23D-195 (3) o ,' City of Northampton REQUIRED INSPECTIONS
kf.74 1 1 a 1. Footings and Walls
4=' - eDEPARTMENT- BUILDING 2. Structural Components in Place*
7 3. Complete Building*
Office of the Building Inspector
No. 614
7/8/97 Fee$148.00 Check# 7835
Zoning Form No. 962481 Date
Page, 23D Parcel 195 ,Zone URB Section 127 ❑ Yes El No
BUILDING PERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Valley Home Improvement Inc before Building Inspections
has permission to construct 2nd floor addition bedroom/bathroom Inspection on Site—Foundations
situated on 29 Warner St - Bob Cilman Inspection of Plumbing—Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON P' ' ISES
Certificate of Occupancy
t;/ Building Inspector
U `= L
FILE # " ^ r Ci 1
��L�' law; ' II t 1
CANT/CONTA T PERSON: /LIi ' 6 ' 2Sa oZ
Fr. ADDRESS/PHONE: t) 06X- 4a� ' U /
DEPi
PROPERTY LOCATION: c29 —
MAP o1,3p PARCEL: ZONE 4.61_
1'H IS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CH F;CKLIST
ENCLOSED REQUIRED DATE
7ONTNG FORM Fli:LET) (NTT
Fee Pairs
Building Permit Filled?$ zW4T�Fee Paid
Type of C'nnctrurtinn•
New Construct-inn Q74 - //
Remodeling Interior i. "V -�� �t A(
Additinn to Fxicting
Accessory Structure
Buildia.),,,,ng Plans Tnrinuded• �—
Owner/Occupant Statement n (hens /13666-0 L/
Sets of Plans /Pint Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
�pproved as presented/based on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received & Recorded at Registry of Deeds Proof Enclosed
/
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
Permit from Conservatio ommission
Signature of Bui dung or Date
NOTE:Issuenoe of a zoning permit does not relieve en applioant's burden to oomply with all
_ zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public" Works and other applioable permit granting authorities.
D .�.., ._.
LuL29( 96(-)22?-7
E File No.
DEFT Gf BUILDING INSFFE i�� NG PERMIT APPLICATION (§10 . 2)
NORTHAMPTGN,ht�r
PLEASE TYPE OR PRINT Al LL U )UJA!
INFORMATION
1. Name of Applicant: iU l I )1/IQ/J-- / 4701-e ,,,,..„
Address: �a`J �S[�t 1 au . I 1 I Telephone: 7a c�el
1 ' � .
2. Owner of Property: V, )►J al tYlet/Y\ a ` 14/Y1P
Address: a f W eAA,NA( bl- Telephone: 5W-6 I
3. Status of Applicant: Owner O^ ,_, Contract-�}�. Purchaser Lessee
Other(explain): f 031I Adk&t (A)Atrattri
4. Job Location: 01 e1 IA)eAk ri-" 0-''
Parcel Id: Zoning Map# 023 P Parcel# 9 District(s): 72,4
(TO BE FILLED IN BY TH BUILDING DEPARTMENT
5. Existing Use of Structure/Property cf 3, ./l7 % • 1t.) ✓ . dlt-)C�'
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
•
.5_i/rm A (j1Jr liii i.tiAN\ /9-c c/ / 4c . 0,-." Ne / 6f1'A- /d0 (*IV&
y2Qfr•D � ,
7. Attached Plans: (/ Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Per it/Variance/Finding ever been issued for/on the site?
NO V 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#
9. 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:
(FORM CONTINUES ON OTHER SIDE)
10. Do any signs exist on the property? YES NO (/
IF YES,describe size, type and location:
42174,
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This column to be filled in
by the Building Department
Required .
Existing Proposed By Zoning
Lot size
Frontage L v �
Setbacks - frnnt J�
- side L: R: N L: 00 R:
- rear ju
Building height
(Y°rJ
Bldg Square footage pp� Q
%Open Space: f � '
(Lot area minus bldg ��//
I' &paved parking)
`pf, Parking Spaces
fof Loading Docks
Fill:
=(vol-ume--& location)
"13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: 7' /- - 7 l APPLICANT's SIGNATURE / am"" .
-sr: NOTE: Is.suanoe of a zoning permit does not relieve an applioa bu en to comply with all
zoning requirements and obtain all required permits from the and of Health, Conservation
Commission, Department of Publio Works and other applloable permit greeting authorities.
. , . FILE #
.A a ... t1'i .Q Q —*gib
9 �. e;>a1 rillallt Roll
*6 ., ,i kilt __
$.VATS"F14 JUL 2 1997 �lasaachnactta ='v_Elyilit—
CIC. 74'0_ DEPARTMENT OP BUILDING INSPECTIONS ___�i=
DEFT OF BUILDING INSPECTIONS =._
NORTHAMPTON.Mt('loan 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 �'" �'
WORI{ER'S COMPENSATION INSURANCE AFFIDAVIT
I, Nelson A. Shifflett / Valley Home Improvement, Inc.
(Lcensee/permittee)
with a principal place of business/residence at:
320 Riverside Drive, Northampton, MA 01060 (phone#) (413) 584-7522
(street/city/state/zip)
do hereby certify, under the pains and penalties of perjury, that:
() I am an employer providing the following worker's compensation coverage for my
employees working on this job:
Eastern Casualty Ins. Co. WC9660047 2/1/98
(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 Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet if necessary 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, cation or repair work on a dwelling of
not more than three units in which the homeowner reside.,or on the grounds appurtenant thereto are not generally considered to be
employrs 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 Compensation Art
I understand that a copy of this etatement may be forwarded to the Department of Industrial Accidents'Oft oe of Insuranoe for the
coverage vtriflc*tioo 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 S 1,500.00 andlor imprison of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S100.00 a day against me.
Signed this err day of 199 7 For departmental we only
,� — Permit Number
��pu ✓ Map# Lot#
Signature of Li ertni
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 5 t- )5a a- Alterations
e:r NORTHAMPTON, MASS. c )cirna ol2 19'9'1 Additions_ .__
:el
APPLICATION FOR PERMIT TO ALTER Repair
IA ' Garage
1. Location 39 l t JC X' )1 Lot No.
2. Owner's name MJ (Ll A r cvr\ P 1rr.�05 Address c q UY C,AXX r' "s/--,
3. Builder's name !')d 1 I l)&,1 k ` h'� ) w? i1. 3d Address 'fAt/S(4i U U .
Mass.Construction Sypervisor's License No. d 3OLP C 1 /� / Expiration Date q)as J�/i(
4. Addition & iv-A - /9 O'd I 07 e_ 10 cti•-. /9-od ds / 6
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating F/f tV = c, /, Z" ? L'
11. Distance to lot lines /� A) v C17/JN` L
/�12. Type of roof l/�0 4 n7-/T • V
13. Siding house ( e //OK -
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
:Oy/te 1,P.,--5.
Signature of responsible appiicant
Remarks /90 CY 4C-64i.oin eve' eA'CiliNv J/UW+-,G /cccr'YI &lc/ Zel(