30C-008 (13) BP-2022-1157
435 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30C-008-001 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-2022-1157 PERMISSIONISHEREBYGRANTED TO:
Project# 2022 APARTMENT Contractor: License:
VALLEY HOME IMPROVEMENT.
Est. Cost: 6000 INC 077279077,79
Const.Class: Exp.Date:06/2 1/202406/2 1 2024
Use Group: Owner: ZELLER BOLTON, JASON C& DAVI b J
Lot Size (sq.ft.)
Zoning: WSP Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON:09/16/2022
TO PERFORM THE FOLLOWING WORK:
APARTMENT OVER GARAGE -REMOVE SHOWER, TEMPER WINDOW, SWAP OUT BATH FAN. PERM IT FOR SPACE
ABOVE GARAGE
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 VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
j
I ' I
Fees Paid: $65.00
•
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
,A4 o The Commonwealth of Massachusetts
I °_ Board of Building Regulations and Standards MUNICIPALITY
F: •
Massachusetts State Building Code, 780 CMR USE
ri r" j USE
`RJ a_ Build' g Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011
cn One- or Two-Family Dwelling
_.__J,-;' This Section For Official Use Only
BuildinglPermi,uN ben: a ZO 2.2-.itG7 Date Applied:
' , : 111 i ,02 7 ,, , .
4a.
Building Official(Print Name) Signature I D• e
SECTION 1:SITE INFORMATION
1.1 Pro erty Address: 1.2 Assessors Map&Parcel Numbers
459 Pbre ncQ.. eCCCLCA 30G- 002-001
1.l a Ts this an accepted street?yes • no Map Number Parcel Number
1.3 Zoning information: 1.4 Property Dimensions:
WSP ).22acres - -
Zoning District Proposed Use Lot Area(su 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: _ Outside Flood Zone? Municipal 0 On site disposal system 0
I Check if yes❑ l
SECTION 2: PROPERTY OWNERSHIP1
2‘.%wnerl co.Wecpid:
otUcn(1--
Name(Print) City,state,
1-135 FkOr�ent_9- ea y[y. .)03-3518
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORTC2 'check au that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': 126f- e✓Z "5.0.4 Cr i t2rFer- vA'va 0-.)
c„-&. pens-=04- S?«c. ,- A too►-t 64c-:€-. L, -5 ;J a,-)+-
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use.Only
(Labor and Materials)
1.Building $ IlK 1. Building Permit Fee: $ ; Indicate how fee is determined:
2.Electrical $ /l< 0 Standard City/Town Application Fee
-D Total Projedt'Cost3'(Item'6)x multiplier x
3. Plumbing $ 1 K 2. Other Fees: $ M1 Y)
•
. .4 1[_ha 1 TRTAC'\ $ T i'st: .
't.1V1cl.uG.flte 1 (11 V!t'.-) .D - -- - --- -- - - .---_
5. Mechanical (Fire $ po
Suppression) Total All Fees:$ I?S
Check No.143152.Check Amount: 105'
6. Total Project Cost: $ (k 0.paid in Full . . 1171 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) U,l.P' /2 l jzO z,
-- t 1 St\ License Number Expiration Date
Name of CSSL?Holder
PO 4`�� (00(6; � List CSL Type(see below)
No.and Street • Type Description
r� t �� ��. U Unrestricted(Buildings up to 35,000 cu.ft.)
�Vc R Restricted I&2 Family Dwelling '
City/Town,State,ZIP M Masonry
RC Rooting Covering •
WS Window and Siding
SF Solid Fuel Burning Appliances
Insulation
Telephone Email address D Demolition
5.2 Reaistered]Home improvement Contractor(MC) + 6S35(4 312O/20
HTC Registration Number Expirati.or Date
- HIC Comp Name or WC Registrant am e
o 6o (oO(o "1
No.and Street • Email address
r)( r (YLc r 01 O(r>-
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. g 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 .Pg 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 tPx1 --)l L u r .s xt1. V l�L
to act on my behalf in all matters relative to work authorized by this building permit application.
� viA 3- 2.e1Iv ti 9/G12-
t er's Name(Electronic Signature) Date
•
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 true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) 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(MC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the BIC Program can be found at
uvv.niass.Qov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
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
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Preject Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
SiT1' Department of Industrial Accidents
srls g 1 Congress Street,Suite 100
4.
`i, ! Boston,MA 02114-2017
— www mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information I 1 I _tT�tYG Please Print Legibly
`
Name (Business/Organization/Individual): la llcc� - Irr.��0�1€mcr i-
tJ
Address: 110 \&L Or rc t?. 0. Pic ( Cow(2,1
City/State/Zip: 11or•erxL ke- 01 002 Phone#: y 13-Ss(-1-1 22-
Are you an employer?Check the-appropriate box: Type of project(required):
LIE I am a employer with 'e employees(full and/or part-time).* 7. ❑New construction
2.0I am a sole proprietor or partnership and have no employees working forme in 8. 2 Remodeling
any capacity.[No workers'comp.insurance required.l
3.01 am a homeowner doing all work myself. t 9. El Demolition
y [No workers'comp.insurance required.)
10❑Building addition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 1 am a general contractor and T have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp_insurance.*
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 sue .
$Contractors 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 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 s•e
information.
Insurance Company Name: 4rbe ka_ V rl Si)-ray-2(,[_ ( i r0i.\A _
Policy or Self-ins.Lie.#: Q,b'jCjO 3 b 2 S Expiration Date: o?) f ) 42
Job Site Address: \ —City/State/Zip: T-tyenC.+!.c(4 ov_
Attach a copy of the workers' compensation 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$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 un err the
, ha
pains and pe►allies of p r�/h t
at the information provided above is true and correc
• Signature: '/ // ) Date: t t 2-2—
Phone#: �� J- �gL�—�S 2 •
-
t .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#:
City of Northampton
�s ,s�
.7,,,_,,_ :
r ''' , Massachusetts �w{S _ rtc
4=7
1 � DEPARTMENT OF BUILDING INSPECTIONS 'I i
i' 212 Main Street • Municipal Building yJ/- ,
Northampton, MA 01060 fyi k1
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: s`AU '�ffL : s M0/-4-41Curn-fk
The debris will be transported by:
Name of Hauler: j00'1/ — 1,vvfl,C\If_XYl_e...k.
Signature of Applicant: Date:
Commonwealth of Massachusetts
1. Division of Occupational Licensure
Board of Building Re ulations and Standards
If'
Cons Ion� rvisor
-) I
CS-077279 �' I spires 06/21/2024
STEVEN A S_ VERMAf . if 4]1 " 4''
PO BOX 606 14 'i I i h,! 5 E 4`''''' .
FLORENCE lill'A 01062 :
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THE COMMONWEALTH OF MASSACHUSETTS
^ 1>
Office of Consumer Affairs and Business Regulation
1000 Washingtd i treat- Suite 710
Bostortr Massachusetts�02118
Home Im ro'emerttYC{� "frac ocTegistration
—11
gym ... 17
: ,k i ;:wry,.4.'i
t�'j _ -�'`f' - tr' Type: Corporation
VALLEY HOME IMPROVEMENT INC �s ' a ist ation: 105543_" "\ - " I ation: 08/20/2024 024P.O. BOX 60627 _;\ - •v-rirs
FLORENCE, MA 01062 \""� � 1 " '"r '' . ' I1f I
t~I -,=- _ r
�"" Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affails,,& Business Regulation Registration valid for individual use only before the
HOME IMPROVENIEN7'CONTRACTOR expiration date. If found return to:
1 PE`-�b�po atiorr Office of Consumer Affairs and Business Regulation
Registrattati EXi iration 1000 Washington Street -Suite 710
q,,ryr 4W..rF ga. ery/k024 Boston, MA 02118
1j h _j,
—9ACEtY HOME 11VIPf9 T I _-5
STEVEN A.SILVERMAN:u. --1��• _'
40 RIVERSIDE DRIVE''-Yr'.; 'S<,5 :*,;t'`-_ G ,m,st CL.(
FLORENCE, MA 01062 .;{ i,~ 1 7"
,
Undersecretary Not valid without signature