35-243 (8) 35 LADYSLIPPER LN BP-2017-1268
GIS a: 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: Deck BUILDING PERMIT
Permit a BP-2017-1268
Project# JS-2017-002118
Est.Cost: $10500.00
Fee: $70.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sa. ft.): 42558.12 Owner: BLOOM PETER A&CATHERINE M
Zoning: 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 0106 2 ISSUED ON:5/5/207 7 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE DECKING ON REAR 35X10 DECK, NO
CHANGE TO EXISTING FRAMING
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 5/5/2017 0:00:00 $70.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1268
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:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 7f /1U
Building Permit Filled out
Fee Paid
Typeof Construction: REPLACE DECKING ON REAR 35X10 DECK,NO CHANGE TO EXISTING FRAMING
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
IN.FO,BMATION 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
P/erm/it from Elm Street CommissionsssiioPermit DPW Storm Water Management
it
/ �! L/
S 1 //7
Si re of tiding :cial 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.
_ ___ Departmentus=only
' City of Northampton Status of Permit:
1 Building Department Curb Cut/Driveway Permit
�j}'1T - 4 2017 212 Main Street Sewer/Septic Availability
I Room 100 water/Well Availability-t__ __ - orthampton, MA 01060 Two sets of Structural Plans
-
on441 587-1240 Fax 413-587-1272 Piet/Site Plans
Other Specify -
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMES DWELLING
SECTION 1-SITE INFORMATION
-' - - -- - -- - This section to be completed by office..__
1.1 Property AdpCress(:� _ ^y�[,y
35 Luci3Slietoey L oc, Map r_35 Lot ; 3 Unit —
CC � Zone Overtly District^__
Fine Stais.ict _-- 'in Clstr:o
SECTION 2-PROPERTY OVPNERSHIP/AUTHORVZED AGEET 1
2.1 Owner of cord: ,
c. tare + :.ei.:.,, _Eel_ d u ✓ilin,G E lOccoce �4 0/06-t)
Nal."h ) / 1 Current Meili _ ltdtl_s.:
e T+VI r IV— Telephone
Signs ure
2,2 Authorized ntp
f*rlyerTh Clvc,rn ?c (.> 0-7 Ftor er-)cr t 1a. )a&2-
Name(Print) 4 f Current.M !i'ng Address:
-T/ft /
5a
Signature Telephone
'r.071 lbire t INC aCitrtiNdianced COSTS , ......
I {tem Estimated Cost(bailers)to be. OfffiNsi Use Only
completed by permit applicant
1. Building I F
7 J
OD (e)auilding Permit Fee �
12. Electrical -�_ (b)Estimated Total Cent of
( (
Construction from(5)
1 3. Piumb:pc - ei_@d!ng Permit.Fee
I
4. Mechanical(HVAC)
5.Fire Protection A`
6. Total (1 +2+3=4t5) to SOD Check Number 3 it., it/ )
Tata Se±clnn For dViicisi{tom Firii
_ui.:ino Garem!seix,ar'laspectir of Manna reale
•
Section 4. ZONING I All Information Must En Completed.Permit Can?e Denied Dun To in:omlket&Iniornation
Esistng Propoeed Requirledrwbc by ZonSiing
Sbis wMinby
Iddiug Deism:meut
Lot Size
Frontage
Setbacks Front
Side
Rear
Building Height
/r
Bldg.Square Footage _. oz I _ . ..✓ . . ......
Open Space Footage ,o _ . /` /
w
(Lotartminus big&paved
s of Parking Spoons -
Nolume3Locarion)
A. Has a Special Permit/Variance/Finding erei been issued Forton the site?
ND Q DONT KNOW 0 / YES C) _
OF YE,date issued:
IF YES: Was the permit recorded at the e gistry of Deeds?
�,
,, vt Cs \dr
tIF YES: enter Book Pags _nd/or Documents
B. Does the site contain a brook, bo. of water or.wettands? NO Q DONT KNOW 0 YES Q
^F YES, `am a permit keen or skid :o :,e obtkin4s1ro the conservation Commt•sion?
hieerys.n 2 nbr_eit+ed okf.,tned r' , hatee ls<_ued:
h..)
C, Do any signs exist on the .roperty? YES t 1 NO 0
IF YES, describe size type and location:
D. tt=ti r p?irons.raq rSessiertier? ?fsi.:shh, itss this;ion , hic— � C 'f`,
El, describe rile, type and location: ..
- _:n. .., . l ve iscreor ,u r'oisc nvi51
tru31 wiil i r oyes 'r YES (...) NO
,F YES,Olen 'a Northampton Storm Minter ldznnpemen , n ft from the??,4W is . Fed.
SECTION 5-OESCRFPTSON OF PROPOSED WORK(check all applicable)
NeW House E Addition Replacement Windows Alteretion(s) 0 Roofing
Or Doors 0 i
Accessory Bldg. C Demolition 0 New Signs (01 Decks-ti4 Siding WI) Other(C7
Brief Description of ProposedI3J � )
Work( k�( f,f.L- �
Ury � �i� RtifiR 9 �)F KA ND oivcrc
Alteration of existing bedroom _Yes t No Adding new bedroom Yes / Nam '7O �'"�)i(1 n{� +?Q if F•"(9-
Attached Narrative _ Renovating unfinished basement Yes / No
Plans Attached Roll -Sheet
Se.Cf Revd hoGse and or af:itiad to salstinq Nonskid, oOamleta the edtidarfiftd:
a. Use of building One Family Two Fernily Other
h. Number of rooms in each family unit [dumber of Bathrooms
c. !s there a garage attached?
d. Proposed Square footage of new construction, Dimensions
e. Number of stories?
E Method of heating? Fireplaces or W oodstoves Number of oath
g. Energy Conservation Compliance. Masschect Energy Compliance form attached?
h. Type of construction_
Is construction within 100 ftof wetlands? Yes No. fa aenemiotion within 100 yr. floodplain- Yes Ns
Depth of basement or cellar floor belowfnishod grade
k. 'x141 building con;olm to the Building and Zoning regulations? Yes No.
i I. Eidson TankCity-..ewer Private Oily weber a op!Y.__
SECTiCNTa-O4uPfdER AI}THORPTA.TbON.TO BS COMPLETED WIRER f
OWNERS AORNT��OR CONTRACTOR APPLIES FOR SUABLDIfdG?EMT
hel)u to a . A i <_ Vey'ma'1
to s -h elh -to work a +p ed by this building permit application.
Lt/2 /
Signa e' 0er Dale �
-1
r �. c tr:Ast tirr �
i as CwnerJkutholtrwJ
Biome de (he pains iclltie o1 perjury.
Sk serm Qe-v rn.a . I
Sf//�, '
•
SECTION a-CONSTRUCTION SERVICES
LI Licensed Construction Supervis0C Not Applicable 0
Name of License Holder: 5§�.v�:C� +.?l�, �t'FV)�Lb'1
License Number
Rod t`sllnCiarr t.-, \Ja o fl 3 alza !g
0.dtlresi11
,' E:.tpirtion 0a.e
Sig e Telephone
S.R�em�s,� b`tered Home fmbravement Contractor. ! Not Applicable 0
C 7�>°. x'z •>i\tri cit' l /0559_3
Comoanv Name Registration Number
Pa., Ppow' 7 44`° `7 `1171/8 _
Address - Expiration Date
I
icye-9( „ryy Q\b(4,Z Telephoneg`‘_ f '.
SECTION 10-WO KERSi COMPENSATION EIGGRANCE AFFIDAVIT c.152,N 25C(0))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit ki8 result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes 0. No ❑
11. =Home Owner &ear/keen
.eran.r, Fv c_:., .. _ '!a. tW is i- . ran•4IL Jof t ¢lia6
and to allow such hosecerri!is sopicipr_Lobtribal .._ She nhc Sher:WE possess a hisease,iiiicYribleti Caps the owner acts
zg
ruppingrorip nitwit egg Stub Er:Titian SectlactFc7d. 5.Y.
DeSnttkn of ytomeoamer: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 he,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.Apercon who constructs moire then one lime in a^t e-t,ast-t -riper shall a8.p rase cox snitieend a hornet-when.
Such"homeowner"tali submit to the Eulkitinig ci 1,oc a fmw acceptable to rhe:Suildiag Official Gist€efoJ+e etie ke
reins =1 n r _' wci __: r s e'.ee bartilistis tiermitir.
t aoting emir sTuscsion`yunen isak your presence on the job site will be required from dine time,during arid Lion
completion of the work kr which this permit is issued
Also be advised that with relierence to Chapter 1S2(Workers'Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,Fen fins'be Sable for parsing()
you hire to perform work for you under this Remit.
The undersie ed"homeowner"certifies and assumes responsibility the compliance with the State Building Code,City of
Northampton Or. _ances and Local Siezing Laws said State of Massachusetts General Laws s Annotated
City of Northampton 212 Main Street, Northampton, 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 byMGL c 111, S 150A.
Address of the work: c'21-) L(AG(uoSLe ,v
Akin Z CLry�
The debris will be transported by: �riYY1t, intp-o me y— •
The debris will be received by: _ 1
Building permit number.
Name of Permit Applicant \II a__ ( ✓vx-mlni—
51/4 11 7 if Ai
Oslo Signature of Permit Applicant
590 W,.s.; g_ is Sc n't
Bvs»n,MA 02111
www.inasago,ria
Workers' Cann eensat_9n insurnmee Aifd_ft: BuLders/Centr'e:t-ars/Ei._etu eaans/Pl`rnz''oery
Apvfieeaut iticanntion }lease feint 1LeliWv
:'.wen (na u.etsio :wa.nw.i 1 ''du 1iTt.\ F 4.,i'r'12 -t'¢`v' oiC, Yl,t•lri�4T' , ••l
1/4Address! 3-t S/.ke002-
City//State/Zip: V k ! f (t 11 Di Phone#: U S ' %4 1St
Are you on employer?Check the appropriate hos: Type of prof eet(required):
1.El 1 am a employer with 7✓� °. 0 1 am a general contractor and I
employees (fell and(mpar-;me) ' gave hied alae sub-contactors
New conwd'oction
2.0 1 am a sole proprietor or par tner- hated on the attached sheet. ' :�
❑aemodiliri
ship and have no employees These sub-contractors have g, 0 Demolition
working for me in any capacity. employees and have workers' 9. ❑D?=1ding addition
[No workers' comp. insurance comp.insurance.
required.) 5. 0 We me a corporation and its 10.0 Electrical repairs or additions
3.0 1 an]a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. ttNo workers' comp. right of exemption per MGT, 120 Roof repairs
insurance required.] t e. 152, §1(4), and we have no
employees. [No workers' 13.0 Other,._,,.,,
comp.insurance required,]
"Any applicant that checks box Al must also fill out the section below showing their workers'compensation policy information.
1 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
^Contractor&that cheek this box must attached an additional sheet thawing the name of the sub-connuomrs and state WSirc or not those entities have
eavpteyees. If the sub-cormactors have employees:they must provide their workers'comp.policy number.
. w?at.0 ';.,,;f notitetwett_ ,w. ,n near e . n aF , opo.. $�,..w,1/21a p-aa.?._.., .+ spec
odey v or ins.L ._{.2`.1 :. p ion Date: a2 f C 1 ZO i 8
The Site t5
ees: J ir Il i(r ✓ ki net city 1st-te/Zip: M otea r- m ._ OIOLn 2—
A-tenth a appy „.= au,ror> t,Stt.a 3 .i: . s_s.....�_„z n (:ueoartag rm pantyaotrb _' .;,a dsta).
ta
iz
1can lead to the innosition. cantina'penalties cif a
fine up to$1,500.00 and/or one-year imprisomnent, a_well az_civil penalties in the form of a STOP u.topx,Oo n ._,a =_`g.rt
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
y
xn e'r£ . .,of u.e ..Id.for::5'.n »G,^,':.^,.ire.ye,.....c....u- ...... . -. ..
-a. v.afaart v_ovzsierf aa5nve as erxee and care�ed.
tt s
`/.25117
i Inc Rei:arrrsHi And Standards
ce se. CS-077279
Y Jn Super' V a .
STEVEN A SILVERMAN
268 FO61ER ROAD
SOUTHAMPTON M .,O1'v]
IN �—'. V� Rxpiraticrt: •.
Commissioner CS121/2OIZ
Office of Consumer affairs and Business Readaatio17
10 Park laza Suite 5170
Boston, Massachusetts 02116
Home Improvement contractor Registration
ey mon: 105543
Pnvete Como scion
aticro 7/17/2013 TH 4H:221
VALLEY HOte.cIM °OV_r _NT V
STEVEN 11 t_RMAN
U. Oc66527
5?
ndaddnd and:roan rodrd.Mark H...assr.n Thr
Licrnrs.or
r5ci.zrztH5 sHlid indiadfunl,7777 oJa
±o5Sll L{02i
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