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16A-020 \5 a '� 5 -0 x 3 -0 SHOWER TILE FLOOR AND BENCH ..TILE WALLS AND SLOPED CEILING ABOVE , INCLUDING SKYLIGHT WELL FIXTURE SELECTIONS: LAV. FAUCET AMERICAN NEW VENTING / BENCH STANDARD 1480.101.002 SEVA SKYLIGHT O -REC. II SINGLE HANDLE I / TWO GRAB BARS TWO RETRACTABLE DRYING / • ,' / GROHE SHOWER VALVE WITH LINES BODY SPRAY, THERMOSTAT / 1/4 FRAMELESS DOORS AND ALSONS RAIN SHOWER 1 MARBLE THRESHOLD HEAD ON ARM. GROHE HAND HELD SHOWER ON BAR WITH I GROHE SHOWER HEAD ACCESORIES: - ANASONIC FAN. V ELCOMA 12" 1 1/4" BISCUIT /- - \ ■ GRAB BAR \ WALL TILE TO 42" kOly / 1-14,(11146( ' TOTO 1.6 DRAKE \ \ REC. ` 1 171.- 7 7 , TOILET (18 ") \ \\ \''. ----- i illi OPEN SHELVES AND RECESSED i T.P. HOLDER i MARBLE CAP ON 1/2 WALL i _ - 1 / TILE FLOOR / 1 / 7 \ REC. - EXISTING DOORS TO REMAIN / MARBLE THRESHOLD / r 3 HEAT LAMP n 1 36" VANITY WITH DRAWERS 1 TWO TALL 21" LINEN STORAGE CABS. 0 et- (--- T Robem 3626FS MED CAB. / LIGHT ABOVE LUADTKE BATH REMODEL 5-0 x 3 -0 SHOWER TILE FLOOR AND BENCH ..TILE WALLS AND 1 SLOPED CEILING ABOVE , INCLUDING SKYLIGHT WELL ' FIXTURE SELECTIONS: LAV. FAUCET AMERICAN NEW VENTING 1 BENCH STANDARD 1480.101.002 SEVA SKYLIGHT O REC. I SINGLE HANDLE ; , TWO GRAB BARS TWO RETRACTABLE DRYING / • GROHE SHOWER VALVE WITH LINES / BODY SPRAY, THERMOSTAT / 1/4 FRAMELESS DOORS AND ALSONS RAIN SHOWER MARBLE THRESHOLD HEAD ON ARM. GROHE HAND HELD SHOWER ON BAR WITH I GROHE SHOWER HEAD �� ACCESORIES: PANASONIC FAN. — V ELCOMA 12" 1 1/4" BISCUIT r \ GRAB BAR \ WALL TILE TO 42" A#(1 r- TOTO 1.6 DRAKE — i R F- ✓ w o /c 7 TOILET (18 ") \ - \ (j , I•_._ OPEN SHELVES AND RECESSED U i i , T.P. HOLDER fl l MARBLE CAP ON 1/2 WALL , _, - - 3 TILE FLOOR / i \ REC. - EXISTING DOORS TO REMAIN / -i MARBLE THRESHOLD HEAT LAMP i 3/ , 36" VANITY WITH DRAWERS ( TWO TALL 21" LINEN STORAGE . CABS. / !'J 0 _ q)4 I Robem 3626FS MED CAB. / LIGHT ABOVE LUADTKE BATH REMODEL O ;II liAMPi(.. t... Ai t.::, /Alt Q xttI of ',Northampton # 0 � i = i` 1 � : ( f _ � asanclittnetfs ' M T _ l= ""' � s m DEPARTMENT OF BUILDING INSPECTIONS ati .era ° 212 Main Street • Municipal Building �j Northampton, Mass. 01060`5f WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, .__Ne.lson A. S` i f.lett /\'alley Home Improvement, Inc.____ (licensee/pe: nittec) with a principal place of business/residence at: .J' i. v ers Driye, Northampton, AA, 01060 (phone #) _(_413) 584-7722 (st- -y t/cit7 /5taif- -' r do hereby certify, under the pains and penalties of perjury, that: (0) I am an employer providing the following workers compensation coverage for my employees working on this iob: American Int'l Companies WC00260737000 2/1/04 (Insurance Company) (Policy Number) (Expiration Date) ( ) 1 am a sole proprietor, general contractor or homeowner (circle one) and have /tired the contractors listed below who have the following worker's 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 additioml sheet if necessary to include information pertaining to all contractors) ( ) 1 am a sole proprietor and have no one working for me. ( ) 1 am a home owner performing all the work myself. NOTE: please be aware that while homeowners who employ persons to da maiuueuance, earretrudion or repair work on a dwelling of not more than throe units in which the homeowner resides or on the grounds appurtenant thereto are not generally oocuidered to be employers under the worker's ontnpeasation Ad (GL152,s3 1(5)), application by a homeowner for a license or permit may evidence the legal status of an employer under the Workers Compensation Act I understand that a copy of this ctatemeai may be forwarded to the Department of Industrial trial Amideo Office of Insurance for the ewvaage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties ooetsisting 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 Order and a fine of 5100.00 a day against me. Signed this . 0 Y tiny of 1- h .Q 3 i For de al use only 1 time SECTION 8 - CONSTRUCTION SERVICES .1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Nelson Shif flett_.____ 060300 Valley Home Improvement, Inc. License Number 340 Riverside Drive, Northamptnn, MA_llO60 9/22/04 Address Expiration Date 584 - 7522 Signature Telephone • I, t 9. Registered Home Improvement Contractor: Not Applicable ❑ Valley Home Improvement, Inc__ 105543 Company Name Registration Number 3 Riverside Drive 7/17104 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 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 heishe 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 he 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 ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ DemolitionD New Signs [ ] Decks [ ] Siding [ ] Other [ Brief Description of Proposed Work: PC/01 ( ';" Alteration of existing bedroom Yes fr/ No Adding new bedroom Yes Attached Narrative 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 Two Family b. Number of rooms in each family unit: 3 Number of Bathrooms____ c. Is there a garage attached ? - i d. Proposed Square footage of new construction. Dimensions e. Number of stories? N /j') f. Method of heating? Fireplaces or Woodstoves Number of each 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 Ina Luadtke & Genevieve Clarke as Owner of the subject prope,i} hereby authorize Nelson Shiff lett, Valley Home Improvement Inc . to act on my . in all matters relative to w•r/ authorized by this building permit application. Signa ure of Owner Date L Nelson Shifflett, Valley Home Improvement, Inc. 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 perjury. Nelson Shifflett Print Name Department use only City P of -Northampton Status of P P$it: Builcting Department Curb Cut /Drveway. rmit 212 Main Street Sewer /Septic Availability Room 100 Wa r /Well Availability. - r 20gIrtharnpton, MA 01060 TwaSets aural Plans phone 413 - 587 -1240 Fax 413-587-1272 Plot /Site Other Specify- APPLICATION TO ALTER, 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 /6/97 Lot Jc7 Unit?/ 301 Fait Village Zone 4611glay District Leeds. MA 01053 Elm St. District_ __ ___ CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 39 Daniel Drive Ina Luadtke & Genevieve Clarke Glen Cove, NY 11542 Nam- (Print) Current Mailing Address: 516 - 759 - 2182 �1., Telephone Signature 2.2 Authorized Agent: Nelson Shif f lett Valley Home Improveme t, Inc— P.O. Box 60627, Florence,.MA 01062 Name (Print) Current Mailing Address: ✓ii� 584 - 7522 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ,S O,Q) (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of �� Construction from (6) 3. Plumbing 3P Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) j / 11) Check Number / 11/4573 This Section For Official Use Only Building Permit Numbe 3 (D ( Date Issued:_ _ Signature: — Building Commissioner /Inspector of Buildings Date File # BP- 2003 -0661 APPLICANT /CONTACT PERSON Valley Home Improvement, Inc ADDRESS/PHONE P 0 Box 60627 (413) 584 -7522 PROPERTY LOCATION 301 FAIRWAY VILLAGE MAP 16a PARCEL 020 031 ZONE URA/WSP /WP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out / / ��i� Fee Paid /z /e 3 (e 7� Typeof Construction: REMODEL BATHROOM 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 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 'ssion Signature of Building 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. fi� X BP- 2003 -0661 GIS #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -031 Permit: Building Category: BUILDING PERMIT Permit # BP- 2003 -0661 Project# JS- 2003 -1088 Est. Cost: $10000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Valley Home Improvement, Inc 060300 Lot Size(sq. ft.): Owner: CLARKE GENEVIEVE L & Zoning:URA /WSP/WP Applicant: Valley Home Improvement, Inc AT: 301 FAIRWAY VILLAGE Applicant Address: Phone: Insurance: P O Box 60627 (413) 584 -7522 Workers Compensation FLORENCEMA01062 ISSUED ON:2/6/03 0:00:00 TO PERFORM THE FOLLOWING WORK: R E MO D E L BATHROOM 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 2/6/03 0:00:00 16103 $50.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo