35-243 (4) 35 LADYSLIPPER LN BP-2017-0459
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:35-243 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Bath reno BUILDING PERMIT
Permit# BP-2017-0459
Project# JS-2017-000761
Est.Cost:$63300.00
Fee:$443.95 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(so. h.): 42558.12 Owner: BLOOM PETER A&CATHERINE M
Zonino: Applicant: VALLEY HOME IMPROVEMENT INC
AT: 35 LADYSLIPPER LN
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
F L O R E N C E M A 01062 ISSUED ON:J0/11/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL 3 BATHS - NO CHANGE TO
STRUCTUAL FRAMING, ALL FIXTURES IN SAME LOCATION
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 10/11/2016 0:00:00 $443.95
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File if BP-2017-0459
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 35 LADYSLIPPER LN
MAP 35 PARCEL 243 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERPLICATION CHECKLIST
'" - ENCLOSED REQUIRED DATE
ZOFee Paid
FORM FILLED OUT )/ 21 'j9e
Fee Paid f-j ,
Building Permit Filled out >�
Fee Paid
typatructiom REMODEL 3 BATHS-NO CHANGE TO STRUCTQAL FRAMING,ALL FIXTURES M
SAMELOCATION
New Construction
Non Structural interior renovation$
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
INFQR1 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 Commission Permit DPW Storm Water Management
Dem".• -llay
Si_ , reo B• di "g effiic I 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,
Department use only
City of Northampton Status of Permit:
.12Vt6 e uilding Department Curb Cut/Driveway Permit
nf� 212 Main Street Sewer/Septic Availability _
LLNN++ �+dt Room 100 Water/WedAvaaataNty
m., `"H*"pp` Northampton, MA 01060 Two Sets of Structural Plans
o Nn phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
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
35 Lath jeer" L-n+- Q— Map Lot Unit_
J Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Pete t Cat -1r Bloom 35 Ladyslipper Lane, Florence, MA 01062
Name ) fir Current Mailing Address
413-584-7564
I�... �_/ Telephone ....
Signature
2,.2 Authorized Agent:
7r �
, esrcn rl
\•lc'en,Cv-.,, _ f(-o 7oc bobYt t-\b✓e9ce �(b.. QOroZ
Name(Pant) jl4 f ,f Current Mailing Address:
Jib ((((/Y t\3-SBH— 1522.
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1, Building / 'i ovo (a)Building Permit Fee
2. Electrical 7 !x� (b)Estimated Total Cost of
r 7Uv Construction from(6)
3. Plumbing Jt ll//oo Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection AA
6. Total=(1 +2+3+4+5) &e, 300 Check Number (30,5.?5 2 9 , C/b
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required Zoning
This column to tilled in by
Building
Department
Lot Size
Fronta•e
Setbacks Front
Side L: R' ,
Rea
Building Height --a
Bldg. Square Footage /
Open Space Footage
ILot•arkina mina.bldg&paved -_
parkin =
Fill: _MM.
Nolum
Fill: a&Location
A. Has a Special Permit/Variance/Finding ever .-en issued for/on the site?
NO O DONT KNOW O YES
IF YES, date issued:
IF YES: Was the permit recorded at the Re:.stry of Deeds?
NO O DONT KNOW 0 YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body o water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or nee, to be obtained from the Conservation Commission?
Needs to be obtained • Obtained O , Date Issued:
C. Do any signs exist on the pro.-rty? YES O NO 0
IF YES, describe size, typr and location:
D. Are there any proposed $nges to or additions of signs intended for the property? YES O NO O
IF YES, describe size,/type and location:
E. Will the construction activity disturb(clearing,grading, excavation or filling)over t acre or is it part of a common plan
that will disturb over i acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration{s} "14 Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition D New Signs ED] Decks ICI Siding(CJ Other[DJ
Brief Description of Proposed
Work: gliMoCEL. 3 &rids 'r No CHA06E- f0 Uel'1. eng. Ok- S7Lvatm Au FrAmq,?. .
t - FrnTUP,Es IN 944F 1• ATa
Alteration of existing bedroom Yes_r No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes hz< No
Plans Attached Roll Shaet
ea.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
a. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
a. Number of stories?
f. Method of heating?_ Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. 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 la•OWNER AUTHORIZATION•TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ?ekey' 4 mi. .-ma v.2 w eon as Owner of the subject
max s
her.y autho ytyfx,,♦1\_ 'e ` h_PAL.,,.1: !. a •
to ' •/ -or f,in all I- relative to wor' authorized by this building permit applliic/ation.
Signature of O T Date __
_ 1ai'_ • i_:.._tl a ,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.
Si; under the pains and penalties of perjury.
S,\ wry /
/
Print ame x.�
l0 Ar
Signature of Owner/Agee / Dale
SECTION 8•CONSTRUCTION SERVICES
8,1 Licensed Construction Supervisor
_ I Not Applicableq 0
Name of License Holder-_,...... eY•iSikltkitriDi Yy _ O17a 1
� �
1 License Number
1'� ��
aces eA, c,G% l Uhl ^ 1`ke-or. 1*0. o\o ib _ & Iit 1 t
Address Expiration Date
1�t3—Sg4--1522-
Signature Telephone
9.Registered Home bnm
preyeent Contractor. Not Applicable C3
V i 1 . .1 As . 1-
.1\ 0 . *L.il .. . I D3SLk3
Company Name Registration Number
Q.° , L°12D1 0,•.. i Met ol0 z zl�� }t2
Address'/ ,. j �j Expiration Date
///�//JL,r/ I // ne �r'cg, /I TelephoL1---752-
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 Va, No ❑
•
11. — Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 he 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 be liable for persons)
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 _ _
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: 3J .TD`IaPYI1Lfl.XIe_
the
The debris will be transported by: , e Won?SorLetbscmari-
The debris will be received by: )€ x?a t
Building permit number J
Name of Permit Applicant V ' 1 1Q1.-4—
I
OAA 71/ 1 / �
Date Signature of Permit Applicant
• Til, C0.c,:'':D" ,Yp?q, Df.1,125s71/.12.u.5 ons
......
: D p-7 tt : f elindustiLg AccideJlis
r . r ,.. e Iiiiii“
600 Washington Street
_ Boston,MA 02111
www.rnass.gov/ilia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): �f�(,�k,( ,'i,A ('(�' c Iv;,0(cpc—rAlertl- , �fl
�J \
Address: 3y� �\v�v5\dAJ(
e kc-C
City/State/Zip: t \oien.CL (�c\ al�h e#: LI 3 SOLI— 522
Are you an employer? Check the appropriate box: Type of project(required):
I.[NI am a employer with f B 4. ❑ I am a general contractor and I
6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
on
listed on the attached sheet. 7. ❑ Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9 ❑ Building addition
[No workers' comp. insurance comp.insmance.l
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. l o workers' right of exemption per MGL
Y comp. 12.0 Roof repairs
insurance required.] t c. 152, §1(4), and we have no ❑
employees. [No workers' 13. Other
comp. insurance required.]
*Any applicant that checks box Al muse also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the subcontractors have employees,they must provide their workers'comp.policy number.
Iain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. t� GT..;
Insurance Company Name: vbF,l�� L.W1," l).ii nc
e ( 0.
Policy#or Self-ins. Lie.#: ce' 0(..±O,....'L. 1 Expira c.-.Date: l2] i `• I 1
lob Site Address: t 5 {.(t(Ar5' .L{H It& LaL.no City/State/Zip:ftin(eyj - Mit Di.06/2—
Attacha copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP v, O_L_0,P_DEP. rind e fine
of up to$250.00 a day against the violator. Bc advised that a copy of this statement may be forwarded to the Office of
Investigations of DIA for insurance coverage yeri c tion.
I do hereby certify ,c the pains a Id penalhek perjury that the information provided above is true and correct
A' t ,i
/ ( 4
Signature: , �'��t2 �/ • lfr�P ,1,t�.�*,.-•• Date: )'D lP I
Phone r.: A jCi y'A—1C%77-rig
lIOfficial use on.;,. Do not write in this area, to be completed by city or town official 11
City or Town: Permit/License# iI
Suing Authority(circle one): iI
1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5, Plumbing Inspector IF
45. Other s
i r
JContact Person: Phone#;
•
1
errs CS-077279
STEVEN A SILVERMAN f
268 COMER ROAD
SOUTHAMPTON MA 01013
{r-/1 ‘ �U&_- Exp atio,i
CommtsS:oner 0612112018
.., .-: fftC t'r ll/it/YveriPrill77,1/ / f flrr4;(1 // ;i;i
_ I
Office of Consumer Affairs and Business Reetiladon
10 Park Plaza - Suite 5170
Boston. NIassachusetts 02116
Home Improvement Contractor Reeistration
Registration. 105543
Type. Private Corporation
Expiration. 71171201E Tr 4!509:
VALLEY HOME IMPROVEMENT INC.
STEVEN SILVERMAN
P.O. Box 60627
FLORENCE, MA 01062 - -- -- -
61n;����,nte„1.,.. •_ l,o,tr ur.1
Office err',numkffmnS. /injury RH: Innv License or registration validfurindiv id ural u.,e onh
:.N"'.. HOME IMPROVEMENT CONTRACTOR INrare N - I.,u d: nc ru:a,rn
-.RI Registration: _Sin T•n=e tRitt:eo l ornani :than..: .t BasmnzsR u,a.wn
Exp.aacn:
Eynon.'Sii J21 in
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T EN I RN ��jf{Jr,)'�,JJff
4 -Rversa D. . 'V ' 4�, ' i % lI. / f?7t/J,i /
Nkr. ln1.tCF= . . �..., N -
;[dwrti orrolIlure
- —
R ,ineeliceiCS vegiAziA, _
5 OrQty of Northamptonim
B 1
u Idin Department
,09
_ Plan Review
° i
212 Main Street w
Northampton, MA 01060 "
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PROJEGT NOTESPROJECT PLAN 2. 0 , 2
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ft l .� I D. 1 AND TM 511310I r of .,�.,.,311333. I/ e II
P _ N 5 P N FOR ST T 'b NORD ORK NOT 5P...,1 ICALLY DETAILED LL BE OONSTPU 9 TO THE SAME PROJECT 35 NAP'S PP.R LASE :Y1513315 cROJECT CONDDOPS .,SUMP 6 WII
`{ /(,. T � E _I - � L`} 1 QULITY. 561I- rv4005.AT 15 DETAILED ALL INIORK SHALL BE PONE IN ACCORDANCE WITH INTRNATONAL I ADDRESS FLORENCE.HA Cm Si
e,I � ( t t f Z E L. I �_ PROPOSED MA BATHROOM 3 J N
III ! 1 \ CROWDED BATHROOM L p _I
RIZ NDI 505 DSPU DN0 SHALL TAKPRECEDENCE OV AL DOI 'f' ION NOGENERAL m (V3
�^� Ei A i A 1 _ NOTES SALE 50NJ $C. ER LB CONSULTED OR CLARIFICATION. SIT CONDITIONS R D I DESIGNER N II
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�� QUESTION ARISES OYER TE INTENT OF THEPLANS OR NO C R N ER OR SUE CONTRACTOR SHALL VERT Y AND F E
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IS ES O 515LE FORAl— N5(1 DI 6 ROUGH OPENINGS/ Cl Z; U. t
III D E CLEF ONOTHER S —
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of f j f r It' Y p p 1 pose Or supponng me conuacmo of sou arm se a agrees mar me eeererHOT1 S plan snan not oa rep,enmeu Or pr nmeu fir anp
form(u iho psrposs 1 V f,nablrnt or sup/ ;ng Ore work ofcop ngpmject cony wllovl the pemiossion of,and conrpens.Uon ped ro,VH/
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`` _ 35 LADY SLIPPER LANE �I�+ 1 1n'{^s SCALE.SEEVIEW SHEET NUMBER
Valley Homo Improvement, Inc FI_ORENCE,MA01062L
�a p� r1 Np�G+'Q
DATE I0/6/2016
ti40 Riverside rive, PO 5m 60621, I Iorthampton, MA 010b2 Se�1�l� 1 ONS DRAWN BY se.
Office?acne 1 3.5b4.1522 Fax 413.505.082( ULOOW+1
VIEW us onlh ycb at- um I'ligegi!omelmprovemertcom ' _.
Torn 'or the put nctIing r sup r ebrimel^mk ole peing project cant tl vlhoul the per or or and comps bon paid lo.VHL oconuen[uro nrrn,eno em oro ragrees nae rna oremensvr nvpy sna ro,o reptu sno orpreee sun anV
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Valley Home Improvement, Inc. PROPOSED MASTER
FLORENCE,MA 01062 DATE 10/6/3016
&4 0 liver aide Er rive, PO Do 506 , Northampton. MA 01062 BATHROOM
Office Phone 412 554 -1522 Fax 4135850820 DRAwry BY.s c
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FLOPNCE,MA01062
DATE 101612016
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