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30C-066 72 CLEMENT ST BP-2019-0524 GIs#: COMMONWEALTH OF MASSACHUSETTS MV:Block:30C-066 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:BASEMENT RENOVATION BUILDING PERMIT Permit# BP-2019-0524 Proiect# JS-2019-000849 Est.Cost: $15000.00 Fee: $97.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: STEVEN SILVERMAN 77279 Lot Size(sq.ft.): 46609.20 Owner: BARNETT ROGER A&SUSAN CURRY BARNETT Zoning: SR(100)/WP(0)/ Applicant. STEVEN SILVERMAN AT. 72 CLEMENT ST Applicant Address: Phone: Insurance: PO BOX 60627 (413) 584-7522 0 WC FLORENCE ,MA01062 ISSUED ON.1013112018 0:00:00 TO PERFORM THE FOLLOWING WORK.-partial basement remodel - no structural changes 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: FeeTyne: Date Paid: Amount: Building 10/31/2018 0:00:00 $97.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0524 APPLICANT/CONTACT PERSON STEVEN SILVERMAN ADDRESS/PHONE PO BOX 60627 FLORENCE , (413)584-7522 Q PROPERTY LOCATION 72 CLEMENT ST MAP 30C PARCEL 066 001 ZONE SR(100)/WP(0)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILE OUT Fee Paid Building Permit Filled out Fee Paid T eof Construction: partial bas ent odel-no structural changes New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 77279 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9AMATION 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 Demolition Delay (2� ` L1� )v 3o 1 Signature of Building Official Date 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. Department use only City of Northampton Status of Permit- Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 WatedWell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413=587-1240 Fax 413-587-1272 Plot/Site Plans ther S ecify APIPLICATION T O CONSTRUCT,ALTE E, R �Y�WLISIAONE OR TV40 FArk6t=Y DIN(ELLK--4 SECTION 1 -SITE INFORMATION OCT 2 9 2018 This ection to be completed by office 1,1 Property Address: }. DEPT.OFBUILDIN(j�ll� PECTIONS E_ot � Unit`ID 0-cmCnA-S NORTHAMPTON,MA 'Ao('e-n :C, Zone Overlay District E6m St.District CS District SECTION 2-PROPERTY O`t, NERS€IPIAUTHORIZED AGENT 2.1 Owner oo Record: Sue- 1 arae� la C;t mend—fta-�P-nc-e I4e C,162 Name(Print) Current Mailing Address: " (��y • &,AY Telephone Signature 2.2 Authorized Agent: c e'o•60,'tao(o � FLC)( M,A- 0100 2 ,JI \Jame(Print) Current Mailing Address: Signature Telephone �ECTIOr4 3-EST.u"AX ED CCN! -,R-U Cu lON CGSTS Item I Estimated Cost(Dollars)to beI Official Use Only completed by permit applicant 1. Building 131000 (a) Building Permit Fee 7. Electric-A o(20 (b)Estimated Total Cost of Construction from (6 i. Plumbing Building Pei mit Fee 9� �o rVechanical(HVAC) i.Fire Protection LL C, Total=(1 +2+3+4+5) , L)0 Check Number 87 TfhEs Section For Official Use Only Date uilding Penn it Number: I Issued: >ignature: I Building Commissioner/Inspector of Bulidings 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 Buil ng 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 er been issued for/on the site? NO © DONT KNOW O YES IF YES, date issued IF YES: Was the permit recorded at a Registry of Deeds? NO () DONT KN ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, ody of water or wetlands? NO © DONT KNOW © YES 0 IF YES, has a permit bee or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained © , Date Issued: C. Do any signs exist on a property? YES 0 NO IF YES, describe si e, type and location: D. Are there any pro osed changes to or additions of signs intended for the property? YES ® NO IF YES, descri a size, type and location: E. Will the constr tion activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will distu over 1 acre? YES ® NO o IF YES,th a Northampton Storm Water Management Permit from the DPW is required. SECT 10€q 5=DESCRIPTIO' OF PROPOSED tff'ORK(check all apgftable) New House" ❑ Addition ❑ Replacement Windows Alteration(s) � Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ Flew Signs [0] Decks [® Siding[0) Other[EJ Brief Description of Proposed Work: NA!d► PUT)�i L, 6,5r-01 w—1 NL �i���c.,l u��r✓ G N���>Es L G���S Alteration of existing bedroom Yes yC No Adding new bedroom Yes No M ears Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll L__ et TT Fra. @f New house and or ae dobe 4o eristing housinc5, coca: Sete the fo9Bowt a:. a. Use of building :One Family Two Family Other-------,/ i b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. i 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 j i. Is construction within 100 ft.of wetlands Yes 1\10. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor b fbw nn!shed grade k. Will building conform to thetiding and Zoning regulations? Yes No. I E M /twe — v t r c Supply . ccpiic .� iity Se�: r "ri rife v:a.i C;t�, v��t r SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR.13I.1ILDING PERMIT 1, }P x(').P.�'} ass Owner of the subject property hereby authorize to act on my behalf, in all mattes relative to work authorized by this building permit application. d /l 8 Signature of Owner Date la����u�\���� V�� ,C�Li Viallol/ltl1 LIIUIILCd A it harebv declare thatthe stmtem6ntS and imorr ii tion or the forecoln7&Gplic2Ltin are truE and accurate.to the bast of mil Imo fl�doe Signed under the pains and penalties of perjury. Prnt NameJ-- c I iynstwc of OinmerlA'e._ L-)ata 3ECTION S-CONSTRUCTION SER.ViCES :3.1 (Licensed Construction Supervisor: \ Not Applicable ❑ Mame ofLicense Holder: `}����(� �ll����UV1�S In (��� License Number a 'la- c )?-D 6 2-k -1 Address Expiration Date AS A 4'A Signa r e p ne 9. Registered Horne Improyerrent Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Data ()AMZ Telephone ������ � SECTOON 10-V ORKER'S' COMPENSAT11014 9NSURMCEAFF11DA e9T(M.G.L.c. 152, 25C(G)) Workers Compensation Insurance affidavit must be completed and submitted vvith this application. Failure to provide this affidavitwill result in the denial of the issuance of the building permit. - Signed Affidavit Attached Yes....... [ : No...... ❑ 11. v Home Owner +xeMd6ffi t ll Cu[rent CKenIr'G_t�'Jt'�'iJ_-1GU+'(;cr"-.ra4 8-cildc'.+'to i-nclude G6i'CEeE'-TCCLT BEd II��c`EL�[gh�c of one;(I �-r Mi-o(D f:-l�_lits and to allow such homeowner to engage aa individual for mire v7ho does not possess a license,�iE`�eW rTC4 that€ie owner ner acts as supervisor.CUM 780, Sixth. Mition SecCE®e 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 stevctures.A persoy who constructs mare titan one bome in a tram-yemr meriod shall]not he congMered a homeowner. such"hoifO�;vnui"shall submit to the B-adding O lclat,on a fbim acceptable t0 the Building Official,L.at 1e/she sh®r]be resDansehle fcnr ZU sueh mark P-erfGFMCduscdel-Lei e htIMMg pte_rmlt. As acting Con Axaction Superviscr*yow-presence on the job site ArM be required from time to time,d-u-ing 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 153 (Liability of Employers to Employees for injuries not resuLting in Death)of the Massachusetts General Laws Annotated,you may be liiable for person(s) you bile to perform work for you under this peivnit. The undersigaed"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and St--t.of Massachusetts General Laws Annotated ISULltGU TY L1Ci�LLLciCJ.i;. - City o' ortha.mpton 2"12 Main Street, Northampton, MA 01060 Solid Waste Disposal A-ffidadt 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: —12 e-n,4S54- Th.e debris will be transported by: ajifflpyonn - The debris will be received by: V Building permit number: Name.of Permit Applicant /o Date Signature of Permit Applicant The e coinino -psalm? of-Massachuseds is 600 Washington Street Boston, MSA 02111 =f www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plwnbers Applicant Information Please Print Legibly Name (Business/Organizationdndividual): � t? Address: j`-�b City/State/Zip: '�A0ff_PCY« 4h e#: — )%LA—_ X22- Are you an employer? Check the appropriate bog: Type of project(required): 1.[ I am a employer with- I i2� 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 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' 9. F1 Building addition [No workers' comp.insurance comp.insurance.t required.] S. ❑ We are a corporation and its 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.E]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.FI Other comp.insurance required.] 'Any applicant that checks box#1 must also fin out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new 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 employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. C am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site kformation. m.surance Company Name: &beko, G C�fl Lf1'7 l aw. 19 auCr fr Vl V V1f-1LlJ.L11•..7T. v�V_.•�`�S�z..L�e_2.��.__ ______-__L1•p1LLL1Cl--r�� I '. fob Site Address: Cly �� l�\ City/State/Zip: Du(enCG D, I ` o O)C)&2 kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ail-are to secure coverage as required-under Section 25A of MGL-c:4-52 cari lead-t6 tlie'imposition of ci:hninal penalties of a ine 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 nvestigations of the DIA for insurance coverage verification. do hereby certify .r the paiyts a'd penalti perjury that the information provided above is true and correct ;i ature: ' r't :�'' ^' Date: 'hone li Official use only. Do not write in this area,to be completed by city or town 6fj;cia—L r: City or Iowa; ' PernritjUcense 4 Issuing Authority (circle one): 1.Board of Health 2.building IDepartment 3. City/To-on Clerk 4.Electrical Inspector 5.Plumblug Inspector -.6. Other ��ae - tr P� tr Contact Person.ersrnn: . � ®L Commonwealth of Massachusetts � Division of Professional Licensure Board of Building Regulations and Standards Con st\jjctV§6pe,rvisor �I CS-077279 Wires: 06/21/2020 1,9 STEVEN A SIEVERMAN 268 FOMER ROD SOUTHAMPT0M,y.A 01073 i' �C /Gbjss Commissioner C/`"" Alec Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improveme tContractor Registration Type: Corporation ,i �1 Registration: 105543 VALLEY HOME IMPROVEMENT INC fes' -- Iiu Expiration: 07/16/2020 P.O.BOX 60627 ( ; FLORENCE,MA 01062 Update Address and Return Card. 'CA 1 C 20M-05/17 ✓� �irr�naait�ae¢�l�t���a��ccc��lell� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registr`ation� Expiration Office of Consumer Affairs and Business Regulation 105543 07/16/2020 One Ashburton Place-Suite 1301 ^ Boston,MA 02108 VALLEY HOME(IMj--,.ir== z.I. 1 saw J�� STEVEN A.SILVERMAN 340 RIVERSIDEDR � � Not valid without signature NORTHAMPTON,M '- -1:62 Undersecretary g