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17C-318 (2) Wanat / Reckhow New Vinyl Tx 2' Awning Window Bathroom Remodel I Shower Base *install ceiling fan in master Hand Held Shower Tile shower walls to ceiling bedroom 1 By Pass Shower Door *2 recessed lights over window seat Add insulation to floor in kitchen *1 recessed light outside closet area R! off kitchen — Toto 1.6 Toilet Existing window/new casing Vanity to have one Door and 2 � Tile Floor drawers — Solid Surface new sheetrock aL_ , counter/undermount sink '! throughout Recessed Medicine cabinet with Mirror new Clear Pine 6 panel Door Wanat / Reckhow New Vinyl Tx 2' Awning Window _ Bathroom Remodel Tile Shower Base *install ceiling fan in master Hand Held Shower Tile shower walls to ceiling bedroom *2 recessed lights over window seat By Pass Shower Door 9 Add insulation to floor in kitchen *1 recessed light outside closet area off kitchen Toto 1.6 Toilet Existing window/new casing Vanity to have one Door and 2 Tile Floor drawers — Solid Surface ,�' '— — new sheetrock counter/undermount sink = throughout 0 R Recessed Medicine cabinet with Mirror i new Clear Pine 6 panel Door 0 O Lzo Jaf N azfflailtp#un r �e B �aSalr Cal tiSrtlS m DEPARTMENT OF BUILDITNG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 , WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, Nelson Shifflett - Valley Home Improvement Inc . (licenseeJpermittx) with a principal place of business/residence at: 340 Riverside Drive, Northampton,MIA 01050 (hone#) 584-7522 (st-c—_tJcih'!Si'____1:110) do hereby certify, under the pains and penalties of perjury, tila': (4 I am an employer providing the following workers compensation coverage for my employees working on this job: Acadia Insurance Co. 0109302-12 2/1/07 (Insurance Corap=y) (Polio Number) (r:.xpirrion Date-) O I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the follovsring worker's c-ompensation policies: (Name of Contractor) (Lnsiran(—_Cormoany/Policy Number) (Expiration Date) (Name of Contractor) jnsumcc Co=ain•/Posey Number) (L=�-atioa Date) (Name of Contractor) (L suranc-c Cornpaay/Policy Nmr-be:) �Expirnnn Dale) (Name of Contractor) (Ins1=ce Company/Policy Number) (Expi-cation Date) (anarh additioc l sbeet ifneocssscy to include informatioa pertaining to all ocatructofs) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:pltese be aware that while homeowners wbo employ persons to do mxi*x*T_ ___ •�• con=xxion of repair Mork on a d"lliog of not more than throe units is wbich the homeowner resides or on the grounds appurtenant therdo are oot generally ooascdered to be employers under the worker`s«:mpcnsation Act(GL152,ss 1(5)},application by a homeowner fora license a pclmit tnay evideoa the legal status of an employer uoder the Worker's Companniion Act I understand that a oopy of this tint-may bo forwarded to the Depnrtmmi of Material A=&n&Office of Iavu+eoe for the covaage vrcificatioa and that failure to seaict coverage under section 25A of MGL 152 can lead to tba imposd'00 of criminal penalties ooasisting of a fine of up to S1.500.00 aadlor imprisoomcni of up to one ysar and civil penalties is the form of a Stop Wmit Order and a fine of S 100.00 a day against me- Signed th1S_ 0�iday Of For dgsl use 00,Y OXI Permit Number Napo Lart� SECTION 8 -CONSTRUCTION SERVICES 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Steven Silverman __ 077279 License Number 268 Fomer Road SouthaM on, MA n1073 6/21/08 i Address Expiration Date 5Q4-J522 Signature T i i 9 Registered Home Improvement Contractor.,__ Not Applicable ❑ Steven Silverman 131945 Company Name Registration Number 268 Fomer Road 10/13/08 Address Expiration Date Southampton, MA 01073 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....... 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 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 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 T 'ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(sy.,4 Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed Work: R-EW DOCL ZN FLOOR- FILL. j6ATH Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll . Sheet 0 sa. 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: 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 No. Is construction within 100 yr. floodpiain 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 CATAMWE WA)J AT as Owner of the subject property hereby authorize Steven Silverman, Valley Home Improvement Inc to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Da e I, Steven Silerman, Valley Home Im1provempnt- Tnc 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. Steven Silverman Punt Name r r 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 Front Side L: R: L: R: Rear 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 b en issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Re istry 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 b en or need to be obtained from the Conservation Commission? Needs to be obtaine Obtained Date Issued: C. Do any signs exist n the property? YES NO IF YES, descri size, type and location: D. Are there any proposed changes to or additions of signs intended for the property?YES_ No i IF YES, describe size, type and location: r r `} v- Department_use onl N City of Northampton Status of �t Building Department Curb Cut/ eway t 212 Main Street Sewer/SepCicAVai fy � } = s Room 100 W IWell Aaailabillty *� Northampton, MA 01060 T t ::Sets Q rral Plans � •.;� r phone 413-587-1240 Fax 413-587-1272 Plot%Site OtherSpee � APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 7 This section to be completed by office 1.1 Property Address: 45 H I G 14 � Map Lot Unit (r0 `p '-�N�� MA O,j)(p Z Zone Overlay District t� Elm St. District C8 District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: CA-TIAL )NE W ANAT 45 l� 1614 s-: olo(". Name(Printy, Current Mai Address �,/` ��4 a3 �s �rf � Telephone Signature 2.2 Authorized Agent: Steven Silverman Valley Home Improvement P.O. Box 60627, Florence, MA 01062 Name(Print) Current Mailing Address: 584-7522 Signature Telephone SECTION 3 - ESTINIATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant i. Building I 5o O (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of 11 2D 0 Construction from 6 3. Plumbing 0 oo Building Permit Fee 4. Mechanical (HVAC) 0 5. Fire Protection 6. Total = (1 + 2 + 3 +4 + 5) goo Check Number ' This Section For Official Use Only Building Permit Number: Date Issued: �gnature: Building Commissioner/Inspector of Buildings Date File#BP-2007-0733 APPLICANT/CONTACT PERSON Valley Home Improvement, Inc ADDRESS/PHONE P O Box 60627 FLORENCE (413) 584-7522 PROPERTY LOCATION 45 HIGH ST MAP 17C PARCEL 318 001 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 • Typeof Construction:_REMODEL 2ND FLR BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Bulldiniz Plans Included: Owner/Statement or License 077279 3 sets of Plans/Plot Plan THE FOL OWING 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 Co on Signaturl of Buildin 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. BP-2007-0733 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) Category_ BUILDING PERMIT Permit# BP-2007-0733 Project# JS-2007-001115 Est.Cost: $13500.00 Fee: $67.50 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Valley Home Improvement, Inc 077279 Lot Size(sq. ft.): 12719.52 Owner: RECKHOW DAVID ALAN&WANAT Zoning: URB Applicant: Valley Home Improvement, Inc AT. 45 HIGH ST Applicant Address: Phone: Insurance: P O Box 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:112412007 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL 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: Date Paid: Amount: Building 1/24/2007 0:00:00 $67.5022034 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo BP-2007-0733 45 HIGH ST COMMONWEALTH OF MASSACHUSETTS GIs CITY OF NORTHAMPTON Map:Block: 17C-318 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Lot: lo Pern-it: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Category: Permit# BP-2007-0733 Project# JS-2007-001115 F,st.Cost: $13500.00 Fee: 67.so PERMISSION T s HEREBY GRANTED TO: cgwL -lass: Contractor: License: Use Group: Valley Home h1 rovement, Inc 077279 �^ %'�:+s,n�• T?EC`1� i ;�V DAVID AT-AN&WANAT Zonin : URB Applicant: Valle m Home improveent, Inc AT: 45 HIGH Sl_ Phone: Insurance: Applicant Address: (413) 584-7522 _ Workers P O Box 60627 Compensation FLORENCEMA01062 ISSUED ON:112412007 0:00:00 TO PERFORM THE FOLLOWING WORK.REMODEL 2ND FLR BATH 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: Footings: Rough: '�'� House# Foundation: Rough.-- g Driveway Final: Final• `�,—�7"� Final: �� Rough Frame: Department Fireplace/Chimney- Gas: Fire Depart Insulation: Rough: Oil: / Final: Smoke: Final: GK 051117'0? L-04 l THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc si nature: Feel e: Date Paid: Amount: Building 1/24/2007 0:00:00 $67.5022034 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo