35-201 Re Trim existing Window
reuse exisitng ��� _ /' Granite seat
toilet
Tile base/ Tiled walls
Frameless Enclosure "
12" x 18" Recessed Cubby
Shower Door at end of enclosure
Meisse Bath
GFfI
1" beveled mirror for each sink ! Tile floor
Solid surface Counter/intergal
bowls \
r
Dfu�P
I �I
New 26 Door
y..
Re Trim existing Window
r
reuse exisitng /Granite seat
toilet '
'
Tile base/ Tiled walls
Frameless Enclosure
12" x 18" Recessed Cubby
Shower Door at end of enclosure
Meisse Bath _
GF I -
1" beveled mirror for each sink Tile floor
Solid surface Counter/intergal
bowls
New 26 Door
4Ct�A11P�.
9�0 o?>a
C"lxo D"f Xart4aillptull
Ilk d is's Rc4rTsetts
cD DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building 'o
Northampton, Mass. 01060
WORKER'S COMPENSATION T.NSURAANCE AFFIDAVIT
I, Nelson Shifflett - Valley Home Improvement Inc .
(licenstrJpermittee}
with a principal place of business/residence at:
340 Riverside Drive, Ncrthampton,MA 01060 (phone,t) 584-7522
do hereby certify, under the pains and penalties of perjury, that:
()) I am an emplover providing the following worker's cornpensauon coverage for my
employees working on this job:
Acadia Insurance Co . 0109302-12 2/1/07
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, geaeral contractor or homeowner (circle one) and have hired
the contractors listed below who have the follov,�ing worker's compensation policies:
(Name of Contractor) ( mnc-, Company/PclicyNumbcr) (Expiration Date)
(Name of Contractor) (Inssrancc Compaay/Po?icy Number) (Expirnoa Dare)
(Name of Coturae�,or) (Insllran(,:.Coinpa.-yiPoUcy mr-x:) (Expun-non Date)
(Name of Contractor) (Insurance Comrzny/Policy Number) (Expiration Date)
(attach additioml shed if neoeasry to iachxk mfonn2non pertaining to all ooa:xadors)
( ) I am a sole proprietor and have no one worlang for me.
( ) I am a home owner performing all the work myself.
NOTE:pease be awaro that whilo homeowners who erap[oy pasoas to do� T■ mmuvctioa or gait wait on a dwelling of
not more than throe units is which the homeowner raids or on the grouz6 appurumw t thereto ate not generally co=dered to be
emrployers under the worker's ampcasation Act(GL152,s s 1(5))�,application by a homeowner for a docnw oe permit may evidrnoe the
legal ctwu of an employer under the Worker's Compemation Act
I undetuand dut a copy of this cLa=ccd may be forwarded to tbo Dep rt neol of Induttial Acadw&Offioo of ln==w for the
coverage verifialioa and that failure to segue ooverago under section 25A of MGL 152 can[cad to the imposition of criminal penalbea
coasis`ing of a fine of up to$1,500.00 aodlor imprison of up to one year and civil p=d is in the form of a Stop Work order and a
firer of 5100.00 a day against the
Signed this j '/-__day Of �� A2 For dcpatme"uac only
Permit Number
s
SECTION 8 -CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Steven Silverman 077279
License Number
268 Fome 6/21/08
Address Expiration Date
584-7522
Signatu4e Telephone
9 Registered Home Improvement Contractor: Not Applicable ❑
Steven Silverman 131945
Company Name Registration Number
268 Fomer Road 10/13/08
Address Expiration Date
Southampton, MA 01073 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....... E 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 Budding 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 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
F 7
ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(sb4 Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ pp New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work: KEM010 EL- " LG01, FULL 6A TH
Alteration of existing bedroom Yes No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet❑
6a.if New house and or addition to existing:housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dime ions
e. Number of stories?
f. Method of heating? Firepla or Woodstoves Number of each
g. Energy Conservation Compliance. ascheck Energy Compliance form attached?
Type of construction
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 ow finished grade
k. Will building conform to th uilding and Zoning regulations? Yes No .
i. Septic Tank City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
60 N N A M lss C as Owner of the subject property
hereby authorize Steven Silverman, Valley Home Improvement Inc to act on
my behalf, in all matters relative to work authorized by this building permit applicat n.
_ � I;./
Signature of Owner Date
I, Steven Silerman, Valley Home Improvement Tnc_ 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.
Steven Silverman
rpnt u Name IV
_. - - 7
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 i y
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
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/Varia/Findnigte een issued for/on the site?
NO DON'T KNYES
IF YES, date issued:
IF YES: Was the permit recorded eeds?
NO DON'T KNYES
IF YES: enter Book and/or Document#
B. Does the site contain a br ok, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a per t been or need to be obtained from the Conservation Commission?
Needs to be obt ned Obtained , Date Issued:
C. Do any signs a Ist on the property? YES NO
IF YES, d scribe size, type and location:
D. Ar there any proposed changes to or additions of signs intended for the property?YES _
No
I YES, describe size, type and location:
r .
"�. Department use on1 °
City of Northampton Status of �ti
Building Department Curb Cut €7rwervaX7: ' it
k
212 Main Street Sewor/Septic
ell
Room 100 1fk r IW Availability x,
n ,
Northampton, MA 01060 Twr ets o tural Plans k*v
phone 413-587.1240 Fax 413-587-1272 Plot/Site; r _ i
Other Spec
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1- SITE INFORMATION
--This section to be completed by office
11 Property Address:
1300 DUP.Ts PITT R-D Map Lot Unit
A O l b �'L Zone Overlay District
Y Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
000NA 1NlCl5S Si4�'►'��
Name(Print) Current Mailina.&Jdress�� :
Telephone T
Signature
2.2 Authorized Agent: Steven Silverman
Valley Home Im rov t P.O. Box 60627, Florence, MA 01062
Name(Prinb Current Mailing Address:
584-7522
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by ermit applicant
t. Building f 2 0oo (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
000 Construction from 6
3. Plumbing 3 200 Building Permit Fee
4. Mechanical (HVAC) (/
5. Fire Protection
6. Total =(1 + 2 + 3 +4 +5) Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2007-0718
APPLICANT/CONTACT PERSON Valley Home Improvement,Inc
ADDRESS/PHONE P O Box 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 1300 BURTS PIT RD
MAP 35 PARCEL 201 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out oau an
Fee Paid
Typeof Construction:_REMODEL 2ND FLR FULL BATH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 077279
3 sets of Plans/Plot Plan
THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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 ssion
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.
BP-2007-0718
GIs#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2007-0718
Project# JS-2007-001092
Est. Cost: $16800.00
Fee: $84.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Valley Home Improvement, Inc 077279
Lot Size(sq. ft.): 46609.20 Owner: MEISSE DONNA&JOE HAMILL
Zoning: SR Applicant: Valley Home Improvement, Inc
AT. 1300 BURTS PIT RD
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON.1/1712007 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL 2ND FLR FULL BATH
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 1/17/2007 0:00:00 $84.0022020
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo
1300 BURTS PIT RD BP-2007-0718
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 -201 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Pen-nit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2007-0718
Project# JS-2007-001092
Est. Cost: $16800.00
Fee: $84.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: license:
Use Group: Valley Home Improvement, Inc 077279
Lot Size(sq. ft.): 46609.20 Owner: MEISSE DONNA&JOE HAMILL
Zonni&: SR Applicant: Valley Home Improvement, Inc
A nnn nl 1r) -� n!-r ,---
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON.1/1712007 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL 2ND FLR FULL BATH
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
1
� � Footings:
,Ro Foundat ion:
on:Rougli:/ = ��
! "
Driveway Final:
Final: - ' '�Q / , inal:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Final: Smoke: Final: ct< 45(2510-7 f -„ ,%
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATION
. r
Certificate of Occu anC Signature
FeeType: Date Paid: Amount:
Building 1/17/2007 0:00:00 $84.0022020
212 Main Street,Phone(4 13))587-1240,Fax:(413) 587-1272
Building Commissioner-Anthony Patillo