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Valley Home Im rovement, Inc.
p
P.O. BOX 60627, NORTHAMPTON, MA 01062
413- 584 -7522
FAX 413 -585 -0820 DESIGN / BUILD
VALLEYHOMEIMPROVEMENT.COM ADDITIONS • RENOVATIONS
EIIVEp
FEB 7 2012
2- 6-2012 DEPT. OF BUILDING INSPECTIO
NORTHAMPTON, MA 07060
Northampton. Building Department
Hello Linda
This application and plot plan is for an addition to be constructed at 37 Prospect Ave.
As you can see from the plot plan attached, we are too close to the lot line on the garage side of the
house, so will need a finding. I'd like to start that process while we're developing construction drawings,
which I will submit within the next two weeks.
Please let Mitch know if you'd like him to make the check out for the entire amount of the permit, or
just the fee for the zoning application.
Thank you
.0?
Nelsorr Shiffl -tt
PROSPECT AVE.
65 '
N FRONT
O
--- 1 1' -8" 32'-4" 3'_6.,
EXISTING MAIN HOUSE EXISTING)
GARAGE
O
PROPOSED
ADDITION
11 -0 3/8" -
01
N
BACK OF HOUSE
0
O
Ul
LOT LINE _
PLOT PLAN
SCALE: 111e a T -0"
> n m j 340 RIVERSIDE DRIVE SHEET TILE NO. DESCRIPTION ET DATE DRAINN EST :IA
0 rn rn NORTHAMPTON MA. 01062 KINNER RESIDENCE
TEL (413) 584./522
FAX (413) 585.0820 PLOT PLAN
. P2-.
' ° at I itk_Ir itl t ( Ilit ]A Alrf 4ampion ) VP
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=
t......411- .40., AtatssacIrtrtsetts MII11=----=-
v ‘ =
DEPARTMEWT OP BUILDING INSPECTIONS
, 7 ._..- .7- -- t.•.-
212 Main S ° Municipal Building ---= ...s•
..0
Northainp Mass. 01060 yr
WORKER'S COMPENSATION NS' ' CE AFFIDAVIT
1_, Ni. i_5cAi E/V ir' vv--4-4g. Y n-i _Z- ,- .4- -- / x, _4;7. c
(licetstetTermittee)
with a principal place of businesslresidence a.t:
3 go /t/Z ,A47, , (phone#) 9 ` 7"
(s Zio 45 0
do hereby certify, under the pains and penslEes of perjury, that:
(X) I am an employer providing the followigg worker's compensation coverage for my
employees working on this job:
• ,SZt.1.-e5S _,./ el?). ek,C. F6 - 55 i
• (Insurance Company) (Policy Number) (ExTriraton Date) ..
( ) T am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:: .
- (Nude of Contractor) (Insurance Corarparry/Polic Number) (Expiration Date)
(Name of Contractor) (Insurance Coanpazy/Policy Number) (Expiration Date)
(Name of Contractor) (insurance Conaparry/Policy Number) (Expiration Date)
k
(Name of Contractor) (Insurance CoripaiWPolicy Number) (Expiration Date)'
(atta.di additicreal ellt-e ifnezetsat7 to ioc-tad inforrnatko prtairLiz4; to all coatractors)
( ) I ani a sole proprietor and have no one working for me.
( ) I am a home oiler performing al the work myself
NOTE: pleaee bs aware that while hcateow=rs Von c,loy, .a to c:t.a =_L aaamw.atico or ra4sairarark on a cf of
1., r ca One •ot.•s zpptirtanalr,.--z- are n goo condidtrcd to to
,5loy\..- 'ar±2te the vacrit.L4 r'-o:fp=*.:ticct. Ar.=, (GL151,Lca I (*I, anT.i , -1 ,- ioo by 7. bctozoww: fora li---=,- c.- ir--fm
laztl ci.-f of an arap!oyzr unasi-tho Workr-r a OonA, ---,,.....tion ie-ci
I u a -- 7Y of th soa±o r""` 'may ra to tIo4 1Dt ef s1 AzziOfficr:J of r”..._2-.11 tACS for th./
Dverm,s,evoifirticzt 1E1= to smttra cowrago ticota 23A afMGL 152 can lb:id to the • inn 0 af-sim:.-eial p.,..r...a
cooaistirtg of a froe of Iv to 11,500.00 andtorcaraaeot of azio) one ya:ty attd civil p=alties itt faith of a Stop Work. Or&- and a
fiLe of Sla1.00 a thy ag'on m.
i el", , f..■-• :
Signed thi ./...; day ol:' /4 /,,, )4, Fcr - .7.=-4 . tmtnW u._ eft
• 4 Permit Numbs
--- •
Sign.2_,L4n:ecf154.,,......2,see/Permitt
I SECTION 8 CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable
Name of License.ryolder: Nelson Shifflet_t 060300
Valley Home Improvement, Inc. License Number
340 Riverside Drive. Northampton, Tvta 01.86.0 I 9/22/a.
Address Expiration Date
584 - 7522 _
Signature Telephone
9. Registered , me Improvement Contractor: Not Applicable 0
Valley Home Improvement, Inc.. 105543
Company Name Registration Number
340 Riverside Drive 7/17/1.
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 tXl No 0
11.E - Home Owlet Exerriptio
The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (I) 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, von 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
' S. DE:,iCRIPTION OF PROPOSED WORK (thqr..k , t16 Lt lispOJO
I
Fkw EIVLIf,e El I Addition Li Replacement Windows Altetation(s) r2 Rooting 0
0: Doors :1 ,
,......„...,,„„.„,
Accessory Bldg. :.I Demolitior:0 New Signs ) Decks [ i Siding !: ) Othe
3v ..; rtc.;, oil ::t i Pfc;rx.;;;,eA.: We.. 4i ot 9,1 iiitAti- neldi FDA' 4 " 101 X/i" 4e4A i ;
/i47/s.. - /?/SC. It- ecfrae.i,k3- A)cw sr it G eta `i:
h i&
raibY:
••: ;' I-:
6. if New house and or addition to existingITLfsingplete the following:
0' 7 ;i , ni; 1
3:: I.;:.,,irt:tEq r;:; ic,',:,: F., 41 e:ir !,:: Nwn:7:77:' :51' ;
. .
... , _ .. . .„
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. 2 f:' Cc - .F....:.=ry.J . :,,ttcn Oor e,? ......_ 1\-".inchcci Encrizy Ccfl, rzkr - ri •attactcf::?
. ','yp;:“.;;:',I• cr..- 44/a 4 f:71
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C0" *It ;,.;0./'..; '1 ‘''.° 1 co 1. f.4 v4.et.', Yes .. c.;,. i:, (.,:,,fr, Lit.::, ,-.0 1 w Tar, I ou
;o1 cf-ii,csr f ne.q:^; 'rl.c:,,h(ffl ;,:yfr:ic _ 7 a
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Pt va tr,:e:i C V. SuDp'y
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1 -
SECTION 7z . OWNER AUTHOP,IZATION - TO SE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
, aik, k( e , as 0 ci ',..;:'7,c suLject p. ',
Valley Home Inpro,yernent,._Tno......„„,_
rtf:,. bf.r.. r 01 it'l r.n6ttt,-,7$ rf;;;;Littvt.. to t,vori i:,,t/thon'tzet:.,i by thi& b-,:tidIfIE: peTtni; ,
,,.. ,......... .,..,, ..„,_.„.,..,,
Slcosa:
or 07of
', ,Neaso.n_Shil.flet.t.___Muli.ey_flonte_Improy_exaent.,_Inc_. ,:.'.:%
r'" dr' If * .tl:' 1;tatrjrliCIt' , - 2 - fld irfor nE,I.;;;:oi ct;7: OW fOtelgtriz itttpIc,:-ttion fftle true 07!,i . ;...1t;‘,:`,_ff;:tle, I!) 'Ile t:1',";, tr;! iry
krCy:fr.70,e .: rid beliof
fz '..tnc-:: dr': fP'.:;rf!if e f.:',:7fEf:tv..: u.!'
Nelson Shifflet. t • ___. ........._______,.........._ ..:.....
_.........:._ . ..
t
L - ::-.:,,ii : f:Jr?-cLI:*),, , ..:;•gii -7 .,. 7 . , rt r„,-...f.,..t. __________,_______ ,
. ,
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 7 (,)7.) 7/5 - a
Frontage 30 • ; 3
Setbacks Front
Side L: 3" R: / ✓'� L: , 3j '1, � R: /kr t.
Rear
3F
Building Height
� a V
--
r
Bldg. Square Footage / V V /�' % / o-', d i q
i
Open Space Footage
(Lot area minus bldg & paved / 9 ; 3 /foe „2,5
# of Parking Spaces a
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 1 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 L�
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:
---X /5 Vc1L GGhl' /l eta a. t.
Department use on iv , ,,, City of Northampton Status. or P ...
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer /SepticAvailaothty
Room 100 V�rater well Availabili'ty - . ,
Northampton, MA 01060 Two Sets of Str icttiral Plans ` it
phone 413 - 587.1240 Fax 413.587 -1272 Plot/Ste Play
F ' F r ' i5ecrfk r f „
APPLICATION TO CONSTRUCT, ALTER, R =PA , . w , . * •0LI3H A ONE OR TWO FAMILY DWELLING
FEB -72012
SECTION 1 - SITE INFORMATION DEPT. OF BUILDING INSPECTIONS
NOnFI IAMr'TON, MA 01060
1.1 Property Address:
i hit section to be completed by office
3 4 / iect /91/1 Map _ Lot — Unit
PD 191 p I l �. l b �i� Zone Overlay District
— T—
Elm St. District_. CB District__
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: I
odt k' , n` SnLJ
Name (P . ) Current Mailing Address:
Il l.,. .: _�A. ■ Telephone
All
Signature r
2,2 Authorized Agent: Nelson Shifflett
Valley Home Improvement, Inc_, P -0. Box 60627, Florence, MA 01062
Name (Print) Current Mailing Address:
4
V 584-7522 _T
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building / D D � (a) Building Permit Fee
/
—
2. Electrical (b) Estimated Total Cost of
J �� Construction from (6) _
3. Plumbing _ Building Permit Fee
S19ad
4. Mechanical (HVAC)
5. Fire Protection
'
6. Total = (1 + 2 - 3 + 4 + 5) 1®r o d Check Number f 1 1 j I i Ay • ✓
This Section For Official Use Only
Building Permit Number: __ Date Issued: _ .
Si _ __ __ _ _ _ �,. _._
Building Commissioner /Inspector of Buildings Date
File # BP- 2012 -0700
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS /PHONE P O BOX 60627 FLORENCE (413) 584 -7522
PROPERTY LOCATION 37 PROSPECT AVE
MAP 24A PARCEL 129 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 0 / /� . T
e /, ;,
Fee Paid yp
Tvpeof Construction: CONSTRUCT 9 X 10 KITCH ADDITION, 12 X 11 ROOM, INT REMODEL, NEW
SIDING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildin Plans Included:
Owner/ Statement or License 077279
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOI'MATION PRESENTED:
A; proved t Additional permits required (see below)
' CANNING 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
,' BOARD PERMIT REQUIRED UNDER: § 3c0 — 7 3 ( ) 6 , ?
fiMing Special Permit Variance* 0 5 ( S
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
2 /9 /
Signat c of Building Official Date
Note: l >s uance 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 puh!ic works and other applicable permit granting authorities.
* Vari. ices are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planni, S Development for more information.