23A-183 (3) 10 PINE ST BP-2020-1192
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A- 183 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Permit# BP-2020-1192
Project# JS-2020-002001
Est.Cost: $65500.00
Fee: $425.75 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq.ft.): 5880.60 Owner: CONTRADA AXELROD JOAN
zoning: URB(100)/ Applicant. VALLEY HOME IMPROVEMENT INC
AT. 10 PINE ST
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.6/9/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-ONE STORY ADDITION
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 6/9/2020 0:00:00 $425.75
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2020-1192
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 10 PINE ST
MAP 23A PARCEL 183 001 ZONE URB(100)/
THIS SECTION FOR OFFICIA O
PERMIT APPLICATIO HECKLIST
CLOSED R WIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildin Permit Filled out ILI LA gr
Fee Paid
Typeof Construction: ONE STORY ADDITION
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
Signature of Building Official 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.
i
DeparJr+errt use only
City of NOriam on arPerm
BuildinVa-11n epar' ent�10 t� uttDrtveway Pefm�t 1 ,tet Fr z
212 Se r1Sep AVai(abtltty
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.' x = Rooth �o0�c �U W r/W AvailabiE+ty x '� "u
Northampton, MA ��N v o Se ofStrvcturalPlarts �4T
T /ate,,
- hone 413-587-1240 Fax 413- tri F
p lotrs aEfatzs ��h�M wig
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APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR 46OLISH A ONE OR TWO FAMILY DWELLING
SECTION t-S1TE INFORMATION
1.1 Property Address:
Then secttan to be completed by,ffibo
���+;'�i"��+(,.� Zone � (OverlayDrstrrct '` ���,�y•
=E(m Se D"iS#nGt a a a4,i15V o-
SECTION.Z-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
1 C �r-, t L',-y4—e,-,iNa6e e{ rint) Current Mailing Address:
Ll I
Telephone
S n ure
1.2/Authorized
c ;-e� n S�I\le'k 1t r-� P o, ,c b0(0 nn' laret �cc A- CA 0(t2
Name(Print) Current Mailing Address:
/*", - z Y-b-
Signature ' Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com feted by permit applicant
1. Building ta)Building Permit Fee
2. Electrical '1 (b)Estimated Total Cost of
a4
F00 Gonstructidn from E)
3. Plumbing ' ��O Building Permit Fee .
4. Mechanical(HVAC)
5. Fire Protection r (J
6. Total=(1 +2+3+4+5) jj r7b Check'Nurnber
This_Section.For Official Use Only
17
/ D"ate
Building.PermitNurnbe; J ' ` Issued:
Signature:
Building Commissiohertlnspector of Buildings= Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed, Permit CaR.111LOenied Due To Incomplete Information
Existing Proposed Required by Zoning
Ms column to be rifled in by
Building Department
Lot Size
Frontage I l '
Setbacks Front I
Side L= R:l___� L:= R`
I ,
Rear I I
Building Height i
Bidg. Square Footage
Open Space Footage �g %
(Lot area mums bldg&paved I f t t
pae-ng)
#of Parldng ParSpaces
_J }
Fill:
(volume&Location) d'
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
iF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document }
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW C) YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location: E
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan I
that will disturb over 1 acre? YES 0 NO 0
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 , Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors Q
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks rM Siding[tom] Other[L7j
Brief Description ggf Pr000sed
Work: 5e, ADD1+�41�
Alteration of existing bedroom YesNo Adding new bedroom V Yes No
Attached Narrative TT Renovating unfinished basement Yes >9:� No
Plans Attached Roll Sheet
sa_'f NeWhau''—,A'n l.or adciit orl to=e3clsting hduslnct comRlete_the f0 owing
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'CONTRACTORAPPLIES:FOR:BUILDING PERMIT
as Owner of the subject
property
her�y uthorize Gi CSM
to p in all atters t t rk author' ed by this buildi�Zp rmit appli atian.
Si na re of Owner Date
I, ett_r i cit U�.r'ir7Q f 1, �f}4'T 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 pairs and penalties of perjury.
even 031 I v-e-
Print Name
Signature of wnerlAgent V Date
SECTIOtJ 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: � ><'V '.t� l'y� I �n Q T1 -1 1q
License Number /
Address Expiration Date
Signai a Telephone
9�Regtsteced Homelmprauerne�ttGontr�ctor...�� ,��; ° � ...�
Not Applicable ❑
W
Company Narhe Registration Number
`1 ` I`l Zo
Address Expiration Date
" -^ Telephone
SECTION 10-WORKERS'COMFENSATtON INSURANCE AFFIDAVIT(M. .L_a 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...... ❑
3 -
i
i
City of Northampton
Massachusetts
DEPARTMENT OF BUITDZNG INSPECTIONS
212 Main Street • Municipal Building Jcti s
' Northamptan,_MA 01060
AFFIDAVIT-
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affaizs 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.
1VoYe:If the homeowner has contracted with a corporation or LLC,that entity must be registered-
Type
egisteredType of Work Est.Cost:
Address of Work
Dare of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by lav(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
Building not owner-occupied
_Other(specify):
OWN-ERS OBT-ALNING THEIR.OWN PERMIT OR ENTERING INTO CONTRACTS V=UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME LNIPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT Ii.AVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILI'TES FOR ALL FORK
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 Contract6T 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
City of Northampton
Massachusetts
DEPARMENT OF BUILDING INSPECTIONS �-
�. 212 Main Street • Municipal Buildingi�ti
Northampton, CSA 01060
Massachusetts Residential Building Code
Section I IO.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 110.85.1. 3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 11 O.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 farm 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-,AU 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
f ` Massachusetts
r DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street *Municipal Building
Northampton, NA 01060 sb2'Y
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:
�
(Pl ` e print ng e and locatfon of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
5-26--rwCl�o
Signature of Permi Applicant or` weer 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.
The Commonwealth of Massachusetts
Department of IndustrialAccidents
1 Congress Street,Suite 100
- Boston,M4 02114-2017
wK w.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED RITE THE PERMITTLNG AL"MORHY,
Applicant Information Please Print Legibly
Name (Business/Orgacization/lndividual): ( 11' }(1 t C7t�Z3 a1f'CYIf'((t� chi 7 L
Address: pz.
CitylStatelZip: ��tCt1C �( t�tl�b2 Phone':
Are you an employer?Check the appropriate box:
Type of project(required):
1,91 am a employer with 16 mployers(tial and,'o:part-time).` 7. E]New construction
2.71 ffi a sole proprietor or partnership andhave no employees working forme in 8. Remodeling
any'capacitY.1'No workers'comp,insurance regrired.}
3.[]l am a homeowner doing all wcrk myself:[No workers'coop,insurance required.]t 1- ❑Demolition
10�Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. Twill.
ensure that all contractors either have workers'compensation inMura ce or are sok 11.Q Electrical repairs or additions
proprietors with no employees. 12.o Plumbing repairs a'irs or additions
5.❑I am a gencal con acbr and I have hired the sub-contactors listed on the attached sheet
lbese sib-contractors have employees and have workers'comp.insmance? 13. Roof repairs
6.❑we art a conoation and its officers have exercised theiroght cf exe tion MGL c, 14.Q Other
mP F�
152,§1(4),and we have no employees No workers'comp.insn *+ce required)
`Anv applicant that checks box#1 must also fill out the section below showing their woike s'compensation policy mfmmzdon
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contzacton mast sobmit a new affidavit indicating such,
+Contractors 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-contact=have employees,they must provide their workers'comp.policy srmbcr.
I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site
information.
Insurance Company Name: j�Y't fm- asU'(�
Policy#or Self-ins.Lic.IT: 0 D50`2 'S Expiration Date:
Job Site Address: City/State/Zip: C re?t?C t' Out (-)l(Xv�—
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 e.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 cdolator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of erlury that the information provided above is true and correct
A..
Si&attire: Mil e Date: 12-
Phone
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permitrl.icense 4
Issuing Autlority(circle one):
1.Board of Health 2.Building Department 3.Cit3ITown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
c Commonwealth of Massachusetts
Division of Pro'fessionai licensure
Board of Building Regulations and Standards
Constr�gjo b ryiso
CS-077279 1� Expires:06/21/2020
STEVEN A SILVERMAI'
268 FOfv1ER ROiD '•;� '` '
SOUTHAMPTDP(�i4/1.01073,
JS 4
Commissioner C/1 -'
ndw
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
6 '�'
Horne lmprovementiCo�ntractor Registration
Type: Corporation
VALLEY HOME IMPROVEMENT INC z Registration: 105543
P.O.BOX 60627 = Expiration: 0711612020
FLORENCE MA 01062
{
-esttea;
Update Address and Return Card.
r � 2�(aayy �ip�
✓/16 L'3sAUlZt4ZctL•LztG/L F`� t7¢�iJ¢cr'cG:BIf3
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:
jI.�e
Recristration Exoiration
Office of Consumer Affairs and Business Regulation
5 07/16/2020 One Ashburton Place-Suite 1301
VALLEY HOFJE�I e-bV1±MEh:If iC Boston,MA 02108
STEVEN A,SILVERt�12T)=—. .'? r'- te
$40 RIVERS(DEDFi % l/I
NORTHAMPTON,MA`04o6z Undersecretary Not valid without signature