BP-20-913--File # BP -2020-0913
APPLICANT /CONTACT PERSON STEVEN S IL VERMAN
ADDRESS /PHONE PO BOX 60627 FLORENCE , (4 13) 584-7522 ()
PROPERTY LOCATION 27 OLIVE ST
MAP 388 PARCEL 250 001 ZONE URB(IOO)/
THIS SECT ION FOR OFFICIAL USE ONLY :
PERMIT APPLICAT ION CHECK LI ST
ENCLOSED REQUIRED . DAT E
ZON ING FORM FILLED OUT
Fee Paid
Buildin Permit Filled out
Fee Paid
TypeofCo nstruction : 2ND STO RY REA R ADDITION
New Co nst ruction
Non Structural inte rior re novation s
Addition to Ex ist in o
Accessory Structure
Building Pl a ns Includ ed :
Owner/ Statement o r License 77279
3 sets of Plan s / Plot Plan
THE FOLLOWl~G CTION HAS BEEN TAKEN ON THIS APPLICATION BA SED ON
INFORMATION P ESENTED:
__ Ap proved __ Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§ __________ _
Intermediate Project: ____ S ite Plan AND /OR ____ Spec ia l Permit With Site Plan
Major Proj ect: Si te Plan AND /OR Spec ial Permit With S ite Plan
ZONING BOARD PERMIT REQUIRED UNDER: § __ 3_$'._D-_9_, -=-),,___ __ _
Findin g, __ ~V __ _ Spec ia l Per mi t ________ Variance* ___ _
____ Rece iv ed & Recorded at Registry of Deeds Proof Enclo sed ____ _
___ .Other Permits Required:
Curb C ut from DPW ---____ Wat e r Availabi li ty ____ Sewer Availability
___ Se pt ic Approval Board of Hea lth ____ Well Water Potability Board of Hea lth
Pe rmit from Co nservat io n Co mmi ss ion Permit from CB Architect ur e Co mmittee ------
Permit from Elm St reet Co mmi ssio n ---____ Permi t DPW Sto rm Water Management
___ Demolition Delay
Da te
Note: Is s uance of a Zoning permit does not relieve a applicant 's burden to comply with all zoning
requirements and obtain all required permits from Bo a rd of Health , Conservation Commission, Department
of public works and oth e r applicable permit granting authorities.
* Variances are gra nted only to tho se app lic an ts who meet th e st rict sta nd ards of MGL 40A . Co ntact Office of
Planning & Deve lopm e nt for more inform a tion.
'I t
i
City of Northampton
Building · Department
212 Main Street
Room 100
Northampton , MA 01060
phone 413-587-1240 Fax 413-587-1272
·· SEctiON: t~ snf INf ORl\'IATION . > · ..
1.1 Property Address :
J, 1 0 l,\J -e s+-v~~+
SECTiON 2: ~. PRC> P.ERTY OWNERSHIP/AUTHORIZED AdENT
2.1 Owner of Record:
Signature
SECTION 3; ESTIMATED CONSTRUCTION COSTS
Item
1. Building 1201 oOO
2. El ectrical
3. Plumbing
4. Mechan ica l (HVAC)
5. Fire_ Protectio n
13 1 4Dc)
d'l 01 tU(,, b<\--b)o(4tao:-p+cn r'l'\o....-O\o'k·o
Current Mailing Address:
Y l3 -5Y<.J -1':f8S"
. Telephone
Current Mailing Address:
Telephone
. Official .Use Only
.. t?Y B~i.iding Permit Fee
• (b) ·E~ti~11~ted Tcital Cost of . > ·Gonstruction from 6 • ·.
. . .. ·.. .·
· Building Permit Fee .
• Check Number
: . . .. ·. ,• ..
.•. 1%'54. l u. : • •:
44
This Section Fcir:OfficfalUse Onl .. ·
Building Permit Number:~· ._b_· _f_ .. ~)J"f-"-. ·_,,_q~· ~'-2~---Da~f ....
·.•Iss ued :_ .. _·_·----------------
. Signature: ----------------~-. . . . . : . .
Building Commissioher/lhspector of Buildings · oaie
s -le ven
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
'. I
,) \
·' I .
New House D
Accessory Bldg . D
Addition
Demolition
Brief Description of Proposed
Work: ·
Replacement Windows Alteration(s)
Or Doors D
Roofing D
New Signs [D] Decks [0 Siding [DJ Other [D]
Alteration of existing bedroom~Yes _L_ No
Attached Narrative
Adding new bedroom ~ Yes ___ No
Renovating unfinished basement Yes ~ No
Plans Attached Roll -Sheet
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 storie s?--------------
f. Method of heating?--------------Fireplaces or Woodstoves _____ Number of each
g. Energy Conservation Compl iance . _________ Masscheck Energy Compliance form attached? ______ _
h. Type of construction ______ _
i. Is construction wi thin 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 __ _ Pri vate well ___ City water Supply __ _
SECTION 7a -OWNER AUTHORIZATION,.:, TO BE COMPLETED WHEN
. b.WNERS AGENt· OR CONTR:ACT:OR:APP.LiES FOR BUILDING PERMIT:
. .·. . . . . . ~.
1. '.6\ \\ ~,ce~ -t--~dv-j :Jbt\:,a..ulJ-
property
hereby authorize\) H-I \ ste',.JCO S, /ver'n-?CU'7
to a my behalf, in all matters relative to work authorized by this building permit application.
~ ~b-u,
Date
, as Owner of the subject
I , lli;,)Cn s /\J ·C-rrnan . \I J+I 'as Owner/Authori zed
Agent here by decl a re that the statements and information on the foregoing appl ication are true and accurate, to the best of my knowledge
arid belief. ·
Signed under the pains and penalti es of perjury .
Ste--1en 'z>1 l~-e~~-
Pnn!Nam~ ~
Signat ure of Owner/Age nt Date
. ') '
City of Northampton
Massachusetts ·
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street• Municipal Building
Northampton, .. MA 010 60
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 Haine 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 be registered.
Type of Work: ____________________ Est. Cost: ___ --'-----
Address of Work: ::rJ QJ,\J'"C S\r--e-eA-t
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 HA VE 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:
Date
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: ·
Date Owner Name and Signature
J,
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Str~et •Muni cipal 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 d~b.ris from construction work being performed at:
(Please print house number and street name)
Is to be disposed of at:
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
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.
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers ' coID.peo.sation for their employees .
Pursuant to this statute, an ·employee is defined as " ... every person in the service of another under any contract of hire,
express or im"'' _:, xal or writteD.."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or ID.ore
of the foregoing engaged in a joint enterprise, and including· the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, eID.ploying employees . However the
owner of a dwelli.rig house having not more than three apartments and who resides therein, or the occupant of the
dwelli.rig house of another who employs persons to do maintenance, construction or repair work oo. such dwelling house
or oo. the grounds or building appurtenant thereto shall not because of such eID.ploymeo.t be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or perm.it to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states ''Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your· situation and, if
necessary, supply sub-coo.tractor(s) name(s), address(es) ·and phone number(s) along with their certificate(s) of .
insurance . Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
empl.oyees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confumation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line .
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. Io. addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit oo.e affidavit indicating current
policy information (if necessary) ·and under "Job Site Address" the applicant should write "all locations in ___ ( city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a _ license or permit o.ot related to any business or commercial venture
(i.e . a dog license or permit to burn leaves etc .) said p erson is NOT'required to complete this affidavit.
/
The Department's address, telephone and fax number:
Revised 02-2 3-15
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel.# 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
www.mass .gov/dia
Commonwealth of Massachusetts
Division of Professional Licen s ure
Board of Building Regulations and Stand ard s
Con s\ri!ithljtls i.l"pe_rvi so r ,. •/ -..... /J
CS-077279 . j! .~-;:~"J ,. ~yires: 06/21/2020
-. 1, '-~cl : ·.r. / J. ·t;w·· -. ~
STEVEN A Sl~VERMAN-',,,.: :·' . : 8
268 FOMER Rcy,.o : ··-r-Ot(/ . .-:C
SOUTHAMPTON>M A · 01073 / {>
,~-!;:t,.c~" \C-l>-
OJ.'iS3":10
Commissioner "cL-J:L_·
Office of Consumer Affairs and Business Regulation
· One Ashburton Place -Suite 1301
Boston, Massachusetts 02108
Home lmprovem~~'\tractor Registration
VALLEY HOME IMPROVEMENT INC
P.O. BOX 60627
FLORENCE, MA 010 62
.-.......
. -'
1 C, 20M-OS/17
§;fe, 'iff'oo1/7?.Mtt.~a!2(' o/ Aia,J.Jae,,{;«J.e,(/.J-
Otfice of Cons um er Affairs & Bu s in ess Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:-forporati on
R egi str'il:ioh \ Ex piration
.QS -· 07/1 6/2020
VALLEY HO MEflM -iNC . (( f
STEVEN A. S ILVE i Ji
3 40 R IVERS IDEDR\\; ,1-:;·::'1
NORTHAMP T ON, MA<o~ -6 2 Un der?ecretary
g:,=· Type:
Registration:
Expiration:
Corporation
105543
07/16/2020
Update Address and Return Card.
Regi stration valid. for individual use only
before the expiration d ate. If found return to:
Office of Consumer Affairs and Business Regulation
One A shburton Place -Sui t e 1301
Boston, MA 02108
Not valid without sign ature
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
\Vorkers' Compensation Insurance Affidavit: Builders/Contracton/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY .
Applicant Information Please Print Legibly
Name (Business /Organization /lndividual):_\...:.=JQ-=----l l.,_-C=j~___;_\+_o_,Yl'-----C __ Tl_m_4'{?_'f"O_'--l_-e_l'Yl_C_n_--1-----'.'--'Xi_n_c_· ___ _
Address: ~O R,'-se'.VCo\G\( :Dn\St'..
City/State/Zip: F\01-enc.c HA-0\ 00'2-
? o. ~o.< f..co0z,
Phone #: 4 l 3 -S'8<-l-IS 22.
Are you an employer? Check the appropriate box:
LIZ] I am a employer with \ 8 employees (full and/or part-time).*
2.0 I am a sole proprietor or partnership and have no employees working for me in
any capacicy . [No workers' comp. insura nce required.l 3.o I am a homeowner doing al l work myself [No workers' comp . insurance required.] t 4.o I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either ba,•e workers' compensation insurance or are sole
proprietors with no emp loyees.
5.Q I am a general contractor and I have hired the sub-contractors listed on th e attached sheet.
The.,e sub-contractors have employee., and have V.'nrkers' comr. insnrnnr.e.t
6.o We are a corporation and its officers have exercised their right of exemption per MGL c.
152, &1(4), and we have no employees. JNo workers' comp. insurance required.l
Type of project (required):
7. D New consD.uction
8. ~ Remodeling
9. D Demolition
10 D Building addition
11. 0 Elecnical repairs or additions
12 . O Plumbing repairs or additions
13.0Roofrepairs
14.00ther _______ _
* Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who s ubmit .this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit inclicating 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 . Tf 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
informatio11 .
Insurance Company Name: -A,/c,e\ \Q '3n £:.uro .. ..v, Ll_ l:J '<0~ p
Policy# or Self-ins. Lie.#: Ob':>SO ~ D 2 \ S Expiration Date: d) I ) ·;;Jo;;i /
Job Site Address: 21 0/, vC f;}-y--e« . City/State/Zip: No~ /L1Ct OJ()lo1
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 fme ofup 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 hat the information provided a ove is true and correct.
Si
,/---~
ature: al /2.020 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#: _______________ _