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24B-004 (6) ^� ~ 1/ � � 1 - 16 Ili , i f 2 A , i . 54 ‘),, • _ i1 ( d_c fa116iigNt RDDP --'- ---_ • i - H 1 ( _, ... . . I 1 , _ — . i wiiii- ,•,y , . •.... -,... -LH i : . " 2S co 1 . 1 • . 6) sisi4 fr IIA a ieed ..S (Zk _-------- _ - . ---- - 1 1 , 1 - 1 P -t i- 6lit‘t ---- 4 - 1* ----a i. ,--- s -- y - sji - ____, _ ,.- 1..._, \ar --- ------------ -- civEAPIN6 10 et m i3 i Aj 1_–_ ■ - f --- – — i . , _ – T • i .. I I .• 1 - I ; I - 1 l' I , I 1 i ; ! • ; i ! - - ..____ 1 . , A)01 _ . _. , I i - - -- __________________ ___. _________ . _ - i __ ____ ___ I_ itfif > 1 • L IA Ni=3 i AKM11- . . • • . .• • • , . . . . . %,-;. :- :' • - - - . . . . . . .. . 1 I - - 31' -6" DORMER J NEW EGRESS VINYL I I f --- – — WINDOW MATCH -- --1 CAMBRIDGE TUB /DELTA VALVE ' �� / - G.'. ... - TILE WALLS T01'0 TOILET \ \ _ PANSONIC FAN - -TV I 1 - I �' 'N F LOOR / 1 5 -0 VANITY WITH DRAWERS / > \SWANSTONE1 ( J �� '7 S OLI D I___- �; CORE SIX \ [1 ._ REC. MED CAB. - 1I -.-� PANEL SHEETROCK ON ALL NEW AND `) HARDBOARD " EXISTING V GROOVE PINE \ NEW DOORS '3 DOOR r SURFACES THROUGHOUT ` _ E CHIMNEY / 1 ii FHW HEAT ON SEP ZONE ,� LINENS r TV- c� I v /d � 1 NEW CARPET BY OWNER - i li 1 / ' CLOSETS BY CREATIVE SPACE ( 3PP SHELVES ! JI iu INSULATED EVES ACCESS SAC Ownicr iZ L Lplof� e DOOR btz c -' ' II \ — - LEAHEV DORMER f - -- - -(1lAM p t td 44,4;44k, Qitlt of ',Northampton c r.44 . • iliasanclinactis a -. r te . : ` : ��'�' DEPARTMENT OP BUILDING INSPECTIONS , i. 212 Main Street • Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, Nelson A. S i ilia L / Vallev Roma Tmprovonient., Inc. — (Iiccnse&per m ittee) with a principal place of business/residence at: JC' de n i z N p . 'v`. 01 060 (phone#) r %1 _ ?) 5 r: -22 - -- �_t,�. ,.r, a(�� c�rth�r1 _t,pn, � __ - . _ - t'• do hereby certify, under the pains and penalties of perjury, th (`C) 1 am an employer providing the following worker's compensation coverage for my employees working on t1;i nob: American Int'l Companies WC00260737000 2/1/04 (Insurance Company) iPoii yNumber) (Expiration Date) ( ) 1 am a sole proprietor, general contractor or homeowner (circle one) and have nixed the contractors listed below who hr:ve 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 Cor meter) an_airan. Company/Policy Number) (Expiration Date) (Name of Contractor) ( Insurance Company/Policy Number) (Expiration Date) (attach additional sheet if necetsexy to include information pertaining to all contrators) l ) 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 homrovve 3 who et ley pccsom to do maitttenaMm, cent ucion or impair work on a dwelling of not more than throe units in which the homeowner raider or on the bourn appurtenant thereto are not generally considered to be employes under the worker's corepensation Act (GL152,ss 1(5)), apptiation by a homeowner 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 ctate:need ntay be forwarded to the Department of Industrial Aodda t Office of itnsurnnce for the coverage verification and that failure to secure coverage under section 25A of MQL 152 can 1c In the imposition of criminal penalties consisting of a fine of up to S1,500.00 and/or ia of up to one year and civil penalties in tie form of a Stop Work Order and a fine of S100.00 a day against tne. Signed this f ! day of irk-4- R 6 0 3 For acg sl tree only 1 • SECTION 8 - CONSTRUCTION SERVICES i 1_ Licensed Construction Supervisor: Not App icable Lil Name of License Holder : Nelson Shifflett _____ — __. 060300_ Valley Home Improvement, Inc. License Nu mber 340 Riverside Drive, Northampton, MA Q106.0_ 9/22/04 Address Expiration Date 584 -7522 Signature Telephone (� "'� � z ' I 9. Registered Improvement Contractor: Not Apal:cabie ❑ Valley Home Improvement, Inc.._ 105543 ------- - - - -__ Company Name Registration Number 340 Riverside Drive 7/17/04 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 ;:nis ai'icart will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes 4L! No ❑ 11. - Home Owner Exemption The current exemption for "homeowners' was extended to include Owner- occupied Dwellings of one (1) or two(?) 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 he0shc 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 -vear 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(s1 you hire to perform work for you under this permit. 'Hie 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) f New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ I Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ Siding L Other [ urief Description of Proposed Work: a 32'__4ormer on back of hoarse to�nr11,Ap nA� loath & . - -Prior remodeli Alteration of existing bedroom ✓ Yes 1 O Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes ^ o Plans Attached Roll - Sheet i7 6a. If New house and or addition to existing housing, complete the following: a. Jse of building : One Family 1/ Two Family Other _ b. Number of rooms in each family unit: a Number of Bathrooms.- _____. c. Is there a garage attached? A/ a d. Proposed Square footage of new construction. /tf /,► Dimensions e. Number of stones? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservabon Compliance. ~44 Mascheck Energy Compliance form attached? Type of construction i Is construction within 100 ft. of wetlands ? Yes Is construction within 100 flood plain Yes No within yr. p � - - ---- Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? _ t/ Yes No . 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 !. Frances & J eph Leahy 2r-e 7 as ()wrier of the subject prope y hereby authorize Nelson Shifflett, Valley Home Improvement, Inc. to act on my be f in all matters rela ve t.) work thorized by this building permit application. 4_ gnat re of Owner Date I. Nelson Shifflett, Valley Home Improvement, Inc. as Owner/Author zed 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 . . , ° Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning -- This column m^u filled .vh nvomnxn"nxxomx F ---- Lot Size ' | - ^ Frontage , | 1 Setbacks Front '' *�' f' ) 4/ ��/ / ( Cx� ~ w ^ Side | K� � K� pi � ^ � _-'__- ' /�~� , ��/ ' /° � f �� . ��y ` ` � __ P " .� \� t /- ^ �' y /� ~, , ( Building Height di ` / • /3 - �� Bldg. Square Footage . Y6 -_ Open Space [uom0e °,-10 | U.m area minus bldg upaved ,pmkiwA . of Parki Spaces _ . Fill: 1 / \ (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 # H. Does the site contain a br0ok, 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 e-__= __ 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: ___ _ - Department use only | , -City of Northampton - Building Department 212 Main Street Availability Sewer/Septic _ � Room l00 N0rfh�nnoton MA Sets �" , , ' ._" ". � � phone 413-5874240 Fax 413-587-1272 -` x � ,� / Other - ' i - - Specify' 1 ' - -- APPLICATION TO CONSTRUCT, ALTER. REPAIR, RENOVATE OR DEMOLISH A ONE FAMILY DWELLING ! . r -- - SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: Map Lot Unit 83 Barrett Street ------- --- --- • Znne Overlay District Northampton, MA 01060 ----- ---- E|mSt. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT | - - - ---- -- 2.1. Owner of Record: 83 Barrett Street Frances & ahiel, Northampton, Mu 01060 ___ Name (F' ' ) // Cu,rertmn/|i"bAddress. 586 — — - ------ \ T�ep�onc doo /onnum _ ` — -- — --- - 2.2 Authorized Agent: Nelson Shifflett _ Valley Home Improvement. Inc~_ P.O. Box 50637, Florence, MA 01052 Name (Print) Current %/lai|ingAun,nss: _ ^q 584-7522 Signature kv Trlon*unr SECTION 3 - ESTIMATED CONSTRUCTION COSTS ( -- - --- -- Item / Estimated Cost (DoUaru)to be Official UseOn>y comp|eiedb ' \ ` Burding | (a)BuiWin8Perm�Fee | - .]� ��J 2. Bactrica| _` L/ (b)Eshn�atud Total Cou of 3 ^ �? Construction ( 3� �bm�nQ Building Parm�Fee �� pu `/^ � Mechani;ai(HVAC) 5. Fire Protection 6. Tots) = (1 + + 3 +4+ 5) 35 Check Number Thip Section For Official Use Only ��r�V� BvUdingPermit Nunnbor: c� �_~ � '��___ Date Issued: __ Signature: _ _ - _- - --- ----- ---- � BuVdin8CommisovnmY|noporo,o| Buildings _ __ _ Date File # BP- 2003 -0740 APPLICANT /CONTACT PERSON Valley Home Improvement, Inc ADDRESS /PHONE P 0 Box 60627 (413) 584 -7522 PROPERTY LOCATION 83 BARRETT ST MAP 24B PARCEL 004 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ,i/ is 3 13 7 Fee Paid / c� Typeof Construction: CONSTRUCT 32' DORMER TO INCLUDE BATH & INT REMODELING 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 F LOWING 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 Cossion r / ---------Z:-----L77:4-- ..1 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. x BP- 2003 -0740 COMMONWEALTH OF MASSACHUSETTS s CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit # BP- 2003 -0740 Project # JS- 2003 -1200 Est. Cost: $35000.00 Fee: $175.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Valley Home Improvement, Inc 060300 Lot Size(sq. ft.): 57107.16 Owner: LEAHY FRANCES Zoning: URB Applicant: Valley Home Improvement, Inc AT: 83 BARRETT ST Applicant Address: Phone: Insurance: P O Box 60627 (413) 584 -7522 Workers Compensation FLORENCEMA01062 ISSUED ON :3/10/03 0 :00 :00 TO PERFORM THE FOLLOWING WORK :CONSTRUCT 32' DORMER TO INCLUDE BATH & INT REMODELING 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 Sisnature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 3/10/03 0:00:00 16233 $175.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo