31A-173 \ c€ A.t.latt,t°tt 1 4' °aat sat r atlais r `tat= °t
Box rd itl [3trrlr tra + kevtil#01oTs Pula 'standards
Coa"?,4,tra.r :la,,n Siipervlsor i.Jc.or ":se
ra°traa,'a CS 77279
Restrict d to CO
STEVEN A SILVEMAN
268 FOMER RD
SOUTHAMPTON, MA 01073
6/211:2012
a , .sa� >ri ..•i� +.� _,.__uw, 26868
11g4.c.4 + 6441tbitOttadefii4v,ditiff �ttl taif€ License or r €+
istr:rnun taint fin' nuns id ul use on Is
HOME IMPROVEMENT CONTRACTOR before the e- .tpiraation date, jr found return to:
Registration' lin.ar €i c{' utldin +„ Regulations atocd `�tntar#;trt0r
Ex ar icara: t F.?. u" Try 4 One As iberttatt Hack i gm 1. M
.,- Type: tnfiL oa. 02 OS
;O
1
STEVEN A SILVERMAN / f
STEVEN SILVERM,AN r
SOUTHAMPTON MA D107 i "'.Not "Mitt �s tiituot signature
�altra'rtt "tztrtatr�a'
}
VA' of Nortljamptrar -;__- L
B �. o* �ji d asaacf�nsctte - _ v '
y -' DEPARTMENT OF BUILDING INSPECTIONS ' _ � �=
212 Main Street • Municipal Building ' o
Northampton, Mass. 01060
WORKER'S COMPENSATION TTSUR.ANCE AF'11DAVTT
I, 4/2 L56 Af S// / F= / %L_L/� !//fl iz Y //'/!Z. e_ 7"�‘ '' "Lai , l C
(license&permitlee)
with a principal place of business/residence at:
3 'to /2)/Z.45 i..6 2 J I'Z / Aib,,li - 77 - gfi7 - - o ,' f , (phone #) 5 if - �� -
( stret/cit y /s•,at ;zip 1/azs v
do hereby certify, under the pains and penalties of perjury, that:
(x ) I am an employer providing the following worker's compensation coverage for my
employees work on this job:
/ Li75 c!0 . 0 e 76 6 55 / 0 / /f!./
(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 vihilo honxowaers who employ persona to do rm+intrmnff, consuuenon 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 ration Act (GL152,ss 1(5)), application by a homeowner for a license or permit may evidence the
legal status of an employer under the Woricera Compensation Act.
I understand that a copy of this statement may be forwarded to the Department of Industrial Accidead' Off oe of Insurance 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 up to 51,500.00 andtor imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of 5100.00 a day z against mc.
Signed this / day of / ;62/9 For departmental use only
Permit Number
• Vii. •Cr / /744 Maptt Lot #
Signature of L h.. • ermittee _
e .
ti
•
SECTION 8- CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable 0
Mane of License Holder : Steven Silverman_._ _._ 077279
License Number
1 21 6
268 Fomer Roa•� S. • + - ,,• •n,_.._�A 0 `3
07__....__^ 6/21/1t.
Address
Expiration Date
/ 1 / /1 584-7522
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Steven Silverman.___ 131945
Company Name Registration Number
268 Fomer..,..Rgad 10/131/
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 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 _
'7CTION 5,. DESCRIPTION OF PROPOSED WORK the k rillp,plichlo)
1
, I
Now lice4e `,...: i Addition Li
, Replacement Windows ' AAeration(01: 1 Roolinn
Dr Doors
Accessory Bldg. Ll Demolition0 New Signs ' 1 Decks r,„ ) Siding$ Other , 1
1
_-,-1 Ill.. c. r.. on t;.. , r ... r -,0q.: t-io't • ,‘ ttr d 4 ... Ne 1p.1 61A 1,,f/aL S (41 / ..)
i VIA , i)al .)r _w_tw___r 0 f sh .
, , ,
/ 414 hakt ,
' - ,o,, , n;..: :)t,t: V-, Nt-, ."(:;1. ttp, r, :Ii-litt`trt 'Yt-i --- ..fr,
.tL ‘.'o tr.:: lit-Thotl R IV .i !..;o-,tiltl
6a. It New house and or addition to existin: housin• com• tete the followina:
, 1!-,i- . . , 1 ..,44 tc,,,'■i' C ' C 7 ..t'C r il ,,' 7v,„
.
i
)1.' ttrt .1
t , ,t,tt:.=,•'
' Vct.r L.' 'Ivo: t:v.
C:(,-;,c,rv,,t;if "I .7...t i;r:' : 70 C.0,1 : jr, f'..trtri ,t'tL.Ci
:
. ' C, I.! \ .1 ea t Fr e I t Ya; t '. V“'71q 1 T: N .. 1:. 1 ■11.1 A i ''... t * 100 Yi ' ILV.. , :1,..+1.i..1 ___
i - t-g r.i 'It n:1 ,An.,.ist : !.. c t.1',Ir I :'n'tr tt-.1t,,v tt , F,h, - -q.; jr,
f.1 trt ",' c Pt! I' :he, t• / ".... t it, t St t",t` Y.':-`.
- lc ___ _ y 4,.1tt z:.'u )1, V,
, , ....... ..- _ i
,
t ' SECTION 7,3 - OWNER AUTBORIZATION - TO OE COMPLETED WREN
OWNERS AGENT OR CONTRACTOR `APPLIES FOR BUILDING PERMIT
3 4" S-74, A `
Stev- Silverman, Valley Home Irproveraent, Inc.
i /If
_atemen_lilmexman,Valley_Hona_Impxomement,__Inc, . ,v, ' .",.m w! /Nit -,,:-1-
',IC , :i.te . . 7 n',. 4 . -- : ',...",,,:itcrry:.'r.:, Ittic tr :.. kr' thu 5t ii irol.'........dicl .41 'kV,' ,1„'d 01,1.. r 71.1., t.1 11 „;-,,', ',' Is -,,,..
r cP,, - Fir! 5CliC`i
:.A.2. - 1 Di..1" ::.. Z ''..1 t. tit::: U`
Steven Silverman ________ I i
[
....._ ....,_____ A i ■
fir //7
- 7f
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 seen issued for /on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Regi- ry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body sf water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or n -ed to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the prow erty? YES NO
IF YES, describe size, typ; and location:
D. Are there arty proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
Department use only
�._ City of Northampton Status of Permit.
r Building Department Curb Cut/Driveway
212 Main Street Sewer /Septic Availability
• f6om 100 Wa er /Well Availability
Northampton, MA 01060 TWO-Sets of Structural Plans_ `,„
phone 413-587-1240 Fax 413 - 587 -1272 Plot /Site Plan
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
L 10 14VtvA (201 Map Lot Unit
N +74) Zone Overlay District
Elm St. District_,_„ CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Prig / Current Mailing Address:
Telephone
Si
ture
2.2 Authorized Agent: Steven Silverman
Valley Home Improvement, c. 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 0 2i (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) 2� � Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner /Inspector of Buildings ` Date
•
.,( BP- 2011 -0041
q5
GIS #: COMMONWEALTH OF MASSACHUSETTS
yMap:B1ock: 31A 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-2011-0041
Project # JS- 2011- 000070
Est. Cost: $21000.00
Fee: $126.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 7492.32 Owner: SMITH STEPHEN E & JOLIE B
Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 40 MAYNARD RD
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584 -7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON: 7/15/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: INSTALL NEW FIBER CEMENT SIDING& NEW
ROOF SHINGLES ON MAIN HOUSE
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 7/15/2010 0:00:00 $126.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
(011'iLL of Cons ,All'airs and .14usiness Re
10 Park Ft ii - Stlite 5170
Boston, Niassaclitisetts 07.116
Irrip)
Fitectistratton: 131945
. .
Type; Incrividuai
Expiration: 10113/20 12 Trig 2045:140
STEVEN A. SILVERMAN1
. . .
STEVEN SIIAIERMAt\I
26$ FOtvIER RD. '
SOUTHAMPTON, MA 0'1073 •
. .
c.pdale rtturo rd. ‘1A13,.. r for
Ite.oe%; al Employlo.e.nt
Ofttue- Cvnsumtr t lWd Lor iod;vidut
HOME IMPROVEMENT CONTRACTOR before. till t t.1;ite. if loud rOu:rn to:
(qlice 4:
:417u
STEFVEt
. .
STEVEN Stt,\IERM!" .
268 FaVIER. RD.
SOUTH.AMPTON., MI 01073 UtidersetT0:40 va 'd ithota forlture
7727a
71 A V
.Pr.) .
5t3LrCHAMI--1('"'N' ""
; SECTION S' - CONSTRUCTION SERVICES
Licensed Construct1on Subervisor: Not ApiDicable
Hanle of License Holder : Steven Siiverm. 077279
Lorinse
,•
268 Pon: r oa Soutbrantori, n 3 6/21/17—
4,c:dr...Hs Expiratol Date
534 7522
Teleph, ne
Retfistered Horne improvement Coritnlcter: Not ApplEcalYe
s teven Silvel /31945
C:omparty Hame Postration Number
svp21.
Address Expiration Pate
i S out:ha:Qv , Iva 0 07 -% Te:ophone 5214= - 7 52 2
SECTION - 10-1 , VORKERS' COMPENSATION It\ISURAN AFFIDAVIT c. 152, c
*orkers Compensation Insurance affi:dawq roost be completed and submitted with this application. failure to provide this atica
I will result in ihe denial or the isSuance of the bulIdinp permt
Signed Affidavit Attached Yes.. .. .. No 0
E-
(
The current exemption [(Jr "home(Jvviiers %, extended to iuelude Cltviler-occunid of one l I) or liwoC2)
and to allow such homeowner to tingme an individual for hire who does not possess a license atttie nets
tjhe
as supervisor, cma 750, Sixth EditIoq Section 105.3.5.1.
iii.efiniflion, of Homeowner: Person (s) who own a parcel of land on r hid hAsh: ty:si6 irAi2ndS io
is or is intended to be, a one or two fan chvelIing, attached or detached structures accessory to such use ands' or farm
i-Artioitires. \\t 20_010 1L,:;11.
Such "Immouwner" shall submit to the Buifding Official, on a Form acce.pt,ttitle to the 111dilding Offtciak thief I::/she
frcw
5th ,'L cswI,
As acrine Cop,stru Supervisor your prf.,sencct on irhe ink site will be required from inno to tiole, during and union
completion of the work for which this permit is issued.
Also he advised that with reference to Chapter 152 (Worlterir Compensation) and Chapter 153 (Liahflity of Ernpiii•,'ots
Employes fc.:r injuries not resulting in Death) of the Massachusetts General Laws Annotated. con mav ho 0 Del°S0:1(S)
OLf. W(iik yeti LiucO liii perititt.
tthii LI reitritiontibi!itv tt
J-;
Nov,' ViiAcve.‘, Ai3g)(0
; Coo
New SIE,ni
. - 2 — k/tPOUL SAQ AVA/Ad5 C/ icy
140,4
:New house and or acidition to existing housing'. cornplete the following,
iort.:
`.• „,„t •A:1 A •
• • d • .
■!: J1:
°
_:f
• t -t-
1;j, ',).1,1 t • N
' : y
SECTiON 7a - OWNER AUTHOPiZATIO: - TO C COMPLETED WHEN
',..T.7'7V1IERS AGENT OP CONTRACTCR OR 131111..D'ING PEP:117
/i7
Steven .T.rt.proveraent, Inc.
4 ?/7/2011
Steven __Silverman., Valley 1-1 Inproyens.... Inc
St.s.w1:n Silvrmln
.
Section 4.
ALL INFO!' ,. ? ;_TION MUST BE COMPLETED 9 or PERMIT CAN BE
DENIED D ,�, TO LACK OF MO) ' z. TION
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
/�apppppermit been or need to be obtained from the Conservation Commission?
eels to he obtairyned t)io inert pp
e
C. Do any signs exist on the property? YES _ NO
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 . R
. , x
IVED iLy o Northampton -----
Department use only
Status of Permit:
It uil sing Department Curb Cut/Driveway Permit
, I 3 2011 2 i 2 Main Street Sewer/Septic Availability__ ,,..,
DEPNI0oRFTHABumiLpoTioNG4.18AproI Room 100 Water/Well Availability
. , .
- "Nribrth;mpton, MA 01060 Two Sets of Structural Plans_
phone 4 - - 7-1240 Fax 413-587-1272 Plot/Site Plans _ l Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLIPG
— _
SECTION 1 - SITE INFORMATION
1.1 Property Address: __.
This section to be completed by office
/WO/ I- 1114 fe2b Map. Lot Unit
X--) Zone ... Overiay LSLCL.
Elm St. District _ CS District .
•
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: z /47,7
..)(' /
f ) 7 / 11 J I I, ir_ A , fr 7 , a / 0 a
.
Name /print) ; Current Mailing Address:
gnatur Telephone 51 ......c) 3
Si: I
2,2 Authorized nt:. S te I- n Silverman
Valley Home Improvement , Inc P.O. Box 60627, F1orence, MA 01062
Name (Print) / Current ".4ailing Address:
Sril e 'JD " SP/ f7 584
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COST
_ _ — , •
i ■
!tern Estimated Cost (Dollars) to be ' Official Use Orq
completed by permit applicant
.
1. Building (a) Building Permit Fee
_ ____
2. Electrical (b) Estimated Total Cost of I
Construction from (6) ,
FrNih r re.p 1
__ _ —.--- I T 5s cro
,- ,
L_). nie. ProLecuon ; _
--
1
6. Total ,-.:-. (1 ± 2 -- 3 + 4 '•- 5) I ?00 heci: Number 2.1c 70 ,
_ ________ — • i — C _ _____ . ____ ______
This Section For Official Use (.',srity
Belong Permit Nun _ ___ Date Issued: _ I
Of ■ _
" 1
___ Signature:
r ---.
c mm:
ling Cossioner/Inspector of Bu ------
ildings Data - ---------
Annionsummoomonwimminummilop
40 MAYNARD RD BP- 2012 -0043
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A - 173 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Non structural interior renovations BUILDING PERMIT
Permit # BP- 2012 -0043
Project # JS- 2012- 000067
Est. Cost: $4900.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC
Lot Size(sq. ft.): 7492.32 Owner: SMITH STEPHEN E & JOLIE B
Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 40 MAYNARD RD
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584 -7522
FLORENCEMA01062 ISSUED ON: 7/13/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: Repair Water Damage; Replace Sheetrock
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 7/13/2011 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner