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Valley Home Improvement, Inc. 83 FRONT SEE VIEW SHEET NUMBER
MO Riverside Driv:a PO Box E0621, Northampton, MA 01062 111 STREETLEEDSMA PROPOSED Dareruzlzms
Off ice: Phone 413.984.11522 Fao 415-.585.0820 4OFFMAN DRAWN ev:s.e.
Find us on the wet, at: aunt ValleuHomelmprovementcorn _R-'4,J110/111____..
83 FRONT ST BP-2017-0625
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: IIA-039 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGLLcc.1144/2�A)
Category: EXTERIOR RENO BUILDING PERMIT
Permit# BP-2017-0625
Protect# JS-2017-001010
Est.Cost:$5200.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Slze(sq. ft.): 37461.60 Owner: HOFFMAN GARY K&DARA A JOHNS()
Zoning: URA(100)/ Applicant VALLEY HOME IMPROVEMENT INC
AT: 83 FRONT ST
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:11/8/2076 0:00:00
TO PERFORM THE FOLLOWING WORK ADDING SHED ROOF OVER EXISTING SIDE
LANDING, REPLACING ROTTEN TRIM
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 ft 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 11/8/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0625 g0.0/6a
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC Q,(2t^ y
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522 I
PROPERTY LOCATION 83 FRONT ST
MAP 11A PARCEL 039 001 ZONE URA(I00)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee daid , y�
Building Permit Filled out IV1, l
Fee Paid
Typeof Construction: ADDING SH R OVER EXISTING SIDE LANDING, REPLACING ROTTEN
TRIM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 077279
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFi$RMATION 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
DeInion Delay
r'-- TA<
tore o B ' .ung 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.
.. t ' r
f1o
C 2
Department use only
l. City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
0i2 212 Main Street Sewer/Septic Availability
- Room 100 WaterNVell Availability
,--n_> Northampton, MA 01060 Two Sets of Structural Plans
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
This section to be completed by office
1.1 Property•Address: pp
S3 �Won4- U-4' Map Lot Unit
L_-eCa2 4v Zone Overlay District
Elm St.District Ca District
SECTION 2-PROPERTY OWNERSHIP/AUTHOR/ZED AGENT
2.1 Owner of Record:
(/yf�, \C1-04. 4. 'S3 cror,k S+ Leeds Ma_ e eE5
Name(Pn fCurrent Mailing M s :
lety� k/ / Telephone
Signature // /
2.2 Authorized Agent:
ern ctVve_v-IrYLOL / (2 0. oc (canal Flc�encc Ma+ olod2
Neme(Pnnt) 'it/,//�, Al �l Current Mailing Address:
/F{/)i//�//y/yYp fl IV `fl3-S311-75 ZZ
Signature / Telephone
( SEC.TtO`l+-EETIB(ATE•N CONSTRUCTiON COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building SJI'700 (a)Building Permit Fee
2. Electrical I (b)Estimated Total Cost of
i �� l Construction from (6) l
i 3. Faun/mod I:, 2m
4. klechanicai (HVAC)
5. Fire Protection 1(/
6. Total=(1 +2+3+4+5) Check Number 30/.37 `�
Tills Section For Official Lire Only
I
( Building Parnit Number: Date
issued:
•
•
Signature:
Building Com:nsslanarllnspsptorof'ouildlogs Date
Lt-
Section 4. ZONING Alt Information Must Be Completed. Permit Can Ee Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Oeparonent
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage % -
Open Space Footage % -
(Lot area minus bldg&paved
arking)
4 q of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Findin ver been issued for/on the site?
NO Q DONT KNOW YES Q
IF YES, date issued:
iF YES: Was the permit recorded a' the Registry of Deeds?
-ErmQ
DON'T hl�;;;<J YES s✓•
€F YES: enter Soak Page and/or Document"
B. Does the site contain a brook body of water or wetlands? NO Q DONT KNOW 0 YES 0
OF YES, has a permit bee or need to be obtained from the Conservation Commission?
ppeeds tre be nreiRlned 0 Obtained r� nate Essued:
L `A
C. Do any signs exist on t e property? YES 0 NO 0
IF YES, describe site, type and location:
N. Are th e n propos d Chances to or A,.innc nsir=htendn-! for thn prey? NES Q NO n
IF YES, describe size, type and location:
vtm Ine construction scam" orsturo(creams, wing,ex .t :i h orfii n )over i acre or - part of=_common plan
that will disturb over i acre? V
YES NO a
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) ® Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks ID Siding[CI] Other[In]
Brief Description of Proposed i- -
Work: pCni-AJG. SFlo PLY OWE FliSUG ,sipt L,41vDPQ6 J- (LEPLAOk6
Alteration of existing bedroom Yes No Adding new bedroom Yes No 2 LriNf3 IM Attached Narrative Renovating unfinished basement Yes 7'- No
Plans Attached Roll -Sheet
sa.if Nev house aced or addition b ezfls€unci housing,. complete the foiiowiria:
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?
d. Proposed Square footage of new construction. Dimensions
e. 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 Cir) weter Supply
SECTIOIJ 7a-OWNER AUTHOREZATVON-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
property C7
hereby authorize
StiOeVir\alTh
to act on my beh in all matters rp.- We . work authorized by this building permit application.
Signaturetatuof Owner Date
•
Aei TcrtC tlVe✓Yricu _as Omer/Authorized
uthorized
b _y - .eth Iomzn the _n ientin&I arc _eer.:r.the tn th._ be_ my I ev -_
Signed under the pains and penalties of perjury. •
MP � I t It AM
S;' titer ef - ___
•
SECTION 8•CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: S\-e-V`_(\ .Dj1\ s'1'
'QC( C1 1 1'
License Number
Pi' .<i. •ri fa i 4 f f �. i L1 121 a4 0
Address Expiration Date
//G/)! /U/ e w 3—c — 5_a
Sign-tore Telephone
9. R�egistered Home Improvement Contractor: Not Applicable 0
+
t *f) r l�V`r' -int' -- /05S93
Company Name Registration Number
PO . 3oK ��• 7/17 /
Address �, - Expiration Date
HO(
k `(O(eV?(,i '*t G\(5(a Telephone 5bt\-1C�) -
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 Q. No 0
11. —Home Owner Exemption
The current exemption for 'homeowners'was extended to include ,n'rrer-oce tte N ethn v C :e(7) .o.a(2)families
and to allow such homeowner to engage au individual for him who does not possess a license,nyrrc ddcd t--h s the owner aces
as scmernisor.CMR 720. Sixth Edeflon Secadoo 109.y.S.L.
deHn@Son 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 persen who constructs store than one home In a two-year period shall rot he eonsddered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall be
sl onsibYe LaCh Werk act-formed knock flee minding permft.
As acting Constzperinn Supervisor your presence on the job site will be required from tint to time,drfe*g 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!nay be!table 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 Signztnre
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: $3 Von1- S L"C cO.S
The debris will be transported by: Ala. . 2✓(JxxnGrt t-
The debris will be received by: Ak D 0
Building permit number:
Name of Permit ApplicantN clYytitvgpn Th2n
11/2/16 /.r/ 1
Dat . - Signature of Permit Applicant
- - The ermitonwgitth of Massnehils"Its
- - _ Depart ent of Imizistrial Aecident5
Office of Iiiiestigaliohs
- ii Sit
600 Washington Street
-r-- Boston,MA 02111
www.rnass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
\l
Name (Business/Orgamzationadividualy v a ,, cci-ve Ion iQ f(U,'Yofien-iL , In L
Address: :3`-t, c2N,t v-S\C:1C S(ILYC
City/State/Zip: t \( fent CA hone#: L11�j—S ok--�Sza
Are you an employer?Check the appropriate box: Type of project(required):
1.a, I am a employer with 1B 4- 0 I am a general contractor and I
employees(full and/or part-timerhave hired the sub-contractors 6. ❑New construction
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. 0 Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.?
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
9 ]
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MOL
1 12.0 Roof repairs
insurance required.] f c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp.insurance required.]
*Any applicant that checks box XI must also fill out the section below showing their workers'compensation policy information
t Homeowners who submit this affidavit indicating they are 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 sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is She policy and job site
inform ado,,. GSU
Insurance Company Name: 1OPX\C� e_t-n. )'�1J'le-e ( P
cy p cr Self-ins. Lite(-)a�: Da._ -II nc-7 C•OCZ 1S--
Poli Expiration Date: ' ,1I In[7
Job Site Address: ) werk Sk- City/State/Zip: L' S 1,VLr (USS
Attach a 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 c vi penalties in the form of a STOP WORK ORDER and a foe
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage y r ca ion.
I do hereby certify 1I the pains a/ld penalttiie3', perjury that the information provided above is true and correct
ti
Signature: �!>:?;:d�� it • gt Tir�ll. Date: 1612L IL,
l2 _CCtx_l _`1 -�-
Phone ii: r 1 v t --/c7o,
IIficial use only. Do not write in this area,to be completed by city or town official II
City or Town: Permit/License 4I
Issuing Authority (circle one): 'l
q
1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ii
ii
S. Other ii
IIContact Person: Phone 4: ii
-are wog P a , u r`dams
Ste s CS-77279
STEVEN A SILVERMAN a3 Jeii ..
268 FOMER ROADll .4
SOUTHAMPTON MA 01073 °' °
Comm,ss:oner 06/21/2012
Offiee of Consumer Affairs and Business Resulation
10 Park Plaza - Suite 5170
Boston. Massachusetts 02116
Home Improvement Contractor Registration
Registration. 105543
Type: Pnvate Corporation
Expiration- 7;1712018 Tr# e'D2S1
VALLEY HOME IMPROVEMENT INC.
STEVEN SILVERMAN
F.O. Box 60627
FLORENCE, MA 01062
teva,..". Rtu Emi> . • •••,Lint la ru
f.
Office of Cum r \'far re S4 ROVIteti N _114ron License or registration -rl fur indtrid uul use only
HOME IMPROVEMSNT CONTRACTOR L.rur thIC. W morn to:
R.otstrat•on 105-7,4 Ty ce': Offize of t ntr,um.r.1 r'ry a 1 thi:nes ke anon
.,n.ru . AI_r 0't in
S ,EN S l A NI g/1 , �
V ,
aP R:ves aC C 1 J (�,� __
rta' r '1 1 amu. lot ra1i4wrhnr ,jnalare