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43-048 (5) 89 AUTUMN DR BP-2020-0210 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:43 -048 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categoa: INSULATION BUILDING PERMIT Permit# BP-2020-0210 Project# JS-2020-000350 Est.Cost: $5410.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sa.ft.): 10280.16 Owner: GALLIVAN EDWARD J zonine: Applicant: VALLEY HOME IMPROVEMENT INC AT. 89 AUTUMN DR Applicant Address: Phone: Insurance: P O BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON.811912019 0:00:00 TO PERFORM THE FOLLOWING WORK.-BASEMENT PERIMETER FOAM BOARD & SILL, CELLULOSE IN ATTIC CHANGE WINDOW GLASS 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: FeeTvpe: Date Paid: Amount: Building 8/19/2019 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner .moo - C C I V L � Dep Ai . City of No am aff Building De art ent 21 Room 00 t AUG 1 9 2019 1 SULA TION Northampton, MA 1060 phone 413-587-1240 axt4*$i5$7j+4MNsPFc IONS ONLY NORTHAMPTON.PAA 010(0 APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 PrODertv Address: This section to be completed by office Map q�3 _ Lot v Unit a I*t kx- ZoneOverlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: E_dwAr3 Iq t U+L)wA.XA- r . Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Aaent: r R'd , Name(Pri Current Mailing Address: 13 54 - Z Signatur lephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) �� 5. Fire Protection 6. Total=0 +2+3+4+5) —T-5,,+-i6 . 33 Check Number This Section For Official Use Only Building Permit Number: DateIssued: Signature: 8_17-209 Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ] Not Applicable ❑ Name of License Holder: cLR A /ePi-A— License Number E 2- 1 Zo Z�o Address Expiration Dat (41s) �O — —+ cS Signat r Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ ke , Io 5 Is/+ 3 Company NArnb IRegistration Number ?>4 LPo P,,.,x - C, r-7-:),) p -:�- I i (,., I z,. Address ,J /� �t Expiration Date t— r�_ I�1 A 0 �ca 2- Telephone � - SECTION 5-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes.......Cie No...... ❑ Brief Description of Proposed Work aaa,dl .� tl CAL L-)� J� I, S'tQAJ eA,.__ ►rt V'QX L.h Q3L as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. i Print Name 1AA /� , (� Signatur of Ow r Ag nt Date I, -E Gl w arct G,4 as Owner of the subject property _ hereby authorize to act on my behalf,in all matters religive to work authorized by this builf Ing permit application. S�2 r✓, a,x1- co�.G� . Signature of Owner Date k SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteratlon(s) Roofing Or Doors 0 _ Accessory Bldg. ❑ Demolitlon ❑ New Signs [[3] Decks 10 Siding[lam] Other[pj Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet da.ifNew house-and or addition to existing housing;complete.the foiiowing: 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 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. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE-COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize to act on my behalf, in all mattersrelative to work authorized by this building permit application. Signat ra.of.Ownoi pate 1 ,as Owner/Authorized Agent hereby declare that the statements and Information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Sfgnature.of Owner/Agent Date `. City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS ' 212 Main Street •Municipal Building ..N \r~ Northampton, MA 01060 Debris 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. The debris from construction work being performed at: (Please print house number and street name) Is to be disposed of at: k'Pj-4A-C (Ple I e print name I location of fa ility) 1 VAA O Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) i G Signature of Permit Applicant or Owner D to If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. Commonnealth of P.-iassachusetts Division of Professional Licensure Board of Building Regulations and Standards COnstr - "S-077279 1p ires: 06/21/2020 STEVEN A SILVERMAN`--� 263 FOMER RQ AD SOUTHAMPTON JwA 0107'3,.' :kC Sq Commissioner CIL W,&G'y W? Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration- Type. Corporation Registration: 105543 VALLEY HOME IMPROVEMENT INC P.O. BOX 60621 7-7- Expiration: 07/1612020 - FLORENCE,MA 01062 Update Address and Return Card. 2C-M-C- Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid forindividualuse only TYPE,Corooration before the expiration date. It found return to' R9q:tA-iPLton Expiration, Office of Consumer Affairs and Business Regulation 07/16/2020 One Ashburton Place-Suits 1301 VALLEY HOME ifilPRO "'M64T INC Boston,MA 02108 S rFVEN A.S1LV-,r-,,.,.4AN 340 RIVERSIDEDII..-. NoR-i-HAMPTON,NIA 01062 Undereeoretary Not vaild without signature ACORD CERTIFICATE-OF LIABILITY INSURANCE DATE(tSC1/00IMy) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO /09/2019 RMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEOA77VELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING WSURER(S),AUTHORIZED N REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: V Sre eettiflcats holder Is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the Polley,certain policies may require an endorsement. A staterFrerrt on this certificate does not confer rights to the certiflcats holder in lieu of such endorsement(s). PRODUCER CONTACTBarbara G NAME: ty nld euvicz Webber&Grinnell PHONE {413)586-0111 � 8 North King Street ADDt c No; (413)586-8481 RESS: bgrynkiewicz®webberandgrinneli.com Northampton INSURERS AFFORMM MA 01060 INSURER A: Arbella Protection INSURED INSURER B i Arbella indemnity Valfey Home Improvement,Inc. IbSURER C: Atte:Steven.S11V@rmaFl L�ISURER D: P 0 Box 60627 NSURER E:Florence MA 01062 INSURER P COVERAGES CERTIFICATE NUMBER: Exp 2/1/20 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE Of INSURANCE POLICY NUMBER A7A",706 AS67/DD LhYdTa u COMMERCIAL GENERAL LIABU.fr1' EACH OCCURRENCE $ 1+000,000 CLAIMS-fvIADE OCCUR PREMISES E $ 100,000 I A MED EXP An one son) $ 5,000 8500063755 02101/2019 02/01/2020 pERSONALBADViNJURY $ 1,000,000 GENLAGGREGATE LkARAPPLIES PER GENERAL AGGREGATE $ 2,00D,OD0 POI-ICY 1'9,� �LOC OTHER; PRODUCTS-COMPIOPAGG $ 2,000,000 AUTOMOBILE LIABArfY $ OM INED NG LtlN ANYAUTO accident, $ 11000,000 OWNED SCHEDULED BODILY INJURY(Per person) $ A .AUTOS ONLY _ AUTOS 1020037691 02/01/2019 02101/2020 8004LY INJURY(Per acddent) S HIRED NON-OWNED AUTOS ONLY AUTOS ONLY ER DAMAGE $ Peracddent Uninsured motorist Bi $ 100,000 UMBRELLA UAB OCCUR A EXCESS 1 E'i CH OCCURRENCE j 5,000,000 CLAIMS-MADE 4600063756 02/0112019 02/01/2020 AGGREGATE $ 5,000.000 DED RETENTIONS 10,000 WORKERS COMPENSATION $ AND EMPLOYERS'LIASILITY Y I it STATUTE E0'R B ANY PROPRIETORIPARTNERIEXECUT(W G OFFICERJMEMBER EXCLUDED? NN NIA 4220051237 02!0112019 02/01/2020 E.L.EACFIgCCOENT $ 1,000,000 (Mandatory in NFO It yes,describe under E.L.DISEASE--EAEMPLOYEE S 1,000,000 DESCRIPTION OF OPERATIONS below 1,000,000 E.L.DISEASE-POLICY LIMR $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schodule,may be attachad If mora apace Is nequUad) CERTIFICATE HOLDER CANCELLATION! SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Greenfield ACCORDANCE WITH THE POLICY PROVISIONS. 