25C-033 r •
rY 4r(
e!
l.r
rn M to -n
,1 g � m4�
m ° --�
7• - -- --- - - - -- - - - - - - - - - - - -- - -- �.- .. JA i
——— — —— — — —— — — — — — — — — — — — — — —— — — — 'h p
a•. (GnpS � � j �
ti
w =
w
Fla
ZGZm
O N�
n
rnrn o x '
� ZZ
O < CU
rn s'a
AN
M rn
co
r .a. O $
,:..
t v
r' rn
r
M•I• V
1�
i
{
;u m -n co O=
mr rZ Zrrt ;
2 w m G7 i
'1 O Z 3� -n1 Cjr
O� m m o pF
xW.
m �(n m rk
m
Z Z
Z —I PJ �a+«•
Ln fA a
- - - - — - - - - — - - — — — — —
o
7EC
OE —< 2
z r
Fot
O
1r 0 0
001 6'4
r
C
;:r > 6'4
�k m
v:1•
fN
r
N�
O\j
6,
c\4\,\
-4•,`
k`�•�b ,
I,
sm O �
-pd0
m m
O .J. mmU c
.b N C7 G7 -
in
s
-- - - - - - - - - - - -- - -
� a ;
k
0 '0
o o —
• m
' ;ap
W Z
zZrn
0 ;r\ �--�
N r
rn
Z
0 CD 0 �
rn 6'4
co
e
,.:
cn rn
=mg.
!�t,
F,
µ'a
.4r
P
• I
1�
Cr
�k
J
x -n co p=
Z w -Dn gZ Z
Z m n�
'D
yZ C tyl.
- m m 0
rn i
0 Z Z O =
N Zr
E C n m
- -- - -- - - - - - - - - - 'R)..
'V^ a
VJ
'D 0 k+3,
- - - - - - - - - - - - - - - - --
OE
-D
z J
k4i1. ❑ c
V l�
,� oo
j
o 644
r
C
.a
8'4
I.I
r'
j.'.
AY
FRS'
P:
r.
Nart4alliptoll
R cam` DEPARTMENT OF BUILDING JNSPECrlo?NS N°
_
212 amain street Municipal Building
iNorthampton, Mass. 01060
WQRKEIV S COMPENSATION INSURANCE Alr MAWT
— l 1 k 9.f 1 t,. ,:m sFal3 P ar Improvemont,_ rtc.
a=rtlpetttee}
uviti a principal place of business/residence av
'2-0 R?yer i _Dr- yn' Qr.ttamp on Kwk o:� o (phone
yt
do hereby certit�,, under the pairs and penalties of pe�ttry, that:
(KY) I aman employer providing the following workers compensation cover-age for my
employees working on tL s iob:
Travelers Insurance Co. U13888D9983 2/1/01
(?ns -anc e CanVany) (Policy,Iu�utser) (Expiration Dam)
I amt a sale proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the follmNN n worker's compensation policies:
(Naine of Contractor) (Insurance CompanyrPoizcy Nusmbcr) (Expiration Date)
anit of Contractor) (lmsura ce Coxmpany/Poiic .Number) 'Expiration Date}
(Na ine of Conlzactor) (Insuranctx Comi3a-uy;P01iC'y?<uzjx-r) (Ex-titatmn Date)
(Name of Contractor) m nsucCornpatrytPolicy Number) (Expiration Date)
(attath additiomi shx ifne.enary to nwlia&mr n=oa pwuuning to ail ooqtraetars)
( I am a style proprietor and have no one working for me.
am a home owner performing aa the work myself.
13(}TE:ply be aware that wtile hamcowncrs who etzploy p=Ao=to do rottgrjctiott or rcpait} tic cn a c}vreliutg of
not morn then thtme omits to vi ch the hombowncr resides or oea the V out at purttrAa therein axe not to 4�to bt
employ=undertho vxtkeez oampe=auca Act t(GL152 m 1(5)),appli maonby a homeow=for a Boar ix pcsxd may-Acn-the
teal datUS Of an aMplvy4W UUdartho Wort fi Compaxwim Ate.
t-U*d4**0d thxt a Dopy''xfthis stat0=0A az&y ba fm wW'W to tbs Dqx tmcr4 of Tn&wrisl A.-4&n1Y Moo of iunu%ow for the
ccovemge r c sUou and that f hate w s=tre oovrrago Unda sectsot;23A of Moo 15 can kart to the imps on of crsn W peualtics
of a fuse ofvp to 51,300,00=41or of up to one year UA dvil peaatties in the farm of it Stop Work t and a
of 3100.00 a day tpiug me
Signed this Jay of , 2000
Pmmit 2"luml>er
,r +• ,0 Mao
Lot
y
Simf
I Licer sed!onstruction a ervisor Not Applicable 0
Nielson Shift 080300
Llame cri_Lscens- Holder::-_-. 1ett #
i
Valley Home Improvement-, , Inc . ' icense Number
320 Riverside Drive 9/02
Address.__..
Expiration Gate
i
Nort~haTpton,
_ ..__ p
Signature Telephone
884-7522
t 1.
Not Applacabie
Valley Home Improvement, Inc. 105543
Corngany Na me — _ __. 1 Registration Number
32_0 Riverside Drive
7/17/02
( Address � 6piratFon mate
}
Nortihapt~on, MIS Ym01060 -Telephone........_584-7522
SECTION+10-WORKERS'COMPENSATION 1NSURANGE AFFIDAVIT(M.�G.L.cw 152,§25C(6))
� 3
Workers ("orrpensation Insurance affidavit must be completed and SUbmitted with this application. Failure to provide this off d�vl+ ;
will result in the denial of the issuance of the building permit,
igned Affidavit Attached Yes--.... No...... 0
The current exemption for"horneowmers"was extended to include Owner-occupied Dwellings of one i;1) or two(2)fain lies
and to allow such homeowner to engage an individual for Dire 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 owrt 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 andl 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 he/she shall be
responsible for all such work performed tender the buildiniz 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 Frrzpjoy ers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated, F-ou may be liable for persons;
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 toning Laws and State of Massachusetts General Laws Annotated.
florneowner Signature
i
PPllc,a e)
New House 0 � Addition CI Replacement Windows Alteration(s) 0 Roofing -�
Or Doors Fl
Accessory Bldg, 0 Der°nolitionC, New Signs Decks Siding[t?----0ther c.
Brief Descr�otion of Proposed Work: ..f^iti � /UW✓��'7 c� =� ,J�l/�
` .v ,w.. r
Alter?:ion of existing bedroom _ ..... ._Yes i/ No Adding new bedroom Yes _ 1,---'No
Attached Narrative / Renovating unfinished basement __-- _. .'des _.__.G�o
Frlt}ns Attached Rolt Sheet / f
a uise of building : One Family_(/� ., a wo Family Other
b. Elurrr r of rooms rt; an each `amity unit: Number of Bathrooms____
is there a garage attached'?
i .7. Proposed Square footage of new construction.____--���
r
I e. N"irnber of stories?
t
y r t=ire ,laces or Woodstoves Number of eac
'.
Method of heisting__ _ /� F _-_-__--_-
tnergy Conservation Comp iance. 111117'1 ^�asclieck Energy (; rYipliance four attacked? ---- ---
r
Type ,uf construction
F
construction within 100 ft, of wetlands? Yes ---- is construction within 100 yr. floodpia€rr— Yes No i
Depth of basement or cellar floor below finished grade._---,--,-
k. Will building.conform to the Building and Zoning regulations? i/ Yes No . r
i
Private rw
j Septic Tank S city sewer rr3vate well �,ity water S+ f:3PtY
I
SEC,TION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
6WNEOS,AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
C
Richard & Anne White as Owner of the subject prcper y
jhereby . prize Nelson Shifflett:, Valley Home Improvement , Inc__...._ -._--_ _—_to act on i
my beh 1 , jr; all matters relay ve �o work authorized by this budding permit application.
Signature of Owner Cate
Nelson Shi l_et Valley I me Improvemen� C
�_ ¢ as rOwner/Autnor zed Agent
`;v e"by c[ectare that the statements and nformatiora on the foregoing application are true and accurate, to the best of my
Knc w e gig? and relief.
IIII �
Signed unde,the pains and penalties of per'ury. {
Nelsen Shifflett
Print Nars e
I
0—
Signature of t wnert�g t Date
_�
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DID TO LACK. OF INFORMATION
Existing Proposed Required by Zoning
1 This column to he filled in kip
Building Department
I
t
Lot Size.
Frontage
Setbacks Front
Side L: R.
Rear }c�
l
Building Height G�
IEd .Square Footageo
Open Space Footage 3 °ro
(Lest area minus hh(,&paved (I
puking)
#of Parking Spaces
1
�cr8un�e Laycataon) [ _--- 3
A. Has a Special hermit/Variance/Finding ever been issued for/on the site?
Na . i/ DON7 KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO _t/ DON'T KNOW --_...a _ YES
IF YES: enter Book "age _. - 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 Comr-nission?
Deeds to be obtained —, __ _Obtained —_ _, Date Issued:- _-
C. Do any signs exist on the property? YES _ NO —_
IF YES, describe size, type and
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location —..,.___ _.
