24C-084 17 MASSASOIT ST BP-2021-1152
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24C-084 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 BUILD.I:NG PERMIT
Permit# BP-2021-1152
Project# JS-2021-001936
Est.Cost: $182000.00
Fee: $1183.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq.ft.): 7492.32 Owner: GOVER JENNIFER
Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 17 MASSASOIT ST
Applicant Address: Phone: Insurance:
P 0 BOX 40627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:4/16/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:7X13 REAR ADDITION WITH KITCH & BATH
UPDATES
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 Signaturl 4 • J; y2 c�� tj
FeeType: Date Paid: Amount:
Building 4/15/2021 0:00:00 $1183.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
L ✓ OK
File#BP-2021-1152
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 17 MASSASOIT ST
MAP 24C PARCEL 084 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATIO - '
NCLOSED 'EQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 4 '
Building Permit Filled out
Fee Paid
Typeof Construction: 7X13 REAR ADDITION WIT IT - : BATH UPDATES
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 •
WN.i . T'• i ` ��
i / /94
Sig ture 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.
Fir- -�E`i-E--.--
i
APR
The Commonwealth of Mas ache etts
FOR
r(4 � Board of Building Regulations d a F C AL,fTY
\� ,i Massachusetts State Building C ..2.a .I DWG INSPECTION USE
MA 01060
Building Permit Application To Construct,Repair,Renovate 91-Demo is ised Mar 2011
One- or Two-Family Dwelling
This Section For Official Use Only
/Building Permit Number: " -a i''' //�a-- Daze Applied:
a
Building Official(Print Name) Signature
SECTION 1:SITE INFORMATION
1,1 Property Address: 1.2 Assessnt-s MapSr Parcel Numbers
17 H42$sa coi1 84- A4G dz�
1.i a Is this an accepted street?yes -no , Map Number Parcel Number
'1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(it) •
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Floyes Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSI3IP1
2.1 Owner'of Record:
13400-ihint ' i- e ns ;r- (rOO JZ.- MY-PrACtilkfAtn tYla. C3Acxn 0
Name(Print) City, State,ZIP
ti Ha 50$01
1 S4- (on- ' covy
No.and Street Telephone Email Address .
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 1 Existing Building 0 I Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 , Addition 0
Demolition 0 4 Accessory Bldg.0 4 Number of Units Other ❑ Specift:Brief Descri tion ofPromed Work': . '' 1—L) '7 1 X !3! w S TN
k..,*.c 91-.a . . idAit-1 U9DAv.z-s_ :cT ,toC-cifaRt_ 4 .,)(VIZ.roil- PtL-
-
-{''�.�L�y Atli
t SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item (Labor and Materials Official Use Only
1.Building — r 1. Building Permit Fee: $ Indicate how fee is determined:
t fl Standard City/Town Application Fee_ •
2.Electrical $ i)' 3
i 0 Total Project Cost (Item 6)x multiplier x
3.Plumbing $ .3, 00 0 2. Other Fees: $
4.Mechanical (HVAC) $ 6,6 D ) List:
5.Mechanical (Fire $ •
Suppression.) TotalA.:l1 Fees: $r
' Checit No,�j(015 Check Among,I)I' Cash Amount:
6. Total Project Cost: . $ ifsa) o 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) ' 01
i 2. 19 1.21 (
j- \ car-\ �.W MO--r\ License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
P.a Zo)<, (oC*21
No.and Street Type Description
t--\0('Prit n,f 0`0( ,2. R Unrestricted(Buildings w to ellin,Ot?licu.t?.)
►V v R Restricted I&2 Family Dwelling
City/Town,Sta 1P I
IV RC Ru fingCivexin WS Window and Siding
SF Solid FuelBurning Appliances
-S2s ::1SZ2'" 1 insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) Owl SfZz
��P - ..k ' �� A)— 1-11C Registration Number Expiration Date
/TIC Company Name or I-tiC Registr nt Name
. o .0o(o 1 ¶lorenc-e_(YAP, b 10(02_
No.and Street Email address
4,t3-5S({-1S22-
City/Town,State,ZIP Telephone
SECTION 6: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 ofthe building permit.
Signed Affidavit Attached? Yes lif No .0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize 1\-T t Cj--r sex-',¶ ,1,Q y- y i
1
to act on my behalf,in all matters relative to work authorized by this building permit application.
1
3i Lte'sName( ectronic Siature)
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in . 'cation is true an accurate est of my knowledge and understanding.
i ' --, -;)„. _......2?)
Print er's or Au rized Agent's Name(Elec on ignatilre) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.ma ss.clov/oca Information on the Construction Supervisor License can be found at www.inass.aov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (includinrggara e,finished basement/attics,decks or porch)
Gross Living area(sq. ft.) W Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half`baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of NorthamptoiI
'--
.402-715T7'?k
Massachusetts 4; ti-A• )1 z,,
L' &-,..t:: -1k
DEPARTMENT OF BUILDING INSPECTIONS .
t , . :,.j --.1
-
212 Mat=t:n7tctlj.6!uilding•._
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined b y Mac 111, S 150A.
The debris will be disposed of in:
Location of Facility: \
la Uf-±3 AOCbC1 ,1..A_ , c .- e ‘C)
The debris will be transported by:
Name of Hauler: \\100.1 \- 150,A0 741A10(Nrenntik--4--
/
Signature of Applicant: / , / / Date: ....., ....),
The Commonwealth of Massachusetts
,* 04, 6% Department of'IrndustrialAccidents
1! .l l 1 Congress Street, Suite 100
1 a� Boston,MA 02114-2017
WWW.711ass.gov/dia
'arker-s' Cnai){r rsisatioai Insurance Affidavit Builders/C'ontr-a irs/ElectricianstPlnuibe s.
Ti)BE rii.Ei)'vviT"ri THE, I:MTT T"NC;Aii T iORITV.
Applicant Information Please Print Legibly
Name(RrrainetiuOrganivai.irm/intiivichra.iy. < i )rv\/f.CYV Et6>i- y r C
Address: -t{.) t ? t7 . C` (c)Q(c)2,1`
• City/State/Z113 areXiC e _ , cLc*2-4-- Phone#: �- �� SS`` $2 Z..
Are you an employer?Check the appropriate bait Type of project(required):
1,`.41 I am a employer with 1 employees(fulh and/or part-tune)." 7. New construction
2.0 I am a sole proprietor or parrnership and have no employees working for me in 8. ®Remodeling
any capacity.[No workers'comp.insurance required.}
9. ❑Demolition
3.n t am a homeowner doing all work myself.[No workers'comp.insurance required.]
10 j Building addition
4.0I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensasrerthat all oontraetare tither leave workers'compensation insurance or are sole • 11.-0 Electrical repairs or additions
•
proprietors with no employees.
12.Q Plumbing repairs or additions
5.❑Tam a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs
These sub-contractors have employees and have workers'comp.insurance.1 E-7
6.0 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 cheeks box#1 must also ll.out the section below showing their.orkors'compensation policy in.rormation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
ZCum•rarstors that eherk this box m et•attached•an additional sheet showing-the name of the sub-coutrawints and state-whether icing those entities have
employees. If the sub-contractors have rmnloyees,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: A-t/ .t .. rtxl
Policy#or SEii ISS. _14.#: Ob 32 Expiration Date: ��C)
Job Site Address: i °� Nit / f tl..Y� Ciry/State/Zip: 1\)e),r•rr ailk Uh. 144 o)O`.
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expir t ion 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 ter " under the p ' s and ties ofperjuly that the information provided above is true and correct.
Signature: Date: SbietlZ
Phone##: r-k t 5- BLS 1"' 22--
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permitil,icense
Issuing Authority(circle one):
'r 1.Board of Health 2.Building Department 3.CitytTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: . Phone#:
•
City of 'orthampton
,,�5 Sir
r�� '• Gr Massachuset+tS i r!`•.
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DEPARTMEN OF BUILDING+ INSPECTIONS rti�+ ' 212 Main Street o Municipal Building
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2dort:>..ptcn, y> 1C�0 c{%iy. ari
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born (insert
month, day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a
parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption,
does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s)who owns 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 home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for
and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work
on my parcel, .1 am not engaged in construction supervision in connection with any project or work involving
construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any
provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my
parcel,I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this day of 10
(Signature)
Commonwealth of Massachusetts
I `t Division of Professional Licensure
Board of Building Regulations and Standards
Cons ji'4'i Abpe visor
•
CS-077279 t Spires 06121/2022
STEVEN A SiEVERMAN
PO BOX 6062 '
FLORENCE Mgt 01062 St,• }>, 1.
•
Commissioner c a< t �. Z7&
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
VALLEY HOME IMPROVEMENT INC Registration: 105543
P.O.BOX 60627 Expi ration: 08/20/2022
FLORENCE,MA 01062
Update Address and Return Card.
SCA 1 C 20M-05117
G m,,,,tweoetll e Sez,waeZI;e/%
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
105543 06/20/2022 1000 Washington Street -Suite 710
VALLEY HOME IMPROVEMENT INC Boston,MA 02118
N ILVERMAN t' 1 %V fL p� '1 STEVE A.S A4-1 I�, r 1 t�L S f_,
340 RIVERSIDE DRIVE <a(ago.,•t;
FLORENCE,MA 01062 Undersecretary Not valid without signature
This plan is the pmpnetary work product of Valley Home Improvement.Inc.(VHF).It is delivered for the hooted and exclusive purpose of supporting Me contract Did of VHI.and customer agrees that the elements of this plan shall not be republished or presented in any
tone ft.,the purpose of evading a supporhnp tw work of compafmg p jeot contractors without the pmassron of,and campansatan paid to.VHF
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Valley Home Improvement,Inc. 17 Massasoit St Northampton, , SCALE:SEE VIEW SHEET NUMBER
340 Riverside Drive,PO Box 60627.Northampton,MA 01062 MA 01060 SITE PLAN oATE:an vzort
Office Phone 413.584.7522 Fax 413.585.0820 Jenny Gover&Alex Wolf
Find us on the web at: www.ValleyHomelmprovement.com DRAWN BY:C.M.S.