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SECTION 8-CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Nelson Shiffl.e.tt__ _-_060300
Valley Home Improvement, Inc. license rJun,t;er
340 Riverside D ve Northampton., MA 01.0.6.0 9/22/f
ddr P ss Expiration Date
_ 584-7522 __
Signature Telephone
9 Registered Home I provemenLContractor. Not Applicable ❑
Valley 105543
Campany Name Registration Number
340 Riverside Drive 1,7/1
Address Expiration Date
Northampton, MA 01060 Telephone 584-7522
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(WG.L. c. 152, §25C(6))
Workers Compensation Insurance affidavit must be completed and su`omitted .Neith this application. Failure to provide this af`idawt
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... lift No...... O
11 - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellin;,s of one(1) or t1vo(2) ianiilies
and to allow such homeowner to engage an individual {'or hire who does not possess a license, provided that the owner acts
as superv=isor. 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 lie/she shall be
responsible for all such work performed under the buildinLy 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 Laces 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 Gencral Laws .Annotated.
flomeowner Signature _._ __ --------
t
Nrw Hc -.
uu Ad itic c-
n �i RepizcmerA Wirdcw:. A.
Cr Coors
ACCES&C"Y S!dg. Dernzlizic,-= New Signs Decks Siding Other
6--, If Now house wid or addition to existing housing. complete the following
SECT;CN 7a - OWNER AUTtiCRIZAMN • TO BE COMWLETCD N WEN
OWNERS AGENT OR CONTRACTCR APPLIES FOR BUILDING PERMIT
L
aw Ch�
Nelson Shi-r-flett, Valley Home Improvement, Inc.
Ne
V'V
Nelson
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: n,R:� L: R:
Iv � t
Rear n d
Building Height 1'
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 v 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:
a
p� Department use only
2 ty of Northampton Status of Permit:
ilding Department Curb Cut/[driveway Permit
212 Main Street Sewer/Septic Availability
AN 23 2014 Room 100 Wi46r/Welt Availability
or hampton, MA 01060 Twcr°Sets of Structural Plans
Electric,Plumbing 8pmftpw, i87-1240 Fax 413-587.1272 Plot/Site Plans
�!^rth�m °nn, t<AA 01060 ;
_ -_-- _ Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION t N 1/("/A
1.1 Property section to be completed by office
P2 jert�y Address:
lL1c,.L_6T(.G'f"? �iP�d CJ� V/I6 f � Map _ Lot Unit ..._
Zone_- Overlay District
Elm St. District__..._ _. CS District.- __,_.,SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
on '�5 _
Name(P .nt) Current Mailing Address:
Telephone
Signature
2,2 Authorized Agent- Nelson Shiff Lett
i Valley Home TmgroveMg t , Inc..,_ P.O. 60527. Florence, oio62
�a.
Name(Print) Current Mailing Ac cress:
584-7522
Sigrature Telephone
SECTION 3.-,-ESTIMATED CONSTRUCTION COSTS
Itern Estimated 'Cost(Dollars)'c be official Use only
corm !eted b e r m i t a p plic.9 nt {
2. Building (a) Building Permit Fee
G9 ado
2. Electrical (b) Estimated Total Cost of
S r D Construction from 6 f
3. Plumbing Building Permit Fee s
j
4. Mechanical (HVAC)
15. sire protec:icn
6. Total = (2 + 2 + 3 + 4+ 5) Check Number
This Section For Official Use Only
f Building Permit Number:_ Date issued:
r�i�natur-e:
Suildinp Corrsmissioner/Inspt--tor of Buildings Jute
File#BP-2014-1097
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 63 HATFIELD ST-UNIT 5
MAP 18C PARCEL 172 001 ZONE URB000)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out 421 H
Fee Paid
Typeof Construction: CONVERT 2ND FLR DECK TO SUNROOM
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 TION 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 gPermit DPW Storm Water Management
el
S re of i icia 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.
63 HATFIELD ST-UNIT 5 BP-2014-1097
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C- 172 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-2014-1097
Project# JS-2014-001872
Est. Cost: $22000.00
Fee: $132.00 PERMISSION IS HEREB Y GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 060300
Lot Size(sq ft.): 0.00 Owner: FISH CHERYL A&CARLA COFFEY
Zoning. URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT. 63 HATFIELD ST - UNIT 5
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:412412014 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONVERT 2ND FLR DECK TO SUNROOM
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 4/24/2014 0:00:00 $132.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner