sq. ft.): 7492.32 Owner: RADKE MARY BETH
Zoning:URB Applicant: Valley Home Improvement, Inc
AT: 15 MASSASOIT ST
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON:4/8/05 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL BATH & RELOCATE LAUNDRY
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 4/8/05 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2005-0933
APPLICANT/CONTACT PERSON Valley Home Improvement,Inc
ADDRESS/PHONE P 0 Box 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 15 MASSASOIT ST
MAP 24C PARCEL 083 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid _
Building Permit Filled out
Fee Paid /93 95 s SV —
Typeof Construction: REMODEL BATH&RELOCATE LAUNDRY
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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO)MATION 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 'ssion
oo ,/ r Loos
Signature of Building fficial 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.
•
L Department use only
�___ City of Norhampton Status of Permit:
Q WiliRlink- .7epartment Curb Cut/Driveway Permit
212A!lain Street Sewer/Septic Availability
Room 100 Water/Well Availability
APR - $403ampton, MA 01060 Two Sets of Structural Plans
phone 413-587.1240- Fax 413-587-1272 Plot/Site Plans __
Other Specify
APPLICATION TO CONSTRUCTT AtTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map Lot Unit
ir5*ev/tr-i. /7, ioycte Zone Overlay District
Elm St. District_.__ CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
/Veld i6
Name(Print ededidql
Current
��Mailing Addr�o��
bttg Teleph6r1eOG y
Signature JJJ
2.2 Authorized Agent: Nelson Shifflett
Valley Home Improvement, Inc. P.O. Box 60627, Florence, MA 01062
Name(P�riint)�/;, Current Mailing Address:
// � � 584-7522
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by permit applicant
. Bu 'ding
/e Oa a (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
V 0 • Construction from (6)
3. Plumbing c� ) Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 +4 + 5) d v,, Or d Check Number /93 93 105) —
This Section For Official Use Only
Signature: _
Building Commissioner/Inspector of Buildings Date
-ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing 0
Or Doors 0
Accessory Bldg. 0 Demolition❑ New Signs [ I Decks [ ] Siding [ ] Other [t] -
Brief Description of Proposed Work: D _ C
Alteration of existing bedroom _Yes No Adding new bedroom Yes No
Attached Narrative L Renovating unfinished basement Yes No
Plans Attached Roll '_ - Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family 1" Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? / 6,44 J/w�d�)d. Proposed Square footage of neta construction. pfe /4 G G /Dimsion,
e. Number of stories? 1 iG I-0 G r
0 /� of each
f. Method of heating? Fireplaces or Woodstoves Number
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
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 Tank City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I , as Owner of the subject property
hereby authorize Nelson Shifflett, Valley Home Improvement, Inc. to act on
my behalf, in all matters relative to work authorized by this building permit application.
' e&StQiimionl________±____
Signature of Owner Date
I, Nelson Shifflett, Valley Home Improvement, In 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.
Nelson Shifflett
Print Name
I I
r
I SECTION 8-CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: Nelson Shif f lett _ 060300
Valley Home Improvement, Inc. License Number
340 Riverside Drive, Northampton, MA 01060 9/22/06
-
Address Expiration Date
584-7522
Signature Telephone
1?1,( 71~71
9. Registered Hoe Improvement Contractor: Not Applicable O
Valley Home Impro_vement. Inc. _ 105543
Company Name Registration Number
340 Riverside Drive 7/17/06
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 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 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 ___
•
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 P-1\S
Side L: R: L: R: (Z.Ly
Rear I
Building Height q ,,,n Cl
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&pavedItj f,'
parking) (�1
fr °A)
#of Parking Spaces /)
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO L/ DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO v 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:
FSt1tit!p� .a.
� ens flit' fr c:aS �. _
` n c.1,.'f (rtf-t rt N rut-f ltmttTtfrttt
3 ,�r�
a
tr asaarlirnctfs —;
c� DEPARTMENT OF BUILDING INSPECTIONS .? \--zi -!"-i - ,
212 iu`ain Street ' Municipal Building `�
Northampton, Mass. 01060 `
WORKER'S COMPENSATION INSURANCE An ill AVTT
I, Nelson Shifflett, Valley Home Improvement, Inc .
