24C-015 BP-, 022-0931
260 PROSPECT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24C-015-001 CITY OF NORTHAMPTON
Permit: Addition
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2022-0931 PERMISSIONIS HEREBY GRANTE4 TO:
Project# MUDROOM ADDITION Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 42000 INC 077279
Const.Class: Exp.Date:06/21/2024
Use Group: Owner: JARRELL KATHERINE A&NATHAN K PFLUEGER
Lot Size (sq.ft.)
Zoning: URB Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON:08/12/2022
TO PERFORM THE FOLLOWING WORK:
MUDROOM ADDITION
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:
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 VIOL • TION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
' � �T. A • •I
Fees Paid: $273.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-I272
Office of the Buildine Commissioner
Z-6R
File #BP-2022-0931
APPLICANT/CONTACT PERSON:VALLEY HOME IMPROVEMENT INC
P O BOX 60627 FLORENCE, MA 01062(413)584-7522
PROPERTY LOCATION 260 PROSPECT ST
MAP:LOT 24C-015-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building P- :• out
Fee P. $273.00
Typ• of onstru• MUDROOM ADDITION
New • . ion
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
NI Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
MajorProject: Site Plan AND/OR SpecialPermit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Perm its Required:
Curb Cut from DPW WaterAvailability SewerAvailability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
i' �. ghoa.
Sign.I ure of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
_RECEIVED
The Commonwealth of Massachusetts
! e Board of Building Regulations and Standards FOR
5 Massachusetts State Building Code, 780`CMR A��' 202 }1du .ITY
' USk
Building Permit Application To Construct,Repair, Rennvat ` '-- CTION dMa-2°11
i rIsaEcrtoNs
One- or Two-Family Dwelling. _._.__ NORTHAMPTQN.MA01060
This Section Fox Official Use Only _
Building Permit Number: - . - q3/ - Date A ied:
1,, . :1Iiii) --41.....
I
Building Official(PrintSignature
� gnature
SECTION 1: SITE INFORMATION
1.1 Property Address; 1.2 Assessors Map &Parcel Numbers
• 1.1 a is tlri s an accepted sb•eet?yes -n o • Map?der P.arczi Nurnbea-
•1.3 Zoning lnformation: 1.4 Pro ertyDimensions: ,� 1
� ,� _
Zoning District Propose se Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required/� Provided Required Provided • Required Provided
U` '3 l 1 f JV I r g/0j �`� r 1L
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
/ Zone: Outside Flood Zone?
Public L4' Private 0 — �e i{yeSL3 Municipal C3�On site dzsposal system 0
SECTION 2: PROPERTY OWNERSHIP1 _
2.1 Ovv erl o e Record:
r4a VY t 4 K' e-'C 'ate (Yl A- 0
• ) City,see,ZEP
P am- (0t7 -(o4c?- 9911
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) 0 Alteration(s) ❑ Addition
Demolition U Accessory Bldg. Q Number of Units . Other l3 Speeifsf: _
S
Brief Description of Proposed VJorlc2: � l!/� /Li� r�[�i'�'�'1__ -- _ 7`[i�-�—
4( M4(n.� ( ! o
,'IBCW vi- - let Goo,`5 ..
1-kJ�r is .4.__ s -
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use_Only
(Labor and Materials)
l Building $ ` - I. Building Permit Fee:$ Indicate how fee is determined:
fl Standard City/Town Application Fee
2.Electrical $ /172 0 0 Tatal Project Costs(Item 6)x multiplier_ x _
3.Plumbing $ - 2. Other Fees:•$
4.Mechanical (HVAC) $ ----- List: .
5.Mechanical (Fire $ r�
Suppression) Total..An Fees: l
rJ Check No.'i�_ heck Amok /1 Cash Amount_
. 6.Total Project Cost: . $ i- Z RD 'J ci Paid is F� Cl Llufistnn g.Balanoe Due:
i
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) - , 011 , 9 C01.Z l,
bG2
C-\ 0 CAI\J ff a J.-1 License Nurzibcr Expiration Date
Name of CSL Holder
List CSL Type(sec below)
No. and Strcet
Typo Dcscriptnuu
U Unrestricted(Buildings u;ta?5,090ctt. t.)
QrenCC- NVA- DAC0 .-_, _ R Restricted I8t2 Family Dwelllog
City/Town,State,_TP M Masonry
11111 y 7:,,c R il(itin it,Covering
Li l'rI' I/ 4/1 / WS Window and Siding
SF Sot id'Fuel Burning Appliances
1-a S3Lt=1522— l ' insulation
Telephone Email address j D Demolition
5.2 Registered Home Improvement Contractor(H1C) I.���� g( !
,��� ' �Q� 4`t' 11.'— 20z2—
RTC Registration Number Expiration Date
C Compa*+Name or HIC Registr nt Name
Ikist- .Fjoo tp(3(02 tof(-r)(A YY1Ps 410( 2.-
No.and Street 4`�� �1S22_ ?✓ ail ad''eM
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 affidavit will result in the denial of the issuance ofthe building permit.
Signed Affidavit Attached? Yes .......... Yq No .O
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 \I L ,.,,e,,,
to act on my behalf in all matters relative to work authorized by this g p ' ap ation.
ST) v )1 P) L VOA -
Print Ovener's Name(Electronic Signature).c.
Dam
SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION r
By entering my name below,I hereby attest under the pains and penalties of perju y that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
\t J\19-kTap'' ..-3-118.122. .
Print Owner's or Au 7-, Agent's Name(Electronic SigiLmse) Date
NOTES:
I. An Owner who obtains a building permit to do his/her owa 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 ivad under M.G.L.c. I42A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License-can-be found at wv.w.mass.Rov/das
. 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
Nutul, 1 of firepiaees Number of bedrooms ',
Number of bathrooms Number of ha I fibaths
Type of beating system Number of decks/porches ,
Type of cooling system Enclosed Open
3. 'Total Project Square Footage"maybe substituted for"Total Project Cost"
_ City of Morthampton
;j t�iassachusetts �4` ,
(------ ,
1� y''' , N1
F-i *# • ...'...; ,
� DEPPI2TlEIJT OF BUILDING INSPECTION'S •?, 4-
L . r 212 Main Street a Municipal Building
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS) 1
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number
b disposedof��G:�7,�er is that ail debris r•es:�itiRg from this work shall. e ClSpnco'� �f in�
v..... v
properly licensed waste disposal facility, as defined by 41.E c 111, S 150A,
The debris will be disposed of in:
Location of Facility: .NsQ
The debris will be transported by:
Name of Hauler: kL.0 Vsinou t ,1-• •..-- •
Signature of Applicant: Date: TJ ��J TN_
•
•
The Commonwealth of Massachresetts
�'=�—' ll L?epar interzt of Industr'ialAccidents
'` 1 Congress Street, Suite 100
^„ �',1' • Boston,MA 02114-20I7
j' wTvw.ruass goy/din
11'akers'COm ewsafio-n Insurance Affidavit Builrters/Conn-a•Mors/Elect ans/Pluinber's.
TO BF nii.F.il WITH THE 1F.RMTTTlNG AITTi;ORfTY.
Applicant Information Please Print Legibly
Narrie(Rnsineti:/(lryxniiaiictniinciivicluxi): \IoJi- ,., cjr- e vIfi rt ,j- 0- )C
Address: b (<\vim, _- --- e-i rC . V- 0 . l' C G ( am 0 C 7r
City/State/Zip Of —2 ;t4--C (d2 Phone#: Li,«-B 9-1 S2 2_
Areyou an employer?Check die appropriate box: Type of project(required):
l.D31 I am a employer with I R employees(foil and/or part-time).* 7. El New construction
2.❑I am a sole proprietor or partnership and have no employees working forme in 8. El Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.1 1 I am a homeowner doing all work myself.fNo workers'comp.insurance required.)t _
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 U :Building addition
e.noare that all contractors tidyer.haue workers'compensation insurance or me:sole - - ILO Electrical repair's or.editions
proprietors with no employees.
12.E Plumbing repairs or additions
5.0 T am a general contractor and T have hired the sub-contractors listed on the attached sheet. 13.DROOf repairs
These sub-contractors have employees and have workers'comp.insnrance.t
DOthea-
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 1
4.
152,41(4),and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box 41 roust also fill nut the section below showing they workers'co..re,....ation policy infonaation.
t Homeowners who submit this affidavit indicating they are doing all work and thenhire outside contractors must submit a new affidavit indicating such.
+Contravtors that chetdt this box mast atta,tdan additional sheet showing The name of sub-coatrartrrrs and state'avhecher or ar t time entities nave
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. A /`
Insurance Company Name: (6e1\j r tk L vf1 r\C C� `fir =�
Policy#or Self-ins.Lio.#: Ob S S('. 3 o 2\c---, Expiration Date: 6 1 i I P
Job Site Address: gob ( eJ1r!-- 1—{i i City/State/Zip: Ir\ kin. 14} 0/OC
Attach a copy of the workers'comp sation policy declaration page(showing the policy number and expir, 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$25 0.00 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 cernfy under t e ins andpenalti ofper' e information provided above is true and correct.
Si E f 0?- - ?-0.A„,7
p, p Date:
' Phone#: tl.� ii— '1 S 22
Official use only. Do not write in this area, to be completed by city or town official I
City or Town: Permit/License.#
Issuing Authority(circle one):
- 1.Board orHealth 2.Building Department I Cityr own Clerk 4.Electrical Inspector S.Plumbing Inspector
6. Other
Contact Person.: _ Phone#: 1
i i
•
Commonwealth of Massachusetts
l:) Division of Professional Licensure
Board of Building Regulations and Standards
Constr. iaS'Pppvisor
CS-077279 T cpires: 06/21/2022
STEVEN A SIEvERMAN �r
PO BOX 6062•
FLORENCE 01062
-74
b.)p .•_ its
O)SS 3 30
n cal
(1naOZ
Commissioner i . II +c�a-
•
•
J F0/2217A61/ O•e gI %0.-4.aalr'ieec 4,
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: 18
P.O.BOX 60627 Expiration: 08//20/20/
2022
FLORENCE,MA 01062
Update Address and Return Cerd.
a I c, 20M-05/17
Finv:xc+vu‘ercMc
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.SILVERMAN "✓L 7 A a
340 RIVERSIDE DRIVE a.g .4'
FLORENCE,MA 01062 Undersecretary Not valid without signature
•
•
.