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NEW VANITY r...
NEW ACCE55ORIE5
NEW TOILET
NEW SKYLIGHT
TILE BATH FLOOR,5
RELOCATE 1 WIND(
NEW 4040 DOUBLE
RELOCATE RECE°
NOT INCLUDED:
ELECTRICAL FIN
FINISH PAINTIN
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2'-8" 4'-8 1/2" 7'-9„
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Valley I-10me
I prove
P.O' BOX 6062
413-584-7522 2 m NORTHAMPTON MA 01062
FAX 413-585-0820 en�� In ce
VALLEYI-IO
MEIA4pROVEMENT COM
DESIGN BUILD
ADDITIONS •RENOVATIONS
12-18-2013
Charles Miller
Re Fred Grinnell Bath rerjod
el
11i Chuck
Thrs house is
W-hi POorly insulated.
As
't tel!you ex You'll�e we're
Vreeland, we will. tf xa t w�hat ami adder,a sk,44ht and
�'detail will work out creatrr�an
We'll air seal a call.Yap ib ,but if we enJarg skylight
and dense 6'Y Once involve Qave
attic above the pack cellul we have eVerYt'hing
bath, cellulose in all new are ned up. Let In
e,add +�knoay.of Thanks and MerryC has loose cellulose to the baianre the
Nelson Shiff(ert
Aze
O0Cl pT0
� s �assachasctts ;
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street a Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
{licenser/permittee}
with a principal place of business/residenae at:
i11� (phone#)
(streeticity/s' f>zips
do hereby certify, under the pains and penalties of perjury, that:
�4 I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(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) (Luai rance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insnrdnce Company/policy Number) (Expiration Date)
(attach additional shed if necemry to mchwe information pata=ng to all cortradm)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myseT£
NOTE:please be aware that wbile homeowners who employ p==to do rani d=aneS cvnsuuction or repair work oa a dwelling of
not more than throe traits is which the homeowner nudes or on the grounds appcutanani thereto are not grapy oo=dered to be
employers under the workees erica Act(GLr52,ss 1(5)),application by a homeowwr for a Buse or permit tray evidence the
legal status of an employer under the Wodrees Compematioa Act
I uadastaad that a copy of this=dement may be forwarded to the Deputmcm of l,%& rial Aeci&=&Offioc of Imtea=for the
cover age ver ficslion and that failure to Sea=coverMgc under sectioa 23A of MGL 152 can lead to the inzfwsition of criminal penalties
oomisting of a fine of up to S1.500.00 and/or kapr6o=cra of up to one yrar ad civil pe xWcs in the form of a Stop Work Order and a
fum of 5104.00 a day against me.
signed � � of
____day � �r L�f "1 For del—only
Permit Number
Mail# Lot#
'&=Wre of Li ertnit#ee
Board of Sufldrnq ReqWabons and S"andands
Coaszrucf �n �pen tw, I S, 2 FjnvA
-<Cense: CSFA-060300
NELSON A SHTF
PO BOX 60627 WN
FLORENCE MA'01
OW2212014
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02 116
Florne Improvement Contractor Registration
Reqjstrabon'. 105543
Type: Private Corporation
Expiration: 7117/2014 TO 226093
VALLEY HOME IMPROVEMENT INC.
Nelson Shifflett
P.O. Box 60627
FLORENCE, MA 01062
Update Address and return card. Mark reason for change.
Address Renewal Eniplo,yrnent Lost Card
A
SECTION 8 -CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License,Holder: Neh;Qn Shiffle.t.t_ _ 060300
Valley Home Improvement, Inc. License Number
340 Riverside Drive, Northnm�tnn, MA n'i Q60 9/2_2/_ tf _
Address Expiration Date
_ 584-7522
Signature Telephone
9. Registered Hon mprovementContractor: Not Applicable ❑
Valley Home Improvement. Inc 105543
Company Name Registration Number
340 Riverside Drive__,_
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....... M No...... 0
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 encyage 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 horne in a two-gear 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 he 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
"TION S. DESCRIPTION QE PROPOSED WORIS_(ch�ck
New Hc:ur.� _ Pt ditlarr ! �RePl2ccn�ent 1"rindows A:ie�ition(s) I- Roelfinr h
ar 00ors
AccEssory Bldg. D Dernolitior`D New Signs I Decks Siding [ I Other I
art �� r�l. hn:�.,+.l: �•�P �C/Y1�Zd �`/�1� .. A�! ._1�j; ��.1 „9p
"F! :1 r't'".:Ft. ; r f.r "s'z1 Yf ✓ Vr ( ,I !r r fir, :lf.rt. { Y<_.., _ . "Ir
tn:Zl. ' IB k'YS I7v.. ld
sa. IF New house and or addition to -"isting housing, complete the following:
M1.
J r
I I ..A,. �C:C.}'F r °"` IR'•R a
+ i
�i L '!Ct! { ' f t I c ! t I,.atc, I"v t!'
"�+ �`F��*,• ..!" :?".t"t�:tC;,•-; �..Ui"�;:icP`::� - .. _._ I." `t�: .:rt�_* C�71''4..,::'4it,7I c'�Ii_E' rJf'T1 s.�c.r'I`�L-°? - u
y" . ."
tv, I V k6'!t i I riw "I .�i r: ° .aF:z, _., � N";, IS L:aslstrj£:I..,I -.%
no IC fnr--n ( u I3l1•InII+F 1 d .. :�!"':C� r �a.I.alt, w.�._ Y'=
y Ott
SECTION 7a • OWNER AUTHORIZATION - TO 13E COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOP BUILDING PERMIT
».�ra_S.dcGti..����F:4'✓VF _ , dS -tvv"le t C! C, lLir_.0 L .1 11
s. n_ hif flet:t , Valley. Home.: Improvement. Inc.
rf" _ '�'l ��a� �I:,•r E,. :�I�: ,u,ld7�:. !.r!: r; E'!!6 l;.!„ 11�; �8•. .!i .7I,'l,,,�Il;�'7
I
N��SS?tLSl1z f lP.t;. :. Value H[ym� Imi?SS�YeIIletl tr, SIIS~ v.
�iJ..0 "f+ s 1 _P. +(! C,;-. IfIG t?tw blr" . ) s< II "' :,G .'lt 9 t.l c#l: .f h.,. ,. + ' !T w'
P
1,,r C.,P7c&c Fn.. ua�rtC .
PIE lson Bhi f f le.t:x-__
. ..;.Ir.
C't
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 ,I
Building Height
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 / 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#
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 i
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:
Y
Department use only !
r - ity of Northampton Status of? 1,;
i uilding Department Curb Cut/Driveway Permit
4 DEC 1 a .-'013 212 Main Street Sewer/Septic Rvauati'sii y
! i--– Room 100 VJaferlWell Avi ailabiiity
(` ='e -�, F �' r,-.. �„ci�j-p thampton, MA 01060 TyJ Sets of S, py tural,Plans
587-1240 Fax 413-587 1272 Blot/Sitei'I g �!
t3tH'er S ec�
F
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
k6o,o/(,/ AG g� /
SECTION 1-SITE INFORMATION /��c✓ q/Gkf V t je rw C/-(-(// /14 /
1.1 Property Address: This section to be completed by office
5(o-A �2rC1'C�CGE� Map Lot Unit
Zone Overlay District
1/► Elm St.District.___ CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
-Name(Pr ) Current Mailing Address:
b - DO 4 7 _
Telephone
Signature
2.2 Authorized Ag nt: Nelson Shifflett
Valley Home Improvement, Inc P.O. Box 60627, Flarence, ._MA 0106.2
Name(Print) Current Mailing Address:
584 7 5 2 2 .._—
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUPTION COSTS
Cf;icial Use (fin)„
Item tstimatea Cost(uoilars)is isc � On!y
completed by ermit applicant
1. Building / J (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee i
E
4. Mechanical (HVAC)
S. sire Protection
6. Total = (I +2 + 3 + 4 + 5) j/0 Check Number 0
l This Section For Official Use Only
Building Permit Number: __ Date Issued: --.-
i
Signature: {
Building Commissioner/Inspe ctor of Buildings Pate _ _
File#BP-2014-0737
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 562 KENNEDY RD
MAP 09 PARCEL 008 001 ZONE RR(100)/WSP(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
T_ypeof Construction: REMODEL BATHROOM ADD NEW WINDOW& SKYLIGHT
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
INF90WdATION 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
moI- ' Delay
7
Sig re of Building ficial 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.
562 KENNEDY RD BP-2014-0737
GIs#: COMMONWEALTH OF MASSACHUSETTS
MU:Block: 09-008 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2014-0737
Project# JS-2014-001251
Est. Cost: $26000.00
Fee: $156.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Groin VALLEY HOME IMPROVEMENT INC 060300
Lot Size(sq_f.): 277477.20 Owner: GRINNELL FRED B JR TRUSTEE
Zoning:RR(100,/�WSP(l00)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT. 562 KENNEDY RD
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.1211812013 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL BATHROOM, ADD NEW WINDOW &
SKYLIGHT
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 12/18/2013 0:00:00 $156.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
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DRAWN BY: G6 Valley Home Improvement, Inc. GRINELL RE5IDENCE REYI5ED:
50ALE: 06/12/13
1 As' = 1'-011 340 Riverside Drive,PO Box 60621,Northampton,MAC 01062
Office Phone 413.5841522 Fax 413.565.0820
— — DATE: 05/22/13 Find us on the web at: w wYalleyHomelmprovement.com — — - -