24C-159 (8) BP-2022-0060
22 ARLINGTON ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24C-I59-00I 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-2022-0060 PERMISSION IS HEREBY GRANTED TO:
Project# BATH RENO Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 29700 INC 077279
Const.Class: Exp.Date:06/21/2022
Use Group: Owner: HYMAN SHERRY B& ARTHUR P TRUSTEES
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:01/20/2022
TO PERFORM THE FOLLOWING WORK:
RELOCATE 1/2 BATH
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:
Gas: Final: Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
lers4
Signature: ti o Til .
yQ 10
Fees Paid: $195.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECEIVE -
I1JAN The 2onuuonwealth of Massachusetts
n B and of Building Regulations and Standards FOR
'•. OF BUILDING INSPEC sachtsetts State Building Code, 780 CMR MUNICIPALITY
�t 02 HAMPTON MA 01060 USE
Building-Permit Appliiccation To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Nwnber 6P --3.-1-COO Date Applied:
Ile
i Ao LP
1f//
Building .-10/a
Official(Print Name) Si nature 1 Dlte
S
SECTION 1:SITF INFORMATION
1.1 Property Arlrireac: 1 1.2;�s ;� 3 ssors Map Pa.ee! Num ar
-�a at-kon C kt-1 `,i o�jC ' /s
h.1 a Ts this an accepted street?}its no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: •
Zoning Disuict Proposed Use Lot Arta(sq ft) Frontage(ft)
I.S Building Setbacks(ft)
Front Yard I Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.'.c.40,§54) 1.7 Flood Zone information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal El On site disposal system 0
Check if yet❑ _
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owne0 of Record:
,i,..k. -v-S1r,.er 1 L` U iert -, it tr, ma C i UCr)o
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ I Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
{
rUrno.tticn ; Accessory Bldg. C I 'Somber of Units i Other Li Specify:
Brief Description of Proposed WorkL: ,Qti1 o c41 t/2 64 XN - No cAN K E 75
ST✓Lut-TGD A Z rk 4$ tvA- - #VO CN,Atv66 To L7- 7-47`Z2E,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item I (Labor and I Official Use Only
I.Building S 2/ I I. Building Permit Fcc:S indicate how lee is determined:
Qlar ❑Standard CityrTown Application Fcc
2.Electrical S q06 0 Total Project Costa(item 6)x multiplier x
3.Plumbing S .2/ ��� 2. Other Fccs: $
4. Mechanical {HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees., $$,/ 4 a
Check Ndio�1 j Check Amount: "i
6.Total Project Cost: $ V--4r 1OO 0 Paid in Full 0 Outstanding Balance Doc:
SECTION 5: (()NSTRITC:TI()N SERVICES
5.1 Construction Supervisor License(CSL) O-1-1:3-) S kvi v.›c).-- - ---
6)-te.1.-\ C11 •e.A—yN.a„r~ License Nwnbet pirauwt Date
Nana of CSL}Iuldi r
V. b 3O (.Ott_)7c� List CSL Type(:cc below)
No. and Street Type Description
_ U 'Unrestricted;Buildings up to 35.000 cu.
11..)
��re in-C �YY L't C to Z R Restricted !&2 Family Dwelling
Cityrrown,Sta .7_TP M A4asontY
•
RC, RuniingCtwering
- -------- WS Window and Siding
SF Solid Fuel Burning Appliances
ql -S 't— 7S2Z.- ' I insulation
7',�cpttrnn Email address D 1 knoll uon
5.2 Registered Home improvement Contractor (HIC) `, .
l IW ,U,�-e�rrur RCC gist ati n N I2c�Lat
HTC Registration?dumber Expiration Tate
Ti ompany�lam or HIC Registrant Name• .O . (,`� (00 _,
N Street F,,,ai!a;icye�
City/Town, State,ZiP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 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 X No...........❑
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,
to act on my behalf;in all matters relative to work authorized by this building permit application.
ebb t
1,.Print reamer's Name cctronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of per'ury that all of the information
contained in this application is true and accurate to the I s o m know dge derstanding.
sr+t --Cl, 141 mm ' /.._ ,) --,: oaa
Print Owner's or Authorized Agent's Name(Elcctr tc.igiiatitre) i 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 timd under M.G.L.c. 142A.Other important information on the HIC Program can be found at
ny.�..rt..A. _i...,_ ,,..1 Information on the Construction Supervisor License can be found at t,�a-A..r+ta;.`:qc clan t
2. When substantial work is planned,provide the information below:
Total dour area(sq.IL) (including garage,finished basainentlat cs,decks or porch)
Gross living area(sq. IL) Habitable room count
Number of fireplaces Number of bedrooms _
' Number of bathrooms • Number of half/baths
Type of beating 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 Northampton
®'.--.' Massachusetts �4., - %.,
', -'LL` k DEPARTMENT OF BUILDING INSPECTIONS �` 1 r
+ '3C:"ti: 212 Main Street • Municipal Building Z�. �.
Northampton, MA 01060 ..r>;•'kit ;�:���`,
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 MG{.c 111, S 150A.
The debris will be disposed of in:
Location of Facility: C-kJ P.A.A-9\-5
The debris will be transported by:
Name of Hauler: Val-Li _ ,--0v
Signature of Applicant: %,-,--- Date: 1 I I 0 I2D22_
•
Commonwealth at Massachusetts
i.05 Division of Professional Licensure
Board of Building Regulations and Standards
Const�r�li�fi rvi tSp7rvisor
CS-077279 ti . t-.. ' cpires: 06/21/2022
STEVEN A SPERMANLI< �' -�
PO BOX 60627 = 1 O '
FLORENCE MAC 01062 l (; / -
1/4
Commissioner e71142,An.
•
Ua/7W2.O/?,CPeeZ, ( iy 9CZ-.1,1 ac 2 e - ' -
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
Registration: 105543
VALLEY HOME IMPROVEMENT INC Expiration: 08/20/2022
P.O. BOX 60627
FLORENCE,MA 01062
Update Address and Return Card.
SCA 1 n 20M-05 17
Fi:,.rr'nevi.eoeu-4(c>/.// lice. r,e/4i
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.SlLVERMAN ��,(,, , -;(4,;/:.✓
340 RIVERSIDE DRIVE l000"4"
FLORENCE,MA 01062 Undersecretary Not valid without signature
___ The Commonwealth of Massachusetts
. .-.tDepartment of Industrial Accidents
'� 1 Congress Street, Suite 100
Boston,MA 02114-2017
" � ed
1. www.mass.gov/dia ,
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO HE FILED WITH THE PERiIITTI.NG AUTHORITY.
Applicant information 1` - Please Print Legibly
Name (Business/Organization.individual): \jai 1-e,i tt-o�v1 G �Yri o,k a n-i e,—r1 . �i'�C.
Address: 3-kO R,�e \ctL r�,' •rt-`J 1p 0. be c (c0(021
City/State/Zip: IOF c . k l4 01 002- Phone#: 4 t3-Sant--t S22
Are you an employer?Cheek the appropriate box: Type of project(required):
l.IM Tam a employer with t f$ employees(full andror part-time).* 7. ❑New construction
2.01 am a sole proprietor or partnership and have no employees working fur me in . El Remodeling
any capacity.No workers'comp.insurance required.)
3.01 am a homeowner doing all wont myself(No workers'comp.insurance required.)t
9. El Demolition
10 El Building addition
4.0 I am a homeoumcr and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or arc sole 11.0 Electrical repairs or additions
pr uprietors with no employees.
12.❑Plumbing repairs or additions
5.17I I am a general contractor and T have hired the sub-contractors listed on the attached sheet
These sub-contractors have employees and have worker io'comp. enrnoce t 13.0Roof repairs
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 checks box#1 must also fill 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.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or nut those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for nay employees. Below is the policy and job site
information.
Insurance Company Na.me: -Al-be"a_. �Y sS,,,r ..►'2 C.t_ Gay.-0,\r,
Policy#or Self-ins.Lie.#: C)() Q% b 2\S _._ Expiration Date: c2) 0 j e 010c3c ,
Job Site Address: Or\1 h City/State/Zip: �i t�O Q
Attach a copy of the workers' comp tion policy declaration page(showing the policy number and expiratl n 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 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.
e
I do hereby certify un r the pains and ppe allies of p tr haattt the information provided/above is true and correct.
Signature: �� �G ' fY//3 l 1 Date: 1��
1
Phone#: Li i - 1.)P(-I-1 GJ2 Z
Official use only. Do not write in this area,to be completed by city,or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector
6, Other .
Contact Person: Phone 4: