23D-001 (6) 51 NONC7 JCK ST BP-2002-0737
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:73D-001 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2002-0737
Project# JS-2002-1211
Est. Cost: $15000.00
Fee: $75.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Valley Home Improvement, Inc 060300
Lot Size(sq.ft.): 12501.72 Owner: BOUCHARD MARY J&M MORIARTY&
Zoning:URB Applicant: Valley Home Improvement, Inc
AT: 51 NONOTUCK ST
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584-7522 Workers
Compensation
F L O R E N C E M A0106 2 ISSUED ON:3/1/02 0:00:00
TO PERFORM THE FOLLOWING WORK:ALTER STAIRCASE & REFURBISH BEDROOMS
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 3/1/02 0:00:00 14710 $75.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2002-0737
APPLICANT/CONTACT PERSON Valley Home Improvement,Inc
ADDRESS/PHONE P 0 Box 60627 (413)584-7522
PROPERTY LOCATION 51 NONOTUCK ST
MAP 23D PARCEL 001 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out //`7 76 1
Fee Paid �`
Typeof Construction: ALTER STAIRCASE&REFURBISH BEDROOMS
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 ATION PRESENTED:
pproved 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 C 'ssion
2 c
Signature of Building 0 icial 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.
4
Vtae
City of Northampton S tus'o Pe }
; ( l 1 i Department
1 g C7ui t �� it s,
31
}tom 100 . ffi
Northa ton, MA 01060
B 5 -_; 240 Fax 413 587-1272
APIPLICATION TOR'lr9(yS RUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: This section ttO be completed by,office
(f
�c9rt °7‘ 6.-/t c�/ Map L t Unit
�JJd I 16,, Zone Overlay District
Elm St.District CB District `'
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
S4 'n r
Name(Print) ( acce(,J,f)e X3ocichar0 Current Mailing A dress:
4 - .._ --- ��. l �. Telephone.
Sign.( re
2.2 Authorized Agent: V
G gyp , /`� // t(o f//'f-9 /6, 6 er J-oe t
)7 C-Ave,
Name(Print) Current Mailing Address:
CP/#4°P/ 7/.5-
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
1_07 D
2. Electrical (b) Estimated Total Cost of
3,pa' Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 +4+ 5) ,0491) Check Number 71,0 c �
This Action For Official Use Only
Building Permit Number: I -7
Date Issued
Signature:
Date
Building Commissioner/Inspector of Buildings
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 vyl 0
Setbacks Front (7
Side L: v L e' R:
d
Rear '" 0
✓ C
,t I
Building Height 1
fBldg. Square Footage %+
Open Space Footage
(Lot area minus bldg&paved
parking) _
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Spe cial Permit/Variance/Finding ever been issued for/on the site?
NO 4 7 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO it 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 U 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 itions of signs intended for the property ?YES_
No (L/
IF YES, describe size, type and location:
•
`ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House El Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[��/]_� Other [ ]
Brief Description of Proposed Work: r7//(j .S'A-i?'lnlc' - It � � �°Ytth �"917coow-
I ow-
Alteration of existing bedroom // Yes No Adding ne bedroom Yes No
At g
Attached Narrative❑ >1* i1,Lw SfiJ�ati. Renovating unfinished basement Yes No
Plans Attached Roll ❑ . Sheet /ii rgr t e ,
1f l+teWfhous -and orAddilti tii tO X.i ltigahn ting. comple t to fvl°Icii 1 n;
a. Use of building : One Family v Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? �']
f. Method of heating? �(/ f 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. floodolain Yes No
j. 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 Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Z02,ch , as Owner of the subject property
hereby authorize lt�G l � / �, �G 4' ^L d�l4'�'t"'l - - L to act on
my be f, in all matters,crelative to work author' by this building p(fmit applicatio6.
,G 4 �
Signature of Ow r gate /
I,
/1)CI`J elft fil9 ' , 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.
Sign der the ains and penalties f perjury.
/-4/
Print Name
Signature of Owner/Agent Date
SECTION 8 - CONSTRUCTION SERVICES
.1 Licens.edConstruction Supervisor: `.ct Apo: cable ❑
Narr�°a of Lice 1=
nse Holder : Nelson Shit lett
060300
Valley Home Improvement , Inc . License Number
340 Riverside Drive 9/02
Address Expiration Date
Northampton, MA 01060
Signature Telephone
584-7522
9. Registered Home Improvement'Contractor; Not Applicable ❑
Valley Home Improvement , Inc. 105543
Company Name Registration Number
340 Riverside Drive 7/17/02
Address Expiration Date
Northapton, MA 01060 Telephone 584-7522
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, §25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit
will result in the denia of the issuance of the building permit.
Sig-led Affidavit Attached Yes No ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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-year period shall not he 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 building 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
$��% 9� fliassaclinsrihs
°-4_t
"'"' . DEPARTMENT OP BUILDING INSPECTIONS ti 1
212 Main Street • Municipal Building
Northampton, Mass. 01060 '�.�
r
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, Nelson A. $hifflett / Valley Home Improvement, Inc.
(licenseeipermittce)
with a principal place of business/residence at:
340 Riverside Drive, Northampton, MA 01060 (phone#) (413) 584-7522
(streekity/staff i p)
do hereby certify, under the pains and penalties of perjury, that:
()9 I am an employer providing the following worker's compensation coverage for my
employees working on this lob:
American Int'l Companies C0.062543.74.01____ 2/1/03
— (Insurance Company) (Policy Number) (Expiration Date)
( ) 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 Com-pany/Policy Number) (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 additional sheet ifneceazry to include information pertaining to all contractors)
( ) 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 persona to do tr-aint..„nr e,construction or repair work on a dwelling of
not more than three units in which the homeowner resides or oa the grounds appurtenant thereto are not generally coaiidered to be
employers under the workers canpezrsatian Act(G1.152,s31(5)),1(5)),application by a homeowoa for a license or permit may evidence the
legal statue of an employer under the Workers Compensation Act
I understand that a copy of thin ataternent may be forwarded to the Dap:atm:a t of Industrial Acadeata Office of inauanoe for the
coverage verification and that failure to segue coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
comistiag of a fine of up to S 1,500.00 and/or imprison of up to one year and civil penalties in the form of a Stop Work Order and a
fine of 5100.00 a day against me.
Signed this 07 7 day of iz,h For departmental use only
,� A Permit Number
/ L° Permit
Map# Lot#
]
existing vinyl windows y
wood floor o.k. her
`, attic access
'
| �
2'-11 |
UP c�
_
no space in electric panel
]
existing carpet
existing bedrooms
Bouchard Existing
Conditions
1