38B-100 ;0«,..s hose'!" Dep.trtment of Nada Nafel,‘
Board of Buildint,t Regobtions am/ Nimotirtbs.
‘s. Construct Ion Super« «Sur L BTQns.r?
License: CS 60300
Restncted to: 10
NELSON A SHIFFLE I
1E', 4410'
340 RIVERSIDE DR P8X60627
FLORENCE, MA 01062
Exton' 9
T 3435
r
,
Board or Building RggulatioBs- and Standarth
License or registration valid for indixidu1 use only
HOME IMPROVEMENT CONTRACTOR before the expiration date,. If found return to:
Registration: 105543 Board of Building Regulations and Standards
One Ashburton Place Rot 1301
Expiration: 711712010 Trt 270245
Boston, Ma. 02108
Type: Private Corporation
VALLEY NOME IMPROVEMENT INC,
Nelson Shiffiett 4 4-re'
340 Rivers;r1,o1)
'
Northampton, MA 010 r10 Nrintinistratur Not vali AO« Montt sigmature
y
O .(t1AMp2 O
B ` l ]] �r Gif y Uf NUri llt�nlrftrn em
$ il�a�•i �� y.la5 RCIJ tifittta tv -_
CC` � y'' � _ * -" DEPARTMENT OP BUILDITjG LNSPECTIONS
212 Main Street • Municipal Building '
Northampton, Mass. 01060 ��" • "��
WORKER'S COMPENSATION INSURANCE Atele.WAVIT
I, A/2 L-$4kr 5%7 / / =/%G-L 77 6/// 7 //7 e_ ..G 7/ 4f"> /../Zcrii,.71 L
(licensee/permittee)
with a principal place of business/residence at:
3-to /ei/!I 5 1.b 2' 1)1Z/i/Z ,f/0,e/ -717rnA ,ij (phone #) .. 8`/ - 7 -- Z2.._
(st eet/city /s atl rip) 41/06 0
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:
(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 sheet if necessary to include information pertaining to all connectors)
( ) 1 am a sole proprietor and have no one working forme.
( ) 1 am a home owner performing all the work myself.
NOTE: please be aware that while hemcownera who employ persons to do maiatraaaee mnst< i on 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 worker's compensation Act (GL152,ss 1(5)), application by a homeowner for a license cr permit may evidence the
legal status of an employer under the Worker's Compensation Art
I understand that a copy of this r-# may he forwarded to the Department of Industrial Accident( Oftioe of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MQL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to $1,500.00 andfor imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine 0(3100.00 a day against me.
Signed this s / day of � 4 . e` For departmental use only
Permit Number
12// A Ma Lot #
Siguatura ofL`�ermittee
y
SECTION 8 - CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder : Nelson Shif flet_t_ — 060300
Valley Home Improvement, Inc. License Number
340 Riverside Dr_ivve, Northampton, MA 01.0.611 9/22/f _ I
Address Expiration Date
584 -7522
Signature Telephone
9. RegiSterect Ho ' / Im • rovementcontractor: Not Applicable 0 4
Valley Home Improvement, Inc. 105543
Company Name Registration Number
340 Riverside Drive .,._____- 7/17/10
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 ail No C7
11. - Home Owner Exemnlion
The current exemption for "homeowners" was extended to include Owner- occupied Dwellin2s of one (1) or two(2) families
and to allow such homeowner to engagee 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 -near period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that helshe 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 tinge, 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
T,CTIcli 5. DESCRIPItON OF li)ROPOSE_D 'WORK fclImrk :Ali .1,illific:.„-,-1,,r1()
_............_,_ ... _
New Ficuse. :L' ' Acclition . I Replacement Windows Aqemtiou(s) '..-: I
; RoOing I— I
Or Doors '. '. I ....
Accessory Bldg. LI Domolitior J. New Signs ` 1 Decks 1 Siciirg `, 1 Utter ,, l
, , A
-, c , 4,^' I ,■, !_tit . : f , 1, ,tot, t o * ,,
/ (6 h 427/1 .19 0(4-Ar oe-4 Cox le • _
:IfIt' t" trl 'Ctt, / \
..t......Ct.t.7,..t 'ti:
611. If New house and or addition to existing housing. complete the following.
,t, ir,, ,' .i C 7 f 7 ,':111 ty // - .':'
%
t '"......:--L - :-: ,. „. ,
,
,...:•1„,-;.h-
i 4
1 r '4t" , t0 , ^!‘ :;,. tt-tr t., t tit;t-t . Itt-t?. . .A.tt,. t tt :)1 ttlitt'tt .t
. _
- \ t i• - - 1 .- "t-,--t=.'
'.,r't2t). t,' 1 Nt,t t;.,... t , Nu- L...;.. ,..,' '..-och ,,,.,,,,,,,__
• i'r iv; :Ir - 7,r i? -- :f:...4 .t , - . ...,c - '
/0
■ yr t' t..1 , :tt' f.s ..■
Ort ' I 'N 1i z ;. 1 1 ...1 v...f: f....:,q,str ,11,,r, Ai %‘. ',', L : Or, .,, 1,..-:./..nr1.-: ..1 t :-; t,
.1
.. C.- f,:i.. Ix - ell. . __,. C ';',...' :,.'..,:',.."&s PP '. '2 ',:r„v ■*,:il'4:1 ;:;.1)1; y
...
. SECTION 7 - OWNER AUTNORIZATION - TO DE COMPLETED WilEN
It OWNERS KGENT OR CONTRACT R APPLIES FOR BUILDING PERMIT
L.,,,A
. ".'i:'; r,-,Ait',:;;:it'.. gelson Shiflett, Valley Home Improvement, Inc
1 . , . . . . . . , . . . . . 4 ' ; . , . 1 1 - - 1 t , ! , , ' t .,' ""k 0 H 'v't I ■tiCh .V l
J)Ceo 1/1 16)efft, 2...1
Ne.,f F.Jre 01 06 le' r t.lr
1
. tielson_Shittle_tt,....YalIey_Home_ImpxoYAment,_Inc,__________7
d(..'ci'l ::. ".Y,' ...,11L'IPrr'r , ..HC, if ,17"V.:',411,, the t:J{ 4) , „ , :q. f e., :OW" ,-:. ''tVi 1 iit t t'r It'l, H 11,z1 tt,t; t ' t , t' It y
'',.r«7",%kr7 711 brii
. ..i
Nelson
1 .
._-_.:.___,-....,.:,- .‘• /, -„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
Frontage
Setbacks Front 49 f
AO]
Side L: R: ,J L:
Rear n eV')
Building Height /G (p
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 f 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:
it . .
Department use only I
,
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit -
212 Main Street Sewer/Septic Availability -
, , oom 100
~
Water/Well Availability '
Northampton, MA 01060 Twoiets of Structural Plans .,,,,,,,
phone 41 5871 Fax 413-587-1272
! -�----- O
■ /^PL|CAT|QN TOCON3TRUCT, ALTER, RENOVATE GH A ONE FAMILY DWELLING
. REPAIR, vn"=""� .
�i; '
' ./
SECTION 1 - SITE INFORMATION '
This section to be completed by office
1.1 Property Address:
�&� ^� Map
' , ^~���'~^^_°' _~��°-°_=_»�
1 � �� ���� � Zone , Overlay District
| ����~��'m'�p^�^r~�^~' ^ "' '°° ~^x w���^
EIm St. District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.) of Record:
__~ - )
^�/ C^� ��0�� ,
' �� �� � ' ~ ^�
�/��/� � _ �y' y .~ig 6 0
Name rintn Current Il4oiUnJAddress:
[ ;'�' ' Telephone - -- --
/ ^" ` -,;/( -16/--(.
^ / / / ' ^ _ �� ��
i Signature / ' ��xrtm 4.. � �^_� _
2.2 Authorized Agent: Nelson 8lzif fIett
V rovaruen_t, Ioo, P.O. Box 60627, FIozezzce 01062
Name (Print) Current Maffing Address
� .
� � ~ .4 4�� _ 584-7523
5igna\Lo /7 To|uphnne
, .
SECTION 3- E5T|PMAIEP CONSTRUCTION COSTS
.
Item Estimated Cost (Dollars) iu be Official Use Only
completed by permit applicant
I. Bwi|dinQ 5' co ^-) (a) Building Permit Fee
~ _
2. Electrical (b) Estimated Total Cos of
. Constructinnfrom(6)
P|umbin� Building | 3 �
'' '
4. IvIeohanice|(HVAC)
5. Fire Protection � ,, �� *�- __.
_�� Tut i = (l + 2+ �+ 4 + 5) Chock Wumbar ' �� � __ �� *" ��
This Section For Official Use Only ___ _
Building Permit Nunnbar: , _ Date Issued: _ __ _ _ ___
` --- -- — — -- --
Signature: _ __ __ __ __. _ __'__ ...
Bui|dipg Commissioner/Inspector n(Buildings _ _ Date __ __ __
File # BP- 2010 -0313
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS /PHONE P 0 Box 60627 FLORENCE (413) 584 -7522
PROPERTY LOCATION 44 MUNROE ST
MAP 38B PARCEL 100 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /(/ ,�
Fee Paid dIP�' / `�
Typeof Construction: REBUILD 2ND FLR DECK RAILS
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 FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved 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
Demolition Delay
• ZZ Z-0
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.
14OST> BP- 2010 -0313
GIS #: COMMONWEALTH OF MASSACHUSETTS
4aP lock: 38B - 100 '" CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:
BUILDING PERMIT
Permit # BP- 2010 -0313
Project # JS- 2010- 000415
Est. Cost: $5000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 060300
Lot Size(sq. ft.): 5662.80 Owner: TODD JOHN F & DOROTHY J NEMETZ
Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 44 MUNROE ST
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584 -7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON:9/23/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: REBUILD 2ND FLR DECK RAILS
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 9/23/2009 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo