49-024 (6) 676 PARK HILL RD BP-2018-1253
GIS#: COMMONWEALTH OF MASSACHUSETTS
MU.Block:49-024 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv�BASEMENT RENOVATION BUILDING PERMIT
Permit# BP-2018-1253
Project# JS-2018-002229
Est.Cost: $57000.00
Fee: $399.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Siae(sa,ft.): 79976.16 Owner: MACLACHAN MAYA
zonine: Applicant: VALLEY HOME IMPROVEMENT INC
AT. 676 PARK HILL RD
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.5129120I8 0:00:00
TO PERFORM THE FOLLOWING WORK.FINISH PORTION OF BASEMENT, ADD BATH
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 Occuoancv Sienature:
FeeTvpe: Date Paid: Amount:
Building 529/2018 0:00:00 $399.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner
File 4 BP-2018-1253
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 676 PARK HILL RD
MAP 49 PARCEL 024 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICAnDN CHECKLIST
EN OSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled at
Fee Paid
T eof Construction: FINISH PORTION OF BASE NT ADD BATH
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)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 Sturm Water Management
Demolition Delay
a eofB (ding inial Date
Note: Issuance of Zing 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
Bad ing Department Curb Cut/orlveway Permit
RECEIVED 2 2Main Street Sewer/Septic Availability
Room 100 WaterlWell Availability
NAY 2 3 AL
orth mptoo, MA 01060 Two Sets of Structural Plans
'6tTe 4 3-587-1240 Fax 413-587-1272 Plat75ite Plans
Cher Specify
oEv r §aEpp�h�N�/S
r� WGfaSTRU T,FLIER,REPAIR,RENOVATE OR DEMOLISH F ONE OR N'O FAM6LV DigtELE1HG
SECTION 1 -SITE INFORMATION
1.1 ProoenVAddress: //��,, � � )) ,/���,,/ This section to be completed by office
&,2(p / al li Cf/ �� Roac Map q_ LotUnit
Rae-r7c-e— Zone Overlay District
Eton St.District CE Dictde[
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Nap + Oodreuu Mar � aLk�a n &?y, (bt-K 1Lh lI/i 11,1419 Dina
Nam�/�1nntO� Current Mailing Address: "
Telephaney I�J -o-7d7— 97
Signature
2.2 Authorized Aoent:
(Iver Q.o 6oGLOc��� Pio errc NR oto�2 f
Name(Pnod Gument Mailing Address:
Signature Telephone
Si,i0f,3•ESTadB.TEO COr2STRUC:Ory COSTS
Item I Estimated Cost(Dollars)to be Official Use Only
completed by permit ap llcant
1. Building (a)Building Permit Fee
2. Electricalr I (b)Estimated I mal Cost of
?i JCG Construction from 6
3. Plumbing J�� Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) S7/ 000 Check Number 'S
This Section For Official U=_e Only
npte
Building Permit Number. I Issued:
Signet e: � )
8ulidl ommissionerllnspecYor of Bulltlings Date
Section 4. ZONING All Information laust Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This colomv to be filled in by
BuildinS Dep.,rl
Lot Size
Frontage
Setbacks Fmnt
Side L: R: L R:
Rear
Bonding Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg d:paned
arlai
#of Parking Spaces
Fill:
(volume&tuceuon)
/ad
as a Special Permit/Variance/Findin ever been issued for/on the site?
O DONT KNOW YES O
date issued:
: Was the permit recorde at the Registry of Deeds?
t,:O —'r.; i,:N0:5% ('1 .YES
S: enter Book Pace and/or Document#
the site contain rook, body of water or.wetlands? NO 0 DONT KNOW Q YES 0
ES, has a per,it been 0,, need to be obtained from the Conservation Commission?eds to be tained O Obtained O , Date €ssued:
ny si s exist on the property? YES (D NO 0
, describe size, type and location:here anv proposed changes to or additions of signs intended for the property? YES G NO 0
ES, aescrioe s'n_e, type ant iocanon:ill dlstut ever 1 acres 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) -ElReefing E]Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [o[ Decks [D Siding[0) Other[M
Brief Descriptipn of Proposed
WorktiOU 61�
_ F r�IS Pon-1�oN �� bfsN�m�. h . NO SN lC--Tlf/zAL WpR r
Alteration of existing bedroom_Yes 7"- No Adding new bedroom Yes A No
Attached Narrative Renovating unfinished basement Yes No
Pians Attached Roll -Sheet
sa.if Il house and or addition to existing housli complete the foElcivir :
a. Use of building ;One Family Two Family Other
It. Number of rooms in each family unit: IJumber of Bathrooms
c. Is there a garage attached?
it. Proposed Square footage of new construction. Dimensions
e. Number of stories?
I. 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 wetands? 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.
epiic :anx e:c:i auppry
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, �{�x-(.1 L i- All Ha d Q 6i la kn ,as Owner of the mbiect
property 1
hereby authorize *V rK '�* CIek)en %kVeVn-0j-N
to act on my behalf,mall matters rela we to work authorized by this building permit applicati n.
�� S 73 �8
Signature of er Date
r�rr,�\�evrrar� \JI�Z
IAcent herhv dac:are that he sta amen, and in`.a alien cn t.s forocinu ecc!icaaon a tma and acewo=.to f`s Les sf my Lno..�dce
Signed under me pains and penalties of perjury.
Print Name 1
ent
� olgnamla of Oumen:' . Dere j
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervise Nat Applicable ❑
Name of License Holder:
License Number
t-O, �� ( ( \� 3 b �1 70
Address / r Expiration Date
Signature/ Telephone
9 Relstered Home Improv\ement Contractor: NotApplicable 13Cpmpanv Nam
r 2' yNam "\ �1Ve'.VlNYQx'�,
Name Registration Number
9117 15re
Address(( Expiration Dale
L7 Telephone516�ii'1
SECTION 98-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(81)
Workers Compensation Insurance affidavit must be completed and submitted Win this application. Failure to provide this affidavilwtll result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... % No...... ❑
11. - Home Owner Exemption
-n^_� i . _.'Ar e.tilZ .,
end ro ailow etc 'Lnmrowner io engage an indivirhiai fm'hire who docs rot po se _Lcense, s 1¢tat�t e K -t .c-Es
tessapervisor.CMR780, Sixth Edition Seciartl0 35.!.
DeBnitlon of Homeowner Person(s)who own a parcel offend on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or me family dwelling,attached or detached structures accessory to such use and/or farm
structures.A moemn who t tr more tltzn one he..in a vii 9 "-led shzil act be'andoered a kemeowne�.
Such"hotncroamer"s1,eI1 s'ubudi ro Ye Bu:ld,'rg CNcial,m s fcru acceptab;e to tre Bm1Lng Official. €hst be/she shall Ge
reSpa[i far UH seek - 'P r t' ed Lyri(he tr *lay a ol
As acting Construction Supervisor you'presence on thejob site will be required "nom 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 M (Liability of Employers to
Employees for injuries not resulting in Death)ofthe Massachusetts General Laws Annotated,You may be liable for persons)
you hire to perform work for you under tris permit.
The undersigned"homeowner"certifies and assumes responsibitily for compliance with the State Building Cade,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Aapetatcd.
City Di Northampton 212 Agan Street, Northampton, AA 01060
Solid Waste Disposal Afiida:�nt
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 1 11, S 150A.
Address of the work: 6176(2LIL 1�
The debris will be transported by: 1' a kik }}� Irn C�vC CY1P�l
The debris will be received by: VQ_ Y (LgA �9 C l I Q
Ili �Ij
Buildingpermitnumber: CJ
Name of Permit Applicant 4eW-LeA71 —
Date Signature of Permit Applicant
x The Commonwealth of Massachusetts
Department oflndustrial Accidents
•-,--t-1 : Office aflnvesSgatiens
600 Washing-ton Street
Boston, MA 011I1
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
_Applicant Information Please Print Leeibly
Name (Business/Orgmization/Individual): o V 4- TQL(
Address: jb Vt Vo(�e C1V�
City/State/Zip: ' 7' ois2_,rj e_
Are you an employer? Check the appropriate box: Type of project(required):
1.1 I am a employer with 4. ❑ I am a general contractor and I 6. E]New constructionemployees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have S. ❑Demolition
workingfor me in an capacity. employees and have workers'
y P lY t 9. E] Building addition
[No workers' comp, insurance comp.insurance.
required.] 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑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 41 must also]ill out the section below showing theit workers'comns
peation polity infman
oton.
t Homeowners who sobmit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such.
=Contractors that check this box must attached so additional sheet showing the name of the sub-contractors and stale whether m not those entities have
employees. If the sub-continctors have employees,they must provide their workers'comp.polity numb¢.
I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site
information. !!��
Insurance Company Name: 6be a_
Expiration cn Date: I 19
]obSieAddress: ,-)QInnQ✓k CiTy/State/Zip: (J/E7Ct
—
0 0iOgZ''
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-cart 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 WORK ORDER and a frra
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage fication.
I do hereby certify ihep¢ins a�d penaJti pie>rpjury that the information provided above is true and correct
Signature ) � .i9 .y✓,�.t,^' Date* 5//71/8
.Phone A`"22 J_CCJpp q_icb c�
Official use only. Do nor writb in this area,to be completed by city or town official n
City or Town: Permit/license#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone n:
Commonwealth of Massachusetts
L®� Division of Professional L lcensure
Board of Pudding Regulations and Standards
C o n s t rU_CY Ibni$J p-
,Vi s o r
CS-077279 -> f
E��ires: O612t/2020
i —
STEVEN ASILVERMAN-rr�',, tl _
268 FOMER RG,AD �
SOUTHAMPTON,,M,A 010734-rjfs�Ll
, a
Commissioner
C>�41
e ;omnzo�rzc�eat!�� o�Cil/Gu�atzc�2��e1��
r - Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 105543
Type: Private Corporation
Expiration: 7/17/2018 Us 419291
VALLEY HOME IMPROVEMENT INC.
STEVEN SILVERMAN
P.O. Box 60627
FLORENCE, MA 01062 —
Update Address and return card.Mark reason for change.
SCA1 r. 201,10s;11 [] Address [-] Renewal ❑ Employment F Lost Card
Office of Consumer Affairs&Business Regulation License or registration valid for individual use only
y i;$ HOME IMPROVEMENT CONTRACTOR before the aspiration date. Iffound repro to:
Registration: 105543 Type: Office of Consumer Affairs and Business Regulation
Expiration: X7/17/2018 Private Corporation 10 Park Plata-Suite 5170
Boston,MA 02116
VALLEY HOME IMPROVEMENT INC.
STEVEN SILVERMAN i
340 RoersideDr. , _, �._..�_ C�
Northampton,MA 01060 Undenceretary Not valid without signature
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676 PARK HILL ROAD scn�e sEr=viEw srtEer NUMar=a
Valley Home Improvement, Inc. CONTRACT 7
340 Riverside Drive, PO Dox 60621, Northampton, MA 01062 Florence,MA 07062
Office Phone 413.554.1522 Fax 413.555.0520 MAYA FOR ILLUSTRATION ONLY. NO SCALE oanwn ar.aua
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676 PARK HILL ROAD SCHLESEEvEW SHEETNUMBEx
SSATE S,4 P0,9
940 Riverside Drive, PO Sox 60627, Northampton, MA 01062 Florence,MA 01062
Office Phone 415.584.1522 Fax 415.585 020 MAYA oanwry ee aKa
Find us on the web at: w .Valle Homelm roVerrlentAom
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676 PARK HILL ROAD srn�s SEE vises SHEET NUMBER
Valley Home Improvement, Inc. ELECTRICAL PLAN A
340 Riverside Drive, PO Box 60627, Northampton, MA 01062 Florence,MA 07062 DATE.512312013 `F
Ofte Phone 413.584.7522 Fax 413.555.0520MAYA DRnwn Br.arca
Find us on the web at: a .Vali Homelm rovement.com