24C-119 (9) BP-202 1-2301
8 FIFTH AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24C-I 19-001 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-2021-2301 PERMISSION IS HEREBY GRANTED TO:
Project# RENOVATION Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 79300 INC 077279
Const.Class: Exp.Date:06/21/2022
Use Group: Owner: HOPKINS ALISON &JOHN
Lot Size (sq.ft.)
Zoning: URB Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522
FLORENCE, MA 01062
ISSUED ON:12/14/2021
TO PERFORM THE FOLLOWING WORK:
RENO 2 BATHS, SIDE ENTRY, WINDOWS/DOORS
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:
r R .
Fees Paid: $515.45
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
.Iv/ —.)
Dec_
The Commonwealth of vlassachu:etts FCC" 20•
o cal
j . Board of Building Regulations and S . :. . r op FO
O e,it�i 1C r ALITY
Massachusetts State Building Code, 780 C HgMpTNOIn,Sp U. .
c
Building Permit Application To Construct,Repair, Renovate Or Demo • A:..,oRevise,Mar 2011
One-or Two-Family Dwelling.
nn This Section For Official Use Only
Build• Permit Number: J-19'A/• 4q 3C / Date Applied:
6)/0 7Z,5 i Z 12-1y-Zozl
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 PrQpe1v ddress: L2 Assessors Map&Parcel Numbers
q- 2,--4 )_L_ -
i.i s is tins aan uccep(ed street'?yes 7,c, . Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard. Side Yat ds• Rear Yard
Required . Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private❑ Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP1
11 nvmerl of Record: •
• ace(Pih City,Ste,ZIP •
8 \1.h41h 41 -5to.0.-5Za-�
No. and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s).❑ Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 •Number ofknits Other 6 Specify:
. Brief Descriptiwa of Proposed Work2: RON `g1,— 'L A 5 I p t eyspriz ,may'
' - .'F LAC�1Mt fyuvepI �' j Ot IS -, I ` �J.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
.Item Estimated Costs: Official Use..O _,nly
• (Labor,and Materials)
1.Building "7 j) 0 7 I. Building Perrait Fee:$ Indicate bow fee is determined:
3 3 0 Standard -City/Town Application Fee
2.Electrical 0 Total Project Cost' (Item 6)x multiplier x
3.Plumbing $ .5- 50 a 2. Other Fees:•$
4.Mechanical (HVAC) S List: • •
5.Mechanical (Fire $
Suppression) l . Total All Fees: $ __
Check NoyZ 3 heck Amount: � e.f Cash Amount:
L6. Total Project Cost: $ "j Cri 3 0 0 paidirkFuld outstanding Balance :
1 SECTION 5: CONSTRUCTION SERVICES
5.1 Con.strticdon Supervisor License(CSL) - i f
Ct . 0-11 2,--1 c Ut2.1 12.022-
XI PI \lot rrtar-N , License Number Ex piraCton That
Name ot CSL Holder
. List CSL Typo(see below)
2a ''s '1- ICICNtr.42e1
Na, d
Type 1 Description
an Street .1
ll Unrest:i.;ted(Btildings up to 35,poo cu...It)
1 0..Cente- W\A- 0 k 0(02, ----R
Restricted I ila Farnily Dwelling
CiryiTown,State, T? 14 Masonry
11117
--i 1/1._ •
RC , R[Ion t2,$:Cti v.tri ng,
WS 'Window and Siding
SF - Solid Fuel'Burning Appliances
14 --Ski.---1522- 1 insulation
Te'leplione Email address D Demolition .
5.2 Reaistered Home Improvement Contractor(HIC)
.Q(11 ' \IYCCILI4- . . 1.DSS(A3 312,olzsl:zz_
MC Registration Number Expiration Date
i 111C Comp Name or MC Regist nt Name
63yJ (00(02,71 C-10x. CY),P, ryto(02-
No.and Street Email addrew
4B-Sgq---Isai
. City/Town,State, ZIP Telephone
• SECTION-6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT,(M.G.L..c.452.§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 )14 No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WREN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize \ ‘47,.["__ tS:17.Ve --S41 ,Kcing:Lin)t
to act on my behalf,in all matters relative to work authorized by this building permit application.
6,-
tAirlua, ialstoLi •
PttiLner'site.e.(Floc r oc ifilarre i je_47 0,1.......___- 'die
I a-4.1 L I
SE TISN 7b:Ovkik 01(1-i- RIKED GENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this .p. *c.don is true an ccurate t f my knowledge and understanding,
• ,
il'eZ q- olOd,/ ..
Print Owner's or Auth' d Agent Name(Electronic Si2,nornre) 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
proaram or guaranty fluid under M.G.L.c. 142A.Other important information on the HIC Program can be found at
v.ww.ina.ss.a loia Information on theronstuction Supervisor License-can-be found at www.tnass.sovidos
2. -When substantial work is planned,provide the information below:
Total floor area(sq.it) (includine.Z.araim,finigl-ted baseinent/attics decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number ofbedrooms .
Number of batlitooms Number of lialfibaths
'Type of heating system Number of decks/porches
Type of cooling system . Enclosed _Open
i 3. "Total Project Square Footage"may be substituted far"Total Project Cost"
City of Northampton
;t::; : Massachusetts .
,� �zssach� efts �tii --� <<\
1 rye` ��
{ l DEPARTIENT OF BUILDING INSPECTIONS .1:y
212 Main Street • Municipal Building �J� cb
qZ�ir Ncrthamptcn, MA vJ W T`1�
CONSTRUCTION DEBRIS 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
.., disposed ,,,
properly licensed waste disposal facility, as defined by MG&_c 111, S 150A.
The debris will be disposed of in:
Location of Facility: \ ka AL QCQ �;�',, 1 R\-e ID �`� . ->
•
The debris will be transported by:
Name of Hauler: \ieik rets4— •
•
Signature of Applicant: Date: f/'. y —2J
4' The Commonwealth of Afassacln setts
a, �• ���. f _Department ofItidusiricrlAccirf`ert.ts
I Congress Street, Srirte 100
i Boston,MA 02114-2017
� www.illass.gov/dia
l�uil; s' Corli*;>:ensatian insarance Affidavit:Buitde>ss/Conti-aegis. lectlrtrfams/Pl>I�;!t~la€rs.
TOR .F1iF1)WITH TH .PRRiviiT TiNGAiliHORITY.
Applicant Information Please Print-44ib1y
Name(Name CR totinexh/rrrgnniixi.ir in/in divicinai)_ \iOttkj(,� `f(\ ]�'f�`.pro�f'ry eNI-- C
Address: 4C5 Q- . - . (c)C0 cc R-
City/State/Zip:TA arn1Ce__/t4G-On(n2r Phone#: q.e)- Ssci S2 2
Are you an employer?Check the appropriate box:
Type of project(required):
t 1.15ram a employer with , employees(full andlor part-tune).' 7. New consnvetion
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ®Remodeling
any capacity.[No workers'comp.insurance required.]
3.0I am a homeownerdoing all work myself.[No workers'comp.insurance required.1
9. ❑Demolition
' 10 Q Building addition
4.❑I am a homeowner and will be hiring contractors to conduct an work on my property. i will
ensure that all-Donn-miters-either have worke+-s'compensation insuranee or are sole 11.10 Electrical repairs ar additi4ns
propietors with no employees.
12.Q Plumbing repairs or additions
5.0 T am a general contractor and T have Fired the sub-contractors listed on the at:oched sheet 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance:
6.0 We area corporation and its officers have exercised their right of exemption per MGL c. 14. Other
152,',.l'1(4),and we have no employees.[No workers'comp.insurance requited.]
*Any applicant that checks box WI must also fill our the section below.showing their workers'compensation policy information.
t�/H-+omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
"C1 r avtors that cheek this txix mast atlathedan-addrtnsnad sheet showtha tht name of the e lntrat tors and state-whether of-mitt/use entities have
employees. If the sub-contactors 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
information.
Insurance Company Name: A(1-)eA r C SU n t- 61,(-61
Policy#or Self-ins.Lk.Tyr .S -C) 3 D2_, Expiration Date: t3 ) J 'DO
Job Site Address: V t"lr1'441 City/State/Zip: 0O,411 J1A path,. Hi1 0)tea{
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expo lion 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 certify under the pains and alties ofp ry ti:a r nation provided above is true and correct •
Signature: • Date: /ll" 2? 072/ -.. . . _ .. _-
Phone#: k.4 12D- SS\~ S 22—
Official use only. Do not write in this area, to be completed by city or town official.
City nr Town; Permit/i,icense
IIssuing Authority(circle one):
1.Board oTSealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing inspector
6. Other
Contact Person: • Phone 0:
•
•
Commonwealth of Massachusetts
Division-of Professional Licensure
Board of Building Re ulations and Standards
Consk 1A4Spp visor
CS-077279 �T cpires:0612112022
STEVEN A S^ VERMANi r f•
PO BOX 6O6G.27 • 3~ -) ^ T
FLORENCE 4 01062
O
•
/CISs3do :•
Commissioner Pi. �Jnc81a
•
K70/2W22A9/W.) C 100/�G�C�Q'c�r1CGGf1� ei
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.
A 1C., 20M-D5/17,
•
•
Fornv,7zoircc.eeze/d el,,/,Sazi4¢cez ael4
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
///jSTEVEN A.SILVERMAN L
�� ,9j,
340 RIVERSIDE DRIVE- f�rw.a lG. iGGaek" 'q'�ii v
FLORENCE,MA 01062 Undersecretary Not valid without signature