17A-128 (3) PIPE IF NECESSARY
ER 2 PC. 48"SH ER NEW SHEETROCK ALL INSI E ALLS
ITHBENCH �I LAPINSKY BATHROOM
S.S. RQD REMODEL
O LIGHi!{ n 315 BRIDGE ST.
QNDINE HAND StjOYvE NORTHAMPTON
ALL SUPPLY// ALL OOK 1.6 PO ER FL S
584-3354
DELTA VALVE
THIS WALL O EMAIN
NEW M.R. CEILING/INSULATION
TI ER
i
I
12"TILE OVER WIRE LATH
NEW.F SINK/DELTA
RE TRIM DOOR F UCET II
r--N f�8I TO—�EMAJN
Valley Home ImprovemenL Inc. 1999
A:_ . w2j for arty Purpose without
:�i_ c:'„a;:.yv Home ImprovernenL h)c.
-2.- -;a-.3 Dr. P.O. Box 60677 Nortt arnpWn MA 01 W
Tsl:413-5&3-7522 Fax:413-585-0820
PAD OUT WALL TO GLEAR
9A 1
NEW SHEETROCK ALL INSI E ALLS
ER 2 PC. 48"SH ER '•
ITH BENCH �I LAPINSKY BATHROOM
S.S. RFD REMODEL O LiGHi/<AN� (--1 315 BRIDGE ST.
QNDINE HAND / A SF 0 K 1 NORTHAMPTON
ALL SUPPLY/ ALL OOK P61 O ER FL S
1 584-3354
DELTA VALVE
THIS WALL O EMAIN
—
T
NEW M.R. CEILING/INSULATION
I ER
i
12"TILE OVER WIRE LATH
NEW P SINK/DELT
RE TRIM DOOR F CET
I
�
ED
FA
� I
FAT TO REMAIN
:'•`,ialley Home Improvement, Inc. 1999
-t 3 d*! e; wai for any purpose wfdoA
� i'1-1. •r°.1.:i,.'N�C.Vazzv Home Improvement,Inc.
t ,..a—'z3 C.. P.O. Box 60677 Norttiamp'on,MA 01760
Tel'413.584-7522 Fax 413-585-0820
� s
9�e c�9
Crz;�r �� �T�x#C�ttnt�rfull z _
�e mass aC4Itse Ile
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORI{ER'S COMPENSATION INSURANCE AFFIDAVIT
Nelson A_Shifflett / Valley Home Improvement, Inc.
(licensee/permittee)
with a principal place of business/residence at:
320 Riverside Drive, Northampton, MA 07060 (phone#) (413) 584-7522
(strert/cih/statc� p)
do hereby certify, under the pains and penalties of pegury, that:
M I am an employer providing the following worker's compensation coverage for my
employees working on this Job:
Travelers Insurance Co. UB888D9983 2/1/01
(Insumnce: Company) (Policy Number) (Expiration Date)
O I am a sole 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 Numbcr) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioanl sfxct if noccssary to include information pertaining to all ooatradors)
( ) 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 whilo homeowners who employ pazons to do maittirnancc,eomhvction or repair work on a dwelling of
not moce than throe traits in which the bonwwner resides or oo the grounds appurtenant ibet-do are oot wally ooasidacd to be
employers under�o svoricces oaapcasation Act(GL152,n 1(5)�application by a homcowna for a Goc=or permit may evidence rho
legal ciatur of an employer under the Worker's Compemation AcL
I understand that a oopy of this ctatcmcat may be for Awded to tho Dcpartaxnt of In&LitHal Acc ida&Offioo of Ina anoo for the
covertge verification and that failure to&ec uc coverago under section 25A of MGL 152 can lead to tha imposition of criminal penalties
000sistiag of a fine of up to S 1,500.00 andlor impriso�of up to one year and civil penattieI in the form of a Stop Work order and a
firm of S 100.00 a day against me.
Signed this_1"T ya//day of y C j �OQO—' For dep rtmerstal use only
� � Permit Number
Map# Lot#
Signature of Li Pcrmi
O
,n^� ' / : uo / u. �x"
r «
SECTION 8-CONSTRUCTION SERVICES
A/ Not Applicable 0
License Number
AdCress
Expiration Date
Signature Telephone
Quivany Name
A&L- T��S--ist-rat,on Number
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c.152, §25C(6))---
Workers Coirnoensa ,cr, Insurance affidavit rnus'. be completed arcl Bubrinitticd with this aoplicat:on. --ailure to provide tilis affiJI)VII.
will result in the denial of the issuance of the b,.)dding permiV
`
The current exemption for^homoo.nom'vo extended minclude [one(|) (-ir nvc)(2)[m)ilks
and m allow such h=mcnwncrmcn8o80.^n individual(or hire who does not pm*mo license.LL�L��yhs owncr a05
`==
` ronon(q who v"oa parcel"||mx\.m which h,//hc,c3id:`", iximJso,,midc.oil Whid`(ho/:
is,^,m /wcooeum be.o one v,two bmi|' UxuUiu:.xxxu`co or-detached Structures accuu`,,;m such use^^mo,farm
structures.,A person 'ivilio constructs more than
e ho
respoii ible for rill such work )�cirforrncd undur tile buildim! ycirmit,
As acting('onstructirin Supei-vl�o ycur presence oil the job site will be required oni finic [(,!:me,dinuig,ard upon
completion of'the woik for which this pertnil.is issued.
Also vu advised omt,with reference m Chapter |5Z(Workoo' Compcnmhox) and C6np|c, !8 (Liability n[Gnp|upsm �
Emp�yvm6xi�o�es not m�hingioDouNof�xMzoochoumGonr�|Laws xu/wm\*|. fo,[n'xm(s) �
You hiro,ope,fonn»o,k for you under(his yconit.
The uoJeoigood^hmnouxnr/'certifies ad assumes re;,00dhih/y for com;|/ooco "iU/the Sutc Building C"dc.COr(If
Northampton Cli-Jinuces, State and Locai Zoning Laws tind State of\4assa6u5c(ts Generill Laws Annota(ed.
it-,
Mar. 16 00 10: 53a p. 3
H
1
SECTION 5- DESCRIPTION IF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) Rooting 0
Or Doors rJ
Accessory Bldg. ❑ Demolition❑ New Signs [ J Decks [ ] Siding[ ] Other[ J
Brief De Sn tion of Proposed Work: ( a [ —_ -- –
e—Alteration of existing bedroom_._Yes �o Adding new bedroom---Yes v _No
Attached Narrative j Renovat ng unfinished basemen; Yes No
Plans Attached Roil P Sheet _!
�a��;e�u��aais�� €I!a�:��d�t�tan:�r��x�st�i ��► �;;�aa ��ls.,f�fi t '�f;: 1
a. Use of building . O-ie Family_�� Two Family Other
b. Number of rooms in each family unit: 61 Number of Bathrooms
c. Is there a garage attached?-ly__
d. Proposed Square footage of new construction._ Dimensions
e. Number of stories? J�!!:�14
p
f. Method of heating? c7/(_ Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance._ 'Aascheck Energy Compliance form attached?
I
h. Type of construction wav' FAV '
i Is construction within 100 ft.of wetlands? Yes ' Is construction within 100 yr. fioodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building anddZZ ing regulati(�'V/e..__Yes No .
I. Septic Tank City Sewer y Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR.BQILDINO'PERMIT
as Owner of the subject property
hereby authorize to act on
my lb t in all matte relativ o work authorized by this building permit application.
Signature of Owner Date
i._��f�s_Q/ff ��/f�/� </ �� ��'D✓f%nf/Iras 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.
Print Name
Date
S gnature of Owner/A V
tiar. 16 OU 10: 52a p, 2
4
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PER UT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be tilled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage I ^ %
iLoi area minus bldg&paved !�(1
parking)
of Parking Space i
Fill:
Volume dr Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO _-Lz/ 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:
4 s
APR
I City of Northampton �rf, � ti ,,+���
Building Department A �,tK
Kt
I 212 Main Street '
� 9
Room 100 r :k: _ n Wf . .
Northampton, MA 01062 : `°rte; {Fa 1 , )
ph
pone 413587.1240 Fax 413.587.127?
� 1�.� d—•' !ab!/'.L'3el btl' n� �� 1;
APPLICATION TO CONSTRUCT. ALTER, REPAIR. RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION_-�
1.1 Pr4Rert�LAddress: lhrs se¢tl4ii'ttl beicotYl.WQWdb#
Map
/d 1 XoneT 'Q,ierIAY;Drslr{Gt ;
Im St:: I ti cf CB DistnG _
SECTION 2 •PROPERTY OWNERSHIP/AUTHORIZED AGENT
2_10wn&r_o_f_Recor :
Marne ' C,.irren':Mailing Address:
Telephony
S gn ure
2.2 Authorized Aeent:
Name(Print) Current Malting Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
--completed by permit a licant
1. Building /� � (a)Building Permit Fee
2 Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 +3 + 4 +,1
Check Number / 3 �(�
This Section For Official US8 On(
Building Permit Number: Date Issued:
Signature:
Building Comm issione Inspector of Buildings Date
File#BP-2000-0882
APPLICANT/CONTACT PERSON Valley Home Improvement,Inc
ADDRESS/PHONE P O Box 60627 (413)584-7522
PROPERTY LOCATION 315 BRIDGE RD
MAP 17A PARCEL 128 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 /O _?�7 D
Ty_peof Construction: MODEL 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
TIr,F LLOWING 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
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservati ommission Permit from CB Architecture Committee
Signature of Buildin Offici. 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
s
315 BRIDGE RD BP-2000-0882
GIs#: COMMONWEALTH OF MASSACHUSETTS
AwIft v1Q�Block: 17A- 128 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category'Non structural interior renovations BUILDING PERMIT
Permit# BP-2000-0882
Project# JS-2000-1640
Est. Cost: $8300.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Valley Home Improvement, Inc 060300
Lot Size(sa.ft.): 11412.72 Owner: LAPINSKI EDWARD J&ANNA MARIE
Zoning:URA Applicant: Valley Home Improvement, Inc
AT. 315 BRIDGE RD
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON:4113100 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL BATH
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 Occupan�-y Signature
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building
4/13/00 0:00:00 11837 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo