29-371 W
z w
z _�
LLI
�0 w Q
(D \ m w
o \I � o w
o Z co
~ mco
LU
m - LO
z
U Q _ Q Q
❑
w p Z Q 2
Y i> E- w
C
w 0-1 I
D Z J
w ti °-°'D 0 Q
U � ¢
C�`p U) w -1-i
w
--/ w F- w J
-❑r -�- w
te
w U
❑
Z-'
W
(� W
J U
W
Z
Ouj
w ❑ 20
N W --�
_ i CC LL
w W
z J CD
QUA
00 � r--
p� U �
OU)
O =)
= Q
r
r
G�
L�
Z
7- ~
Z_ LLUU
uj
Q
H
O W U) ry
`� w
O
Ow
/ z = � p
O O � _
I— m U)
_ F- J
_ � a _
c) Z fY z
ui
Cf) Y XX
= Q >
C w -� U) ° w � ¢
� :D �i J
w LL U O Q C o
�-
LLJ
O
/ 0/ u)_w w
fi U) z
uj
-'
W
C k �.�.�
W
4 0
w oa O
�- :E O
Q N W
= S ry LL W
z � .-i CY)
QUA
� U �
> ZLO
OUj
O ::)
= Q
of Nart alliptall --
* � ,�la�atzsllnstfte ��`
t.
c
DEPARTMENT OF BUILDrNG INSPECTION
6
212 Main Street ` Municipal Building
Northampton, Mass. 01060 ;
'
WORKER'S COMPENSATION INSURANCE AFFEDAVYr
----v ror TTaii1:'C3vPTPI-nt t Inq.
Oicenserf zmittee}
with a principal place of business/residence at:
'?t v v ba 58 7�i _ 05 -
_
0ctTr'4/czts.l�?f t nl
--rf
do hereby cerdf�, under the pains and penalties of penury, that:
} I am an employer providing the following workees compensation coverage for my
eruployees working on this iub:
`travelers insurance Co. UB888D9983 ?f 11,0It
{fit°s rance Company) (Policy Number) (Expiration late)
{ I am a sole proprietor, general contractor or homeowner(circle one) and have hires
the contractors listed below who laiave the foilowin worker's compensation policies:
,I`lame of Contractor) (Insurance Company/Policy Nun:) (Ex-piration Date)
(Name of Contractor) (Insurance Company/Poilcy Number) (Expiranon laze)
(,Name of Conirac-ior) bran Co p °tPalicy?vtut l r� i�`�iratr;,n Mara,;
,Name of Contractor) ansutwce Company/Policy Number) (Expiration Date)
(attach additioexat stmt Tnecessary to fgrmatioss'peguin ug to au wdnwton)
} I am a sale proprietor and have no one working for me:
( } I am a home owner performing alt the work myself.
NOTE:pl=w be aware tilt wb le hoacowacts who en*oy P=,o,=to do fir,o==umon orrcpazwetkon a dwelling of
r,A:note then tbrft units sn whuct tbt hatneowncr rtndes or on the grounds appazt= thereto=wt v y oo= to be
es tlo ta€�du the svcrltes's lion Act(GL152431(5))applimt on by a homtowner fora liaise or permd.may cvxkwc t€tc
legal status of an employer undartho Worker's compensation Act
i utadeertxuxd that a OOPY of this statemeta mXY be forwarded W tho DVu�of Ir>d sxria€A Os4,of Iu.....=f"ti,
00vftVgC salt0400 arA qua :irut'r to S=Lre OOVM age under section 23A of MOL:152 cau imd to the inxposdioa of=mind
i%
of w afup to S€,500.00 and/or of up to one year and civil potaitits in 60 f�a of Stop lvolkOrd
f a
of 100.00 a;day agazA tnc
Signed this _cloy of FoM
i« _� .. .._
2000
hermit Number
MW
I,ttt
SiPatumm of Li erml
„ CTJO �-CON�STRUC�TION SERVICES
.1 License construction Sqperviscr. Not Applicable U
i060300�0
N—ame tUaense#finder .Nelson Shif fleet
'
Valley Home Improvement , Inc . tense Number
320 Riverside Drive /00
Address Expiration bate
Northampton, MA 01060
Signature Telephone '
584-7522
R ! # Not Applicable 0
! Valley Home Improvement, Inc . ___105543
Comvan Name 1 Registration Number
17/02
7
320 Riverside Drive —_-- /
Address _ . Expiration Date
L IN rthapton, MA 01000 Telephone____ 584--7522
SECTION 10-WORKERS.—COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
4
Workers Compensation Insurance affidavit must be cornpieted and submitted with this application Failure to provide this affidavit
will result in the denial of the issuance of the building permit,
i Signed Affidavit Attached Yes....... No......
The current exemption for”ltomeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2) families
and to allow such homeoNvner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor.CMR 7801 Sixth Edition Section 108.3.5.1.
Definition of Homeowner. Person(s)who oven a parcel of land on which lie/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-rear 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 wort: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,Lou tray be liable for persortt.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.
Horneowner Signature
r •
'E`CT14T+15i t7-E��#�I�'T�C� '�E���} E�1NQRK�ctaeck alt aPP�ic�hi��
New House F1 Addition 0 Replacement Windows Alteration(s) Cl �Ranting
Or Doors t i
Accessory Bldg. 0 i DemolitionO New Signs F I Decks [ Siding[ Other i
1 Brief Description of Proposed Work:
s
Alt�e�r�iion of existing bedroom Yes No Adding new bedroorr Yes t- p 11
( tfa hen Narrative" / Renovating unfinished basement Yes
} Plans Attached Roll Sheet �
a
r. Use of building : One Family r!! Two Family Other _ ._...._..
_
b. Number of rocims in each family untt: _._ _ Number of Bathroorris__- 1
i
c, is th-e,e a garage attached? 1
1
Proposed Square footage of new od"I�tE'LICtl4 1.- --, -- -- _- Dirriensions
t
l e, i larnber of stories?
f Methoo of heatii.gj Fireplaces or Woodstuve ._ Number of each
g. t.ne gy Conservation Compliance. Mascheck 'nergy Coripiiance form attached? __-----_._�----
Iype of constr#ictlo!',__...._
i, is construction within 100 ft. of wetlands? Yet. ,— No. is constructs , within 1-00 yr. flcodpla€n e' _-_-No '
I
Cj. Depth (--if basernent or cellar floor below finished grade
'K Will building conform to the wilding and Zoning regulations:' Yes __._._. No .
i Septic Tank _ City Sewer Private well City water Supply --- --•---
a
SECTION 7a-f?WNER AUTHORIZATION'.TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES 17OR BUILDING PERMIT
C
l E
Gail Hoover or Clifford Hoover as Owner of the subiect proper,y
nerety a tihorize Nelson Shifflet t, ValleHome Iwrovement , Inc. — _ to apt ,
my be lf, in all ma tern relative to work authorized by this b=uilding permit application.
Signature uwner Date
3
'hereby declare that thefsta}ernents and information on the foregoing application are true and accurate, to the best of my
Nelson Shl flea Valle Home Improve—me-at- Inc _ as owner1Aut wrier/Authorized {pert I
{{{� kr;owiedge and belief. i
Signed under the pains and penalties of perury.
Nelson Shifflett
{ Print Narn,e
i wig lutarr rf C ni;r Date
r •
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
t
Lot Size
� f
Frontagei
Setbacks Front
V
S
S€le L: R
Rear
1 Building Height a_
a
! Footage LN °fo
Open space rootage V % k
il,ot area minus bldg&paved i
I
parking)
of Parking Spaces
(vol URIC&Locatio-
A. Has a Special Flermit/Variance/Finding ever been issued for/on the site?
NO .� _ DON'T KNOW YES
IF YES, state issued: ------
IF YES: Was the permit recorded at the Registry of Deeds?
NO _.� DON'T KNOW _. YES . _..-___.
IF YES: enter Book Page - -- and/or Docurnent
B. Does the site contain a brook, body of water or wetlands? NO L� DON'T KNOW
YES IF IF YES, has a permit been or need to be obtained from the Conservation Corr misn?'
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
!F YES, describe size, type and location: -_- __ - - -
' ify of Northampton
Building Department
I i SEP 26 2000 212 Main Streeter
Room 100
&thampton, MA 0106 Z
C}
-phtne- 3-5-97.12403 Fax 413-587-x.272 ��� �g�
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SEC`FION 1 -SITE INFORMATION
1.1 Prerty Address: is s+ Cfiittt#t >CtkMt b? fe
t map Lx�t
h. Austin Circle {
MA 01062
one Overlay District
Florence
SECTION 2 - PROPERTY OWNtRSHIP/AUTHORIZE€ AGENT
a
y.1 Owner of Record:
€ Gail & Clifford Hower 15 Austin Circle
'
Name Tint} Current Marling Address:
Florence, MA 01062
i — - Teleahone
Sinnaaiur _...-_e
l 2,, Authoriged Agent: nelson ShiftJett _...
l Valley Home ImiDrovement, Inc P.G. Box 60627, Florence, MA 01062
N arne(Print'), Current Mailing Address:
5 8 4-7 5 2 2
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUGTiQN{'C1STS
! ltexn Estimated Cost(Dollars)to be Official Use Only
1 _ cQrn feted b ermit ao lica nt
_._
t, BuiiJing (a) Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction frdi'n 6
3. P;urnbia g J Building Permit Fee
i
4. Mechanical (HVAC) ..
1 5, Fire Protection _
16- i"ota3 = (i + 2 3 4 5) �C ` One( (*lumber
l This Section For Official Use Oni
Building Permit Number: Date Issued: ,m _
Building Commissionertinspector of Buildings Date �
File#BP-2001-0325
APPLICANT/CONTACT PERSON Valley Home Improvement,Inc
ADDRESS/PHONE P O Box 60627 (413)584-7522
PROPERTY LOCATION 15 AUSTIN CIR
MAP 29 PARCEL 371 ZONE URA
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
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 LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presentedibased 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 ission Permit from CB Architecture Committee
A d�e�z�f
Signature of Building Official Dat —YYY
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.
15 AUSTIN CIR BP-2001-0325
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-371 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2001-0325
Project# JS-2001-0528
Est.Cost: $6000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Valley Home Improvement, Inc 060300
Lot Size(ss .ft.): 11020.68 Owner: HOOVER CLIFFORD A&GAIL E
Zoning:URA Applicant.• Valley Home Improvement, Inc
AT: 15 AUSTIN CIR
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON:1013100 0:00:00
TO PERFORM THE FOLLOWING WORK.-BATHROOM REMODEL
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:
Footings:
Rough: Rough: House# Foundation:
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 10/3/00 0:00:00 12536 $50.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo