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17C-258 (3) �ubo�i _ 1 (04.1 gr- 117(x? 4 s EjR f a i t � 1 �YRVOW lP), ?1610 L`ti, - - - - - - - - - - - - -- - - - - - - - - - - - - - � I II ` li - 11 li f I 1 i I L �I � INFILL DOOR TEMP STEPS rl — —� NEW VINYL CASEMENT FROST PROOF SILLCOCK kl _ — �i NEW DOOR _j J 0_X STD.DEPTH REFER. I = BOOKCASE/CORNER SHELVES LAM TOP / /WOOD EDGE COUNTRY WOOD SHOP PI . CABINETS C'; k UP I _ GAS RANGE D.H.WINDOWS/TRANSOMS A I_ T ABOVE HUTCH STONE TOP STEWART / WATE RMAN `— CONFIRM LENGTH OF 1/2 WALL / KITCHEN / ADDITION - SAND AND SEAL OWNER'S n NEW OAK FLOOR HERE 2-15-05 WOOD FLOOR -�: 3 CONFIRM RADIATOR LOCATIONS - surface rrim line of the ironing board _ pantry cab u --- ti supply feed/panel to garage,2 OLI r7_1 I �CIr= ceramic fixtures,opener outlets etc RELOCATE VENT PIPES \ �� / -� owner to provide phone/cable n I bends/Coat wiring i TILE ENTRY �) ! - i '� ., hooks/cabbies �� NEW TILE FLOOR ' I I above / I ' a �. GAS DRYER OVER WIRE �I 3 O MESH I �� c tr% a �.�-- sk✓�§5an.�+ R'r«*t ham, 2. ' ', ` k5: '. �v. as � � !_'`' ,vv•,�- k •� 'YGliy�� h�YK is 4 Nn rc tier r a� X ry � ��fq!= ,e ,�► , i-.i�.% i E py 4 I:�rl��,f�l� I j (�.. r ice`' �i,.,, P`'•'` A rill, r' , 5F my i� i I i i k J { } 110 67 Z r �,�Rr, aa $UN - ol I PUQGl1 --- ��7 j X31 1 � � i � 3 SrEwART WATER,t4l AM 58 IV ora.t-iA M A i' � U R F N CE N �T i2�-�-T 'L Ulo(o f'ARcEtr a ►—I G - 2�$ i s a 3 C' � � r�asaxcfirsrtts �t DEPARTMENT OF BUILDD\'C; INSPECTION'S 212 Main Street ' Municipal Building ?tirorthampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE A AM I, Nelson Shifflett, Valley Home Improvement, Inc . (licenser/permittee'} W itltl a principal place of business/residence at: 340 Riverside Dr. , Northampton, MA, 01060 (Thone-=) 584-7522 do hereby ce rtL- , under the pai.-is and penalties of perjury, (x) I am -a empioyer providing the following wer-r:ers cempe:uation coverage 7C)r m; employees wor-dng on this job: Acadia Insurance Co. 0109302-11 2/1/06 (r-as=anc:. Cor pazy) (Folic;L:u Leer) (�Iz7piratica D,=-, Ian a sot pro netor reaeral -ct h e - .,ie ore) and ha.e i . e n , g con �� or �r cn o��,�ncr (c� L.. Lhe contractors listed below who have the following worker's wmpensason policies: ('V<=e of Coin,a--y/Po Lc V`Lr11LY ) (�c L�IIJII 12:Cj (\1�Tlp of Conirac—oi) :m :o a Dale, l 2-Ic Of CG Lvcioi) -- (lasuanon Compn.<y/PcL'-. (Name of Contraoior) (Insurance Comcany/PoEq,Number) (E.rpLmiion Date) (a^xM�di'.iocn!s.'ctit ifcecexsar�to ine'ucie i.°arsiurioa pcm.ir..�g to all oocrsn�on) ( ) I am a sole proprietor and have no one wor4dng for me. ( ) I am a home owner perforning all the work myself. NOTE:plr...se be na=tai whilo homrAwvaa who employ pers„-m to do r caszix-,ion cr rpca work co a dµXdia&of r cx tnoce than throe uniU in which the homoovver reside or oa the gt VladS xppurter ant th=to arc not Gaxm ly oorridered to be eaq)loy=3 under the work='%coa*=s ioa Act(GL152,=1(5)�application by a hotmcownrr for a Gwne a pcimit say c%idcna the lea}i rtlnua of an e=ployec under the workees Compematim Act I",.ir-.±•^d that zoo-"of thin mLcmcat may bo rmw"dod to tbo Department of Indzitria1 A=A,,,ti 0frcoo of L=um co for the �rovera ge waif cniioa acr!thst f ilure to secure mveraso under soczioa 25A cf MGL 152 can lcu.'te t`x ikon of aiaamil pGUltia of a fine ON;)to$1300.00 and/or of up to Coe year and civil penahia in the form of a Stop work 0r`—and a ;=c(5100.00 a day gsinsl mt df n Signed this day of For dcp=ta=W use eaty Permit Number Map,{' Lot# /✓ L S-o t�i Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAIN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 2�, I � ]UU 5� Frontage ICI 1-31 Setbacks Front Side L: -7 U R: L: U R: J Rear F 1 i 1 i'eu G r)'/'4� Building Height Z�r _Z'E5 % l� Bldg. Square Footage 21 S � % 2' ¢ 3f T % F��" Trr.1s f l ef Open Space Footage % ? /? e'r Lot area minus bldg&paved �j Q S{. L narking) 6 U 3%��� 7 of Parking Spaces F1: 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: SECTION 8-CONSTRUCTION SERVICES .1 Licensed Construction SuQervisor: Not Applicable ❑ Name of License Holder : Nelson Shif fh .t_ i____ 060300 Valley Home Improvement, Inc . License Number 340 Riverside Drive, Northamgtnn_,�1 A 0'!Q_60 9/22/Q6 --- Address Expiration Date 584-7522 _ Signature Telephone 9 Registered Home I provement Contractor: Not Applicable ❑ Valley Home Improvement, Iuc _ 105543 Company Name Registration Number 340 Riverside Drive _ __ZL:L7Z06 ------- i Address Expiration Date Northampton, MA 01060 Telephone 584-7522 SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(6)) L i Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the :ss:arce of the building permit. I Signed Affidavit Attached Yes....... X 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 cn�age 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 Building Official,that he/she shall be responsible for all such -,york performed under the buildiny,permit. As acting Construction Supervisor N our presence on Lire job site wiii be required from completion of the work for which this pen-nit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter.153 (Liability of Employers to Employees for iniuries 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 pen-nit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of 1` 'orthampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature r ! 'ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑ / Or Doors ❑ Accessory Bldg. ❑ Demolition[�J New Signs [ ] Decks [ ] Siding[ ] • Other[ ] Brief Description of Proposed Work: �,h�11 d e-,r ,N ��►�/��/"�' �llJ���"'l 'G� ��' f pr,.ti f v CX,J ,�� S`/GfcwC. A!teration of existing bedroom Yes No Adding ne©bed(bom Yes N Attached Narrative Renovating unfinished basement Yes Ne Plans Attached Roll !_ Sheet..� 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family i� Two Family Other _ b. Number of rooms in each fami:y unit: __-. Nu cr o` Pact;rooms. __ n c. Is t^ere a garage attached? cat G &)(l`i/4 ✓,'Id. d. Proposed Square footage of new construction. ___._ Dimensions e. Number of stories? I f. Method of heating?`�� irepiaccs or `,'oodstoves Number of each _ ii g. Energy Conservation Compliance. 19 t Mascheck Energy Compliance form attached?_ -ype of construction _Z No.Is construction within 100 ft. of wetlands? Yes !/ No. Is construc'ion within 100 yr. floodplain Yes No Depth of basement or cellar floor below finished grade k Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank__ City Sewer L­� Private well City water Supply SECTION 7a - OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ( ! as Owner of the subject property hereby auth Nelson Shifflett, Valley Home Improvement` Inc o aci n my be . in all atters relative t�worrk au thorized by this building permit application. Signature of Owner Date I, Nelson Shifflett, Valley Home Impx"2yPmPnt _ Lnc_ as Owner/Authorized Agent �- -iare that the StatemertS and information on the fore,i�oing application are true and accurate, to the best cf my knowledge and belief. Nelson Shifflett _ — --- Print Name A. # �epartr'ent use only City of Northampton $status o �' 4 Building Department CtirbCutlD I e y 212 Main Street Sewer/Septic vase...R .. a Room 100 W �WOE,Aa�aliliij� Northampton, MA 01060 ' phone 413 587 1240 Fax 413-587-1272 Plot/Sate E? k APPLICATION TO CONSTRUCT, ALTER, RI=PAIR, RENOVATE;O4,ISEMOLjSH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: Tf'is sect on to be completed by office _- Map Lot Unit i Zone Overlay District Elm St. District-- CB District i SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: SE Q �Co 6eN� ��2lIJ�R� Name(Pri , Current Ma ing Address: Telephon _ Signature 3 2.2 Authorized Agent: Nelson Shifflett Valley Home Improvement, Inc. P.O. Box 60627, Florence MA 01062 Name(Print) Current I failing Address: Tt�&� , i+' 584-7522 _ Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS item estimated Cost (Dollars) tc be Official Use Only completed by ermit a licant 1. Building ti _ (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing 2V Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 +4 + 5) (;' Check Number This Section For Official Use Only Signature: _ �,ii!dir, Comm!ssioner,'Inspector of Buildings Date File#BP-2005-0829 APPLICANT/CONTACT PERSON Valley Home Improvement,Inc ADDRESS/PHONE P O Box 60627 FLORENCE (413)584-7522 PROPERTY LOCATION 58 NORTH MAIN ST MAP 17C PARCEL 258 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction: CONVERT ATT GARAGE INTO FAMILY RM 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 INFOVIATION 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. 58 NORTH MAIN ST BP-2005-0829 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-258 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BE 005-0829 Project# IS-2005-1144 Est. Cost: $60000.00 Fee: $300.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Valley Home Improvement, Inc 060300 Lot Size(sg.ft.): 23870.88 Owner: STEWART ROBERT B& Zoning:URB Applicant: Valley Home Improvement, Inc AT. 58 NORTH MAIN ST Applicant Address: Phone: Insurance: P O Box 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:3118105 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONVERT ATT GARAGE INTO FAMILY RM 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 3/18/05 0:00:00 $300.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo BP-2005-0829 58 NORTH MAIN ST COMMONWEALTH OF MASSACHUSETTS GIs#: Map:Block: 17C-258 CITY OF NORTHAMPTON Lot: -001 Permit Building BUILDING PERMIT Category:Permit# BP-2005-0829 Project# JS-2005-1144 Est Cost: $60000.00 Fee: $300.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Valley Home Improvement, Inc 060300 Lot Size(sa. ft.): 23870.88 Owner: STEWART ROBERT B& Zoning:URB Applicant: valley Home Improvement, Inc AT. 58 NORTH MAIN ST Applicant Address: Phone: Insurance: P O Box 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:3118105 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONVERT ATT GARAGE INTO FAMILY RM POST THIS CARD SO IT IS VISIBLE FROM THE STREET Building Inspector Inspector of Plumbing Inspector of Wiring D.P.W. g p Underground: Service: Meter: '.' � US Footings: Foundation:G 1(It Rou g h: Rou h MA 17 House# C 5 Driveway Final: Final: j'`� "'t�5~ Final: �� 6� Rough Frame:( Gas: Fire Department Fireplace/Chimney: �j_ � Roughs- ` O's Oil: Insulation: 0 " Final:ke:,p r THIS PERMIT MAY BE REVOKED BY THE C TY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL TIONS. Certificate of Occu anc Signature: Feel e: Date Paid: Amount: Building 3/18/05 0:00:00 $300.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo