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AS, 1.-. 4 -• .1 1 ,.... ,......m.:.......,...;Au.......L....---‘j :Lf;;;ILN.rii:sjiliCT Onik - ....• '413**acitosetts OttpArtuncut of Puffin,' Nuft,-1:4 B itt Rtihhn. RettULlikM*, s ifiti NI,IndArd, COnStrOCtiOn License, CS 60300 Restmted to tG NELSON A SHIFFLETT 340 RIVERSIDE DR PBX60627 Wec FLORENCE, MA 01062 mkV Expo' 41mirc 9,'22:2010 T 3435 o 4 /r/ Board ot Building Regolatio'os and Standards License or registration valid for individul use ords HOME IMPROVEMENT CONTRACTOR before the expiration date. It found return to Registration Board of Building Regulations and Standards : 1055,43. (,)ne Ashburton Pktce Expiration: 7/17/2010 Tr# 270246 km 1101 Boston, Ala. 02108 Type: Private Corporation VALLEY HOME t INC. Nelson Shiflett 1/2 340 RiversirreDr , / z Northampton, MA 01060 taiiiiinistrator Not vaIlK'4 dhow signature __ The Commonwealth of Massachusetts (' Department of Industrial Accidents _ = Office of Investigations • :4 -.......- 4. y� 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit name: Jocation: " city phone # ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity • • w., �,, x..'a�;5-',2� , ,r�t .g r . r,', i. , ,r �,.,, p,?,:-- ,b,�lt£..¢ , ;4. xr , , i"�`r's x r" =o-:-3..': :-.......:- -, r,fa,�rr rr"r.1_,^, ,.Tx „.:,,4-,`. ", I am an employer providing workers' compensation for my employees working on this job. company name: 1/ t <7/°1f-olrr.f -`/T/ <C address: c > //0/e..-77/ 1 .y : 0. 1 0 . phbaae # 4 „ 7 2 . insurance co. �� S G' policy # - .:: . f � :ik1a.,,,,, .td ,, z: siu „ , tYfrr rr .. ;, ,, :k” „ ,, c` 1r,C 4 ,', ,,, , , F/ n!`fir1 d>e , ,:x■■ 4 .a c::w: ,, SA , ., .,..■ ; s: ,, .t. ?N4 ❑ I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address; city: phone #. insurance co, policy # : *443L 7.44:',a1°':r,r :.✓ sib l. ; w,.: str i- fie,F'irIP;r6,,, It1";, <444.Z.. ,';;; 4.0 ? , i1P eW' / •. :r`k 4%_-Err.,,,,'Z. ...zi t" {,,rc.:.... e",...:- 1 t...:+ ,fzx;:V, company n ame: address: city; phone# insurance co, policy # e 7 ; gg; � r ,; r . z' r v,.. �r�,,,tf> sa'fi%_011 &�S e'°i�° t% . tn s . • :�- Fri, ��! 1r��.�wp'��'.'�f�i?;�t� �," �.��" �+"r�tyi���Y«�" sx� ^p�u�w� , �, ,� � , v''w ; n � �o-.€ a�k; ;��;es, Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and /or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against Inc. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of erjury that the information provided above is true and correct. Signature g4 C Date )' � 3 -0 / , < :__ / 5////i="- Phone # �f 3 —+� L� / J � 2 Pri nt name _ / f ..k`.;a..... n,, .,..,...,,,.,.... a.,,,,P :, M 3i ' : 1471i4A;i i Kos. ?b "- ,VI;xd' ?kJ' . 1 -'.r iu.vur' c�ra «azc: a =.t.6 k,. ,., official use only do not write in this area to be completed by city or town official city or town: permit/license # Building Department 1. OLicensing Board ''. 0 check if immediate response is required ❑Selectmen's Office ['Health Department 1 contact person: phone #; OOther (revised 7/95 PM) • Versionl.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT old, I, - , as 6wner of the subject property 1 hereby authorize to act on y behalf, 'n : matters relay - o • rk authorized by this building permit application. Signature of Own, \_ Date I, 1/deieit % J45% , as Owner /Authorized Agen hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and b -lief. Signed under the p nd pe alties of perjury. Print Na 3h/ )r/ Signature of /Agent r Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: S c Not Applicable ❑ Name of License Holder : 1 U C.i 5 »-) h I . / e 1 ® 6 0 3c License Number 3 q6 kr vc(S 1a Nor -ivafri p . Mm &O /° Address Expiratiorf Date 6 1 ?5a Signature Telephone SECTION 13 - 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 0 No Versionl.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): /� Registration Number Address ! ( ri' Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor /4 1 6 7 , i1u.� /rdwYlla Not Applicable ❑ Company N me: O f fl' 4 . Responsible In Charge of Construction Address 61/ Ati Signature // Telephone Versionl.7 Commercial Building Permit May 15, 2000 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear I Building Height id 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 0 DONT KNOW @1 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW CV YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW e YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained , Date Issued: C. Do any signs exist on the property? YES a NO 0 IF YES, describe size, type and location: 4/ �/ D. Are there any proposed changes to or additions / o _ f signs intended for the property ? YES ® NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, exca ion, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations jeti Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Enter a brief description here. / L - Of Proposed Work: (gad /O t% /ior 71' d c & O �� c��/Y/ L s./cf ✓L " 6if7'L SECTION 5 - USE GROUP AND CONSTRUCTION TYPE oileLGod J USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1 -1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B I ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1 /)'2n 1st 2nd 3 3 ` 4th 4d Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system C o)Oces Version1.7 Commercial Buildin& Permit May 15, 2000 Department use only ,Cihy,of Northampton Status of Permit: Buil ' Department Curb Cut/Driveway Permit 2112 lain Street Sewer /Septic Availability v• \\;� R m 100 Water/Well Availability ^No mpton, MA 01060 Two Sets of Structural Plans phone 413- 587 -1240 Fax 413- 587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office 3 ?o Map Lot Unit f,, VJ ri Zone Overlay District �"" Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: g - � k .O . G? 12 Name (Print) 1 C� ��(/� � , , Current Mailing Address: Signature ' ` 1 _ Telephone aisir 2.2 Authorized Agent: /0//e y /. l' - -lfiO /c2kk/Y1 eft} - Z C Jy0 44; c ( 1 00r. Name (Print) Current Mailing Address: 4 �c3 4zx G'&7 /e 0A0.2 Signature $r �j Telephone SECTION 3 - ESTIMATE ' CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building p (a) Building Permit Fee 2. Electrical O (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection ! �.►- 6. Total = (1 + 2 + 3 + 4 + 5) 3 OQV Check Number G J This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0168 APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC ADDRESS/PHONE P 0 Box 60627 FLORENCE (413) 584 -7522 PROPERTY LOCATION 320 RIVERSIDE DR MAP 30A PARCEL 032 000 ZONE SI THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 1529 � 'c Fee Paid p'LJ ri W Typeof Construction: CET OFFICES - CONSTRUCT PARTITION WALL TO DIVIDE OFFICE & CONSTRUCT GATE AT LOADING DOCK 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 FOL WING 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 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. t la RIVE It SIDE Dit BP- 2010 -0168 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30A - 032 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0168 Proiect # JS- 2010- 000207 Est. Cost: $3000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 060300 Lot Size(sq. ft.): Owner: CFP PROPERTIES LLC Zoning: SI Applicant: VALLEY HOME IMPROVEMENT INC AT: 320 RIVERSIDE DR Applicant Address: Phone: Insurance: P O Box 60627 (413) 584 - 7522 Workers Compensation FLORENCEMA01062 ISSUED ON:8/13/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:CET OFFICES - CONSTRUCT PARTITION WALL TO DIVIDE OFFICE & CONSTRUCT GATE AT LOADING DOCK 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 8/13/2009 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo