31A-156 (6) BP-2021-1982
61 MAYNARD RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-156-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-1982 PERMISSIONIS HEREBY GRANTED TO:
Project# PP-2019-0281 Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 36600 INC 077279
Const.Class: Exp.Date:06/21/2022
Use Group: Owner: SHATZ LAUREN J& AMY
Lot Size (sq.ft.)
Zoning: URB Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P 0 BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON:10/07/2021
TO PERFORM THE FOLLOWING WORK:
REPLACE 20 WINDOWS AND 2 DOORS, INTERIOR RENOVATIONS
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.
Signature:
. 11, 3.9
Fees Paid: $237.90
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
if...1
The Commonwealth of Massachuse '/
r...__.._ _ Board of-Building Regulations and S .ndara.. OCl �~`
'4. i Massachusetts State Building Code, ' 1 _:' Q` " �`': Il'. ''
Ain()� 420 USE
Building Permit Application To Construct, Repair, Renova l` a", dish a Re. red 'r2011
One- or Two-Family Dwelling �,p�4, 6yso
�1 re tian For Official Use Only 4�q07,,io,
Btuldin Permit Number. eV- Date Applied: -.4444r
—
KLSvll.)�Z� 1Z ? lb- 6-Z)Z)
BuildingOfficial
Ofi"c aJ(Porn Name) Signature Datc
SECTION 1:SITE INFORMATION
1,1 Properly Address: � 1. Zsses�srs ap& Parcel Number
s
t PekCit.i nei-All f.
.1 a IS IffiS an accepted street?Yes no - rap Number Par el urril er
1.3 Zoning Information: r 1.4 Property Dimensions:
civAt
I, +Li
7oning District Pr pos L`sr Lot Area isq ft) Frontage(ft)
1.5 Building Setbacks (11)
Front Yard I Side Yards I Rear Yard
Required Provided Required ! Provided Required Provided
1.6 Water Supply:(M.G.1_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 O
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
Name{i ) City,State,ZIP
tol r1akc V-CYACA LIk3-e3a5 -NS() L64-1417Q6A/01-/L,Ifni
No.and Street Telephone Email Ad s
SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction 0 E Existing Building 0 l Owner-Occupied 0 Repairs(s) "Altetation(s) V Addition 0
Demolition 0 ! Accessory Bldg. U ' Number of Units Other 0 Specify:
Brief Description of Propo- d Work2: ill) l
4•Vt4," i t A 4-c — t i , -f—
i Litrl ,tt. j 01 " VI inet Cat7ANI CEY 5 ( /
ivl •eNC TSti Ci'✓Cu t jr f 4 J,{-C k (c ad—iwt S,. () rAc.•ro 30
SECTION 4:ESTL'VIATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(TPhrr aand Matari-ls)
1 I. Building $ 0- (I(f 1. Building Permit Fee:S Indicate,how fee is determined:
� fl,Standard City:Town Application Fee
2.Electrical $ ryli'
i 0 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ --- List:
5.Mechanical (Fire 5 q--
r Stt tpressintl) Total All Fees: S
Check Noy A I ck Amount: 2 c '• /
6.Total Project Cost: $ 3(..E 1(it10 . a Pail n Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CST,) 0-7.7 a--7 C u (Pt I -
Liccnsc Numb Expiation Date
Name of CSL Holder
l Lis! CST.Type(see below)\--ekrx-)6ae,,e-yrtx.—)
No,and Street TYPe Description
U Unrestricted(Bui ldings up to 35,000 cu.ft.) ,
" � R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
�(_ . �f yj \'( 0\ 10 Rf Roofing i,owering
T t.l� 1 WS Window and Siding
SF Sol Burning Appliances�t��SS4�5�
T insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ice
�� gl l�
\ip�Ll Y -.Q... '" HIC Registration Number Expiration Date
Mc Co mpaiy Name or HTC Re so nt Name
it"N d Street /� ,�t� '::nail a�t;.i,•ens
t (Jlt°�1 g.t. INA IU�Z (4/3-- 4.-752.Z.
City'Totan'1, 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 of the building permit.
Signed Affidavit Attached? Yes _ liK 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 \)if SA-e Jt 1 ve..tic
to act on my behalf,in all matters relative to work zzed by 's bu�,f` permit application.
i 1
7t.
Print
Ch n 's Name(Electronic Signature) Date
SECTION 7b:OWNER 1 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 is pplication is true and accurate to the best of my knowledge and understanding.
siilyn.
/ t
nt mer's uthorizedAgent's Name(Electronic Signature) !!! Date
NOTES:
I. 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.tn ss ro, vi__,Information on the Construction Supervisor License can be found at k .,',.m:' : 0..nv:'drrs
2. When substantial work is planned,provide the information below:
Total Boor area(sq.ft.) (including garage,finished basemeritiatties, decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halflbaths
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" I
City of Northampton
Massachusetts• �a
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, Mk 01060 'rrt: .1,�`�
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 by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: 4\10 '•� -a C. 1Q , � �. r' -.,
The debris will be transported by:
Name of Hauler: \ QL VC vM.rY LQ-/..r3'--
pp
Signature of Applicant: IDate:
g
The Commonwealth of Massachusetts
. . .e
Department of Industrial Accidents
I Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
— Workers' Compensation Insurance Affidavit:Builtlers/Contractors/ElectriciansfPlumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (BusinessJOr anization:Individual): Art fit_ Ac v-c .S.t r e p^SE r'tz . .-he
Address: -1U Rt veldt. r , ? 0. ?c.)tc (co(aZ1
City/State/Zip: lUcer2C . a-1 b\O(o2- Phone#: 413-SSt -1522-
Are you an employer?Check the appropriate box: Type of project(required):
1.K4 I am a employer with employees(full and;orpart-time).* 7. El New construction
2.01 am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling
arty capacity.[No workers'comp.insurance required.)
9. ❑Demolition
3.0 Tam a homeowner doing all work myself.[No workers'comp.insurance required.)
4.0 I am a homcowmcr and will be hiring contractors to conduct all work on my proper T will
10 El Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5.171 I am a general contractor and I have hired the sub-contractors listed on the attached sheet
7he.,c sub-contractors have enrpinyrrs and have wnrT ers'comp.insuranne,t 13.171Z00f repairs
6.0 We are a corporation audits officers have exercised their right of exemption perMGL c. 14.El Other
152.41(4).and we have no employees.[No workers'comp.insurance required.)
*Any applicant that checks box#1 nutsi also 1311 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.
tCantractors 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 roust 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: -AY'beL\o.. all Si.trQ,r t.�__ -,i v c o
Policy or Self-ins.Lic. (..7'2,\S Expiration Date: ta?J 1 )
Job Site Address: (pt. g`-'{i mAale 1L . CityiState!Zi � �C �th 1 �'t' ( o '?5
Attach a copy of the workers' co pensation 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 51,500.00
andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 )ties of p r hat the information provided above istrue and correct
Signature: ? Date: V 1C t (t nd
C7�)Ga
Phone#: 413- cL52 1-`1 S2 2—
Official use only: Do not write in this area,to he completed by city or town official
City or Town: Permit/I.icense#
Issuing Authority(circle one):
i.Board of Health 2.Building Department 3.City/Town Clerk 4,Electrical Inspector 5.Plumbing inspector
6. other
Contact Person: Phone
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constsr- t AiYpprrvisor
CS-077279 6cpi res. 06121/202'2
•STEVEN A STVERMAN , ( ; 7- is ;x :t
PO BOX 60627 4 gr.
FLORENCE M/j 0106 ;
•OlSSldO t•
sti
Commissioner cjoa na-ta..
lJJ
,_-'/ ��z/»e-zmii-ea %IzcAe/).
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 ai 20M-05.17
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 08/20/2022 1000 Washington Street -Suite 710
VALLEY HOME IMPROVEMENT INC Boston,MA 02118
STEVEN A.SILVERMANA 340 RIVERSIDE DRIVE �rn,.�+'GG� ��
FLORENCE,MA 01062 Undersecretary Not valid without signature