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23A-093 (3) 1 +:;.. M'tssachusetts - Department of Public Safety ` �, Re.u( >nd �uulards Board of Buif(ln� g ervis tati or ns Lice nse St Constructi Sup 1 License: CS 77279 Restricted to: 00 1 STEVEN A S 0LVERMAN �` } 8 F RD � J SOUTHAMPTONOMER , MA 01 073 i 26 Expiration: 6/21/20 i .— - y Tr#: 25795 (ulnOiissiuner P ►Maio ti License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR s before the expiration date. If found return to: 1 -- t Board of Building Regulations and Standards Expiration: P� 10/13/2010 Tr# 275412 Ex One Ashburton Place Rm 1301 - Registration: 131945 ,. °' Type: Individual Boston, Ma. 02108 STEVEN A. SILVERMAN STEVEN SILVERMAN r 268 FOMER RD. .....,, /e l'f �C� /( �f�` - SOUTHAMPTON, MA 01073 Administrator 'Not valid without signature f • rrtivo*-1. 1/u fp�, ;it o �XLR xf � iip1on / = —'t �f� assa rF =_ _ " ' - �� _ Ate; _ _� _ *�' D EPARTMENT O P BUILDING INSPECTIONS 4 __4 f 212 Main Street ° Municipal Building_ Northampton, Mass. 01060 WORKER'S COMPENSATION NISI RANCJ: AFFIDAVIT /V2 L.SaAT Sit / /�` %z_ ii vz/-z .%.-. ;! /7 / ;�Z. . e__ �� -7, ft/Ls"? , 2 (:._ (licensec/permittee) with a principal place of business/residence at: 3 `fo 1/ 5 i.b 2 /) /i/`Z. , / /O'/7f , 7i✓i / /9.11 (phone #) 9 - 8 `f / ZZ___ (6<tr ,t/city /s a t elyip) h /Oc3 0 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: (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 th t if ne t:ve y to include information pertaining to all contractors) ( ) X am a sole proprietor and have no one working forme. ( ) 1 am a home owner performing all the work myself NOTE: please be aware that wrhile homeowners who employ persons to do me R,tmArm, fiction or repair work on a dwelling of not more than throe units in which the homeowner resides or on the grounds appurtenant thereto are not generally considered to br employer under the worker's er`s mmp satian Act (GL152,s 1(5)), application by a bon s:m ate for a license or permit may evidence the legal status of an employer under the Worms Compensation Art I understand that a copy of this staternerit may rn for - startled to the Depertmeet of Industrial Accidents' Off oa of Imam: uses for the coverage verification and that failure to secure coverage tm'.or ration 25A of MUL 152 can lead to the imposition of r. immal penalties consisting of a fine of up to $1,300.00 author imprisonment of up to one year had civil penalties in the form of a Stop Work Order and a fine of 51 00.00 a day againet tae. Signed thi S / day of e i . &41 For departmental use only Permit Number vx Signature of L ensee/Permittee • AA • m i , SECTION 8 - CONSTRUCTION SERVICES .1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder _ Steven Silverman - ___ __._.._ 077279 License Number I 268 Forcer R +. c Sszuthampton,_._MA nh n73 6/21/10 — I Address _ Expiration Date t � 1 ' �� 584 -7522 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ I Steven Silverman 131945 Company Name Registration Number 268 Fomer Road 10/ Address Expiration Date Southampton, MA 01073 __Telephone 584, -7522 r 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 0 11. -- Hams (honer 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 -veal' 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 he 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, von may he 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 • ,CT(4 S. DESCRIPTION Or PROPOSED WORK_Ltrleck .14 • Now Hvosd ; Addition LI Replacekfient Windows A:teirJtian(s) Bowling 17 Dr Doors Accesso:y Bldg. J Dernolitior New Signs I Decks ; 1 Siding { Other , flc Lor F..flAely, 3 KNfo stI A-f-11*() Ca 55 4C/J4 illiihrunk p lov-eCt Wi00,1 t ASLI 1 A 1 Aacr 5dWif ut 7A' n ¥ _ ROI 64. if Now house and or addition to existing housing„c9Lnplete the following: Tyr:, 7 :mnily Or, " r F. 1 ,;! Vetrz.y.,i 1 f'41-71;.:,t• t.rocti F % Or , Erre21,..zy $7, :rirDI:LIrl:i2. fttr-Ti • tin itX1 % .1:; IOU :11 cellor I ;:ror 'Y . tit 7;:r ik 1,1; `„y pr v;57:,-; %v .; 'I SA:N) SECTION 7a OWNER AUTHORIZATION TO DE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT uLc p 5 r't11:1.17i. Steven Silverman, Valley Home Improvement, Inc. ;.! I t tu v. ; l'ilf• Si;:1`,3* o: derief , Drid kr' the tOr.:,.*t<)a r.ind '111 belicf Steven Silve 7 // , /// A / 4 -/ , iTr;rit rr. a 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 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 een or need to be obtained from the Conservation Commission? Needs to be obtaine 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: • • ►t 'r` • Department use only City of Northampton Status of Pei rit: Building Department Curb Cut /Driveway P rmi 212 Main Street Sewer /Septic Availability o ! Room 100 Water /Weil Availability 'vim Nortlhamppton, MA 01060 TWO Sets of Structural Plans phone 413- 5$7 -J. -240 Fax 413-587-1272 Plot /Site Pl Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: / l7 / 7/ — � (/ .. Map Lot Unit / g7 ©7Q , �, Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: /7 j �� l £ L� .•�/ t" s E77 �,- tiiu` 1 / / /Z z2, ,/41- /do z Name (Print) Current Mailing Address: ' -t./ Telephone �- 611"L 2 Sigrfure 2.2 Authorized Agent: Steven Si lve an Valle Home II.rovem-A t . . P.O. Box 60627, Florence, MA 01062 Name (Print) r - Current Mailing Address: �� // / _ 584 - 7522 Signature i Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 41 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection ` ��{�S 6. Total = (1 + 2 + 3 + 4 + 5) Check Number �/ �W This Section For Official Use Only Building Permit Number: Date Issued: Signature: _ - Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0311 APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC ADDRESS /PHONE P 0 Box 60627 FLORENCE (413) 584 -7522 PROPERTY LOCATION 17 FAIRFIELD AVE MAP 23A PARCEL 093 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out p ly 5-� Fee Paid ! J Typeof Construction: REPLACE 3 KNEE WALL ATTIC ACCESS,INSULATE & ADD SOFFIT VENTS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 077279 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO$ 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 Commission _ Permit DPW Storm Water Management Demolition Delay Signature of Building 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. 1PAIIELDAVE ,� BP- 2010 -0311 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- 2010 -0311 Proiect # JS- 2010 - 000413 Est. Cost: $3000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sq. ft.): 13242.24 Owner: GOTTLIEB SETH G & JENNIFER N Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC AT: 17 FAIRFIELD AVE Applicant Address: Phone: Insurance: P O Box 60627 (413) 584 -7522 Workers Compensation FLORENCEMA01062 ISSUED ON:9/23/2009 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE 3 KNEE WALL ATTIC ACCESS,INSULATE & ADD SOFFIT VENTS 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 9/23/2009 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo