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NOTE:
THIS 15 A PRELIMINARY PROPOSED PLAN DETAIL
A MORE DETAILED ARCHITECTURAL PLAN SET
WILL FOLLOW
PROPOSED REAR ADDITION PLAN VIEV4
Valley Home Improvement, Inc.
� THE GHAPMAN RESIDENCE
ssumulo
340 Riverside Drive, PO Box 60627, Northampton, MA 01062 TITLE: PROPOSED SCALE: DATE:
Office Phone 413.584.7522 Fax 413.585.0820 DRAWN BY: I.GOMILLION 1/4" = 1'- 0" 12.15.11
Find us on the web at : www.ValleyHomelmprovement.com
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' INFORMATION, KNOWLEDGE AND BELIEF
(AT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
DWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
7
-- NOTE
.W , ..1..ct - THIS PLAT FOR MORTGAGE LOAN PURPOSES
s AND DOES NOT CONSTITUTE A PROPERTY SU
)F. 1 —MART i i;, • Ls P - --
NORTHAMPTON, MASSACHUSETTS
MALLA __
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INFORMATION, KNOWLEDGE AND BELIEF
-!AT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
)WN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
7
- -NOTE— W% . THIS PLAT FOR MORTGAGE LOAN PURPOSES
AND DOES NOT CONSTITUTE A PROPERTY SU
IF — MORTGAGE LOAN INSPEC PLAT- -
NORTHAMPTON * HAS SACHUSETT
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'} DEPARTMENT OF BUILDING INSPECTIONS _
212 Main Street • Municipal Building ` SJ s „
Northampton, Mass. 01060
WORKER'S COMPENSATION NSURANCE AFFIDAVIT
I, Wiz-504r vi i frL6,T% !/ 7' //0/it-e_ ..Gd��/ r/e -e4%, J L
(hcense&Jpermittee)
with a principal place of business/residence at:
3 ‘ /2)1Z.4.5 j es I)/ Z. ,�/D, 7 ,7 2 std (phone #) 98 e-/- 7,
(6,-,tkcity /sttP J2ip) e go a
do hereby certify, under the pains and penalties of perjury, that:
I am an employer providing the following worker's compensation coverage for my
employees working on this job:
Acadia Insurance Company WCA5029908 2/1/2013 "
(Insurance Company) (Policy Number) (Expiration 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 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 additional shed if necessary to include information pertaining to all contractors)
( ) 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 employ persons to do maintenance, construction or repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thereto are not generally considered to be
employers under the wor oompe asation Act (GL152 sal (5)), application by a homeowner fora license cc permit may evidence the
legal statue of an employer under the Worker's Compensation Act_
I understand that a copy of this statement may be forwarded to the Department of Industrial Accidents' Otfioe of Issuance for the
coverage verification and that failure to secure coverage under section 25A of MOIL 152 can lead to the imposition of criminal penalties
consisting of a fine' of up to S1, 500.00 andlor imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
find of 5100.00 a day against me.
Signed this - i $ day of j-4 tot .. For departmental use only
Permit Number
Af
' , /A1t ` ''zt° Map' Lot it
Signature of L1 . -- • ermittee
ip
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 R iverside Dr ive,. N _ m
or ptnn, MA 01060 9/22/12
Address Expiration Date
584 -7522
Signature Telephone
Reeistered Home Improvement Contractor: Not Applicable ❑
Valley Home Imp.r.svement, Inc! _ 105543
Company Name Registration Number
340 Riverside Drive — 7/17/12.
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 22 No ❑
1: H a u O wner Exempt
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
I
CTION S. DESCRIPTION OF PROPOSED WORK (check all applica,h140
(
! New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing 0
Or Doors 0
Accessory Bldg. 0 1 Demolition0 New Signs [ ) Decks [ ) Siding [ ) Other f_ )
.3rie. De:se-I.:I.:on of f reixrf.tle 1,VO'N.. C, L CAI / j/
W 1914
i N Itertt14.)n D` Cxislint hEtr:toi:ri Ye. No Ac.,,:ine new DON:1'0'r Yes No
Attach Narrativt ' Rpovetir.p. , ,,:nfinished basement Yes Nv
?tors 1 Poll . Shoot . gc/ci itic 4 idrov vD,200...7 ,cznge W
&-
a a „ If New house and or addition to existing hoUsing, complete the following:
tise DI :M.HICirig : ON:: 7 arn'tv 1,.. .- -- " Two Family Other
1 b Number ct tool's n each tarny tint: Number ot E..l'atnrcorrts )-
t ......„,,
c. It; t'lee 2 garage attached? •/"
1 d Pr G Sc .; imr e ikot ak.e or new ...: / ,9 Di Y V
Ntx!1!;.--3.• ot ,, ,,t«:'iei . ..`) a .
f. ethe of hoatrig 7 615 /.../ iii
r i!' e I; acts or Weecif.;toves Numbe of eoch
, a Er.e.rey Conse.rvatic.-. Corp ,iarp. fr (71/0 4.../ tk.cascheck Energy Cprriplian:e form attached?
/ _
I ype
of cc
..„
,. fs co**tit;•.;tic.11 Antliri 10 t of wf-...finos? Yes .o. I:. Lon.struction w,ZtliC 100 yi , lootlplaiii Yes No
1 !. Depth of oafernent or cellar floor below , inithec! grade 1
r k, Wi li t:itr Idirti; COnform to the Buridin8 cind 20hirtg rJalions? Ye.s No .
i
'-, 1. Septic Tank
City Sewer Pr Riate vo; City N'iater SLIOWY
SECTION 7a • OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
(, I I's 4 ille-ei. , _ _ _ _ , as Owner el the subject property
hc.retv airainnae. ., Shif f let t,_ Valley Horee_Improvernent,Inc,._____ to , s - zt on
my - nalf. iit all rn • .1f. ret au
atiVe to OliN authorized t)y this b permit aoplication.
if
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Signature ot Orme7 Date
g1:s:: Valley Home Inpromement,Ino., as (1).....tnerfAutrioizel gent
. 7
hereby declare that the statements Mid information on the foregoirg appIrcation 1-.1e t'u t.. orid ticeur•le, to the best 01 my 1
I
kr End belief.
Si under the pai ard penaities of peri...'y. l
Nelson_Shitflet
Pr;r I N:111.0”
......._ I • , A f
St t0•.? CO ct4 .Tit - , D:Ile i
„
,
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 2 yo0 2Y
Frontage )0 ,So
Setbacks Front
Side L: 9 R: /? L: 9 R:
Rear r
Building Height d y t�
Bldg. Square Footage vk /3 % 7.470 / J )a
Open Space Footage
V of area minus bldg &paved /6 �� g / 6 0
parking) (d
# 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
_ l
IF YES, describe size, type and location:
,De artment use on!
- p + a r xs b ^� -�
0 i ty of Northampton St�tirso `�
. . rysx�'' 7 i < .s
1- ■ - . uilding Department Cuek5Cut/0 i W ' way � it
�
212 Main Street ., z�� �... ,�f 4 :- _ Vav
r /$epfi+ v i sf , ,, ,,,
FEB ' S Room 100 . F , ./ o. � i i i $t � > x
�W A a b 'f �' TAW,
o hampton, MA 01060 e ts'o ` i ial�P ' �_, p� „ ,`
, .' T o W f” 4 r s t rep, � y
���{ oo °•.•; ,-. . 87.1240 Fax 413 - 587 -1272 Pi / Site t �F =V�� � �
DE " 0 .'+ . � 1 74.54; , :r4: y " ✓' '�` t§� A u "'tr' g ` �nf „ " ' i q t' v
t eC� s�3Bi f .. ,w * ° t r y l - ixiN° , ?
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
Li Property Address: This section to be completed by office
r Map Lot Un
/ iO rAinip A) t !) J4 Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: rr c ^^
�t.A?u�cao�
L Si- Q2QMQrc.4 -&k 5-v eie T€zrAc.e. l � ✓I r/
co, ILEA, "_,� ,,{{ "
Name nnt) Current i a Ad
t iling dre
1
: o ` d10�
. '3 X
Telephone
Signature
2.2 Authorized Agent: Nelson Shi f f lett
Valley Home Improvement, Inc. P.O. Box 60627, Florence, MA 01062
Name (Print) Current Mailing Address:
77 584 -7522
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 6 / Oa (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
5-00 Construction from (6)
3. Plumbing Building Permit Fee
4, Mechanical (HVAC)
5. Fire Protection .
6. Total = (1 + 2 + 3 + 4 + 5) Are 0, Check Number (Q? / g V.S _ (2 IOISu-)
This Section For Official Use Only
<. Building Permit Number: Date Issued:.
Signature:
Building Commissioner /Inspector of Buildings Date I
File # BP- 2012 -0709
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS /PHONE P 0 BOX 60627 FLORENCE (413) 584 -7522
PROPERTY LOCATION 50 RIDGEWOOD TER
MAP 24A PARCEL 072 001 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 y ,Y' /
Fee Paid d 1 9 445- %
Tvpeof Construction: CONSTRUCT 8 X 24 TWO STORY BEDROOM/BATH ADDITION
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
INFORMATION P SENTED:
Approved I 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: § 3J 0 /+ 3
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 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.