37-022 (33) 600 FLORENCE RD- 15 MOUNTAIN LAUREL PATH BP-2019-0153
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:37-022 CITY OF NORTHAMPTON
Lot-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: Porch Enclosure BUILDING PERMIT
Permit# BP-2019-0153
Project JS-2019-000262
Est Cost,$20325.00
Fee,$131.95 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License.
Use Groun: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sp ft.): Owner: METZGER AMY
Zonin : Applicant. VALLEY HOME IMPROVEMENT INC
AT. 600 FLORENCE RD - 15 MOUNTAIN LAUREL PATH
AnnlicantAddress: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.811512018 0:00.00
TO PERFORM THE FOLLOWING WORKCONSTRUCTION OF SCREEN PORCH ON
EXISTING DECK WITH NEW FOOTINGS
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 sienature:
FeeTYpe: Date Paid: Amount:
Building 8/15/20180:00:00 $131.95
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File 4 BP-2019-0153
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 600 FLORENCE RD- 15 MOUNTAIN LAUREL PATH
MAP 37 PARCEL 022 000 ZONE
THIS SECTION FOR OFFI LY:
PERMIT APPLICATlerN CHECKLIST
ENCLOSFP4 QUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TypeofConstruction: CONSTRUCTION OF SCREM PO ON EXISTING DECK WITH NEW FOOTINGS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildine Plans Included:
Owner/Statement or License 077279
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INMATION 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 Storm Water Management
molition Delay
lure of ildmg ial D9
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.
I /GTXV- S
Department use only
City of Northampton Stam.of Permit
Building Department curb CutlDriveway 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 PI.VSo.Plans
-
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DiNFELLING
SECTION 1 -SITE INFORMATION &p- / % - /G3
This...fion to be completed by office
1.1 Pnop"`Ad,dress:
Map - Lot O�� Unit
Tone Overlay District
Elm St.Distria CS District
SECTION 2-PROPERTY 0114HERSHIPIAUTHORIZED AGENT
2.1 Owner a5 Record:
tSHctun n,�azl �1uax h1+ro(o�z
Name al
(Priv Cumeni Mailing Address:
Telephone
Signature
2.2 Authorized Aaenk - f
e tiver �� P•o 6ow(ao/oal �(orerYr MR otoC�2 '
Nama(Prot) r A a Cunent Mailing Address:
413- �8�f-75aa
Signature Telephone
SECTION 3-Ealt-.ATEO CONSTRUCTIO63 COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit ap licant
1. Building I O poo (a)Building Permit Fee
2. Electrical 11 0 (b)Estimated Total Cost of
Sas Consmucdon from 6
3. Plumbing Building Permit Fee
4. Mechanical(hVAC)
5.Fire Pmaod.n
S. Total=(1 +2+3+4+ 5) qQ 335 Check Number NJe�
This Sectlan For Offlclal Use Only
Dste
Euildin9 Permit IJumber. Issued:
r
Signam e
Building Com is nedlnspectorof Buildings Date
Section 4. ZONING An Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing - Proposed Requied by Zoning
Itis colamo to be fi➢cd is by
Building DcPzrrLment
Lot Size
Frontage
Setbacks Front
Side L R: L:' R.
Rear
Building Height -
Bldg. Square Footage % -
Open Space Footage %
(Lot azg,ndaa,bldg&paved
ding)
#ofParking aces - -
Fill:
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW 0 YES (D
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT Klduvi v YES
IF YES: enter Book Page and/or Document?i
B. Does the site contain a brook, body of water or wetlands? No 0 DONT KNOW C) YES 0
IF YES, has a permit been or need to be obtained fron the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES 0 IJO V
IF YES, describe size, type and location: -
D. Are there any proposed changes to or addition=_of signs intended for the property? YES a No C)
IF YES, describe size, type and Location:
isqn
thatwnl disturb aver l arra? YES O y NO O
IF YES,then a Northampton Stamm Water Management Permit from the DPW is required.
SECTIOIU 5-DESCRIPTION OF PROPOSED WORK(check all aDaHcablel
New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing
Or Doors ]]
Accessory Bldg. ❑ Demolition ❑ New Signs [o] Docks [q Siding 073] Other[
Brief Description of Proposed 1y p \ y ]� p N9S c 1p�r
Work -OWI CNC'I'0N pt SC�eN PDf CM ONycok'Nf dQc wt Nzv �1
Alteration of existing bedroom Yea_No Adding new bedroom d Yes _,No
Attached Narrative Renovating unfinished basement Yes ?K. No
Plans Attached Roll Sheet
6a.If New house and or addition to existing h0USIng complete the ffonnowang:
a. Use of building :One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. 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 weuands? Yes No. Is construction within 100 yr. floodplain Yes IJo
j. Depth of basement or cellar door below finished grade
R Will building con'arm to the Building and Zoning regulations? Yestro.
! Sepiic Tsnk r Frivz:s nail Cir water 5u
;-,F!serve ! pal,
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, llf TLr-Lir as Owner of the outlast
prop. C
hereby auihoriz. li� � �PA1P�'t A%reVrr`0-Yl
to act on:ng behalf, in all ma relative to work authorized by this building permit application.
Signature 6fOwner Data
r.pv. t��t2.yr>'w'1ykl'Z cwnerAutnor_ad
Agent hacaby daclar that the state eatb ead icform=flan,or the'orsao1no application are true and accurate-to the best of mV I:rcafsdee
Signed under the pains and penalues of perjury.
Print Name
61gna[wam OwnerlAy . Osts
SECTION B-CONSTRUCTON SERVICES
M Licensed Co astcuedon S}}upervisca Not Applicable ❑
Name of License Holdee \c\)7'(1 JI <�s�l'V1CL' f� n10 �—5 I 1
�j \_ License Number
7L f� G-, 20
Addess zz t Eepirauon Date
Slgnatur Tele
9 Repiatered Rome Improvement Contractor: Not Applicable ❑
Comnanv Nam Registration Number
Address Eepiiadon Date
-,dchfPl/7�� �C/l Q�)F:» Telephone
SECTION 90-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affil result
in the denial of the issuance of the building permit-
Signed
ermitSigned Affidavit Attached Yes....... % No._.., El
Roue Owner Excekeaptian
[�xc("')ri^hies
mien allow such homeowner to cogage an individual for hire oho does nor possess snores.,neovided ttaoe toe marc¢_ees
assapendsor.C'MR780 Sirth Edition Secdaa P08.3.5.A.
Deflnitlon of Aameowner:Person(s)who awn aparcel ofland on which he/she resides or intends to reside,on which there
is,oris intended to be,a one or two family dwelling,attached or detached structures accessoryto suchuse and/or farm
stmctures.A person who constonectii more them one ni a two-year palled&bell not he ranrdered a homeowner.
Such"tomeorvaer shall subaalt to die Building Official,on a four acceptable to the bo.l2'ng Official,that he/she sbell bu
respondirle for all such work performed wader(he liad ing[vermin
As acting Congfrverion 6upervisar you'presence on diejob site will be regvred from time to rime,during and upon
completion of the work for which[Itis permit is issued_
Also be advised that with reference to Chapter 152(workers' Compensation) and Chapter L53(Liability of Employers to
Employees for injuries not resulting in Death)ofthe Massachusetts General Laws Annotated,you may be Mable for persorr(s)
you hue to perform work for you coder this permit
The undersigned"homeowner'certifies and assumes responsibility for compliance with the Sate Building Cade,City of
Norrhzmpton Ordinances,Sale and Local Zoning Lvws and State of Massatbusetts General Laws Acetated.
,."mecnner S:fin=:u e
City of Northampton 212 iMaia Street, Northampton, MA 01060
Sohd 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: n yipunk!n Lauzei
The debris will be transported by: �o W2) 44nmf Q
The debris will be received by:
Building permit number: \ p p
Name of Permit Applicant '�y �4D Q T4tn ✓nJeYY1Q. +-
Date Signaiureof Permit Applicant
The Co.ninofawealih ofAlassachnseits
Department ofladastrialAccidents
)' flfftce of Inveszigations _
600 3/'ashingtovStreet
` Boston, MA 02111
"%�`----' tvww.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information 1 Please Print Legibly
Name (Business/Oiganizaticn/individwl): (jt� J� "oO" e }- ASN I
Address: 1j ({ )
City/State/Zip: V �(�1��r1.Cf. \ rte aj°Ph...4:
Are you 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 andlorpart-time).= have hired the sub-contractors 6. E]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 g. Demolition
workingfor me in an capacity. employees and have workers'
- Y P ty t 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 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.[_1 Other
comp.insurance required.]
"Any applicant d,a[checks box#I must also fiIl out the sectionbelow shawiug tLrir workers'compensauonpolicy iuformatioa
t Homeowners wfio submit this affidavitindicating they are doing all work andthen titre outside cona,ctors must submitanew affidavit indicating such. '
tContracmrs that check this box,vuat attached as additional sheet showing the name of the sub-contractors and state whether cruel those enuties have
employees. If the sub-contractors Lave®ployees,thry must provide dterz workers'comp.p.Hey number
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information at
Insurance Company Name: AVIpPMC` tJKleel a(fAJ'1ee GCCXJD
r
Policy;: n:Se..-....,. Lic.,r. C>Q _ r�� _ Z): — -_,,__ ___rxpration Date: a1 , L �9
-Sob Site Address: 1�J !-1 U.hkdlJ'� s'�-r-�t"�1 `0A City/State/Zip: 1062—
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-le-adto the imposition of criminal penalties of a
free 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 may be forwarded to the Office of
Investigations of the DIA for insurance coverage yrification.
Ido hereby certify i rjury that the information provided above is true and correct
1
Sivratme ja _// r/�:^' Date:
Phone#:
Official use only. Do not write in this area, to be completed by city or town official
City or Torn: Permitluceme#
Issuing Authority(circle one):
1.Board of Health 2-Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phoaa#:
i
f Commonwealth of Massachusetts
Division of Proles'mma l Lic e-sure
Board of Building Regulations antl Standards
Con stryctllSEISi3Fgr`�isor
i
CS-077279 > IC��Pires: 0612l/2020
STEVEN A SILVERM'Nti
OA
268 FOMER RD t
SOUTHAMPTOMYA 0107] , 30
tlJlSSijC��
Commissioner
"Tee
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement 6ontractor Registration
Type: Corporation
VAL /1 Registration: 105543
P.O.BO 60627OME IMPROVEMENT INC '�.Ir--o ` Expiration: 07/16/2020
P.O.BOX 60627 I — � )^—= _ P
FLORENCE,MA 01062
X
Update Address and Return Card.
scn t o Im.asnr
Jyl da.. Ja�ll
Mice of consumer Affairs a Business Regulation _
HOME IMPROVEMENT CONTRACTOR Registration solid tar individual use only
TYPE:Ccrocra8on before the expiration date. If found return to:
Reaiste466\ Expiration Office of Consumer Affairs and Business Regulation
105543=, 07/16/2020 One Ashburton Place-Suite 1301
VALLEY HOME IMPROVEMENT NC Boston,MA 02108
STEVEN SILVERMAN - //I/ ,
340 RIVERSIDEOR,;; /74� ?r U Not valid without Sinature
NORTHAMPTON,MA-6i062 Undersecretary 9
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