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23D-093 (7) 26 NUTTING AVE BP-2002-0700 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D-093 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2002-0700 Project# JS-2002-1126 Est. Cost: $1700.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Valley Home Improvement, Inc 060300 Lot Size(sq. ft.): 13808.52 Owner: SPENCER NORMAN Zoning:URB Applicant: Valley Home Improvement, Inc AT: 26 NUTTING AVE Applicant Address: Phone: Insurance: P O Box 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:2/7/02 0:00:00 TO PERFORM THE FOLLOWING WORK:RE-TILE SHOWER, NEW VALVE & FAN 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 2/7/02 0:00:00 14619 $50.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2002-0700 APPLICANT/CONTACT PERSON Valley Home Improvement,Inc ADDRESS/PHONE P 0 Box 60627 (413)584-7522" PROPERTY LOCATION 26 NUTTING AVE MAP 23D PARCEL 093 001 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 7/6�` �� Typeof Construction: RE-TILE SHOWER,NEW VALVE&FAN 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: 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 Co •ssion z zoc)z— Signature of Building fficial 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. ar a Department use only ._T 1__ City of Northampton Status of Permit: Department Curb Cut/Driveway Permit __. - (� r� 11 �f 2 ain Street Severer/Septic Availability_�- 1, R m 0 Water/Well Availability � ' rth E on,10MA 01060 Two Sets of Structural Plans-__�_ FE5ha4 4 -5 0 Fax 413-587-1272 Plot/Site Plans Other Specify T ,���yc�c -, APP 1 1 f"' �A CT, TER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING i SECTION 1 - SITE INFORMATION j 1.1 Property Address: This section} to be completed by office 26 Nutting Avenue Map� e & Il Lot '3_ Jni:_ Zone ,/k .---- Overlay District Florence, MA 01062 Elm St. District CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 26 Nutting Avenue No "an Spencer Florence, MA 01062 Name(' int) Current Mailing Address: A w, . & 586-3060 ,t,�-- .,--•,s--t: Telephone Signature __ 2.2 Authorized Agent: Nelson Shifflett Valley Home Improvement , Inc . P.O. Box 60627, Florence, MA 01062 Name(Print) Current Mailing Address: 584-7522 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building /dOv (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of 0700 Construction from (6) 3. Plumbing p-0 Building Permit Fee 4. Mechanical (HVAC) 7� 5. Fire Protection /� 6. Total =(1 + 2 + 3 +4 + 5) 71 1i/ ` ` Check Number /7 � /9 .' -D This Section For Official Use Only Building Permit Number: & 2}--240 Date Issued:__.____ i Signature: Building Commissioner/Inspector of Buildings Date i 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 If)Y Side L: R: lJ�: �l1 Rear rkpt Building Height 0-" V Bldg. Square Footage Open Space Footage cyo (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 t/ 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: a i 'ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House 0 Addition 0 Replacement Windows Alteration(s) ❑ Roofing 0 Or Doors 0 Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other,[(] ��1ocrti Brief Description of Proposed Work: C 7//L low&— 'UC`-. ✓N w r/Jti Alteration of existing bedroom Yes No Adding new bedroom Yes 4—No Attached Narrative C Renovating unfinished basement Yes `J No Plans Attached Roll ❑ - Sheet ga. If New house.and or addition to ting 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? 4,ilt d. Proposed Square footage of new construction. pliOciAA 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. floodplain 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 I, Nara") JOeA , as Owner of the subject property hereby authorize Nelson Shifflett, Valley Home Improvement, Inc, to act on my beha f, in all mattes relative to work authorized by this building permit application. Signature of Owner Date I, Nelson Shifflett, 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. Nelson Shifflett Print Nam Signature of Owne gent Date CTICN 8 - CONSTRUCTION SERVICES 1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: Nelson Shifflett 060300 Valley Home Improvement, Inc. License Number 340 Riverside Drive 9/02 Address Expiration Date Northampton, MA 01060 Signature Telephone 584-7522 9.Reef* ome Improvement Contractor: Not Applicable 0 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 denial of the issuance of the building permit. Signed Affidavit Attached Yes gl No 0 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 O:wAMp2. . B_A / 1I Crxti i f Northampton _ _*_' EAU r:!,�°`:. �Ij• �laasrtrhnsrtts -_��_ `Z '` DEPARTMENT OP BUILDD.G INSPECTIONS ```` __II1` 212 Main Street • Municipal Building Northampton, Mass. 01060 ' WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, Nelson A. Shifflett / Valley Hone Improvement, Inc. (lioensee/permittee) with a principal place of business/residence at: 320 Riverside Drive, Northampton, MA 01060 (phone#) (413) 584-7522 (stt,r_t/city/state zip) do hereby certify, under the pains and penalties of perjury, that: (O I am an employer providing the following worker's compensation coverage for my employees working on this iob: American Int'l Companies --31C_ 00625437401-- 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 Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Nnrnkrr) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional sheet if nece nary 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 while homeowners who employ persona to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner resides or on the grounds appurtenant thereto are not generally considered to be employers under the worker's compensation Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the legal statue of an employer under the Worker's('.on..r...riee AcL I understand that a copy of this cratonwint may be forwarded to the Departmost of Industrial Accidents'Office of lnsuraooe for the coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties consisting of a fine of up to$1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of S 100.00 a day against me. Signed this ( day of 1--z h J 2002 For departmental e only ,2/9 Zka Permit Number � Map# Lot# i Sre ofLu r rv�.