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38B-228 (6) 61 FAIRVIEW AVE BP-2020-0852 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B-228 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Siding BUILDING PERMIT Permit# BP-2020-0852 Project# JS-2020-001461 Est.Cost: $55000.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO.- Const. O:Const.Class: Contractor: License: Use Group: STEVEN SILVERMAN 77279 Lot Size(sg. ft.): 5532.12 Owner: MARTINE GANTREL-FORD Zoning: URB(100)/ Applicant. STEVEN SILVERMAN AT: 61 FAIRVIEW AVE Applicant Address: Phone: Insurance: PO BOX 60627 (413) 584-7522 () WC FLORENCE ,MA01062 ISSUED ON.112712020 0:00:00 TO PERFORM THE FOLLOWING WORK.-RE-SIDE AND TRIM HOUSE 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 1/27/2020 0:00:00 $60.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner s"`� } �v Department use oply , � 1.+ City of Northto Building Department eay Permit urrf` � � ,�.� 212 Main,Stre ,,1Q/V Se /Sep A allabillt �t 1,- � •. - J r y�,.,w _ '�� .•� a• r}t e�.,� L -s�.4� ze>,,.-ate. ,paµ - r Room 109� C �Q�� Wa i/WeAva�lal)IrCty Fa� �' _�s°'k'� Y skri �A+` ' A �.s ��+:' 3W�i�sa�c, su'.#a r�z., r'�"z`�. -+.r�i'`C. J ' Northampton,'MA Nrp T set o Strvctucal Pians 3 erxas *'r s phone 413-587-1240 Fax 4 �A ,. ..yau �v # �,, r•g, iMXZ 1q f N 41,1 ro ther_' ped T` APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE 0 LISH A ONE OR TWO FAMILY DWELLING •SECTION I.-SITE INFORMATION • secllon to.be compE-ted byofFice,� 5 1.1 Property Address: � � { � gar¢ x )� c �� `- oti � w� fJr)itr r �r� 4-5�t y. '_�� 9iZ'one r a Overla�>D�striet � 3TA4 'a i I-'i• ,ak i f 4'' u� ^B -ZA w Ti 3 1� w 4 yi4 EEm j SECTION.2---PROPERTY OWNERSHIP/AUTHORIZED AGENT:..• 2.1 Owner of Record: (ot TGAYyfew 61c Oo,_c>10(00 Name(Print) Current Mailing Address: pp —� LA/ Telephone 2.2 Authorized Agent: I der P �•(�ax t�oc�a1 Blore,-)cx_ MR- Otc)G2_ Name(Print) Current Mailing Address: _.,A#& 413-,59q--1522 Signature Telephone SECTION-4.;ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 0 0 ; (a)Building Permit Fee 2. Electrical _ — (b)Estimated Total Cost of Gonstruction from 6 '. 3. Plumbing Buiiding-Permit Fee . '. 00 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) S$, UUO Check Number coon:Foy-Off] Only Use . T his.Se Permit-Number: Date Buildin ' 9. lssued: A. Signature: Building Commissioner/lnspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) I ' J SECTION 5-DESCRIPTION OF.PROPOSED WORK(check'all.applicable) New House F—] Addition Replacement Windows Alteration(s) Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [[] Siding N4 Other[Eq Brief Description of P posed Work: R�=t i©E LI01 PAF HOUSE ; >-W CON clitT'F wylLkAM11/ Alteration of existing bedroom Yes No Adding new bedroom Yes N Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Newhauseiand.or addition to ex[sttrq hodsncrcomplete the'folfoavinq: 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 COMPETED_WHEN OWNERS:AGENT OR:CONTRACTOR.APPLIES:FOR.BUILDING PERMIT as Owner of the subject property hereby authorize d t r ��n �!/VCrrrcuo to act on my behalf, in all matters relative to work authorized by this building permit application. Sig . Date I. 31 eA_)-c►'1 V RT 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. e�e r1 (�) I v-er Print Name ` Signature of Owner/ gent Date SECTION 8-CONSTRUCTION SERVICES 8,1 Licensed Construction Supervisor: ; Not Applicable ❑ Name of License Holder: Steven Silverman s License Number P.0 Ftnx 51157 077179 Address Expiration Date Florence, MA 01062 06/21/2020 signatureJ, A ;'413-584-71M '7 , 9.Re istered Home Improvement Contractor: Not Applicable EJ t 1 ,i Com2anXNam eRegistration Number C) . 105 543 AddrAs Expiration Jato Telephone l ti 07/16/2020 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....... E No...... �h�. J j � - City of Northampton r Massachusetts - DEPARTMENT assachusetts DEPARTMENT OF BUILDING INSPECTIONS 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("HIC"). 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 LLC, that entity must he registered Type of Work: C A� Est. Cost: Address of Work: (U Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _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: C 0 5b y 3 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 roperty:Date Owner Name and Signature City of Northampton �' Massachusetts � ` F, G �1( e DEPARTMENT OF BUILDING INSPECTIONS ~ Y 212 Main Street •Municipal Building �yiy a NQIN' 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: (4c \C) �Daaa"& n (Ple ` e print n� e and locaeon of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) A,, Signature of Permit A p icant or Owe ate 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. V l 1 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Const\ ct1 Sib-pervisor IJ CS-077279 �� E ires: 06/21/2020 STEVEN A SILVERMAN-..i�::"% ^ 268FOMERR6 D ' '`-`J=��= y SOUTHAMPTO U,� Cj1,SS3� P Commissioner Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improve-menti-Contractor (; Registration Type: Corporation VALLEY HOME IMPROVEMENT INC ' �`�` Registration: 105543 F P.O.BOX 60627 E �� ,i� f Expiration: 07/16/2020 FLORENCE,MA 01062 Jr 4.y a Update Address and Return Card. 2OM-05/17 ,5ye �in�maiccc�¢Cl�c c ��¢�1¢r clell� 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: Registration Expiration Office of Consumer Affairs and Business Regulation 05543 07/16/2020 One Ashburton Place-Suite 1301 ALLEY HOME(IM2ROVEMENS INC Boston,MA 02108 EVEN A.SILVE RMP,TIq 3 10 RIVERSIDEDR' � , N RTHAMPTON,MA 01062 Undersecretary Not valid without signature y The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia \i'orkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant information Please Print Legibly Name (Business/Organization/ladividual): Address: _1$A0 ��yC�rro�d �rt�rc 1� O• (c0(o21 City/State/Zip: 1"I of-encc, WPfl Z>l o o2 Phone#: y Are you an employer?Check the appropriate bog: Type of project(required): 1.2)I am a employer with 1 E3 mployees(full and/or part-time).* 7. []New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.1No workers'comp.insurance required.) 3.F1 i am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4.❑I am a homcowncr and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I L Q Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑1 am a general contractor and i have hired the sub-contractors listed on the attached sheet. ]3.❑ROOFr airs These sub-contractors have employees and have workers'comp.insnrance.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.] *Any applicant that checks box#1 must also fill out the section below showing their workers'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. tContractors 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: CA_ (Q rU� y Policy#or Self-ins.Lie.#:_� J Q,f�Cj�50 3 Z y \s Expiration Date: A I ) �C) nn,, Job Site Address: U ` _Yy\LW 4C-C City/State/Zip: auoc 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 and/or one-year imprisonment,as well as civil penalties in the form of 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. I do hereby certify un r the pains and pe alties of p at the information provided above 1is rue and correct Si afore: Date: y�`1 � Phone#: LA U5- 5S'A—_1 512— Official ZOfficial 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#: