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18C-161 (3) 41 WARBURTON WAY BP-2019-0125 GIs 4: COMMONWEALTH OF MASSACHUSETTS MamBlock: 18C- 161 CITY OF NORTHAMPTON Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2019-0125 Proiect# JS-2019-000203 Est Cost S23500.00 Fee, $156.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sa.ft.): 0.00 Owner: KANTROWITZ RICKI ELLEN Zoning: URB(100)/ Applicant. VALLEY HOME IMPROVEMENT INC AT. 41 WARBURTON WAY Applicant Address: Phone: Insurance: P O BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON.7/31/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE FLOORING IN BEDROOMS, ADD BUILT IN CABINETS AND LED LIGHTING 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: O_I: 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: FeeTvpe: Date Paid: Amount: Building 7/31/20180:00:00 $156.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Loo ii N� G46 I Department use only �^ City of Northampton Status of Permit: Building Department Cum Cutforlveway Permit 212 Main Street Sewer/Septic Availability JUL 3 G 2018 Room 100 VtlatarNyeu Availability Northampton, MA 01060 Two Sets of Structural Plans— Fax 413-587-1272 Plotlsite Plans Di IT Or ru DIN,L JsPIr -I _ vov 1111','4.A TON.IIA J, Cher Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TV40 FAMILY DWELLING SECTION i-SITE INFORMATION R ` _ jq-1> 1.1 Pra)aN Address: IarlT is section to be completed layoffice Map O V Lot Unit Zone Overlay district Elm St.Distuift CS Uistdcf SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Reeord: ILK-t Q,/7 4' qtlu /;Ol�tcO Hent Mailin� gA y1Atldress� Q, Telephone Signature 2.2 Authorized Agent: e 11 Qo bow ooroa� Plaenr tiLR ©lors2 Name(Print) /^ Curter Mailing Address: 77AE� i SignatureI I ITelephone SECTION 3-ESTIti CCEJSTRUCTCCC3CCoTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building /L' / (a)Building Permit as 2. Electrical - 2 500 (b)Esumated Total Cost of Construction from (6 3, Plumbing Building Permit Fee 4. f0achanlcal(Hl'AC) 5.Fire Protection / 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only nate Building Penn Idumbar. issued: Signature. �� Building islonerllnspec[or of buildings Date Section 4. ZONING All Information(dust Be Completed.Permit Can Be Denied Due To Incomplete Information Existing - Pmpased Required by Zoning Itis column to be filled ea by Buildi,DreaNneut Lot Size Fruitage Setbacks Front Side L:_R: L: R__ Rear Building Height Bldg.Square Footage Open Space Footege (Lu[oxamiuus bldg Be Paved ._. .. azldao) #o4'Parking5 aces Fill: . . Nalume LLocaion) A. Has a Special P/ndariance/Finding ever been is ed for/on the site"? NO (D NT KNOW O ES Q IF YES, date issued: IF YES: Was the pcorded at are Registl of Deeds? NO uONT hIQOW C YES IF YES: enterk Page and?or Document B. Does the site contook, body of ate'or wetlands? NO DON'T KNOW YES IF YES, has a peen or nee to be obtained from the Conservation Commission? Keeds to be obtObtained O , Date Issued: I Do any signs existpr perty? YES 0 NO 0 IF YES, describe pe and location:D. Are there any propanges to or additions of signs intended for the property' YES a NO 0 IF YES, descrihe size, type and location: thrtavilldiarrm overtacl,? YES\0 eNO,0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESC'IPTEON OF PROPOSED WORI(/check all applicable) Now House ❑ Addition ❑ Replacement Windows Alteration(s) �- Roofing ❑ Or Dears 13 Accessory Bldg. ❑ Demolition ❑ New signs 101 Decks [Q Siding[0] Other[O] Brief Description cf Proposed Work: azo;!' Flo�KI ur �.�VCO'l'S" A44b6^' l4In, (Ar �J d- �[� Lt�L r, d F�9Au QZ Altemtionofemstingbedroam�Z Na Adding new bedroom Yes /\ N 11p t fw' /✓b Attached Narrative Renovating unfinished basement Yes N, 1,6 ' Plans AttachedR II -Sheet UO � f Ba.If Eley house and or addition to existing housing condpIlete the f09Eow•sne:. a. Use of building :One Family Two Family Other h. Number of rooms in each family unit: Number of Rathroems c. Is there a garage attached? d. Proposed Square footage ofnaw construction. Dlmen ' ns e. Number of stories? f. Method of heating? places or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.o 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 . ! Sepik Tank_ C—HySswsrr Frivaio wail Cry wafer Euppiy_ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, _�, �tr �C 1 `•((' '�+!/u. 'F2 as Owner of the subject property hereb uthorize toL77-1 n my b If,in all matter�r iativ.to work authorized b is building permit application. 1 L7 /�-/ a1 J Slgneture of Owner Data I, C>.Ir. y3r\ l�Veyry@➢ 1. Viz he bast ofmr,kmsead Aoant hereby dsc!ar'diE the staYemants and Icfomatian or tha foraalna c�W.maOmi are hug autl octal a,�, w the bast of my knwdladga Signed under the pains and penalties of perjury. lVV ll `� Print flame _ -f) -.6 t uata SECTION S-CONSTRUCTION SERVICES 8.9 Licensed Construction Supervisor: Not Applicable 17 Name of License Holder: .11"x-�1"�fl _711��-�1'V1�AY� -(17� �� 1 ` d/1, License Number -s GILL (1 C Address r Eryiraiion Date Signature Tlap Mne 9. Registered Home Improvement Contractor: Not Applicable ❑ CompanyName Registration Number el Address I,, \\'' rr 6:pirnon Dare SECTION 10-WORKERS' COMIPENSATION INSURANCE AFFIDAVIT(Rill c. 152, §25C(8)) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavitwill result in the denial of the issuers.of the building permit. - SignedAffdavitAttached Yes....... IN No...... ❑ 11. - Home Owner ExemRdoaa TI- c_r mut-x�p-r c.. - lu .er �=,t�dd[� nclede s3woree-uecunted IIcreft,rr€n="ei 1i: - .rro(2:f=i^!ger Led to allow isi popgow uv w engage an individual ion hire who does not possess a Lcense,Lsa• dE'd[1eL tee Owhepaces Lai suvertrigor.CMR 790Stith Rdhi ❑ Seedort Definition of Homeowner.Person(s)who own aparcel of land on which hehhe 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.Aperson whof tr more then b cone in a tm v d-hall n ot be waaMeled a h Such"6omrxrwner"shah'submit to the Pudding Cwcial, ona€o=acceptable to the building 0156 at,that fie/she shO be resnensible for ail such work,performed ander the huildiae permit As acting C.nstruefion Supervisor yom'preseooe on the job site will be rcgnired nom time to time,doing and upon completion of the work for which this persit is issued. Also be advised thatwith refereuce 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 rnaY be liable for person(s) you lilm to pufotm work for you under this permit The undersigned"homeowner'certifies and assumes responsibility der compliance with the State Building Code,City of Northampton Oidinarces,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Hames-k=-:;na:a:e City of Northampton 212 Again Street, Northampion, MA O1G60 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: L11 UJOL✓Vi-jeAcx� The debris will be transported by\:tyd41 1 o c�� The debris will be received by: 0y_ dA- . Building permit number: Name of Permit Applicant Date Signature of Permit Applicant The Comyrionivealth of lassachnsetts Deportment of Industrial Accidents n Iijjtce of Investigations 600 Washington Sti -! Boston, MA 02111 - -- v.Rvw.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information t 1 Please Print Lelnbly Name (Business/Organization/Individual): Address: 3-b City/State/Zip: r \of_, ce_ \ t a[°Pb no e Areyou an employer?Check the appropriate box: Type of project(required): 1.M I am a employer with ]S - 4. ❑ I am a general contractor and I employees(full and/orpart-time). have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P ty r 9. ❑Building addition [No workers' comp.insurance comp, insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their ll.❑Plumbing repairs or additions myself. [No worker's' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] 'Any applicant that checks boxA must also fill out the section below showing their workers'comp=sation policy infotmatioa t Homeowners who submitthis affidavit indicating they are doingall work andtwa hire waide contractors mostsubmitancwatidmtindicating sucb. ' tContwetms that check this box most attached=additional sheet showingthe name of the mfi-contractors and state whether ornotthose entities have employees. If the sub-coatcactors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. t� Insurance Company Name: AYIDC ei 1 I / Policy,;;or Seal:itis. Lie.#: ��'CJQ�O'2".]_'=--._ _ _—___Exp;;aticn Dale: I 1 I. Job Site Address:% WQ,V)OL� City/State/Zip. Iry nti�H0- (YO 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- atrlead-to the imposition of criminal penalties of a fare 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 fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage Hcation. I do hereby certify W, the pains a�d penal6 peeerjury that the information provided above �iss ttr+ue and correct Sionature: d X ^ Date- lV 112 Phone t!: �l`-J— E) Oq'- Icb11 , Official use only. Do notwrite in this area,to be completed by city or town official a City or Town: Permit/License4 Issuing Anthoriiy (circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone r: Commonwealth of Massachusells L®� Oivision of Professional Li,ensure Board of Building Regulations and Standards C o n s t ryct�1{/$J p¢ry i s o r J CS-077279 J f3oire5:06/21/2820 � I _ STEVEN A SIO ERMAfJ 268 FOMER ROAD SOUTHAMPTO1fy,A 01013, Sa Commissioner V^^- Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home ImprovementContractor Registration �a==_ Type: Corporation ^'��-� i Registration: 105543 VALLEY HOME IMPROVEMENT INC Eviration: 07/16/2020 P.O.BOX 60627 FLORENCE,MA 01062 ( rS�l r� Update Address and Return Card. SCA 1 0 200�MMOoV$777 ✓@G OL✓/eweve uASQ��C�✓/OP.W6fR[[JP//J Office of Consumer Affairs b Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:�Corporation before the expiration date. If found return to: Realstlraich, Expiration Office of Consumer Affairs and Business Regulation 055.43_--1 07/16/2020 One Ashburton Place-Suite 1301 VALLEY HOME TMPRDVEMEN 1NC Boston.MA 02108 " / Ti STEVEN A.SILVERMAN e. C�Q,r.�.-- ill//i �� NORTHAMPTON, M U NORTHAMPTON,MA 01062 Undersecretary Not valid without signature