30C-054 (10) 528 FLORENCE RD BP-2017-0857
GIS#: COMMONWEALTH OF MASSACHUSETTS
Man:Block: 30C-054 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: GARAGE BUILDING PERMIT
Permit# BP-2017-0857
Project# JS-2017-001440
Est.Cost: $10000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 45607.32 Owner: DAY ROBERT A& ANNE M
Zoning; SR(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 528 FLORENCE RD
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01 062 ISSUED ON:1/13/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:INSULATE & INSTALL REMAINING SHEETROCK
IN 3 CAR GARAGE
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 1/13/2017 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0857
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 528 FLORENCE RD
MAP 30C PARCEL 054 001 ZONE SR(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT z
Fee Paid (1
Building Permit Filled out 111
Fee Paid
TypeofConstruction: INSULA STALL REMAINING SHEETROCK IN 3 CAR GARAGE
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 ION 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
/,,//y'
uJ cS.I/i� 1/21e
atureofBui : g iffi 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 40k Contact Office of
Planning&Development for more information.
Department use only
/ City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
/
212 Main Street Sewer/Septic Availability
N / Room 100 WaterNJell Availability
/� p`; Northampton, MA 01060 Two Sets.of Structural Plans
7 ' / phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
_:/ Other Specify
APP CATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Peooerh•Address: -- -- - This section to be completed by office..
525 c ora,cc Qpp,�,, �cj 4 Ithap Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2•PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
4A- +tkrtni_V i 525 F\o,ehc_e Re ctorence (Y_ otaa'Z
Nam doll �� Current Mailing Address:
tpl.t__� 6'1- Telephone413-`. 0 -31c3.1
��LL ✓
Signa re
2.2 Authorized Anent:
ce en ` LW; ?ie.Gc Laca-i fc 'ence_ °to 4a2
Name(Pint / / Currant MailingAddress:
irk t3- —14: 2�
Signature Telephone
SESTICril j.-ESTIMATE`f-ritiSTRUCT4iOlt COTS
1
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
t, Building /0
DOC?—
. (a)Building Permit Fee
i
. Electrical � (b)Estimated Total Cost of
I I j Contrustion from (5)
lg I rf u_u;r,ning Pertt•tF,_
4. Mechanical(HVAC)
5.Fire Protection Jq' /
5. Total=(1 +2+3+4+5) 1CD <v7r Check Number �lc/(73 r us
1 Phis section For Official Use Ernie I
Date
I Dunning[Permit Humbert
Issued:
Signature:
Building Cammissicnerinspector i Buildings Date
Section 4. ZONING AU Information Must Be Completed. Permit Can Se Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column tab:fiVcd iu by
Suildingnepuvnmt
Lot Size
Frontage - -
Setbacks From
C't e
L: R: I L:
RRear ..
Building Height -
Bldg. Square Footage - % v —
Open Space rootage -.. °ib -
(Lotareaminus bldg&paved -
4t of Parking Space& .. `
Fill:
(volume@LDCatinni --... _ _ .....
A, Has a�S'p�tecial Permit/Variance/Finding ever been issued for/on the site?
�../
NO DONT KNOW 0 YES Q
W YES, date issued:
Ir'YES: Was the permit recorded at the Registry of Deeds?
Pirsi .�Ili7t4 ' , YES
EE YES: enter Book Page and/or Document Pi
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0
W YES, has a permit been or need to be obtained from the Conservation Commission?
41eede to Fe nL._;iyaeA V €Maimed Q h:te feer,eA
C. Do any signs exist on the property? YES 'ice NO 0
IF YES, describe size,type and Location:
D. Ara!Bern ticFy pro,P2sxal ch.,nries aaltiaan �R ._7.a _ aiir - pro YES PS NO 0
7 YES, describe size,type and location:
vim uie or..nstr...=0;actriuy cisiuro pearing,gracing, Or ': Irl j. e- r &c'6 ,,
or '- art of common p an
matt rover di tura ie? YES 0 NO fl
iP YES, then a Northampton Storm W'eler Munaaerner4 Permit from?he DPW is rent.red.
SECTION 5.DESCRIPTION OF PROPOSED WORK(check all apolicable!
New House 0 Addition Replacement Windows Alteration(s) Roofing E
Or Doors 0
Accessory Bldg. 71 Demolition ❑ New Signs [C] Decks IO Siding[C] Other(ix
�. wyK-+..nrra>
^unef Description of Proposed
Work: ,1 C1`'1 i,(0'e k- "on,SSCfi,il CA^YOC•tC A fl ear I-5QA.C.Ly -
Alteration clotting bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll •Sheet
6a.€f Mew house and or additpon b ex¢stinu housann, oonplette the foNoWin :
a. Use of building:One Family Two Family__Other
b. Number of ro‘edItteirreeth tangly unit Number of Bathrooms
c. Is there a garage attache
d. Proposed Square footage of new co 'ruction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves _Number of ea r
g. Energy Conservation Compliance. Ma eck Energy Compliance form attached?
h. Type of construction
i. - Is construction within 100 ft.of wetlands? Yes No. is construction 100 yr. floodplain Yes lNo
j. Depth of basement or cellar floor below finished grade ......_
R. Will building conform to the Building and Zoning regulations? Yes No.
I. Styptic Tank City Sewer PrivateCily!Atier Supply
SECTION 7a-OWNER AUTHORIZATION.TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERhBOT
�f
0\rX, t'�. � • (1 _cubject
property �q
hereby authenze V(I_Clis... r.1L.
to act on m, a.-half,in all matters raatre to work authorized b; this building permit application.
Signatureof O yl° Dewe
3.:-,," may"` ' Y ram
1, Sliserry\cion .as Owner/Author ed
: Ace .,gyttere dud.tste erentddre . i9f0711aitvi ahe kareavainaa aaottion _o. a .._ . he.
ISigned under due pains and penalties of pehdrv.
e -edams
,n ` vev ry c r
Jill /1 . j di/6 I 7
SECTION 8.CONSTRUCTION SERVICES
$.1 Licensed Construction Supervisor ` Not Applicable 0\
Name of Licence Holdet: `rt.retro Jk\hatfiEtW1CLt't n1 i c-1-�
License Number
Z > v-on-yri- tt eAbT3 (01z t 1 f
Address ` Expiration Date
Signature I Telephone
9. Recdstared some tmorovemenl Contractor. Not Applicable ❑
-esz r, Si\\r-rArtQ1 _ 1055j3
ComnanvHain@ Registration Number
Address ss - Expiration Date
TelephoneS)I7O/1
•
SECT1ONN 10•WORKERS'COMPENSATION INSURANCE AFFIDAVIT Rit.G.L.c.552,§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....... ER No ❑
lir Home Owner Exemption
currentTht fatempti 3.1 fee _ ie __ ed d uevtper_ c nreu Dvct 'irds_.ane(:;, Cr _wo(_}families
and to allow such homeowner o engage individual fon hire who does not possess a license,rtittatided dear the owner sets
as surliemvicor.CUR"S.. Sixth ]them Sections 105,33.5.1.
Beftnidon of Homeowner:Person(s)who owe 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.persona who constraints mere Chun one home int tine-vs tr morsd shat:not he ccsx cooed a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official.that due/sRre shall he
imisnotsibis Ent en to eh work;outtormea ander We bnisitatieu permit
As acting Construction Supervisor your presence on Are/ob sire wiii be required from time to time brine and moon
completion of the work for which this pp0rmit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers m
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,eon May he gable forperson(s)
you hire to perform work for you under this permit
The undersigned'homeowner"cantles and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinmace,Sri and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Skase-ore .
City of Noithampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 4Q 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 MOL c 111, S 150A
Address of the work: 52-co clU(E3��'lc'e I, cit 1eYKe—
The debris will be transported by:r , J t-Cytt \rn\Cyyu ,�
T ne debris will be received by: Va It C __) c &
Building permit number: ��" r
Name of Permit Applicant V(Lclt-tt e,•po.-vna, .sl-
) 71/ 7
A it
Date Signature of Permit A.ophcant
a
100 WinkirnD71 S8:'2°'
Boston, MA 02111
30,0w.n2ass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant information Please Print Legibly
Name (Business/Organization/Individual): bbd.at_t- ken C
Address: 31-\ —€VS'(\C \)(IVB
City/State/Zip: 't" \ciente Z71 Ph e #: q S, 5::DSLA`152Z
Are you an employer? Check the appropriate box: Type of project(required):
I. I am a employer with [B 4. ❑ I am a general contractor and I
employees(full and/c:part-time).* have hired the sub-contractors
6. ❑New construction
2.0 lamasoleproprietororpartner-
listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, 0 Demolition
working for me in any capacity. employees and have workers'
.insurance.• 9. ❑ Building addition
corm
[No workers' comp. insurance P
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 [No workers' comp. right of exemption per MCL
12.0 Roof repairs
insurance required.] t c. 152,§1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant hat checks box ill must also fill out the section below showing then 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.
I-Contractors 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.
_F rt.xr_n.. ?4,9?*2759 Co.aTeESif . , . ts3 `9rray expl
cveos. Rehm-, ,h..policy and fob site
information.
Insurance Company Name: 13or0f',0C=- //11.-CM, ;f _rr t-e. e {'��
Policy#of SeGoas. Lie.-: C;Cc:.•-�is L,.7 1r. d t �l [ i
7 Expiration Date:
kb Site Address: 526 TVO([',♦7(f' City/State/Zip' Ticricyyc Ha O io(02-
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 ::nposition of orad- .ties of a
tine org. -15. 0nO r• /e - y _ - ell _ civilpenalties in the.o .- es aRrn v —_
� . -nen - ,.a �. __ -
ofup to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of thz DIA for insurance coverage.'yeri ca.cn.
I do hereby c ry' th. 4l or_tethsp w It
P ^r perimm that the rrflr2IldiOtl frOV3dPi above is true and correct71r. /i /A
non f • ,tr/4( ,,,,
., Date: I \ 2_1.1.9
r'nonea:
rir. iseriTikniCale#
II ssWrithilthity r }+
1. Board of Health 2.Building Department 9 Chy/Yawn C-:rk 4,&!acts. al Irtaveet r c, -Pie:Thing, r m. c,nr
Co Person; Plegoa
}p} ,;carC ns go :.nn r..ares
LicenseCS-077279
-i
STEVEN A SILVERMAN ry
Hlt
268 FOMER ROAD d°
SOUTHAMPTON MA 01073:..
rn+tA lJ'._.- Expiration_
Commissioner 06121/2018
—
°v !/C' l/f( f//t{'(////f f/ r (jli1`,..f/('//LiI,//
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 105543
Tyoe'. Private Ccmoraean
Expiration. 7/17/2013 Tr% 4i>291
VALLEY HOME IMPROVEMENT INC.
STEVEN S;1_VERMAM
P.O. Box 60627
FLORENCE. NAA 01062
au.aa nu rx Jl Y:npie:n1kin Lost l:iU
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