29-423 •
•
,/emu ona /ei Ol ✓f'l..:Y/dda
`�'- L icense or re gistration valid for individul use -onl
�\ Office Affairs Business Regulation e only
17 -, 777 f
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 105543 Type: Office of Consumer Affairs and Business Regulation
,i, .- Expiration 7/17/2012 Private Corporation 10 Park Plaza - Suite 5170
Boston, MA 02116
VALLEY HOME IMPROVEMENT= INC.
Nelson Shifflett
340 RiversideDr. -, (�` ,
Northampton, MA 01060 4!
Undersecretary Nfivalid without signature
\lass -chu�sttts, Dtp i tmcnt o Pub Sa#L`.
+ Board o Building Rte ul !bona mil St :Intl rth
1, onstruct]on .)Lip...r :soa License
One- and T Farnily D
License: CS 60300
NELSON A SHIFFLETT
• 340 RIVERSIDE DR PBX60627
MA 01062
`i --- ��,y` Ertii; Lion: 9/22/2012
( ntnnO,Niuner r r;=': 2383
4.../ (- xtf Xttritiumpion
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Acts5ncfrni5etts
DEPARTivf ENT OB BUILDING INSPECTIONS Mil
•, 212 Main Stree ° Municipal Building
Northampt on, Mass. 01060
WORKER'S COMITENSATION MI'SURANCE AFYIDAVIT
L-5 C SIY` ni="77Z- //h,
(liceastermittee)
with a principal place of 1) Tsiness/residence
J 47'0 /:_i/Zi/z-..5 A-2)/Z , j„64 Al: (phone#)
(s zi6 6
do hereby certify, under the pains and penailfes of pedury, that:
am an employer providing the followigg, worker's compensation coverage for my
employees working on dais job:
2//11:1
55
(Insurance Co torpemy) (Policy Number) (E.xiiraton Dare)
) am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have tht following worker's compensation policies:
(Nanie af Contractor) (nsaranc Company/Policy Namkr) (E.xTiration Date)
(Name of Contractor) (1.a.suranct Corrrpany/PoLicy Number) (Expiration Date)
---
(Name of Contractor) (Insirranc°,.._ Company/Policy Number) (Expiration Date)
„a.
Conf-racter) (T-DISILI CaliClp,a4/TdiGy (n011 DaV,)
(attach additicaal tht if n ytd inohide - infoarifi,±€,,m pie tn edl o 0 cs )
) 1 atra a sole proprietor and have no cne cworking for me.
) If am a home owDer perfotTainq a U the work WYSelf.
aware %tilt Wffile to " !"' 1
_ LT, az L-1 coo LIca.`
6 Act (G3I-157y.ii lby f P•%'=" `-
5121, , rnr2!:.)rX Ur.4.4 V,
th,-.LL cpy ofh ay b ths D ofLhriJ Ai Offi,J of h=s_oacs
Va" 0 .--Ifa fail= to ==- corgrtr A , of MCIL 157, cj l o - L1=55 ;nv- elf crialifisJ
of a Et.--.0t FLIek 310:pr f n1 J p=31 j tfc,m of a Stc, V./a& Ore-: and a
9no of n0 Jay 0
SiP LUIS
day o). 4,9 F L!_Ct.. 1) 1
» 7 ,1 ' Pormit Number
1
T 44
// il=t ■=4
11
is...._atitre: of L'44,,szt/Per-initt"
r
SECTION 8 - CONSTRUCTION SERVICES 1
.1 Licensed Construction Supervisor: Not ;Appiicabi;; El
Name of License Holder : Nelson Shifflett_.__ 060300
Valley Home Improvement, Inc. License, Number
340 _ Riverside Drive, Northamp MA 0106 9/22/f
" Expira. on Date 1 ./ ► i.... _// 584 -7522
Saratur Telephone
.
• 3., Re> istered Home improvement Contractor: i Not Al ,I.cahe ❑
Valley Home Improvement, Inc- _ 105543
Com_an - -Name
P_ -�' - Registration Number
340 Riverside Drive 7/17/12.
Address Expiration Date
No rthampton, MA 01060 Te,ephone 584 -7522
1 SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6 L
i 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.'- =lame Ow ner Excin. jt� on
The current exemption for "homeowners" was extended to include Ow ocr- o cetrn icd Dwweliin��s of one (1) or two(2) families
and to allow such homeowner to eivage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. Citi1R 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on Nvhich he/she resides or intends to reside, on tvhich 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 -vear 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'shc shall he
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required fi 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 15 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, von mav he Liable fOr person(s)
you hire to perform work or 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
• 7- CTT1N 317.SCilyTtON Q • VrORI(wrk
u itscdittitt P.12t VR'ird:;vef, A tut,',Itiott(L) r
f2Out,.f, :
Sig ps Decks
Othe
' insulaic moan a411c- netU loor 5 tnsI
geucte \JeA+ fl k."iieeL,,,(1.1,1 cLrect_
4 „,t,„„h; 1,
6.: 11 etY . 11c)t;e and or addition to existing liousirm. complete the followitiox,Cm s7or
• 0.3
'kL r
/"; ■1 „ r , , ^ r.„
4
,
%%. i:M" 't t ' ".":" ■;`"
SECT:Cf^: 7 OVER AUTNORLZAT TO CIE Ca.',)PLETED MIEN
OWNERS ACCT OP CONTRI-` APPI IFS FOE BUILoING, PERMIT
• GZ;04UNr) • a..
Nelson Shifflett, Valley Home Improvement, Inc.
.t tt '„-
efiet t ,_,,Valley Home_ Iraproy_emen t , Inc.
Nelson Shi±flett ,
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
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 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit 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:
,
`
�
\ ��%���~~~ City of Northampton Department use only !
Status of Perrnit: i
n0\\ Building Department Curb
DE-C 1 g ��`` 212 Main Street --- —�Driveway -�-°
Room 100 Water/Well Availability ,,. _,,
`'w hanlPtOD.N1ADl060 Two Sets of Structural Plans , ,,,
°-wonn°�''- ML hOO 413-587-1240 Fax
phone ' ' '
Other Specify
����� _
H APPLICATION TO CDNSTRWCT.ALTER, REPA|R.RENOVATE ORQBMOUSHA ONE QRTYYD FAMILY DVYELLING
__ _
SECTION 1 - SITE INFORMATION
- - .
imueudontnhmoomp|e�dbyu/�ne --'
1.1 Proper
�
/�n�/ map Lnt Unit _______
�� ����^`'~_, . D'r.
Zone Overlay District
8rus,.Dis�i,t �B �is�,i�� __
SECTION 2'PROPE ( OWNERSHIP/AUTHORIZED AGENT
! - --- �
2.1 Owner of Record:
� ~ d Q�
~�������‘�� K;��«�vAo ^ � ( ��� Dr, _ ��-�\
---- -� --'—`--' '
- Name (Print) Current Min Addrcss:
��� \~_' Telephone
--- --- -- - �
__- � ��^� ,�-=�� ' -_ p''~''
Signature �
- '
` 2.2 Aut obzadAAent: Nelson Shifflatt
^ Valley Home Improvement, Inc. P.O. Box 60627^ Florence,
Name (Print) Current Mailing Address:
' 584-7522
--~------� /r� ., -- -- - -- --'-- ---- --'--
Signature _ Ta;cp:onr
SECT|ON3 - ESTIMATED CONSTRUCTION COSTS '
Item Estima�edCost (DoUao)tobo Official Use Dn]y
completecrnit app/icant
I Building �U��/��u*� 7)/�> Bui|dingPenn:t
_ _ | �W����`�^�^ `~-- � �
2. E!octrioo| (b) Es imated Total Cost of
Construction from 6 |
—
/
3. Plumbing Building Permit Fee \
4. Protection
� �� l �� ��
=(l +2+ 3 +4 + 5> Ch ac k Numbor L� _ � ~~ `��
5. Fire _
This Section For Official Use On|
Building' Permit Number: __ __________ Date |sxued� __
- - -
_ ___ _
�i8netue� __ __ _- __- _-_ -- '____'_ __-___ _-_ __'- _
| _Bni|g�n�Cnmmi,�irnm/|nspoo�/nfBuU�in�, _ _ __ Date __ __ |
^ ,
File # BP- 2012 -0587
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413) 584 -7522
PROPERTY LOCATION 47 GOLDEN DR
MAP 29 PARCEL 423 001 ZONE URA(100) //WSP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /�Q • 1 30 r'c�
Fee Paid Q ' 7
Typeof Construction: INSULATE MAIN ATTIC & KNEEWALL & INSTALL REPLACEMENT
WINDOWS/DOOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 077279
3 sets of Plans / Plot Plan
THE FOLLOWING 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 Commission _ Permit DPW Storm Water Management
1 emolitio • 1 elay
7 ; ;
Signature o Buil, g Official 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.
47 GOLDEN DR BP- 2012 -0587
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29 - 423 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit # BP- 2012 -0587
Project # JS- 2012- 001002
Est. Cost: $8000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 14374.80 Owner: GOODWIN STEVEN D & GAY L
Zoning: URA(100) //WSP Applicant: VALLEY HOME IMPROVEMENT INC
AT: 47 GOLDEN DR
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584 -7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:12/22/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:INSULATE MAIN ATTIC & KNEEWALL & INSTALL
REPLACEMENT WINDOWS /DOOR
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 12/22/2011 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner