31A-152 (2) 35 MAYNARD RD BP-2019-0148
GIs s: COMMONWEALTH OF MASSACHUSETTS
Map.-Block:31A- 152 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category ROOF BUILDING PERMIT
Permits BP-2019-0148
Proiect4 JS-2019-000248
Est.Cost$4000.00
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sa.ft.): 7971.48 Owner: BRAUSE CARYN
Zoning:URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 35 MAYNARD RD
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:8/7/2078 0:00:00
TO PERFORM THE FOLLOWING WORKSTRIP & SHINGLE ROOF
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 4 Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplare/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.
Cerlificate of Occupancy SLnature:
FeeType: Date Paid: Amount:
Building 8/7/20180:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
x.00 r"
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Diiveway Permit _
212 Main Street sewer/septic Availability
Room 100 WaterNVell Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PloyEite Plans
ther Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAWLY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed byoffice
35 f'1wAno r\a 2oocq Map 3/.4 Lot� nit
Zone Overlay D'esfirict
Elm St District CS District
SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED AGE14T
2.1 Owner o9 Record:
�ra >_)se. ?fi !-Ifi 1 Ac,n n �_, F�ooltm, IL fq- O 16 coo
Na nt) Caa.nt Mallin ddresr
y��-3zo-�zcoi
Telephone
Signat,
2.2 A oris d A en6:
I�V2.r leo g0>G L20(oal �IOIPXY� (`{.A Ol0(g2
Nem.(Pm t) p Current Mailing Address:
qt-6- 88`f-7noa
Signature I ITelephone
SECTION 3-ESTtlRtATEO CONSTRUCT ION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by eit m applicant
1. Buildin /7
g 'l)ew (a)Building Permit Fee
i
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Nacharical(I VVAC)
5.Fire Protend.n
6. Total= (1 +2+3+4+5) .lb(J Check Number
This Section For Offlcfal Use Dolt, j
nate
Building Permit IJur-ber. Issued:
Signa e:
Bondi g Co lonedlnspector of Buildings Date
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This cot,um to be Und in by
Ropbouq Depwessamt
Latsize -
Frontage
Setbacks Front /
Rrar
Badding Height
Bldg.Square Footage %
Open Space Footage
(rot azmiamors bldg@paved _
ak n)
g ofPsrkingSpaces
Fill: . . . _
(volume So rx.tion7 - - - - ---
A. Has a Special Permit/Variance/Finding ever been issued f /on the site?
NO (D DONT KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of D ds?
No FJ DONT"NCtil (�) YES
IF YES: enter Book Page and/or Docunenta`
B. Does the site contain a brook, body of water rwetlands? NO 0 DONT KNOW 0 -YES V
IF YES, has a permit been or nec-0 to h obtained from the Coreelvatton Commission?
(deeds to be obtained O Obtained 0 , Date issued:
C. Do any signs exist on the proper . YES 0 NO 0
IF YES, describe size, type d Iodation:
D. Are there any proposed c noes- to or additions of rens intended for the property? YES NO
IF YES, describe size type and location:
[hat will disturt ua iacre? YES � NO}0
IF YES,than a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5.DESCRIPTION OF PROPOSED WORK(check ail apnlicable)
N-W
House ❑ Addition ❑ Replacement Windows Alteration(.) Roofing
Or Doars D
Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [p Siding[0] Other[0]
Brief Description of Proposed SNSfai� N2LV Lf�A�1 -O 9x(ST•�n�
Work:
Alteration of ousting bedroom_Yes No Adding new bedroom_Yes _�N.
Attached Narrative Renovating unfloared basement _Yes No
Plans Attached Roll -Sheet
so.if Ii house and or addition to existing housing complete the follojyjal
a. Use of building :One Fari Two Faii Other /
b. Number of rooms in each family unit: Numberof Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensio
e. Number of stories?
E Method of heating? Fireplac or Woodstoves-Number of each_
g. Energy Conservation Compliance. sscheck Energy Compliance form attached?
In. 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 door below finished grade
k. Will building conform to the Suilding and Zoning regulators? Yes No .
I. Scpoio Tank_ CiySeeer Frivaie :eil City Water Supply
SECTION 7a-OWNER AUTHCRIZATION•TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ntll�'Q� ,as owner of the subject
property ll IA1'\1� C
hereby authorize V 5'C` `PAIPY"1 HT1 Veyn
to out behalf,' II matters relative to work authorized by this building per t app cation.
��_ � LLF
Slgn.ture o O r Date
C1..�..o,.st��evmnr� V 41�Z a_c✓.radnut;Dorsad
Acant herby declare that the sistemec s and in'om si on the fwsaoma spohc20an zi time and accii .c tha bast of my :nca✓lecke
Signed under the pains and penalties of perjury.
TYl .
Print Name
Signs.of � Oats
SECTIONB-CONSTRUCTDl HSERVICES
"0.9 Licensed Constructionn SSuuervisa': Nat Applicable ❑ —5
Name ofucense Holder: iCl
1�� !_ License Number\ `
a' ( Fri -,''-11 .�L�1 '�( 4�Q CAM-")-") t I2-) ! ZC)
Atldress Expiration Date
Signoldirl Telephone
9. Reaisteretl Horne Improvement Contractor: Not Applicable [3
Company
Name. Registration Number
Y Q 6� &06 .;P -) `P17 L 20
Address �1�(y r EspiaUon Date
Q\ct%'9 Telephon,CD_
SECTION 10-VUORKER5'COMPENSATION INSURANCE AFF90AVIT(NI.G.L,c.952,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavitwill result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... DX No...... ❑
Pl. - Home Owner ExeEMffo'ta
TI_ur_II ee�4. _-rr� v.a.eo r __�dlC inclu�e€x arae-oecunied IIwelE na's orot ilt -eo(2) flics
zd to aIlow such'�umeoyrner io engage zn�dividuzl for lire who does not poesees a(cease,ns'o«cd theE E er awneeecis
assuoervisor.CMR790. Sirth Edition Section168.3.5.1.
Dstirldon of Home epner:Person(s)who awn aparcel of land on which he/she resides or intends to reside,on which but
is,or is intended Io be,a one or two family dweWug,attached or detached structures accessory to such we and/or fano
structures.A person whot is more t!hen one home in a two-wets- nodhpilnot be temei8ered a heiretteracr.
Stich"bomeo.rner'shall submit to the BuIlding CfEcial,on a focu acceptable to the B u 2—OfHciaL that he/she shall bz
resp raphe for 01 such wozk per€armed order rhe Isbr ins tpermit
As acting Cco strserion Supervisor you presence on the job site will be rcqun ed-nom time to time,during and upon
complct rsr of the work for which this pemnit is issued
Also be advised that with reference M Chapter 152(Workers'Coupensatiou) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)ofthe Massachusetts General Laws Annotated,you may be Bahl e for persou(s)
you hire to perform work for you under this permit.
The undersileed"homeowner'certifies and assumes responsibility for ceimphauce with the State Building Cade,City of
Nordsampton Ordinances,State and Local Zoning Lsw's and$tate.of Massachusetts General Laers Annomted
lumeowac-r--&oa^aro
City ofYTorthampton 212 Alain Street, Northampton, M-A 01060
Solid Waste Disposal ASMdavit
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: 3i5 FAa�
The debris will be transported by: �a �o�n bo 1VV1 �YYlQ�I�
The debris will be received by: V QJ 1A 1Q
Building permit number:
Name of Permit Applicant 2.YY1Q�J
Date Signature of Permit Applicant
The Coniorson veac'th ofMassach^oseds
Department ofIndustrial Accidents
offm ofdnv¢siiganwns
a 600 Washington Street
Boston, ALI 02111
- _- evww.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information —('' Please Print Legibly
Name (Business/Organization/Individval): L l SV 'e —1� 'D- UV e -" T`t J.' t
Address:
City/State/Zip: Y \ofeVl.ce � 1 `(1� 'al�h n#: -���j— <)%A—�SZZ
Are you an employer? Check the appropriate box: Type ofproject(required):
1.M I am a employer with 19 - 4. ❑ I am a general contractor and I
employees(full and/or part-time).= have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor m partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have S_ ❑Demolition
working for me in my capacity. employees and have workers'
.insoronce.t 9. E] Building addition
cam
[No workers' comp,insurance P
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. tight of exemption per MGL 12.❑Roof repaus
insurance required.] t c. 152, §I(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
•Any applicant that checks box IIl moat also fill out the sectianbelow showing tlre'n workers'compensation policy information
t Homeowners who subritthis affidavit indicating theyare doing all work andthen hireoutside cmcmrsmustsnbmitanewaffidavitlndirdngsuch. '
;Contactors that check this box must attached an additional sheet ahowing ue name of the sub-connactom and state whether arnot those entities have
employees. If the sub-contractors have mployees,they raastprovide their workers'comp.policy number.
I am an employer that is providing workers'compensation insera ee for my employees. Below is thepolicy and job site
information. !� /�
Insurance Company Name: Avbema, C)X1i7,D 1C& Gf6jp
Policy;: 9es ins. L:c.#: C, ------E.p �iticn Date
Job Site Address: 1-5po \ UlAnC1ALI Cy/State/Zip kt:�.-yy{ 1I
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.i 52-cat load-to the imposition of runinal penalties of a
fore up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the fo=r of a STOP WORK ORDER and a fore
of up to $250.00 a day against the violator. Be advised that a copy ofthis statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage yen cation.
Ido hereby certify t the pains a dpenahi perjury that the information provided above is true and correct
Sigliature: r ,. _-_. ^' Date:
Phone#: L\\"J"SDI-L—I1b
Official use only. Do not write in this area,to be completed by city or town official a
City or Town: Permii/S.icense#
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
i
Commonwealth of Massachuseps
DlVj sion of Pro fess'mma l Lice mme
Board of Building Regulations am,Standards
C o n s t ru cll�r{'I$if p4 ry j s o r
C5077279 % a� I F�Pnos. 06/2V2020
STEVEN A SILVERMAfJ-�
268 FOMER ROAD �t >
SOUTHAMPTON11A 01073/ 10
0I AD N
Commissioner
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement_contractor Registration
Type: corporation
<.. l; L Registration: 105543
VALLEY HOME IMPROVEMENT INCA, Expiration: 07/16/2020
P.O.BOX 60627
FLORENCE,MA 01062 — -i
..,`,,,;.•� =rte
1�c
-� - Update Address and Return Card.
s A 1 0 20MG5117
.awrlP�e&BusaessRegeati
Office of ME IMPROVEMENT
6 easiness Regulation
HOMEIMPROVEMENTCONTRACTOR Registration Validicr individual " only
TVP,E:CvporaExc before the expiration data. a d Business
lo:
9eatstraron� Excitation Off icesh Consumer Affairs and Business flegula0on
05593--- 0]/16/2020 One Ashburton%ace-Suite 1301
s—�=�
VALLEY HOME JI PROVEMENT INC Boston,MA 02108
Ili ////�//
4r > i�����✓I/
3T SILVERMAN
RIVER
340 RNERSIDi
NORTHAMPTON MA 062 Undersecretary Not valid without signature
0