11A-072 (5) BP-2022-0874
17 LEONARD ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
1 I A-072-001 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-2022-0874 PERMISSIONIS HEREBY GRANTER TO:
Project# PORCH Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 15000 INC 077279
Const.Class: Exp.Date:06/21/2024
Use Group: Owner: G RYAN SUZANNE E &TIMOTHY
Lot Size (sq.ft.)
Zoning: URA - Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON:07/25/2022
TO PERFORM THE FOLLOWING WORK:
REBUILD PORCH
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of H lying D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House# Foundation:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I 4
•
Fees Paid: $97.50
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
-
/1.cs cry, .,�°P t�
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The Commonwealth of Massach ctt ,
Board of Building Regulations and Sta •.1.-'�.,' �� � OR
,G N.i. .•ALITY
Massachusetts State Building Code, 780 C '�o �4� US:
/' Building Permit Application To Construct, Repair, Renovate A'lish a evise, cr2011
One- or Two-Family Dwelling. "71 c<0��
This Section For Official Use Only �°�'1's
Building Permit Number: ►3P• a a-' `13 74 • Date Applied: \ .
ti
). 111,' i 6,
Building Official (Print Name) Signature 1 Dat
SECTION 1: SITE INFORMATION
1.1 Property Aridre.ss: 1.2 Assesso..s Map & Parcel Numbers-
i9 Lro ut S _ (( .AV pI),
- 1.1 a Is this ari accepted street?yes n o Map Number Panel Narrlbei.
•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 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: _ Oh Flood Zone? Municipal El On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
21 nwner 1 of Record:
a_k -e niA0 cDkas,3
. Name Trial) City, State,711" .
11 •'- i .Ad. L1(5-30- '91 a.
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK= (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s).❑ Alteration(s) 0 Addition 0
Demolition 0 1 Accessory Bldg. 0 Number ofUi ita Other 0 Spcci1 :_
l Brief Description of Proposed Work2: bk..)'',j k * Po rc..t-, i N c- £s- C)00 r— .
4 51...,r•-., d.C) r~
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) •
1.Building $ i 5 K 1. Building Permit Fee:$ Indicate how fee is determined:
' a Standard City/Town Application Fee
2.Electrical $ 0 Total Project Cost' (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ •
Suppression) . Total All Fees: $ 4/I 0
Check No.1Q IA Check Amount: ' Cash Amount:
6.Total Project Cost: $ F S . -0 Paid in Full .Oatstaacling.Balance Due:
__.
I ( SECTION 5: CONSTRUCTION SERVICES
51 Construction Supervisor License(CSL)
. 0_112"19 .otZ 1. (2,0G2 -
3;�xv fir' C-A1`f5(ti ar License Nucaber Expiration Date
Name of C-SL Holder
' List CSL Type(see below)
( (D2.1 Type Description
No.and Street
n'cy �l Lf' Unrestricted(Buildings'up•o 35 r�ful cu.ft)
i'AO CC >i' CO R Restricted Iea Family Dwelling
i City/Town,State,ZIP M Masonry
,/ RC Ruuiing,Cuvering ,
' WS Window and Siding
SF Sol id Fuel Burning Appliances
k4V5- ` 1S22— I Insulation
Telephone Email address D Demolition •
`5.2�Rteaistered Home Improvement Contractor(HIC) Q g 12 ��
V('X.1�e �Q.L `�C'� HIC 12egistration Number Expiration Date
1�lTzC CompatiSr Name or T-1C Reipstrhnt Name
Y.t>_ C,F to0(02,-) C-Iorc. C.C 'L O 10Cs2-
No. and Street l ;nail address
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 affivit will result in the denial-of the Issuance of thebuilding permit
Signed Affidavit Attached? Yes )4 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 V 1-k-T 1 --•t" .Iven 1\ v ,.}Th
to act on my behalf;in all
matters relative to work authorized by this building permit application.
0-7-yly ‘/9 7/2_X
Trim Ov er's Name(Electr uuic St ature) !Jr,T^
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 this application is cue and ace t the best of to know and understanding.
Sre S) Lllk12.FirinN U -7- 2a-'2'd). •-
Print Owner's or Authccized Agent's Name(Electronic SiTfanre) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered corm-actor
(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. I42A.Other important information on the HIC Program can be found at
WA-VS',mass.t?ov/oca Information on the Construction Supervisor License can be found at vvww.raass.sov/dos
2. When substantial work is planned,provide the information below: .
Total floor area(sq.I.) (induct:7g garage,finished basement/attics,decks or porch) .
Gross living area (sq. ft.) Habitable room count
• Ntm,ber of fireplaces Number of bedrooms
Number of bathrooms
s 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 northampton
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Lvassach�setts �4��' _ `�e{, ,. ,,,. .
„.. .,.,
, .•i''' ` DEPPRT[ENT OF B(1FLDING INSPECTIONS k li iii, '
212 Hain Street o Municipal Building v•- c�
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, SS4, 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: , 1 (r-4- .-�
The debris will be transported by:
•
Name of Hauler: V113. I ( , t5L - .
Signature of Applicant: Date: 7- -o - .2.0a,),
•
The Corrrrrtorfwealth of. icEssachi setts
fr3 Department of Industrial Accidents •
>� 1 Congress Street, Suite 100
•
Boston,MA 02114-2017
6.. IVw i'.Ntass'.gov/dia
/ Marl ers'Compensation nsation Insurance Atfir_Iavit_•Builders/C.ant-rastni•.s/ cb-icians/Plua},bes-s.
Ti)RF.Fii,FnV ITT ii-iF,RI-Z/011 n Nil AII11-1)1ITV.
Applicant Information Please Print Legibly
Name rt+r:incv,ehrr�a.rtirai.innrrnriivirivaii:
\3(`�.�,�pj arc c1,� h c
Address: C`s� c� -
City/State/Zip ` \-Q,G-CM(02_.- Phone#: 1 PD- %9--`i S2 Z
Are you an employer?Check the appropriate box: Type of project(required):
1.�I a m a employer with (g employees(hill and/or part-time).* 7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees walking for me in 8. ® Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.17i am a homeowner doss„all work myself. INo workers'cutup.instu-aece required,h t
100 LJ Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all worst on my property. I will n
ensure that al non-uactors eiahe;+lave workers'compensation islsaran ce or are sole • - 11.1..]Electrical repairs t+r additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.�T am a general contractor and I have hired the sub-contractors listed on the arachedsheet. 13.�Ro0{repairs
These sub-contractors have employees and have workers'comp. insurance?
6.❑We axe a corporation and its officers have exercised their'right of exemption per MGL c. 14' Other
152,§1(4),and we have no employees. [To workers'comp.insurance required.]
`Any applicant that check bon R1 must also La out the section below.showing their workers'compensation policy iofos ation.
t Homeowners who submit this affidavit indicating they are dotal all work and then hire outside contractors must submit a new affidavit indicating such.
«Cuertractors That rrheckitus box must attached'anadditioaal sheet showing The name od'the stab—cuuttarturrs and state-whether ur•nut'tlruse 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 my employees. Below is the policy and job site
information.
Insurance Conip any Name: A( ,',\cA._ r�'�'1 S�'i� Ylt( Cqr(ILL.f
Policy u cc Lf r:_ #: Expiration C
r ULll.y tt or J�+LI-ins.Lali.rr. W� 7� 3�Lr 1� L�cpirQ,aoa Date: t� I eP-042
Job Site Address: \l a.et�t-,Cs b • City/State/Zip: NI(),e4 A ptt� 01
Attach a copy of the workers'compensation policy declaration page(showing the policy number and eipir tion 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 ag-nin.t 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 e 'ins andpenalti ofper-' e information provided above is true and correct. •
Signature: Date:
Phone#: Llk23- 1S4— ¶22—
Official use only. Do not write in this area,to be completed by city or town official
City nj-Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
I 6. Other
Contact Person: Phone II:
^Commonwealth of �K
VI Division of Occupational Licensure
Board of Building Regulations and Standards
Const nrSvisor
CS-077279 I�pires• s...06/21/2024
STEVEN A SILVERMA ,�r 11 F a,x ► '�`
PO BOX 606 1 '',� ,}+� 1. ,,i ,� ;°_ rt
FLORENCE NA 0108201 ^ .' ;1
r:Vr:STti Sol e•l . _. i/ £d N/....d �
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affair and Business Regulation
1000 Washingtcrt - Suite 710
Bosto n};-Massachusetts_;.02118
Home Impro'et ert `u tractor- • e istration
,'''� ':. s�� .. .� 1:•;Type: Corporation
t�_ '�= .4,•:a a ist ation: 105543
VALLEY HOME IMPROVEMENT INC �- , _ g,
P.O_ BOX 60627 •-"'t • = . E�EPi ation: 08/20l2024
FLORENCE,MA 01062 1}:•f' SF�+�N�! _�,,
• �•.• -,_, ' ..,
ti,_-.../—'-- Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs A Business-Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE': brporetiort Office of Consumer Affairs and Business Regulation
Reglstfatlditi•_!`1_EXIAt ltion 1000 Washington Street -Suite 710
f j,AO8j29( Boston,MA 02118
••;a �'
'ALLEY HOME IMPfZp, EM _�I -,.;:,, �
;TEVENA.SILVERMAN, . 'y,,APP- .,
40 RIVERSIDE DRIVE', . .:.w •.; , liLORENCE,MA 01062 .+t CG.�'�G1`"ra
:''` Undersecretary Not valid without signature