31A-125 (5) 10 JEWETT ST BP-2020-0408
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 A- 125 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Bath reno BUILDING PERMIT
Permit# BP-2020-0408
Proiect# JS-2020-000687
Est.Cost: $280.00
Fee: $280.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(_sg.ft.): 6751.80 Owner: KUDLER NEIL R&NANCY A FLAM
Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT. 10 JEWETT ST
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.9/30/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-RENO 2 BATHROOMS
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 9/30/2019 0:00:00 $280.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2020-0408
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 10 JEWETT ST
MAP 31A PARCEL 125 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
.Building Permit Filled out
Fee Paid
Typeof Construction: RENO 2 BATHROOMS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 077279
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
9 30
Si ature of Building Official U V 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.
epartmeitt use ogty
City of Northampt n status a �t s
Building De artm Int SEP C rb CutlD yew Permif ,
212 Main Stre -
jk � r -c Room 100 OFpTOFgUrLD/Nc r Wate/W o Str' ns
ility
Northam tMA NORTHA
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phone 413-587-1240 Fax 413-587-12 .r
Other Speaty >>
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTI6.u:i: SITE INFORMATION
r This section to-'156,completed by office q*;_� �� t
1.1 Property Address: M10 (ve1 , A.
+ iOi'nrif.""fi
��-('1Q.✓YL P � Zone�' J t OverlayDcstrict
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}ESEDisfnct i ;.•_ $: CB D�t1LGf. 2c, im
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SECTION 2-PROPERTI(OWNERSHIP/AUTHORIZED AGENT.
2.1 Owner of Record:
I- CX 10 met u� cCf� �U-' C2�x�o�t-t 17 I CXR
Name(Print) Current Mailing Address:
4 U5- )2D_
Telephone
�tgnature�
2.2 Authorized Agent:
ikit✓r Q_O.C�> x (90(0a1, Rorer-)c-c- MICA- p►(:)GZ
Name(Print) Current Mailing Address:
A0 413-584-7522.
Signature/,,',,,"' Telephone
SECTIO.N`-3=ESTIMATED CONSTRUCTION COSTS.
Item Estimated Cost(Dollars)to be Official Use.Only
completed by permit applicant
1. Building (af Building Permit Fee
37
2. Electrical (b)Estimated Total Cost of
2
WO
Construction from 6 '.
3. PlumbingvUU Building-Permit Fee ,
4. Mechanical(HVAC)
5. Fire Protection :
6. Total=0 +2+3 +4+5) o CDCheck Number
This.Section For'.offictal Use Onl .
Date
Building Permit-N'umber. Issued:ly '
Signature: kv
?A
JV
Building Commissioherlrnspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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Section 4. ZONING AIL Information Must Be Compteted. Permit Can Be Denied Due To Incomptete Informatio
Existing Proposed Required by Zoning
Tb�s column to be filled in y
Building Department
Lot Size
Frontage 1Z
Setbacks Front
Rear
Building Height
Bldg. Square Footage
Open Space Footage %
(Lot area mini, bldg&paved
#of Parking Spaces
(volume&Location)
A. Has aSpecial Permit/Variance/Finding ever bpenissued for/on the site?
�� ��
NO �~��� DON'T KNOW �~� / YES \�/
IF YES, date issued:!
IF YES: Was the permit recorded at theigistry of Deeds?
NO K ) DONT KNOW YES 0
and/or Doc
IF YES: enter Book i 11
B. ,Does the site contain -brook, --
of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or eed to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
— -- _any signs exist _ the
type and location:
'IF Y-_. describe size
D. Are there any propo d changes to or additions of signs intended for the property? YES 0 NO 0
"IF '^^ describe ize, type and location:
E. Will the constructi activity disturb . grading orfilling)over 1acre orisdpart dacommon plan
that will disturb oer1acre? YE3K ) NO K )
`�' `�,
`
IF YES.then a Northampton Storm Water Management Permit from the DPW is required.
|
/
SECTION 5-DESCRIPTION OF.PROPOSED WORK(check all applicable)
New House ❑ Addition ElReplacement Windows Alteration(s) Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [0 Siding [0] Other[CI]
Brief Description of Proposed
Work: E 106ITL 2 bATnIftMs — NO C W6�J 6,u TD JATt121U>2, N CNA tV 6 t 11
No Adding new bedroom Yes No 6r�U CTt,�Qr9 L �N
Alteration of existing bedroom Yes g
Attached Narrative Renovating unfinished basement Yes No
-
Plans Attached Roll heet�
fia. If Newhouse and.or asfdition'to exstrng ho�snlg, complete tFie it i64
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.ApPLIE&FOR BUILDING PERMIT
I t� L1('� -� baa �� as Owner of the subject
property
hereby autri �► e V-M
to act on y ' all matters relative to work authorized by this building permit application.
i nature of O Date
I. l,J C L�XI �1 I�►e.rmQ `f WE E 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 �f
11
Signature of Owner/Agent Date
SECTION 8-CO:NSTRUCTION SERVICES 71
8.1 Licensed Constructions Supervisor: Not Applicable ❑
Name of License Holder: C 3«�l�XZ S 11 {'�rYt�rl 01-7,9--19
License Number
(01,;11
/ao
Address Expiration Date
ZM
Signature Telephone
..g.RR�-teiC21Ra- e-.Fn-p�oreNhfnencdgdlt =ltraco .-.. .__ Not Applicable ❑
16L PAA C.
Company N e Registration Number
P.a . `I I ►-1 12-0
Address Expiration Date
Telephone�113-5g�1-75z
SECTION'10-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....... No...... ❑
i
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City of Northampton
Massachusetts-
DEPARTMENT
assachusettsDEPARTMENT OF BUILDING INSPECTIONS
�*•!� .��._. 'rte; � =4a.
212 Main Street • Municipal Building
Northampton, _MA 01060
AFFIDAVIT-
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR')regulates the registration of contractors and-
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("E110).
M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation,repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building'be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LL C,that entity must be registered
Type of Work Est.Cost:
Address of Work:
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(-):
_Work excluded by law(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
��b�tr�-n�Jb c 1055 13
Date Contract6r Name HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
1
City of Northampton
Massachusetts ''
S 1 DEPARTMENT OF BUILDING INSPECTIONS 7t
\ " 212 Main Street • Municipal Building ZE 4
Northampton, MA 01060 ��3jY
Massachusetts Residential Building Code
Section 110.R5.1.2
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 constructs more than one
home in a two-year period shall not be considered a homeowner.
Section 110.R5.1.3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5,provided that if a homeowner engages a person(s)
for hire to do such work, then such homeowner shall act as supervisor.
Such homeowner shall submit to the Building Official, on a form acceptable to the Building
Official, that he/she shall be responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to
time, during 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 liable for person(s) you hire to perform work for you
under this permit.
City of Northampton
Massachusetts
� 5�4
DEPARTMENT OF BUILDING INSPECTIONS
Y 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:
(Please print house number and street name)
Is to be disposed of at:
�ke \�PW-QAIR��L� n
(Ple ` e print n�fWe and loc.-Won of facility)
Or will be disposed of in a dumpster onsite rented or leased from: \
J
(Company Name and Address) \
Signature o e it Applicant or caner 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.
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Lezibly
14aMe(Business/Organization/Individual): \h ueu , f 1 i0�_�1P(11 Pt"L� t ah C.
Address: p,p.Pax, 1Ocko��
City/State/Zip: F\uenCe, V41 O\bb2 Phone#:
Are you an employer?Check the appropriate box:
Type of project(required):
1.gI am a employer with I B roployees(full and/or part-time).* 7. ❑New construction
2.7 I am a sole proprietor or partnership and have no employees working for me in 8. 2g Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3.❑I am a homeowner doing all work myself[No workers'comp.insurance required_]t
10 E]Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance t
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other _
152,§1(4),and we have no employees.[No workers'comp.insurance required]
IL
*Any applicant that checks box#1 must also fill out the section below showing their woikers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors thatcheck 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 subcontractors have employees,they must provide their workers'comp.policy number.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: 7D1SL)(^CL= 6 V77)t
Policy#or Self-ins.Lic.#: Expiration Date: 07� Iw
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
m
and/or one-year imprisonment,as well as civil penalties in the forof a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
Ido hereby certify under the painsand enalties of erjury that the information provided abbov/e is trMo
e and correct
signafore: Date: ` (
Phone#:
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
f
Commonwealth or Massachusetts
®�
Division of Professional Licensure
Board of Building Regulations and Standards
Constrjictl S�iSpeNisor
if
CS-077279 �� �� E�pires: 06/21/2020
_ j i
STEVEN A SILVERMAN
268 FOMER ROD
SOUITHAM .01073 % >C
Commissioner
JZg
c� mo�� ��
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvementi:Cor�tractor Registration
Type: Corporation
VALLEYHOME IMPROVEMENT INC " u Registration: 105543
( Expiration: 07/16/2020
P.O.BOX 60627
FLORENCE,MA 01062 n y 1
\ ,
Update Address and Return Card.
i 20M-05/(117 r
[�in7mcs2c�w¢�G�c �r7¢ijc�ellt
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration validfor individual use only
TYPE:,orporation before the expiration date. If found return to:
Registration\ E iration Office of Consumer Affairs and Business Regulation
05� 07/16/2020 One Ashburton Place-Suite 1301
EEEN%LLEYHOME(I�MeEIQSamVE EVENIf1
:FC Boston,MA 02108
i
'EVEN A.SI LV
RIVERSIDEDR��.�.
1RTHAMPTON,MA'040s2 Undersecretary Not valid without signature
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