23A-183 10 PINE ST BP-2021-1309
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: REPAIR BUILDING PERMIT
Permit# BP-2021-1309
Project# JS-2021-002170
Est.Cost: $20000.00
Fee:$130.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq ft.): 5880.60 Owner: AXELROD JOAN
Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 10 PINE ST
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:5/12/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:REBUILD FRONT PORCH
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 UPOONN VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. csfl\toL
.) • d'
Certificate of Occupancy Signaturet
FeeType: Date Paid: Amount:
Building 5/12/2021 0:00:00 $130.00 •
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
i �q 1 A _,
/ Y 1 •-- -."
The Commonwealth of Massachusetts n ; ° (.2n, OR
Board of Building Regulations and Standardsul op
�9r wii CIP.ALITY
L; 1 Massachusetts State Building Code,780 Civil?.-4? tiQ4 "No
� ----_._ r�N"Isp�.. USP
Building Permit Application To Construct,Repair,Renovate Or Demo , *7 / ised gar
One-or Two-Family Dwelling_ I
This Section For Official Use Only
Building ermit Number: /' ii /r /.9 • Date Applied:
6'010 e3 1/‹./.2 5-1 Z•ZOZI
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1,1 Property dress: 1.2 Assessors Map S.Parcel Numbers
( 0 r t 1.140, c -rec.
I.1 a.Is dris an accepted street?yes _ -no Map lumber Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required i Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: , Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY O' ERSHIP3
2.1 Ow*nerz of Record:
o f iSie i vv CA— Ott. 4 4,4 C:1 f i O f-ent t' iil'ACL. a 0(c 2-
Narue(Print) City, State,ZIP
io et, Si-r-ee A 4 i 3- .3S0- 669 7
No.and Street Telephone Email Address ,
SECTION 3:DESCRIPTION OF PROPOSED WORK; (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg.it Number of Units Other ® Specify,:
. Brief Description of Proposed Work2: l.e'ou't k 4-s."4- vr: ..... fNoz>, c- d.0 ✓\
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1 Building $ 0 kc I. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: '
5.Mechanical (Fire •
Total All Fe
Suppression) -
Check No. deck Amount,/ V Cash Amount:
6.Total Project Cost: . $ 20 K .. .p Paid in Full -1 Outstanding Balance Due: .
•
SECTION 5: CONSTRUCTION SERVICES c • f /
5.1 Construction Supervisor License(CSL) _ Q,'�, ,2-t 1 (Oar 1 7D2-2-
b\-CxiOn s.3k. \J n-larN License Number Expiration Date
Name of CSL Holder
7-7 List CSL Typo(see below)
Pc go (i��((" ��` ` Type Description
No.and Street
_ II Unrestricted(Hui!clings upto35,nnn ~ ft)
A-A0re t� '� O\C` CO R Restricted &2 Family Dwelling
• . City/Town,S ,•,r • M Masonry
RC l Ruttiintt Ciivering
WS Window and Siding
SF Solid Fuel Burning Appliances
4&l 4=1522 ' I Insulation
Telephone Email address D Demolition
5.2 Reistared home Improvement Contractor(HTC) � �I. �� � ( + LZ
.
,11e jL\ (n.Q:c� 'r sty fY u- RTC Registration Number Expiration Date
,-TIC Comp Name or HTC Registr t Name
Y n �Q(n'? lor�r�C P C\nPs• b 10(02--
No.and Street Ernail address
412-7Sal-7')2Z 1 City/Town,State,ZIP Telephone
SECTION-6:WORKERS' COMPENSATIONIINSURANCE 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 No 0 !
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as of the subject •opeity,hereby authorize -Z i1 S i v>°. �.a-h
to act m behalf,in all afters elative t wor` oriz by this • ding permit applica•
9- .- l ` -I
Print O`wn -s Naive(Electronic ignature) Date
ISECTION 7b:-WNER=OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest der the pains aad penalties of perjury that all of the information
containe ' 's applicatio is true to to the best of my knowledge and understanding.
5---0' -- o700-y ,
Print Own s e(Authorized is:tame(E ectronic Signature) 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
w w rriass.aov?oca Information on the Construction Supervisor License can be found at www.mass.cov'!dos
. 2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) .
Gross living area(sq. ft.) Habitable room count
Nturber of fireplaces Number of bedrooms •
Number of bathrooms Number of halfksaths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
City of Northampton
r` �-e�. F s` �- Sic
t i' Massachusetts v� -- r'
'i
,�_ T DEPARTIINT OF BUILDING INSPECTIONS , t T
"^ F` 212 Main Street • municipal Building �6 "" rl1
Ncrthampton,
CONSTRUCTION DEBMS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS) .
In accordance of the provisions of MGL c 40, 554, 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 by MGL c 111, 5 150A.
The debris will be disposed of in:
Location of Facility: \la 1.A , C Ct i e l � , r�1'�Q� 'Th
J J
The debris will be transported by:
Name of Hauler: \IlCM its
Signature of Applicant: / Date:
....__......... .
•
The Commonwealth of Massachusetts
.Department of IndustrialA.ccidents
(.11 1 Congress Street, Suite 100
fr Boston,MA 02114-2017
ww}ufrrass.gov/trig
1 arms'Compensation Insurance Affidavit:Builders/Contaactors/.E.ircri ans/Plunubers.
Tit13'Eli,F.)WITH Tiir,PERMITTING AUTHOR Ii r'.
Applicant Information Please Print Legibly
Name lnu,,inessicirstniiai.inn/inciividid): ( ,(f%',( � l!)�rCjfirlrVy1i
Address: C) �t �\ck,c•- ��1�v C . Q. 0 . Y r. . (no Cc)2,R-
City/State/Zip: Orey'2C e \,0-cApb2_.. Phone#: �-�,�2j—Sc Li--1 S2 2
Are you an employer?Check the appropriate box: Type of project(required):
I.le I am a employer with t employees(fill and/or part-time)." 7. 0 New construction
2.1D I am a sole proprietor or partnership and have no employees working for me in g. ®Remodeling
any capacity.[No workers'comp.insurance required.]
3.71 am a homeowner doing all work myself.(No workers'comp.insurance reo.uired.l
9. ❑Demolition
10 j 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 worker'compensation insurance or are Gale • 11 Electrical repairs or additions
proprietors with no employees.
12.D Plumbing repairs or additions
5 El T am a general contractor and T have hired the sub-contractors listed on the attached sheet. 13.CRoaf repairs
These sub-contractors have employees and have workers'comp.insurance?
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 41 must also fill out the section below showing their worlmr s'compensation policy info.mation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
TCuntraetorsthat check rids box.must attachedan additional sheet thuwiri5thu name of the gab-cuntrac-tors and statewhether urnut those entities have
employees. If the sub-contractors have employees,they must provide their win-ice's'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: 4,-v-)e,1, 6-prOk
Policy#or Sell ii;s.Lie.#: . 'j("') b2\ Expiration Date: e9 ) I I O 2
Job Site Address: I C) "Pt rvc ee-i- City/State/Zip: O,41-h J1 RI-h. 01 OC.0
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expirktaion 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 th Ice of Investigations of the DIA for insurance
coverage verification.
I do hereby cernfy under the tallies of p ./uei'that j'on provided a ove is true and correct.
Signature:
uDate: t�t!t!_ i Z r2.4
Phone#: \:i 19D- $O 1- 5 22_
Ofcial use only. Do not write in this area,to be completed by city or towns official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CityfTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton •
4$ A °`,.. sus S.,c
y•,max ., Massachusetts �r •,re
!45 -,..-
' , J DEPARTMENT OF BUILDING INSPECTIONS V
` f .7.4, -7 212 Main Street o Municipal Building •jJ! ,\, �
HOMEOWNERS'EXEMPTION FT IGIBILITYAFFIDA VIT
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:
Persons) 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, I am not engaged in ccntstruction 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 fur 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 .clay of , 2.0_
(Signature) •
Commonwealth of Massachusetts
1._DDivision of Professional Licensure
Board of Building Regulations and Standards
Constr 4i nfStIP p,isor
CS-077279 t. empires:06/21/2022
STEVEN A SIEVERMAN
PO BOX 6062 } ` ,
FLORENCE Mlj 01062 t { > f
,>bi/OfS 3d0-6.��
Commissioner c-la,
UU J
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 Expiration: 08/20/2022
FLORENCE,MA 01062
Update Address and Return Card.
SCA 1 Cr 20M-O5/17
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
STEVEN A. N
340 RIVERSIDE DRIVE L.„44' '/1.
FLORENCE,MA 01062 Undersecretary Not valid without signature