(licenste/pe:mitten'}
with a principal place of business/residence at:
340 Riverside Dr. , Northampton, MA, 01060 (phone==1 584-7522
(.stir.-,t/city!; :dp)
do hereby certify, under the pans and penalties of penury, that:
(x) I am an employe: providing the following worker's compensation coverage for my
employees worldng on this job:
Acadia Insurance Co. 0109302-11 2/1/06
(Insurance Ccmpny) (PoUcv Number) ( piraccn 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 compensalion policies:
(Name of Contractor) (Insur-ance Company/Polio- Number) `..:✓Lorna Data)
(Name of Contractor) (Indira= Company Peiic•Number) cp rano a Date)
(Name of Coi.Lrac or) — (Insurance Company/Policy Nau'.bc.:) .xpt et:cn Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(avant sdd•tiocsl shed,foeecnuyto include information pertaining to all oorn:n..^..ors)
( ) 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 cnploy pc-sons to do n ezir^- r e eces r Dion cr ran-work on a dwelling of
cot more than three units in which the homeowner resides or on the grounds appurtenant tbcdo are not gwaally cocsidered to be
c pIoycs under the worker's ennipcsztion Act(GL152,ss 1(5)),application by a homeowner fora license or permit mey evidence the
legal status of an orcployer under the Worker's Coo pe nation Act.
I unSe ascend that a copy of thin r atcm,nt may bo forwarded to the Deport:need of industrial Accidents'Office of acausaoe for the
coverage verification and that failure to secure coverage under section 25 A of MGL 152 can lead to the imposition of cr'rim.l penalties
conniving of a fine of up to S 1300.00 and/or inipeisonment of up to cne year and risil penalties in the form of a Stop Welk Order and a
n=of S t 00.00 a day against me
SIgned this f y r! day of /"i h ct;�S For depesestal use only
Permit Number
Mat# Let# -
15" UTILITY CAB TO "MATCH "
EXISTING CABINETS
COAT CLOSET
PATCH SHEETROCK AND
2 X 3 NEW 30" FRIDGE
BASEBOARD
NEW 2-4 DOOR
REMOVE UNDER COUNTER
LAUNDRY AND BUILD TWO BASE
CABINETS WITH SLIDE OUT INSULATE UNDER EXPOSED
SHELVES TO "MATCH" FLOOR AT REAR OF KITCHEN
REPAIR OF"ROCKING TOILET"
DONE ON A TIME AND MATERIAL
NEW NG ED RADKE KITCHEN BASIS
OPEN
PATCH CEILING ONLY MODIFICATIONS
PATCH FLOOR ONLY
EXISTING DOOR
zJP ,
INSTALL
I, I OWNERS r-( I I- I
NEW MOSITURE RESISTANT 7 WINDOW I j U
SHEETROCK AND INSULATION l h
THROUGHOUT ,\vent relocated
SHOWER ROD /CHIMNEY TO REMAIN
TOTO 1.6 TOILET O TI�E IWALLS OVER DUROCK / /
\ / 'I [I -----UU___
DELTA VALVE AND PERSONAL
_GRANITE TOP,UNDERMOUNT SHOWER
SINK
I PANASONIC FAN A.S.CAMBRIDGE TUB
BEVEL EDGE MIRROR / a
DELTA VALVE PATCH CEILING. PAINT BYa.
\ I OTHERS
48"CUSTOM VANITY SIX A O
DRAWERS \ \
/ STACK LAUNDRY RADKE BATH REMODEL
FRAME TO 38 1/2"X 31 I
2-6 DOOR
RECESSED MED CAB I - /
—
NEW SIX PANEL DOOR Ask3-0 BIFOID li
NEW 15"DOOR REPAIR AND REFINISH FLOOR
LINENS
NEW SURFACE FIXTURE
yNEW 2-6 DOOR..NARROW\
3/ CASINGS
INFILL AND REPAIR CEILING -/
— %i
)FFSET FROM CASING TO
AATCH..BOTH SIDES OF / \
VINDOW — EXISTING /
�
\
— < � � UP
EXISTING