14 Court Square AUTHORIZED REPRESENTATIVE Greenfield MA 01301 �O ©1988-2015 ACORD CORPORATION. All rights reserved: ACORD 25(2016/03) The ACORD name and logo are registered rnark5 of ACORD The f om momwealth of?ilassachusetu ct r•-.,.�,..-��;^�£ .Depar•trtrerrt o f btrirastriat A cciclents A .1 Congress Street,Suite IOp ' fit Boston,.AM 02114-241 fvww.ntass.gozfdia Workers' Compensation In"su"rance Affidavit:Builders/CurztractorslElectiicianst#'lurrrbers. TO BE FILED WITH THE PEK'NUTTING AUTHORITY. licant information Please Print Legibly rltltiie (BusinesstOrgatlization.'individual): *11 telt- tSC;tti'1 Ytrti�1-`G 1 'M£r�-i l•nC. .addlt'SS: 5JQ L_ 77 Citi/State/Zip:F lU�52 G 0100'2- Phone �- Are you ars employer?Check the appropriate box: Type of project(required): 1.&as a ertaployer with_ 16 employees(full and:or port-tinte).� 7_ nNem,CUCiSl1'UC11411 2.❑1 ani a sole proprietor or partnership and listre no employees working for tut in 3. Remodeling ary capacity,Rio workers'cutup.insurance required.] 3.p i am n homeowner doing all wort rnysatf.[•tu wurkrra'camp.insurance required.]' 9. ❑Demolition l.QI wilt Ill 0 Building addition],tor a homcat4srcl•sad:.lid lie hiring ctrnlractors to cvaduct all ccr€:nn eny Frcpcir:. ensure that all conudctors cithcr hate•Nvotkcw compensation infur t.rce or arc sole I I T1 Electrical repairs or additions proprietors with nor employees. 12.❑Pltunbidtg repairs or additions 5.Q t am a general eontiacto,•and 1 have hired the sub-contractors listed on the attached sheet. 'lrc,e r„h-cor+traCwl--liave colpin,ecs and ha%e w'otkcen<'c,:mf, ir:cr,rarre+ 13.[]Rooi'repairs i 6.[:]We art a corporation and its officers have exercised their rid-, of exemption pct NIGL c_ 14-[30d]ery_��_�� 151.r 1(4),and we have no c inpIoyees.[No workers'comp.insut auce required.] 'Auy applicant that checks boss t:i must also.till out the section below;hawing their workers'compcitsation policy utfvmuatiun. t Homeommers who Submit this affidavit indicating the r are doing all work and thrid hire outside c ntraetors must submit a new tffiliti\it incheating;loch. #Contractors tout check this box must attached an additional slitet showing the name of the sub-contractors and state wlietbe or not those entities have employee” lrtht suh-contractor;have cmplti,yccs,this mint provide thei, worke.W torr•.pol,'cy number, I ant an employer that is proriding workers'compensation insurance for nrp employees. Rehnv is ific lobe),aFid joie.site its}ornration. Insurance CompanyMaine:. CY �� -Y�S�j�Ce'2CR_ Polido#or Self-urs.Lic. }: )(:)CD C>�� Q)2 \ j Expiratioa Date:_ ;j 1 i C - Job Site Address: City StateZp:_.. _._. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requited under MGL e. 152.. �25A is a criminal violation punishable bye a tine up to S 1,5061.00 atidnr one-Meas iroprisonment,as well as civil penalties in the form of a STOP NVORK ORDER and a fine of tip to 5250.00 a day against the violator.A copy of this statement inay be forwarded to tbr:©slice of Ltivestigations of the DIA for insurance coverage;verification. I do hereby cerdfjr urrr the pairr.s and pe hies f p lir hat the issforrnation provided above is true and correct. Sin atu e: /' rf ;� ,,�, Date: Phoneii LiI CCJ&�`-1ej` Official use only. Do not ierite in this area,to be c:onyrleted by cite or tower official City or Town: Aerrr»til]cense#I imuitng Authority tcirele line): 1.Board of Health 2.Building Department 3.Cityrro °n Cleric 4•Electrical Inspector 5• Plumbing Inspector 6 {lilts?' i Contact Pei-son: ___ _ Phone t: