25-064 (3) 9 CROSS PATH RD BP-2020-0399
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25-064 CITY OF NORTHAMPTON
Lot:=001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2020-0399
Project# JS-2020-000679
Est.Cost: $6381.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sa. ft.): 11194.92 Owner: DECKER EDWARD C& MARY L
Zoning: Applicant: VALLEY HOME IMPROVEMENT INC
AT. 9 CROSS PATH RD
Applicant Address: Phone: Insurance:
P O BOX 60627 (413)584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:9/27/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:ATTIC INSULATION
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:
Rouhh Frame:
Gas: Fire Department Fieeplace/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 9/27/2019 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
61-P,9- ,,IV --�K,
Depjo Of?
.M ter. City of Northampton
, - Building Department
212 Main Street
INSULATIONRoom 100
' Northampton, MA 01060
. , phone 413-587-T240 Fax 413- 7-1 �. ONLY
APPLICATION FOR INSULATION FOR A O ORO F Y D
SECTION 1 -SITE INFORMATION �O RMI T
1.1 Prooertv Address: i��<�,� Thi secti to be completed by office
f, C dp Lot �y / Unit
Zone Overlay District a4
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Name(Priv Current cling, Address:
Telephone
Sig ature
2.2 Authorized Ascent:
Name(Print) Current Mailing Address:
Signature Telephone
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) b4D
5. Fire Protection
6. Total=(1 +2+3+4+5) ?j 8 Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature: 6& I va
VV
Building Commissioner/Inspector of Buildings Date
,CovA
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: i ) 1)P A P uA (7_� - C) 23'
pn License Number
d bS 2 l Z
Addres Expiration bate
/A, C41a) S94 ISZ1-
rTe ephone
9.Registered Home Improvement Contractor: Not Applicable ❑
vQ X43
Company Name 1 c� Registration Number
Address /An —� Expiration [mate
�C�C✓
!C6-fyVkA o i o c,2 Telephone i 3 -
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.......ot No...... ❑
Brief Description of Proposed Work
I, tJl�V' C as Owner/Authorized
Agent hereby declare that the statements and infor@ation on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
r
r ,
Print Name
Signature of Owner/Agent Date
I, as Owner of the subject
Property
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 6-DESCRIPTION OF PROPOSED WORK icheck all aupiicabfe)
New house ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors ED
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Slding[Clj Other[1:3)
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
6a.'if New'.house`and or.addition to?existincl houslng, .complete the followinc:
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
L 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.
1. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-Tfl Br+,;COMPLE?t`EA, WK
OWNERS AGENT-;O C,ONTMOTOR iii►WLIES FO+R BUILDINMP,ERMIT
I, Ll
as Owner of the subject
property
hereby authorize a� -
to act on my behalf,in all matters rela(je to work authorized by this buildin i
permit application.
Signature of-O wl'erq 6-'e, Data —
as Owner/Authorized
Agent hereby declare tate 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.
Plitt Name
Signature of was drat Date
City of Northampton
Massachusetts �� c,Y
DEPARTMENT OF BUILDING INSPECTIONS
ti\* 212 MainStreet
9nM Municipal
Building
MA
MANDATORY FOR `HOUSES BUILT BEFORE 1945
Property Address: 9 e'r-0<-Zg -PCQ -10A
Contractor Lhxj
Name: A
pp �
Address: �Lt�7 �l P X�1 o d 1" uzC l Cb 5 C►�2
City, State: O �0(2 rP� w_ �A A
Phone: (L412� S g�: -4-S 2- -
Property Owner
Name: rVj I
c�
Address:
City, State: ?Q
(; �7kV (contractor) attest and affirm that the building I intend to
insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit.
Contractor si e
s
Date 2-2,
2, 1
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building
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:
Cry \)"i CQ
(Please print house number and street name)
Is to be disposed of at:
�CA�1Rm — � �
(Plea print name an cation oility)
of
Or will be disposed of in a dumpster onsite rented or leased from:
Company Name and Address)
Signature of Per it Applicant or Owner Date
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.
Commonwealth of Massachusetts
Division of Professional licensure
Board Of Building Regulations and 5tandard5
ConstrP. n'`sop rvisor
CS-077279 .• .f
E�ires: 06121/2020
STEVEN A S&ER11flAM-!J j
268 FOMER R4,�1D �
SOUTHAMPTOIV oioir
Coni missioner CL
61,
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration,
Type: Corporation
VALLEY HOME IMPROVEMENT INC -_ _ Registration: 105543
P.O. BOX 60627 -_ _ Expiration: 07/1612020
FLORENCE,MA 01062 -
Update Address and Return Card.
KA 1 O MM,C�17
,Jr,,. f�.;ai r,,ii•'>•iii'�1.Ir�ri•CJ�...tea' ill['/�/.Ifiil
Office of Consumer Affairs&Business Regulation
'HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration data. It found return to:
gsgis anon EAWWAR Office of Consumer Affairs and Susiness Regulation
07ito/2020 One Ashburton Place-Suite 1301
VALLEY HOME!lAk61Vh;SAE4T INC; Boston,MA 02108
•.: :• :�+ 1,i,+
8 f EVEN A.SILVI."PU
340 fl1VERSlDFDW:, '• ��
NORTHAMPTON,MA 01062 Undereeoretary Not valid vAthottt signature
The C'r3ttrtrrtJrm ealtit of-Massachusetts
:fie arttueut o .ftitlu.shialAccide:its
r'. l C'olrgress Street,Suite 1 DQ
14, Rosfmz,..,VA 02114-2 017
r`1"rvta:trtass.�;ov/dia
1yorkers, Compensation Insurance Ai#ltlaeit: Builders/Corttractor•s/Electiicians.rliitlnibers.
TO BE FU,ED NVITH'l'1•iF PERMITTING AUTHORITY'.
A licant Information Please P11nt LeoiblF
�i1717z tBu;iness'Ur�anization�lltdi�•idual t: V(�•�l Z'�� �C:LY1� �t'Y��.�•J P_dY1 tr.'1-! .�,t-t C,••
Address: '-Ib � .t�arZ.—_,�sc 1�- C�caCF 7
Cit`%/State/Zip:T kb!'e c-c � 4! 01 00,'2_ Pflnne g:_4
Are you an employe,'?Check the appropriate boT: _
Type of project(required):
L�I am a employer siert _e vployets(roll and nr part-timet.
7. n i�ieet� constrlretiola
2'[31 ant a scale propri:tor of parm rship;:tld have no emptor ees worlcilig ft,.
rnetitt
over cap ci^. 8. Remodeling
Rio trnrl:ers'comp.insuean, requi:cll.j
3.[31 stn a hemeou'ner fining,alt wotk mvc,1t'.[Nu u-Lmrkers'comp.insutanco.reauircti.]r 9• Demolition
+.Q lm,,a ho'llcL:-mr and wall be ltira,g eont,actocs to conduct all:coil;on my prop,•.;t;. I von I o Q Building addition
erts'tre that all ca-tntractors either have workers,cottrpcoAattan instt tm;e or-oi c sw I I.Q Electrical rcpair s or additions
propricuars with no enlployecs.
1?. P1ultabing repairs or additions
S.Q 1 ant a g�netai cor,ttsctnr and 1 ha, hirci the soh-contract,;r.it,tc,l.v,file atwchai cheer.
Tit .e aih_._mea ttrc h{sti cnit�r :dc;carat ha+',cntkrr:'crntl ..;.a;:rr; 1-'•QRoofrepairs
6.Q'We area co p„ration and its of7ite.ts hate exet_,isnd their right o,''.xemptii,a pcc 1fCi1L c. 1=1.17Other L;2.,41(4)-and w•e have no ctnptoyct:s.pigo workers'con;p.iusuranc re ufrcll,l �- ---_ _
'Alai applic.trt chat c1_i•.F1s boa t;l ntuct also lill out O)c sectian Moly J7IW A img their o:orkcts'compel;saiioo pOUN illtt rmalii�u.
°Homcov.-rets NAto antrltIlt this affida•.it indicating tlt,y=doiIig all a„rt:and thca!lire outsitic coattactors t„ust submit a f,e�v ati d,,.it indreatinw;iaclf.
tC ynvactof.s that clll;cl.thi<bo-c must attached ao additional:;beet sll, iag the name of the sub-coatractors avid state u ticih r or no; r,entitle:;have
ernpin��e_;• If th_41-Cklntrace,r.have em tlovct:c,ihee moa rovids their r,orl. r;`corn nU
l p e i^ p ,y nun;t,»,',
I am an employer that is I+rnridin,,workers,cvirnpen.saiimt insurance for rnr cnrployec:s. .ftelow is the policy and job site
in jortrrutinrr.
InsuranceC.otttltanyNanle: .nS�jr �.�
Policy or Seli-in;. Lie, C�> - O_ E piration Date:_ � I �� 12t�.
Job Site Addr4ss'_��,C`�5����_�,��� t�it}�iStale•Zip:_-� ;hAk
Attach a cola'of ties:wo*-kers" compensation policy declaradmi Papesp
e(showing the policy rumbev tenzj ies on date).
Failure io secure coveragt~as r:sowed wider MGL c. 151 c§25A is a criminal violation punishable by a tuts:up to 51,500.00
and or Olaf-war imprisonment. a; well as civil[,ZI ,1rie5 Irl the form of a STOP 1l ORK ORDER and a fine of uI?to S250.00 a
dad against the violator.A copy of this statement I lav be forwarded to cite Oft-ce ofI.m c;tin lticiils of rite. DIA for insurance
covet-age v;;rificatlon.
I der her•eht•verdfr unrje r•tire Pains and Ire alties f P reel' Itcat the information pro above A triter deed correct.
Date:
Phony : �� '�4-�1 cJ
Uf ectal ere u"k- Da riot Write ill this at-elf,to be completed bj•cit?.or town
City or Town: Permit.'Heensc#
Issiti7lt„Aeltlaot•ity tcirr.lt otec):
1.Board of Health ?,Building Department 3.Citc!Towtt C'lerh 4. FlectAcal Inspector 5. Plumbing Inspector
Contact I'vi-son: Phone
AC D CERTIFICATE OF LIABILITY INSURANCE DATE-JMMMomYri
0410912019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THlB
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY 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
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the polfcy(les)must have ADDITIONAL INSURED provisions c►be endorsed,
ff SUBROGATION 18 WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement: A statement on
this certlffcate does not confer rights to the Certificate holder in lieu of such endorsement(s).
PRQOUCER NAME: Barbara Grynldewicz
Webber 8 Grinnell PHONE
8 North King Street N (413)58"111 pa (413)586-8481
ADDRESS: bg"iewicz@webberandgrinnell.com
Northampton INSURER AFMcM""
W9U�O
MA 01080 NSURER A: Arbella Protection
NGURER g: Arbe9a Indemnity
Valley Home Improvement,Inc.
E
Attn:Steven Silverman [N8URI C:
P 0 Box 60627 INSURER o
Florence INSURER E'
MA 01062 INSURER P:
COVERAGES Florence
NUMBER: Exp 2/1/20
REVISION NUMBER:
THIS IS TO CERTIFY THATTHE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY 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.
ww LTR TYPE of INSURANCEMALAM POLICYNUMBERPOU
COMMERCIAL GENERAL LIABILrrI LIMITS
EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE _ OCCUR
PRM Ea occurrence) 100,000
A MED EXP(Any oneperson) $ 5,000
'L AGGREGATE LIMIT APPLIES PER:
8500063755 02/01/2019 02/01/2020 1 000 000 p
PERSONAL 8 ADV INJURY S N
CiEN2,000.000
POLICY ®JERC ED LOC GENERALAOGREOATE
OTHER:
PRODUCTS-COMPIOPAGO S 2,000,000
j;
AUTOMOBILE LIABILITY $
ANY AUTO COMBINED TNG $ 1,000,000
cc en
A, OWNED SCHEDULED BODILY INJURY(Par person) $
aLrms ONLY AUTOS 1020037691 02/01/2019 02101/2020 BOnILY INJURY(Paras dent) $ �H
HIRED NON-OWNED
AUTOS ONLY AUTOS ONLY 0
Per accident $
Uninsured motorist at S 100,000
UMBaELLA LIAR OCCUR ,........
A EXCEBa LJAB EACH OCCURRENCE j 5,000,000
CLAIMS-MADE 4600068756 02/0112019 02/01/2020 AGGREGATE $ 510001000
DED RETENTION S 10,000
WORKERS COMPENU ION $
AND 6MPLOYERS'LIABILITY YIN STATUTE ER
B ANY PROPRIEfORIPARTNERIFXECUTIVE
OFFICERIMEMeEREXCLUDED? FN7 NIA 4220051237 02/01/2019 OTl01/Z020 E.L.EACH ACCIDENT $ 1,000,000
(MandatoryinNH) 1,000,000
K yes,desmba under E.L.DISEASE-EA EMPLOYEE
DESCRIPTION OF OPERATIONS below
E.L.DISEASE-POLICY LIMIT S 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached Mmore a"ca Is required)
CERTIFICATE HOLDER-- CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Town of GreeMield ACCORDANCE WITH THE POLICY PROVISIONS.
14 Court Square
AUTHORIZED REPRESENTATIVE
Greenfield MA 01301 I ,
ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and 1090 are registered marks of ACORD