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c4 BANISTER- WHITLOCK INTEGRITY
(1 t7 x RESIDENCE BUILDING PERMIT Development & Construction, Inc.
1
9 C4 L, 1206 BURTS PIT ROAD, FLORENCE, MA 01062 SET 110 Pulpit Hill Road
Cr1 H Amherst, Ma 01002
L A.) ,--] O Cs1 'r1 Z 413 -549 -7919 FAX: 413-549-7918
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Z V d BANISTER - WHITLOCK INTEGRITY
Z - t7 x RESIDENCE BUILDING PERMIT Development & Construction, Inc.
CA `" 110 Pulpit Hill Road
tt N y by 1206 BURTS PIT ROAD, FLORENCE, MA 01062 SET Amherst, Ma 01002
N y Cr1 'r1 Z 413 -549 -7919 FAX: 413-549-7918
tit •t' DECK EMAIL:INFO @INTEGBUILD.COM
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c4 d BANISTER- WHITLOCK INTEGRITY
x v d x RESIDENCE BUILDING PERMIT Development & Construction, Inc.
1 > to a 1206 BURTS PIT ROAD, FLORENCE, MA 01062 SET 110 Pulpit Hill Road
CT7 N y e9 Amherst, Ma 01002
H DECK 4 EMA�L INFO@ NTEGBUILLD COM
ValleyHomelmprovement
P .O. BOX 60627, NORTHAMPTON, MA 01062
413 - 584 -7522
FAX 413 - 585 -0820
DESIGN / BUILD
ADDITIONS • RENOVATIONS
4 -27 -10
Northampton Bldg. Dept
Re Erickson Sunroom
The attached application for a 12 x 14 Sunroom addition will require a finding.
I will submit elevations and Mass check calculations once the finding has been approved.
Thank you
Wedrfre
Nelson Shifflett
■
x t
NI tss,tcliusetts 1Tcpar ment lit Pnl Iic: '
t* Board id Bitiltlin�� Inc�„tr t 's i (Anthills
Construction Superf gsor i ?nsta
License CS
Restricted to: 16
NELSON A SHIFFL TT
340 RIVERSIDE DR PBX60627
FLORENCE, NIA 01062 m
; :.7...: ..
.w. s Eck.ii.dc 02"2;12010
i ;,zina4i, =,titr " - ' 3435
fl Or urrtudding Regulations and Standards license or registration x alid for ittdix"ulul use nnls
e, HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 105543 Board of Building Regulations and Standards
(Inc Ashburton Place Rot 1301
Expiration: 7/17/201 Tr# 270246
Boston, 1Ia.02108
Type Private Corporation
VALLEY NOME IMPROVEMENT INC.
/1/,/ f / .
340 :Ft.1r 1
I'{I�t Jt'. ��." ..n. J <++ f ......... `�f` d .F
Not ,, t;^it, tv1r, t)1rhr Adadnistratut Not s:tli + it hou tPP signatut'e:
88.35
garage 12 x 228'
270 sq ft
sunroom 12 x 14 13
188
[ sqft. h112 428"
1148 48 sq. q. ft
driveway 9 x 58
s 504 sq H.
57.25
2 r{vwry 9 30
27'
H
9 Falnnay Ave. 5058 sq R.
Fairway Ave.
A CTttAMPi O EIMitOD ;4
a rc : $ ('Lxt of Narfij &ntpfnn 1 -
a ,f ` ; `B laesarlinsetia _.
`u } -" D EPARTMENT OP BUILDING INSPECTIONS . =_` i
.....„ .
. , 212 Main Street ' Municipal Building
Northampton, Mass. 01060 or"
. WORKER'S COMPENSATION rNSURANCE AFFIDAVIT
i, 4/E /-5cA r sly /G/%“T 1 /,1Z -I y f�: .2= 7 i /S r, 2
(Iilttee)
with a principal place of business/residence at:
3 `to ie/v6S 1 � /Z , lr/o , � 7 / , /II} (phone #) 98g - 7 ZZ.
(street /city!st t> ; rip) 4 /0c5 0
do hereby certify, under the pains and penalties of perjury, that:
1 am an employer providing the following worker's compensation coverage for my
employees working on this job: .
/iEt 4iss ��ZS, Gv _ u) C 476 o 55'6 1 a /ili/
(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 Conipany/Policy Number) . (Expiration Date) •
(attach additional sheet ifnecesauy to include information pertaining to all contractors)
( ) I 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 do ern i,Ttro■an, construction or repair work on a dwelling of
not more than throe units an which the homeowner mikes or on the grounhs appurtenant thereto are not generally 000sidered to be
employes under the worker's oxopeasstien Act (GL152,sa 1(5)), application by a homeownrs for a license or permit may evidence the
legal status 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 Accident( Office of Insurance for the
coverage verification and that failure to scare coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1, 500.00 and/or imprison of up to one year and civil penalties in the form ofa Stop Work order and a
fine of 5100.00 a day against
Signed th day Of /74 Z 2 /i For departmental use ally
�� y Permit Number •
Tl r Map# Lot #
Signature of L • ermittee
SECTION 8 - CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder : Ne son Shi f f 1 t<t 060300
Valley Home Improvement, Inc. License Number
340 Riversid Dive, Northampton, MA n1.160 9/22/f
Address Expiration Date
584 -7522
Signature Telephone
�,.Re "sI r'e�.t!• a m'rovernentCoi racl`r ; ; Not Applicable ❑
Valley Home Improvement, rnc_. 105543
Company Name Registration Number
340 Riverside Drive 7/17/10
Address Expiration Date
Northampton, MA 01060 Telephone 584 - 752 2
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 IM No ❑
=.Home (3livener...Exem!cotion
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, 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
WI FON 5- D OF PROPOSED Wu • h k 111 ,' . fir t.
..._
. .. _
........_—,....„.___ i
New House --- 7.17Addition E6 Replacement Windows Atteration(s)D Reefing 0
Or Doors 111
Accesso - 0 ry Bldg. Demolition° New Signs [ J Decks [ ) Siding [ j Other H
Brief Dc of Proposed Wok L _shoe I
Alteration or onsting brit:room _Yes _ _ (40 Aodne new bedroom
Attached Narrative " Re.novatiing unfinished basement Yes e —./ No
Plans ktachod Rol;
6a. If New house and Or addition to existing heUsing coMplete the fellthiting:
a. Use of building : One 7 amly 1,7_____ Two Family Otner
.
b, Number of rooms tn each family unit: , _ _ Number or Bathrooms_
i
Is tnere a garage attached?
I t 4
J Pic:post:0 Souare footage of new constructiDn 191_ Dimensions, Id
e. Number of stdrie3? _ 1____
f. Vtho of hting -Cepu 7 - 4v..1 -vow ,i
ed ea! , , I rreWaces or Wdedstuves NurnI>v' of tztcn
t g Energy Conservation Corriptiarce /91,97k1 Mascheek Energy Cornblian:e form attached?
Type
o cc-a _th_i_j_Eifoi.
1 t. fs artstl ti:Ctic,f1 Yhttlirt 10 ft ot Art:At Yes //No. Is construction withir 100 yr. fleoriplain Yes No
i. Depth of bas,ement or celfar floor below hnithed grade .
k. Will building conform to :he Building and 2onirtg regulations? VYes No .
l. Septic Tank Cy Sewer e-- ------ po,ate well City water Suppty
1
, ..
SECTION 7a • OWNER AUTHORIZATION • TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
d - cnkz / as Owner of trri t subject property
hereby at nri7e. Nelson _shif flett, VAlkeY liome_Improyeme4t,......Inc...___ ___ to ,at on
my btr.: f, irt all rnatterS relative to volk authorized by this L‘uilding pertnit application.
C---P eitatr-
yrel
Signature of Owner Dzitc a Tit - fro --------
1111111.1111niniiialinen_ _ 1._
t. tiels Vall_ey_liorma—Improxement...___Ino, As OwneriAtithon7erl Agent
.
hereby declare that the statements anc.f information on the, folegoirg application are true and accurate, to the bet of try
knowledge End belief.
Signed under the pains end peltaittcs of per IL:ry.
...NelAon.„Shiffiett ----
rq' t NAmtt ,
itt
,,,
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
SPA, L o7- over #6 1y'd
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size 5058 505
Frontage g. 3 S ki 3
Setbacks Front /' :f ,•M-I0 • Side L: 3 • R: / 3 • L: 3 R: /3 • 15.
Rear
7 't
Building Height
y ;Y 444/7,
Bldg. Square Footage / qi r dg % /06 3/
Open Space Footage
(Lot area minus bldg & paved c9/7 0 y3 ^3 � . i/
D
parking) '7 O J 7
# 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 i: 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 ( 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:
I�
APR 2 8 2010
��Depatmerituse only
City of Northampton +'„ Y
Building Department ----- bw
212 Main Street
Room 100 WelrA�rei
Northampton, MA 01060 ts` aI fa
phone 413- 587.1240 Fax 413- 587 -1272 tS t ►� q
APPLICATION TO CONSTRUCT, 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
/ ,gb• 1 LG J L sap . Lot Unit
" 4 "lid et /O a o
Zone Overlay District
Eltn St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: 9 ,t///4J /
—Name (P nt) Current Mailing Address:
j' rn
C.��,t�- d.c---+ r t .-rh c / - JA2 4.12 CAtZe €ephone (,-76 - i s z
Signature
2.2 Authorized Agent: Nelson Shifflett
Val a Home Im•rovemen _ P.O. Box 60627, Florence, MA 01062
Name `rint Current Mailing Address:
584 - 7522
Signatu re Telephone
SECTION 3 •ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building ava (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
5 Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) � 8 j i ' r
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) a . . o Check Number 62i r ;� $f_
•
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature: _ _ _ --
Building Commissioner /Inspector of Buildings Date
\ S
File # BP- 2010 -0949
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P 0 Box 60627 FLORENCE (413) 584 -7522
PROP TY LOCATION 9 FAIRVIEW AVE
MA PARCEL 218' VOI 1 ZONE URB(Ifeli
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid j,� - �j�
�Jl �Q `]
Tvpeof Construction: CONSTRUCT 12 X 14 SUNROOM
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
P ' 1VIATION PIjISENTED:
dproved (Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
!%A (tic
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan � - ` ,
Major Project: Site Plan AND /OR Special Permit With Site Plan 51 ti /u -Ir S
ZONING BOARD PERMIT REQUIRED UNDER: 35 ?( 3
Find , L Special Permit Variance* 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
q/G f 16
Signature of Building fficial 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.