25C-040 �'
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4ANDERSEN
D.H.WINDOWS
24'
DORMER
u z�SEP ZONE FHW HEAT
ALL SQUARE EDGE PAINT
GRADE TRIM WITH BEAD WEATHERSTRIP INTERIOR SIX
PANEL PINE DOOR
READY FOR CARPET
STAIRS READY FOR CARPET
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sD' UNFINISHED ATTIC STORAGE
112 WALL
OAK CAP ) INSULATE' -IIS WALL
�-up- EXISTING WINDOW
4'VANITY I SWANSTONE TOP / STUDY
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PAINTED BEADBOARD CEILING 'UP
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NEW STAIRS AND SURFACE
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RAIL ^
WASH LIGHT
wa ZERO CLEARANCE
NINE LITE FIBERGLASS DOOR FIREPLACE
SHIST HEARTH\, NEW POCKET DOOR
PAINT 5-0 DIVIDED LITE DOORS n
GRADE PANTRY FLUOR. �� DOOR REVERSED \\
CUBBIES
WIRE ?� i l COAT EXISTING CASED OPENING
SHELVES , / j i \ ! CLOSET
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WI DOW Z-3 SIX PANEL PINE DOORS
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FIXTURE
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RE TRIM EXISTING DOOR AND MUDROOM O
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NO WORK HER\ — REFNISH CEILING
TO MATCH EXISTING PROFILE
NEW CABS TO MATCH DW — — TOE KICK HEAT i
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RE CASE WINDOW AND DOOR
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$e � �laEErtCIIIrErttE
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DEPARTMENT OF BUILDITNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATTON INSURANCE AFFIDAVIT
I, Nelson A. Shifflett / valley Home Improvement, Inc.
(licenser/permittee)
with a principal place of business/residence at:
Riverside Drive, �,orthampton, ^CIA 01.C60 (phones`) (413, 584_7522
p�
do hereby certify, under the pains and penalties of perjury, that:
M I am an employer providing the following worker's compensation coverage for ply
employees worming on t i icb:
(Insurance Company) (Policy Number) (Expirrion Date)
( ) I am a sale 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) (Insuran(mm Company/Policy Number) (Expiration Date)
(Name of Contractor) ansu ance Company/Policy Number) (E)piration Date)
(attach additional shoes if n«xnary to include informaaoa pertaining to au cootradors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ persons to do n iatcn. k,, c=shvction or repair work m a dwelling of
not more than throe units is which the homeowner resides or on the grounds appurteaaat thereto are not generally comickred to be
employers under the swriax's conpemsation Art(GLI52,ss 1(5)),application by a homeowner for a license or pezmh may evidence the
legal antra of an employer under the Worker's Compensation Act
I understand that a copy of this statcmrsrs may be forwarded to the Department of Ind�al Accidents Office of rnmuanee for the
coverage verification and that failure to seci coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
combdrq of a fine of up to$1,500.00 and/or imprisomocat of up to one year and civil penalties in the form of a Stop Work Order and a
f=of 5100.00 a day against rot
Signed this day Of For deppaunate use nary
� Permit Number
Mao Lot#
Signature of Li errm
SECTION 8 - CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Nelson Shif f 1pt-t __ __ 060300
Valley Home Improvement, Inc. License Number
340 R 9/22/04
Address Expiration Date
584-7522
Signature Telephone
I
I
9. R 6„i,. ered H e Im rovem n C ntract r: Not Applicable ❑
Vallex Home Imt�r.�S�°�^Anty Inc 105543
Company Name Registration Number
340 Riverside Drive 7/17/04
Address Expiration Date
Northampton, MA 01060 Telephone-5-84-7-522
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, § 25C(6))
Workers Compensation Insurar:ce 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....... 20 Rio...... ❑
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-vear 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 buildiny-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 __ _�
'ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition Replacement Windows Alteration(s) Roofing ❑
i Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ 1
Brief Description of Proposed Work:C'�!JV(r1 119fJA 4F[107 V AfrWr e"J'P"12tW7 v4&I
4,1 L' 3 v1 /an,6/ryl-
Alteration of existing bedroom Yes li No Adding new bedroom Yes No j
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet 57ae(�1 �'�� '4 S -'So N�� 'Smd
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family f/ Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
�� cGh Dimensions
d. Proposed Square footage o new construction. 70
e. Number of stories?
f. Method of heating? _ Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
Type of construction
i. Is construction within 100 ft. of wetlands? Yes (/ No. Is construction within 100 yr. floodplain Yes
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? lames No .
I. Septic Tank City Sewer Private well City water Supply
i
SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
r
/:L�� � �— ��L � ✓f'Lf't S as Owner of the subject prcper y
hereby authorize Nelson Shifflett, Valley Home Improvement, Inc to act c:i
my behalf, in tters relax-ye to work authorized by this building permit application.
Signature of Owner Date
I, Nelson Shifflett, Valley Home Improvement Inc_ , 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. G
Nelson Shifflett 4 "
IPrint Name
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 Fronts ZO
Side L: R: �R: /5
1 �®
Rear ,'1 0
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 "
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:
Department use only
City of Northampton Status of Rerriit
�V
Building Department Curb Cut/Driveway r
K�
i 212 Main Street Sewer/Septic Ayalla Iity
! Room 100 Wier/Well Avallari Wity
MA 01060 Two Sets of 4 'u I Pla T "
Northampton,
phone 413.587.1240 Fax 413-587-1272 Plot/SitefP1
Other Speci
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO'FAI4IILY`DWELLING
I
r.� a
SECTION 1 -SITE INFORMATION -
This section o be completed by off ce
11.1 Property Address:
z- ��f s Map �y e— Lot � Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
t—'� Z/llc5s'
' Name(Print`
1 %urrer,t � ress
iv`�( �✓"� Telephone
Signature
2.2 Authorized Agent: Nelson Shifflett j
Valley Home Improvement, Inc P.O. Box 60627, Florence, MA 01062
Name(Print) Current Mailing Address: i
f
� 584-7522 I
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Q Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 +4 + 5) /C? d Check Number (p
This Section For Official Use Only
Building Permit Number:_ Q Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
FEE-06-04 10 :51 AM VALLEY HOME IMPROVEMENT 1 413 585 0820 P_ 02
i
I
I
ENERGY CONSERVATION APPLICATION FORM FOR
LOW-RISE RESIDENTIAL NEW CONSTRUCTION AND ADDITIONS
780 AMR Appendix J{-e�twe 3/1/98)
t/ T
� r►gpliuM Name: t/ �� .��` S+fe�d+ess: �!
Appt,csnt A6drnss: City/Town ' h'
I _ Use Grow5l.
J Date or Apphcjl or„
ApC4rr!•nt Pt1C?t: Aayi:�v;v` S.Gr,nt
I
CeMPUALnte Ptt f(check anek
❑ Proscriptive Packaee !'.miu:to I. or 2- family wood frvne Du ld.ngs healed witrl fossil fo Is only)
Ptc�a .a (A througti KK from Table J5.2 lb):_ Heating Degree Drys (MDDm)from Tat)la J5,2 la: ..
(;or iterT)S d, througn i.• fill in b11 valuat that apply from Table J5.2)
a. Gross wolf Area sq, ft f. waa:f R,Vefvr IR
b. Glazing Are4l sa. M a Hoar R :'a::,e
c. GI>zting (10o x o�a) qb n. Basement wall _
Q. Glazing U-v2r_t J_ i S:.o Feelmefeu
R-
e Casting R•value 1 Her ring AFUR
Q Campone•nt Performance 'Manual (Limited to wood or metal framed build'm only)
C11M f@ Z00e(from Ftgure x6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14
Attach Trade-Off tY.-Wer from Appendix J,(Ind HVAC Tra0e•0414vtsheer, if aoolicaNc}
❑ rtAScnact Sohwatt
Attach Comp/lance Repod and Inspovion Cnecki nn pr Moats
❑ Systems Analysis OR ❑ Renewae(e Encrgf Sources
Attach Mass RniMered Atzhitect or Engine�v Analysis
ALTERNATIVE FOR ADDITIONS ONLY:
a. Gross Wall + CCifing Area %k sq ft. b Glazing Area'Z_L sq It c, Glazing%(100 r t)--a)
❑ ADDiTION vritfi Gta2ing%(C)up to 4O%may use 7AO CMR Tabre J) 1.2,3.; Delow:
MAXIMLOA U,.,jlum Mmlrnum F vaJucs
FN1ASlratton Ce;tirg Wstt I Floor eastm,nnt Wall ' Slab Perimeter. Dept
0.39 37 v jA!j'3j R 19 1046 4 20,a ft.
❑ 'SU.vi UM' alert on(graatsr an a in •�o waf;1. cos! P.gross eres")
Attach 'Consumer info,rrnation Form' tTom 780 CWA Appendix 8
Official's Name: Official's Signature:
Application Approved 13 Denied ❑ Date of Aparovat/Defial
R3aSLt(s)for Denial. (proricle additional oatails as needed on pack siae)
'GUj:6%z Aev racy be cmbw R000 epammg or uns nLmen&&ajt
FEE-06-04 10 -50 AM VALLEY HOME IMPROVEMENT i 4i-- 36 �
1 1
t
Movement Inc:
Valley Home Improvement
P.O.BOX 60627,NORTHAMPTON,MA 01062
413-584-7522
FAX 413.585.0820 DESIGN /BUILD
ADDITIONS•RENOVATI S
r,
2.06-04 J -
Tony Patillo 3 LC�'`r
Norhtmpton,Building Commissioner by fax.
Re: 212 North St. side setback
Hi Tony
1 stopped by the Gold project yesterday. The side lot setback is 17' +_
Also attached is Mass Save info for this project.
Thank you
I f, L2�
Nelson Shiffl tt
V
1
File#BP-2004-0795
APPLICANT/CONTACT PERSON Valley Home Improvement,Inc
ADDRESS/PHONE P O Box 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 212 NORTH ST
MAP 25C PARCEL 040 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid M&2 aS-
T_ypeof Construction: ADD DORMER(STUDY&BATH) CONVERT PORCH TO MUDROOM,REMODEL
KITCHEN&ADD 2ND FLR BATH
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
INFPRMATION 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 Co 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. s
212 NORTH ST BP-2004-0785
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C-040 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2004-0785
Project# IS-2004-1160
Est.Cost: $105000.00
Fee: $425.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Valley Home Improvement, Inc 060300
Lot Size(sg. ft.): 6577.56 Owner: GOLD HOWARD J&JENNIFER INNES
Zoning: URB Applicant: Valley Home Improvement, Inc
AT. 212 NORTH ST
Applicant Address: Phone: Insurance:
P 0 Box 60627 (413) 584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON:2110104 0:00:00
TO PERFORM THE FOLLOWING WORK.-ADD DORMER (STUDY & BATH), CONVERT
PORCH TO MUDROOM, REMODEL KITCHEN & ADD 2ND FLR 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• Receipt No: Date Paid: Check No: Amount:
Building 2/10/04 0:00:00 17663 $425.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo