17A-099 - UP
�t -
T1 F
white vinyl rolling windows and new all glass door with storm UP cEXTEND LANDING ! BUILD NEW STAIRS
T1
vct tile inset
i
y SURFACE FIXTURES
BLOW CELLULOSE INSULATION IN CEILING
NEW CASEMENT WINDOW
new carpet FIRECODE THIS WALL NOT INCLUDED
T.V.
NEW CABS. LAMINATE TOP op
T NEW GAS HOT WATER HEATER AND 3'X 5' PANEL HEATER ON SEf
i i i i
NEW SHEETROCK CEILING AND WALLS
17DOOR TO REMAIN raise door for sweep
� U I I
vct the inset
NEW D.H. WINDOW AND NINE LITE DOOR AND STORM
I
TEMPLE PORCH CONVERSION
i .
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 060300
B i rthdate: 09/2Z11950
Expires: 09/2212008 Tr. no: 1182.0
Restricted: 1 G
NELSON A SHIFFLETT
340 RIVERSIDE OR PBX60627
FLORENCE, MA 01062
Commissioner
- ✓X22 �!.�r .,y��.Y»!� ,l�� r t✓ l/�� ,..�iCL� .,
€: Boar of Buiraing e�ula ions an Stan r -
=_- a. -
'� One Ashburton Plac- - Room 1301
Boston. Massach!-sews 02105
borne Tmrrovement Con_rac-or R1lstrat on
r=egis�raticr,: 1 Ccc-=
iYPP: ?rvat_ ��rpc.aticn
;ratio,:
`I,',L-=Y ;-SOME 1MP°0VE? 11E::NT INC.
Nelson Sniriett — - ---
P.O. EOx �30627
_ --- -
r--ORENCE. MIA 0106 2 - -- -- -
Update address and return car. Mark reason for change.
— --Address — Renewal — --.-.jolo�ment Lost Card
30.rd or 3uildiny Regularions and candar"s License or registration valid or individui use oni"
=CME :+1PROVEMENT CCNTRACTCR before the _spiration date. If found return to:
a --- Registration: ^0.5, 3 Board of BwldinQ Regulations and Standards
– v One-ashbur.on P!ace Rm 1301
Exciration: 7/1"X03
Boston, .Ala. 02108
Type: Privat-3 Ccirccration
c a ctcr - Depury.ldministracor
Not/,, choutsignature
_ t _
a
�asaacEl rig cfla
o DEPARTMENT OF BUILDrNTG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 '
WORKER'S COmrnENSATTON T-N'SURA_NCE AFFIDAVIT
1, Nelsen Shifflett - valley Home Improvement Inc.
(li�nsMJpt::•,.ut'w.,j
V t a crncioal place of DLSi tss/residence at:
340 Riverside Drive, Ncrthamptcn, MLA 01, 060 (phone;*-) 584-7522
Co L.ereov C--7 under :he 321Q pe:Ia!t1eS
X? �n e-p oy°r aroti?d :g 11e follo���s :�e-�e-s ,.c-=nsa::on cove :cr -=:.
eWc:ovees wor:zmv on ibis iec:
A. -T .M. Mutual Ins . Co . WMZ8005610 01 2007 2/1/08
� 3 uIlw r rlt cLT/
'Pc E—_' .z:f 6n 1.721:',
_. . _ so:e ;�- on ! Z_ =11 =11C
or ; n h . , :_
he cc=ac-Lcrs inset beicw wro have the fellc 7;"_'Z2 Co:loensado::
vaWc e1 Con^c,.or) ( ^��-a �cm�an�;Pc_ 'v = z Dat
of C -or; �sary c Con�ai-..�,�� i 1 coa Da—t
vi l Day C" 1 17S1I CJ T j u4'iC i� 'v;. �k) _�_aa Da
Name of Contractor) �las:ran Cora:- /Poi c� tllLnDC ) (�tii Juan D2te)
(ara toait do i=_;brn=oa Qc•tai=cg'a a.il ox�sro sl
O I am a sole proprietor and have no one worming forme.
( ) I am a dome owner perfor,=g aU the work myse ,
?MOTE:plcsc be atva,�that wf:ilo hameouacrs who e.�iay pe-�to do—••,»•..•-�- xcat:ction ct t�s wcrz cn a dwellicg of
coc moc,e thra throe units in which the homeowner r=d=or on the g txu�zapurr.. thevn arc om gexcaily oxsdesd to be
e=ploy=under the vvorkcez o=pc= oa Ace(GL152-1(5)),zppu_apes w a comcowne for a Goose or p==r-y ev dco=the
lepl st=wa ofan==ployer under the Woncnr's CompamaLion Aat
I ursdesuad the a co?ry of this: =Ay be for-corded to the iertmea:of Ind•=a1 Axi ofsoc of L==.noe for the
covezgc vcificoiion and that f dart to wear:coverage under sc=oc 25 A cf MCL 152 can I=d to tsa impasitca of cimits%i P=&Ldes
ootzi._�g of a fine of up to 31,500.DO and/or i *-- - -•of up to c=y=rnd civil pemltia is the focm of a Stcv Werlc etc and a
f--cf 5 1DO.00 a day aghima ttx
Signed this S 7--ary of z04 For dcp=ta=tLI„r arty
Permit Number
l.l....y T m 41
�"T-
SECTION 8-CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Nelson Shi fflett 060300
Valley Home Improvement, Inc. License Number
340 Riverside Drive Northam tong?QAQ 9/22/08
Address Expiration Date
584-7522
Signature Telephone I
W Y1
9. Re i tered H m r' vem n Contractor:,. _ Not Applicable ❑
Valley Home Improvement, Inc 105543
Company Name Registration Number
340 Riverside Drive 7/17/08
Address Expiration Date
Northampton, 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 denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... IM 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 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 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 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
'ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ j Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work: C'a �q r /'�-SJ`g/fG�ti, fi�e'v��iC�j eert.C'V j-'*t3 pie
Alteration of existing bedroom_ Yes No Adding new bedroom Yes No
Attached Narrative a J Re opting unfinished basemen Yes No
Plans Attached Roll Sheet i ///f�yJr� t
6a. If New house and or addition to existing=housing, complete the following:
a. Use of building : One Family �' Two Family_ _Other---
b. Number of rooms in each family unit: v 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", 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 ,G o. Is construction within 100 yr. floodplain_ Yes___No
I. 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
I, Lucille Temple as Owner of the subject property
hereby authorize Nelson Shif flett, Valley Home Improvement, Inc to act on
my behalf, in all matters relative to work authorized by this building permit application.
. i. - --
Signature of Owner Date
1, Nelson Shif flett, 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. n
Nelson Shifflett
Print Name Name
i
Section 4.
r 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 14, t
Setbacks Front 11 1_
Side L:
Rear
r
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:
r
M
Department use only
City of Northampton Status ofd', f:
Building Department Curb Cut/ war dt, 41,.
212 Main Street Sewer/Septic Avatl
Room 100 W Well Availability
Northampton, MA 01060 �. ets of aural Plans ` 3
phone 413-587-1240 Fax 4,13-587.1272 P1411site t?
a,
Other Spec
APPLICATION TO CONSTRUCT, ALTER, REPAIR nN.PVf11.,,,Q' DEMOLISH A ONE OR TWO FAMILY DWELLING
b
SECTION 1-SITE INFORMATION
1.1 Property Address: This section to be completed by office
27 Grandview Avenue Map Lot Unit
Floreance, MA 01062 Zone Overlay District
Elm St. District___, CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 27 Grandview Avenue
Lucille Temple Florence, MA 01062
Name(Print) Current Mailing Address:
�`" Telephone
Signat 586-1091
2.2 Authorized Agent: Nelson Shif flett
alle m
Home Im rovee t P.O. Box 60627, Florence, K 01062
Na (Print) Current Mailing Address:
584-7522
ignature Telephone r
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a) Building Permit Fee
2. Electrical `'
(b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4+ 5)
Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File #BP-2008-0664
APPLICANT/CONTACT PERSON Valley Home Improvement,Inc
ADDRESS/PHONE P O Box 60627 FLORENCE (413) 584-7522
PROPERTY LOCATION 27 GRANDVIEW ST
MAP 17A PARCEL 099 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out do _
Fee Paid
Tv peof Construction: CHANGE DIRECTION OF STAIRS REPLACE WINDOWS ADD INSULATION NEW
HEAT
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 F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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 Cominittee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
Signature of Buw ding 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.
27 GRANDVIEW ST BP-2008-0664
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map.Block: 17A-099 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2008-0664
Project# JS-2008-001013
Est. Cost: $25000.00
Fee: $125.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Valley Home Improvement, Inc 060300
Lot Size(sq. ft.): 9365.40 Owner: TEMPLE LUCILLE G
Zoning:URA Applicant: Valley Home Improvement, Inc
AT. 27 GRANDVIEW ST
Applicant Address: Phone: Insurance:
P O Box 60627 (41 1) 584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON.112512008 0:00:00
TO PERFORM THE FOLLOWING WORK.-CHANGE DIRECTION OF STAIRS,REPLACE
WINDOWS,ADD INSULATION, NEW HEAT
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 1/25/2008 0:00:00 $125.0023621
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Conunissioner-Anthony Patillo
BP-2008-0664
GIs#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
cate�ory BUILDING PERMIT
Permit# BP-2008-0664
Project# JS-2008-001013
Est. Cost: $25000.00
Fee: $125.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
tIse Group: Valley Home Improvement, Inc 060300
Lot Size(sq. ft.): 9365.40 Owner: TEMPLE LUCILLE G
Zoning: URA Applicant: Valley Home Improvement, Inc
AT. 27 GRANDVIEW ST
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON.112512008 0:00:00
TO PERFORM THE FOLLOWING WORK.-CHANGE DIRECTION OF STAIRS,REPLACE
WINDOWS,ADD INSULATION, NEW HEAT
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 1/25/2008 0:00:00 $125.0023621
212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo