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24C-157 (4) 36 ARLINGTON ST BP-2019-0443 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24C- 157 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Skylight BUILDING PERMIT Permit# BP-2019-0443 Project# JS-2019-000718 Est.Cost: $4100.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group; STEVEN SILVERMAN 77279 Lot Size(sa. ft.): 11804.76 Owner. &PHIPPEN Znd(� Zoning:URB(100) Applicant: STEVEN SILVERMAN AT. 36 ARLINGTON ST Applicant Address: Phone: Insurance: PO BOX 60627 (413) 584-7522 () WC FLORENCE ,MA01062 ISSUED O.N.•10/12/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACEMENT OF 2 SYLIGHTS 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 Signature: FeeType: Date Paid: Amount: Building 10/12/2018 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only RE *� ton Status of Permit. 11g epatfi ent Curb Cut/Driveway Permit 212 Maii tre t Sewer/Septic Availability OCT I kczQl%O Water/Well Availability Northampton, MA 060 Two Sets of Structural Plans pho P $3-5 7-1272 Plot/Site Plans DEPT.OF B NORTHAMPTON.MA 01060 ther Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OF DEMOLISH A ONE OR bV40 FAMELLY DVWELLWG iECTION 1 -SITE INFORMATION 1.1 ProaErt�rA«idress: This section to be completed by office � �( J� sk-y- e_ ' Map vt /,f Lot Unit Zone Overlay District Elm St.District CB District iECTION 2-PR OWNERSHIP/AUTHORIZED AGENT !A Owner of Record: Rov-fA4 Ph cryylo R rltt l��d �� r-+� M o�c�o v dame(Print t- Current Mailing Address: Telephone 'ignature !;2 Authorized Agent: St 1 e,o•6oK(Qo&,3:) F(uerycc �4 R ©1 o0 2 Jame(Print) t Current Mailing Address:Lf signature Telephone ;ECTION a=F_1SToiw ATED CONSTRUCTION' OUSTS l `em IEstimated Cost(Dollars)to be I Official Use Only completed by permit applicant Building j�v (a) Building Permit Fee Electrical �.! (b)Estimated Total Cost of Construction from (6 Plumbing Building Permit Fee A--n Mechanical(HI V AC) Fire Protection Total=(1 +2+3+4+5) f J J 00 Check-Number (113 j This Section For Official Use Only Date uilding Permit Number: I Issued: ignature: l oll zf o Building Commissioner/inspector of Bulldings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R. Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever be n issued fOr/ort the site? NO O DONT KNOW © YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Re stry of Deeds? NO Q DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body f water or wetlands? NO 0 DONT KNOW O YES IF YES, has a permit been or ne d to be obtained from the Conservation Commission? Needs to be obtained Obtained © , Date Issued: C. Do any signs exist on the pr petty? YES ® NO IF YES, describe size, t e and location: D. Are there any propose changes to or additions of signs intended for the property? YES ® NO O IF YES, describe si e, type and location: E. Will the constructio activity disturb(clearing,grading, excavation,or filling)over 1 acre or is it part of a common plan that will disturb ov r 1 acre? YES ® NO IF YES,then a orthampton Storm Water Management Permit from the DPW is required. 3EC T ION 5-DESCRIPTION OF PROPOSED lfrORK(check-aH applicable} Mew House ❑ Addition ❑ Replacemen inflows Alteration(s) Roofing E Or Doors �} "LEcessory Bldg. ❑ Demolition ❑ New Signs [Il] Decks [® Siding[Ilj Other[El 3nef Descriptic f Proposed Mork © ��o L5 1.� _� np T U kiteration of existing bedroom Yes No Adding new bedroom 0 Yes No 4ttached Narrative Renovating unfinished basement Yes No ?tans Attached Rall -Sheet 3a. Bf NeVJ house and or addition to existing housfincl, comj.20ete the follo sina:. a. Use of building :One Family Two Family Other b. Number of rooms in each family unit: Number of P�2throoms c. Is there a garage attached? / , . . i 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 Is construction within 100 it.o/er Yes No. Is construction within 100 yr. floodplain Yes No Depth of basement or cellar flshed grade :. Will building conform to the Boning regulations? Yes No. Ze-tiC i ark City SE3e, �'nVutc vm;i ciiy w rater Suppry { SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN :)VV 4ERS AGENT OR CONTRACTOR APPLIES FOR.BUILDING PERMIT i( is Ph as Owner of the subject )roperty \'\,' iereby authorize V T��L �l Py o acton rriyalf, i all ers relative to work authorized by this building permit a licati . 3Ignature of Owner Date ,as; iVdl lC I Ir KL!LI IU(ILC<� ,aarit haraby decl2rs that the st2tementS and infoi titian or the forcGulnG&131ACed3f-I 21c L`U 2nd accurate,to the bast of my knGiJicduc Signed under the pains and penalties of perjury. I 'rint Name Id 1 �� ignami-e of ovne-riAgAt rC��te pECTM S-COHSTRUCTION CERVICES 1.1 (Licensed Cornstvuction Supervisor: Not Applicable ❑ dame of License Holder: � License Number (o 1 t -2,C) address Expiration Date aa3ignafdel Telephone D. Registered Home Improvernent Contractor: Not Applicable ❑ :otaeb�aray N/fa��me Registration Number Sddress Expiration Date "f1 b\�� Telephone°�)Q�� 5 SECTION 10-WOM6 ,.EkS' CC)MPEfr1SATlf564114S RANCE AFEIDAN.e13'(M.G.I_.e.152,§25C(6)) Norkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavits ill result h the denial of the issuance of the building permit. - 5igned Affidavit Attached Yes....... [ : No...... ❑ I1. e Home Owner +xe����ffi r r i r'r-'`R_, rte"—r 4 — -r; !I '1 'i r p. i fnz c t' 11 ice. 2) r T lie CU telt ctcriir'Ho _ i .rJI cu-i'sc_ -as F_tceLel t_aaclude G&c CeeE'-PCCLi EtEf IIF Ell[ __ C le( �1' i.^. (��, t _it�S and to mow such homeowner to engage as individual for hire vjho does aot possess a license, i,n gjj Jed(hunt€he ownev acts as sumervisor.CIS 780, Sim Mition SeCLi®n 109.3.5.1. Definition of Homeowner: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 be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who eonnstmcts more than one home in a teen-Fear meriod shall not be co nsMered a liomeocw ner_ S ch"hon,eowinar"shall submit to the B-aJding C tial, on a form acceptable to the baildir,-,Off iciA a.at he/she sh 01 bxe reSDOUslble fOr all sUch fark PCLfe'ii'ined tMdei'the bn ldia6 tnel nnit As acting Constxuctior Superviscr'yow-presence on the job site will be required fi-om time to tirne,d-u-ing and upon completion of the work for which this ptimit is issued. Also be advised that with reference 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 may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated 1Ct1 LkFell F�LL(�t �:LgI1C.i.r"-tl.'. City of Northampton 212 Main Street, Northampton, M-A 01060 Solid Waste,Disposal Mfidmvit 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: avl i.?m ki--,&L Th.e debris will be transported by: (� 0 P.�U►�Y��1�C��1 " The debris will be received by: V Building permit pumber: Name.of Permii Applicant 001A . 1611 Date Signature of Permit Applicant :rte. The Coinikeomweat'di: of 1iV�t?�sttc�t"Jse�s Devayrtmento'Ind-as►rialllccidents F 600 Washington Sheet " Boston, MA 02111 f- mow.mass.gov/dia Workers'.Compensation Insurance Affidavit: Builders/Contractors/1Jlectricians/Plumbers Applicant Information Please Print Le .idly Name (Business/Organization/Iudividual): _]. O UV e 4— 1 n ,- Address: �aa City/State/Zip: 101f_;( ce, Yhoo'—'ne#: Are you an employer? Check the appropriate bog: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. F1 New construction employees (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 8. ❑Demolition working for me in.any capacity. employees and have workers' t 9. ❑ 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 1 1.F1 Plumbing repairs or additions myself. [No workers' 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 box#1 must also fin out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have mployees. If the sub-contractors have employees,they must provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site ,zformation. asurance Company Name: 'Nobe G` cy 1-1c. . �-t ---terpiaiGl Daii: , 19 Db Site Address: Ap fi- /I e Q Fo-7 City/State/Zip: attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 'ailure to secure coverage as required under Section 25A of MGL c:152 cari read to the imposition of ci'iirinal peraalti es of a he 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 f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigations of the DIA for insurance coverage erification. do hereby certify .i the paras d�!d penald perjury that the information provided above is true and correct i afore: �! •• .�'' •i^' Date: hone#: , ��--�� '-�c1b Official use only. Do not write in this area,.to be completed by city or town Qf lcia City or Town: PermitUcense 4 Issu ng A_utho city(circle one): 1.Board of Health 2.]Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Phimbing Inspector 6.Other Contact Person: Pha-iIe#: Commonwealth of Massachusetts ®� Division of Professional Licensure Board of Building Regulations and Standards Const q4c@t)&�V§0pervisor II CS-077279 �� I E�Pires: 06/21/2020 STEVEN A SIL-VERMAIUI 268 FOMER ROAD i SOUTHAMPTWA-.61073 �Q y, Commissioner Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 a Home Improvemen".xt;�Contractor Registration Type: Corporation Registration: 105543 VALLEY HOME IMPROVEMENT INC i P.O.BOX 60627 Expiration: 07/16/2020 fes,�y.; __ FLORENCE,MA 01062 ,` OF �~ U date Address and Return Card. CA 1 20M-05/17 ✓� �srrtnacierae¢�l�c�,��a��ac�cdell� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE,Comoration before the expiration date. If found return to: Reaistration\ Expiration Office of Consumer Affairs and Business Regulation 05543— 07/16/2020 One Ashburton Place-Suite 1301 VALLEY HOME()MCROVMEN >:INC Boston,MA 02108 9 STEVEN A.SILVERMAN'�—;:�� �.Q CLQ -- / , �/ - s 340 RIVERS IDEDR�`,—��;i;� NORTHAMPTON,MA'01062 Undersecretary Not valid without signature