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23D-001 (5) 51 NONOTUCK ST BP-2000-1087 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D-001 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:renovation BUILDING PERMIT Permit# BP-2000-1087 Project# JS-2000-1944 Est.Cost: $22500.00 Fee:$112.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Valley Home Improvement, Inc 060300 Lot Size(sq. ft.): 12501 .72 Owner: BOUCHARD MARY J&M MORIARTY& Zoning:URB Applicant: Valley Home Improvement, Inc AT: 51 NONOTUCK ST Applicant Address: Phone: Insurance: P O Box 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:6/6/00 0:00:00 TO PERFORM THE FOLLOWING WORK:CONVERT PORCH TO ENLARGE KITCHEN POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: �J', �'y Footings: Df- Rough: l/<We I ..t3 Rough: ,Y5 ` rV) House# Foundation:Q if 6 •.27 co Final/;t A0ZeJ/ Final: - Rough Frame:�f-; Gas Fire Department Fireplace/Chimney: Rough: Oil: Insulation: C -3 -CO a^ Final: Smolcc:: Final © k I ' /3-Q THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATI N OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu•anc Si.nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 6/6/00 0:00:00 12008 $112.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo • File#BP-2000-1087 APPLICANT/CONTACT PERSON Valley Home Improvement,Inc toomk ADDRESS/PHONE P 0 Box 60627 (413)584-7522 PROPERTY LOCATION 51 NONOTUCK ST MAP 23D PARCEL 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 Fee Paid MCt 2 Typeof Construction: CONVERT PORCH TO ENLARGE KITCHEN 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: Approved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § w/ZONING BOARD OF APPEALS 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 Co r sion Permit from CB Architecture Committee dl.oe).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 e of public works and other applicable permit granting authorities. \ v ^°•°"'1 City of Northampton trf r f TY.� '',, x, �r i 6 5 ,, z Building Department `1.„ tii� �s� „ '., 14 ' Ati a :� , r. �� ��� -9/1 kAr s f, �J 3 212 Main Street ,„:y : il1, ,,'� . , ,, pr 77t Room 100 41.1P; r :i a : , .k : DEFT OF ER ri _ Northampton, MA 01062 �. ,1 , c� . 4 MW Mfr„ , {vOt;Til;t -� ._ 01 le�e 413-587.1240 Fax 413.587 1272 1r 12�P 1 �Ar K, 'i+ r � y 1 C 101:.;',',.;',.t44 :�,.,,hyI'CCg �. 1--rt tix ,,y: t�1 Tom:-.4, '3q�(4iV Jt i� 1 , t W " ,r.311 �1 ts. t,, APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1•SITE INFORMATION This settttOn td be oo0l1tetett':I y l'ffice 1.1 ProaertY Address: • ti Si 0%/077/ 71"--E --/r m44 _ nt t Th . ., i Zone eri�y Dtstr�ct „' �Q,e,7% ,/)Nf�/2 OX) 7 F fn st l triot ,.CB DastriCL SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: "it, El Oaeh47/LJ 5/ AiroiJO/U ed Sim- Name(Print) Curren: M ill A r f , 77 l6a / —_ Telephone D . Signature / c/f 2/�/ ?2 Authorized Agent., V/ �y//Z� i,,,e6v`z ,p ,.-:/.-1 yG/ ,1//Jsv .1 .S,// -7% /:GI , .10 6o62:7/7_6;f/AZ.-4 , W.1 2 Name(Print) Current Mailing Address: /l/67ser c ,-f 04 '51/3 -51Y 7-s a ) 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 g a;v©d 2 Electrical (b)Estimated Total Cost of d ,coc7 Construction from(6) 3. Plumbing d o) Building Permit Fee • 4. Mechanical (HVAC) _ 5. Fire Protection J i N Mar 10 00 10: 52a p, 2 Section 4, ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE • i DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be tilled in by Building Department Lot Size -I t Frontage Setbacks Front .) VVV ' ((JJ Side L: R: f :Q k: Rear Building Height Bldg.Square Footage "% — Open Space Footage °% (Lot area minus bldg&pave d 1 1 parking) �J #of Parking Spaces Fil l (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 t7. 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: ftar 16 UU 10: S3a p. 3 SECTION 5-DESCRIPTION OF PROPOSED WORK.(check all applicable) i New House ❑ Addition ❑ Replacement Windows Alteration(s)C Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolitionn❑ New Signs'[ ] Decks [ J Siding[ ] Other[ Brief Description of Proposed Wot: ( &) 3L(! / �,'C.A/v '',J C'*�c' c - i7�- t/�/t Alteration of existing bedroom Yes v No Adding new bedroom _Yes o Attached Narrative / Renovating unfinished basement, Yes C/�o Plans Attached Roil n • Sheet 8' 6.al i; !DOS Atitt 'pare lO radditib ttti iDagtittgtlOtaattg','!itb tiOnWifie Gfll> ilig: a. Use of building: One Family v Two Family Other b. Number of rooms in each family unit: c Number of Bathrooms _ c. Is there a garage attached? A>_ n d. Proposed Square footage of new construction. 'Al /, Dimensions e. Number of stories? 4 f. Method of heating? Sh Fireplaces or WoddS#oyes Number of each g. Energy Conservation Compliance./C, Okt Mascheck Energy Compliance form attached? h. Type of construction_ ail i'lA-K,O 40'e c''— i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supp;y SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING_PERMIT /"Z/ .dC2frt'G/r% as Owner of the subject pr erty hereby authorize //< QA15 // j Z //fie to act on my behalf, in all matters relative to work authorized by this building permit application. ��-fro- OO Signature of Owne Date I. /° Sd-/t) `S///P 77;/// //d/te ���� / .� as Owner/Authorized 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. Print Name /1 a I • t Signal re o •wnf/'ent Date l M,nr 1 6 (JO 10: 53.a p, 4 SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction SSuperviso�r:: y Not Applicable 0 Name of License Holder: /j/Z1- /"' d -S/ f 06-O.30 License Number /.�� ' s/1 /— / s /OD Address Expiration Date ro,f /M , O/5�% Signature Telephone ` i3- -g737 �1 'tt �..i .l1 •�l !. "all:q "Llt ���AL'I' }a+i a:il:f"v tla�Yli'''fi �. ,•i, ..T it,t ,, :1;: Not AOPlicable — 76, Company Name Registration 1 umber 3 zo , /v/t /.�2 7 // Address // Expiration ate , 7t7,9 e/(1�aelephone N' 7 -75 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` wilding permit. Signed Affidavit Attached Yes No 0 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-ve;tr 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 huildin2 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(s) you hire to perform work for you wider this permit. The undersigned"homeowner"certifies and asssunes 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 ) /' w �'ttiAMpi. .o ev"4'�pi,.., ii A s �9 Crxt-r of Northampton 1 $ rte,,; asartrflnsctfa =-'�'l ._ � }.- DEPARTMENT OF BUILDING INSPECTIONS 4 v 2 4._ 212 Main Street • Municipal Building Northampton, Mass. 01060 `'s WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, Nelson A. Shifflett / Valley Home Improvement, Inc. (I►ccnseeipelmi tree) with a principal place of business/residence at: 320 Riverside _)rive, Northampton, MA 01.060 _(phone#) (413) 584-7522 (std et/city/statelzip) 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 iob: Travelers Insurance Co. UB888D9983 2/1/01 (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 ifneccssary to include information pertaining to all=Manors) ( ) 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 pazoni to do rm.mrmanrr,construction or repair work on a dwelling of not more than three units in which the homeowner resides or oa the grounds appurtenant thereto arc not generally considered to be employers under the worker's compensation Act(GL152,st 1(5)),application by a homeowner for a license a permit may cvidcnce the legal rtnr,ia of an employer under the Workols Compensation Act. I understand that a copy of this statement may bo forwarded to the Depatmcut of Industrial Accidents'offioo of Insurance for the coverage verification and that failure to secure coverage under section 23A of MOL 152 can lead to the imposition of criminal penalties ooesistiag of a fine of up to S1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of 3100.00 a day against me. 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