,
City of;Northampton
Building Department
2000 212 Main Street R-6om 100
Northampton, MA 0106E �� 3
4pfi'06e 413 587-'12 0 Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1roperty Addre�i:
'This-sectirtn erre �arap�le#esl f ?a�lfi
33 Northern Avenue Map :. """ Lot
Northampton, MA 01060
Zone Qiverly Dlstricf
(( __ 'Flint St.I3rstrkt CB Distric# _
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
_.. _---
Z.1 Owqer of Record: f
Richard & Anne White 33 Northern Avenue
° N rr t) (,arrent Mailing Address: I
Northam ton. MA 01060
Telephone
Signature 584-7593
,2Au%gr-zed-Agent-' Nelson Shiffle+tt
Valley Improvement , I nc Home P.O. Box 6,0627,
Flot Bence, MA 01Q-62
s .-.... _...�T
Name(Print) Current Mailing Address:
i 1
584 -7522 i
Signature Telephone
IiC7lGI ISTIMAI ED CI3lVa'fRIIITI{ N CCISTS
_ ,-I
i iterr Estimated Cost(Dollars)to be Official Use Only
I _
Completed ny periit a2phcant
t. Puildirtg (a) Building Permit Fee
V67 Zoo
1 2.Licctrical _ (b)Estimated Total Cost of �
d ,� o ConstrdctionJram 6 i
3. Piumbmg a Elul#ding Permit Fee 1
4 Mechanical (HVAC)
5. Fire Protection
f"A. t"ltai = `t-+2 . 3 + 4 � 5) (�V Check Number
This Section Far Offi ial,Use Only
uilding Perrnit"Number: Cate Issued:
a
j Signature; l
t
Building Commissiorver/Inspector of 8uildlrlgs Date
File#BP-2001-0441
APPLICANT/CONTACT PERSON Valley Home Improvement,Inc
ADDRESS/PHONE P O Box 60627 (413)584-7522
PROPERTY LOCATION 33 NORTHERN AVE
MAP 25C PARCEL 033 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERM_ IT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building,Permit Filled out
Fee Paid
Typeof Construction MODEL(2)BATHS&KITCHEN INSTALL VINYL SIDING&STRIP&SHINGLE
ROOF
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
T FOLLOWING 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
i � p .$b�xd b�ealh Well Water Potability Board of Health
Permit from Conservati ommissi Permit from CB Architecture Committee
d
Signature of Buildin 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.
r
33 NORTHERN AVE BP-2001-0441
GIs#: COMMONWEALTH OF MASSACHUSETTS
Ma :Block:25C-033 CITY OF NORTHAMPTON
Lot: :001
Permit: Buildina
Category:renovation BUILDING PERMIT
Permit# BP-2001-0441
Project# JS-2001-0756
Est.Cost: $45000.00
Fee: $225.00 PERMISSION IS HEREBY GRANTED TO
Const. Class: Contractor: License:
Use Groin Valley Home Improvement, Inc 060300
Lot Size(sq.ft.): 1001 8.80 Owner., WHITE RICHARD D&ANNE E
Zoning Applicant. Valley Home Improvement Inc
AT. 33 NORTHERN AVE
Applicant Address: Phone: Insurance:
P 0 Box 60627 (413) 584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON.•10131100 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL (2) BATHS & KITCHEN, INSTALL
VINYL SIDING & STRIP & SHINGLE ROOF
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 10/31/00 0:00:00 12718 $225.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
OD cj
0 - �' f=
h
t
�t
33 NORTHERN AVE BP-2001-0441
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mau:Block:25C-033 CITY OF NORTHAMPTON
Lot:-001 It.
Permit: Building
Category:renovation BUILDING PERMIT
Permit# BP-2001-0441
Project# JS-2001-0756
Est.Cost:$45000.00
Fee:$225.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: Valley Home Improvement, Inc 060300
Lot Size(sq fQ: 1001 8.80 Owner: WHITE RICHARD D&ANNE E
Zoning:URB Applicant. Valley Home I,rnprovement, Inc
AT: 33 NORTHERN AVE
Applicant Address: Phone: Insurance:
P 0 Box 60627 (413)584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON.10 131100 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL (2) BATHS & KITCHEN, INSTALL
VINYL SIDING & STRIP & SHINGLE ROOF
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: �2 f���d,�,�r/ House# Foundation:
Final: ei jl , Final: .l.2-o/o( W/
Rough Frame:ok
Gas j Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:&1< Hof
Final: Smoke: Final:.0 bf 01
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy—. i nature:
Fee Tyne: Receipt No: Date Paid: Check No. Amount:
Building 10/31/00 0:00:00 12718 $225.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo