31A-176 rl
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C 9 all new fir framin , �� �' removable screens ::.1.1:11 L i
r tempered glass panels Pi
_ 1 .."------- f\,\
ll
I
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V - n —II IN
Ruddy Hollywood alum porch enclosure ri
Outswing Hollywood storm door ri
Header height 7'0"
1.3E
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9 ►� �,., j � B lasaxc}Insetta
DEPARTMENT OP BUILDITNG INSPECTIONS 4 -_�_f_=
• 212 Main Street ' Municipal Building = 5��
. Northampton, Mass. 01060 �?
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, ,V E LS O kr EH / /%L.L i/ 1 //-u -L 5 its .L -#'r� g-avf �; 2 L c
(licenseeipermittee)
with a principal place of business/residence at:
3 `f o k . 51 nlii`Z il f/ae -/-7 ii%iWl; /Mf (phone #) 5 / ,
(se et/city, Sat °Drip) ef/OG O
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 sued if necessary to include information pertaining to all coafradors)
( ) 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 persona to do maintenance, crructionor repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant than to are not generally considered to be
employers under the worker's compensation Act (GL152,ss 1(5)), apptiration by a homeowner for a license cc pcniit may evidence the
legal data of an employer under the Worker's Compensation Ad.
I understand that a copy of this statemem may be forwarded to the Department of Industrial Accidents' Office of insurance for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to 51,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of 5100.00 a day against me.
Signed this / $ day of /4 261 For dcpartinental use only
e Permit Number
I - ,/.,,( 1 ` A Map# Lot ii
Signature of LIZ.. •ermittee _
gibe 6 a/✓ iaaaacr
'' \ Office. of. Consumer Affairs & Business Regulation License or registration valid for individul use only
— i HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration .•' 105543 Type: Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Ex iratio 7/17/2012 Private Cor oration
P P
Boston, MA 02116
VALLEY HOME IMPROVEMENT-INC.
:. F
Nelson Shifflett . � /
340 RiversideDr. 4 l� „te
Northampton, MA 01060 >. ;; : ; : Undersecretary Ns, alid without signature
,-
.\lassachusetts - Department of Public Safet)
I Board of Building Regulations and Standards
I k
+
+ Construction Supervisor License
One- and Two- Family Dwellings
License: CS 60300
NELSON A SHIFFLETT s .4 # i
340 RIVERSIDE DR PBX60627 •
FLORENCE, MA 01062 ' '
�--�— -� Expiration: 9/22/2012
( v Trm: 2383
I SECTION 8 - CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Nelson Shif f le.tt 060300
Valley Home Improvement, Inc. License Number
340 Riverside Drive, Northampton, MA 01060 9/22//Z
Address Expiration Date
584 - 7522
Signature Telephone
/
9 Re inter d H /./e Im.rive
n .ntract' Not Applicable ❑
Valley Home Improvement, Inr• _ 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 No ❑
11. Home Owner Exemption
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
t
' ' 5 DSCRIPTION O PROPO W (c hec k 1 I bppficbI
' - ----1—
New House ::: I Addition U Replacement Windows ! AIteration(s)E Roofing 0
Of Doors : i i
i
Accessory Bldg. 0 1 Demolition° New Signs j Decks J Siding [ ] Other
3-in! Dese,-1!)., on of Pr . ploSeC No' k leCOAPtel 1 r 44 la; / SI kr qkihtlif SO IA b bop k vAt 4/4/b"
::•riti,l,:,7 enstirr !Irltrro.nrn Y.z7i; Nr! Arft.np, ne*,,^ nit(Pnr./.•," . e ., i. 7eirce 6/11-i-f ei
i 2,,ttoi!ec, Ndrvi,tivt, lteq3vesting ..mtirw,,,h 1,;,,w
Plo-: !'!.t. Poll 5._;`leet
6a. If New house and or addition to existing housing, complete the following:
e :7)1 t)wica-rE, . C. 7 a - mly b/ Tv.. 7 ,11Thly
b t',41'n'Oei *, ic:O-rS. ,i) each tartily itri,t: Nerrgio.i:!' r, liati
g;7!!aie attaehee:?
Pit41:r.,!!!i., Seimir. fc.;C,1,4f •,;1 ilt / 9 . Drz'Reir,
. W,I•rh-?' t S!
i. Vett70i of hetitirig? i i't-,1:. or Wciodstove!. Nur of eucti
F7erEy Cc 7,;or Nfascheek Envgy Ct:!rin)liart:e form attactied?
I , yr,:', Of Cr.:"*".f,tf u<', tiC1
w, Ulf 1 I CO 1 ,l4 v.i YeS No. Is curistructs.in w,ttil! t 00 vi, °Ioipiiial,
i
of ciii!,enwit n! cellar I. ofir neln4 ' i
f
' 'NA. ,Mi Idirf: :,: fpril tn 1f4,... 13tnICtnp, f'sn;i 2orarp. r _ Yes, _ . No
!
I. StTlic 7 '.rli( C'',y 5ewt-',1 i>f viel City viater Sun' y
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEW
1 —
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
6/ftRaz re-‘1)f , as 0 ct t*ie subject voiocrty
ffl!!"*:nt'1,7E' Nelson , Shif flett, Valley Home Improvement, Inc. _, ,, on
rriy Lf w 0•:1 7ne4tie!S rt,I,L;itl. tO W;)1;^ i,t,ithC."1:r;(% :,),' Ifilf, 1.)i'lli: pel anpfic,itivi
V 4/3 4 '0 liell3 C51"" — _ _ .._ .............._ . __
Sikr, a:ure oi OKrier L:.711te.
r
r rue o te
..Nels.otLShiiifaelt4__Y_all_ey Home Impro3rement.,_Inc.. 3
r , • ,-, P. Aflerit
hr -eby dc!cithrP tzt t •,trterr1 It tld i r f Arqt.b1 07: the fortotr sior ,I.e trt1 i ii,:co,i, tO 9 y
Ie bt-..,", G ir
krewlec pc! End belief.
- ,cd J.: tt rDarii ir t.v.L-ier tic:: o
!
Nelson Shif f lett_ _ ...
r I
( ,
Oi 1 . , Ac°,7?r / Dahl ,
..,
__....,...._
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
Side L: R: L: R:
Rear (3 G A
Building Height G P t1 L/
Bldg. Square Footage 0 � /
Open Space Footage (fly
(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 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ,/ pe 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 6/ 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 V
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 on
- . _ � City of Northampton Status of Pe) t ,
\-- \ \ Building Department Curb Gut /Drive ay Permit
x Z % 212 Main Street Sewer /Septic Availability f n ,
E Room 100 Ulj r / Avai ��
: : . J1A01060 ' A
F orthampton MA 01060 Tw of ,S aura! Pl an s
" phone 413-587-1240 Fax 413-587-1272 i'lot /Site Pi°
x X
Other Speci0 .,,
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
2(_e 7l Map Lot Unit
//G 1 `- ` n /71.,i-- e/0 ) Zone Overlay District
Elm St. District_._,_ CB District ,
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: `ir //I ✓% 7 A.
Name Current Mailing Address:
A A / /�. 4 Telephone
Si: atur- /V SeAirliaw 9S/04i) y 77/ _ il . 6,370
2 Authorized Agent: Nelson Shifflett
Valle Home Im•rovemen • P.O. Box 60627, Florence, MA 01062
. e (Print) _ Current Mailing Address:
c '' (Lg`rte) 584 -7522
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
/6 o o
2. Electrical (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) /e, f7 d+ Check Number J0
(o ff
This Section For Official Use Only
- Building Permit Number: Date Issued:
Signature: __
Building Commissioner /Inspector of Buildings Date
File # BP- 2013 -0191
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413) 584 -7522
PROPERTY LOCATION 26 MAYNARD RD
MAP 31A PARCEL 176 001 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 J /�—
Fee Paid 1 V sto
TYpeof Construction: REBUILD PORCH WALL SYSTEM
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
INFO 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 Commission _ Permit DPW Storm Water Management
De i �el.
S . . '.. e s i . din_ ifficial 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.
26 MAYNARD RD BP-2013-0191
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A - 176 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2013 -0191
Project # JS- 2013- 000309
Est. Cost: $10000.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 060300
Lot Size(sq. ft.): 14984.64 Owner: RUDDY DANIEL & BEATRICE C
Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 26 MAYNARD RD
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584 -7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:8/22/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:REBUILD PORCH WALL SYSTEM
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 8/22/2012 0:00:00 $60.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner