30C-083 BP-o 022-1285
144 CLEMENT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30C-083-001 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-2022-1285 PERMISSIONIS HEREBY GRANTS S TO:
Project# KITCH RENO Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 87150 INC 077279
Const.Class: Exp.Date:06/21/2024 .
Use Group: Owner: DAVIS J MICHAEL&ALINE LABOR T-DAVIS
Lot Size (sq.ft.)
Zoning: SR Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P 0 BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON:10/11/2022
TO PERFORM THE FOLLOWING WORK:
KITCHEN RENO
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:
lE
Fees Paid: $566.48
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Buildine Commissioner
A
4,, The Commonwealth of Massach eats -i F R
4,/ . Board of Building Regulations and tan ds OCT
Massachusetts State Building Code 780 7 202 I ctALITY
Building Permit Application To Construct,Repa'-;,) not?att molish a ev1dMar 2011
One-or Two-Family.Dwelling O�TyA C'�nGpvsp
This Section For Official Use Only n/.MA O'osC1oip Ns
Building Permit Number: 6109^ a 2" "12 FS Date Applied:
41.0 a5 ,i/i2 JO-►l'zozz
Building Official(Print Name) Signature D to
SECTION 1:SITE INFORMATION
1.1 Prupe Address; 1.2 Assessors Map Parcel Numbers
t`I1 &CA-crn S4— C. o 73
1.1 a Is this an accepted street?yes no Map liniber Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage f lt)
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.40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private❑ Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
I Check if yes0
SECTION 2: PROPERTY OWNERSHIP1
1 Owned of Record:
VAyek .�!-4.Lf\C&cs ,v Ls ACC(. 1r —_ _o.o(.07-
Name(Print) City, State,ZIP
4. 4 Slr 4 t 27-320—(033S-
No.and Street Telephone Finail Address
• SECTION 3:DESCRIPTION OF PROPOSED WORK2 (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition . ❑ Accessory Bldg. 0 Number ofU its I Other ❑ Specify: {
Brief Description of Proposed Work2: (C., vy1 e.0 PR r% D d, - N R..t4 1 1)tJ d 0 u S 4-
C.4t Amita, .kb Sit v+v,/4 1 r ILi k,,fix 1 -
1
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ f) Co Q I. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ )vU� •
0 Standard City/Town Application Fee
'❑Tdtal Project"Cost'.(Item'6)x multiplier x
3.Plumbing $ 1) , �0 _t ( 2. Other Fees: S
4.Mechanical (IlVAC) $ Ligt:
5.Mechanical (Fire $ Total A!1 Fees:$Suppression) f�✓' /.0 `�1
Check No XI Check Amount: Y
6.Total Project Cost: &7 I SD— 0 Paid in Full . 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
-----
SI Construction Supervisor License(CSL) 011?-19 6,3 12 ozy
License Number E%pilatiun Date
Name of CSL Holder
List CSL'Type(see below)
No. and Street Type Description
eteCC Ch° °k° 2—. U Unrestricted(Buildings up to 35,000CU.
/ Restricted I&2 Family Dwellins
City/Town,State,ZIP M Masonry
RC Rooting Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
(3SSCk1522--- I Insulation
Telephone • Email address D Demolition
5.2 ReFistered Home Improvement Contractor(MC)
6S5(1 /21262-A
IND-WLA . .kersk— HIC Registration Number Expiration Date
FTTc CorripatI Name or HIC Registrant Name
65eic 4.004 -1
No.and Street Email address
fibre-Mt C)
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 of the building permit
Signed Affidavit Attached? Yes 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 authorizet oevrmou--, V
to act on my behalf,in all matters relative to work authorized by this building permit application.
IfY1,chke toy‘& 4tt
Print Owner's Name(Electronic Signal Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of.erjury that all of the information
contained in this application is true and accurate to the b < my knowl—,1-.and undemanding.
S.I .--Vv%) A Si L st)wthi fiA)
j - 2 I - 2-
Prim.Owner's or Authorized Agent's Name(Electronic ignaturd) Date
NOTES:
1. An Owner'ate 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 nothave access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
v.ww.massrn. o Information on the Construction Supervisor License can be found at www.rr.asN co\ Jis
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 halfbaths
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"
The Commonwealth of Massachusetts
e::: l'
Department of Industrial Accidents
;saw 1 Congress Street,Suite 100
iii fc_ rl Boston,MA 0211 4-2 01 7
=,6,1- www.mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information 1 i - Please Print Letibl'
Name (Business/Organization/Individual): Bat t-C3 1�-CNYIC �rrt e--0.-.1€01 Cry4 - T.Fri c_.
Address: 5-IO Q\,-.Yer-s\dt ---)n rc . 0. Xoac (a0(02:7
City/State/Zip: r lot-et- u, ke- 01 002- Phone#: t-1,t3-GS4- 1 S22-
Are you an employer?Checktbe•appropriate box: Type of project(required):
l.E3 I am a employer with 1 6 employees(fall and/or part-time).* 7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working for rue in 8. 19 Remodeling
any capacity.No workers'comp.insurance required]
3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.)t
9. El Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
10❑Building addition
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 I 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 141 must also Ell out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicaramg they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractws 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 site
information. qq
Insurance Company Name: -r't1r1ce11C>` -:_tYISurQY)t:.1.... 6;1 rot,`o ,�-�Z_
Policy*or Self-ins.Lic.#: U655o 3 b 2\S Expiration Date: o?) f )•tadOe --�
Job Site Address: V-M aunVt,Q,i - a City/State/Zip: tofein f v1- 41 U(o'L
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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify un r the pains andpe ties of p r/�h��att the information provided above is true and correct
SiSignature: 1 fat/ .) Date: B 11(012-2-
Phone#: Al ' 'es(A--1 S2 2--
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
f. ether
Contact Person: Phone#:
City of Northampton
1 ' Sf
Massachusetts
I S A * t -,G
i DEPARTMENT OF BUILDING INSPECTIONS V42} F
t� !' 212 Main Street • Municipal Building
\ - a;e-. 0 3 �
,. Northampton, MA 01060 *;61 (1
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of
in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: Ti Unit� M CY-
The debris will be transported by:
Name of Hauler: \ialtaj CXVt- _ ThiT1f(
Signature of Applicant: Date:_ FT_ £z- z
Commonwealth of Massachusetts
® Division of Occupational Licensure
• Board of Building Re ulations and Standards
1r
Cons ton S ttvisor
CS-077279 �' ( L pmres:06121i2024
STEVEN A St VERMAlZ4 y : „ ;,'.. i.:
PO BOX 606 11 �r
FLORENCE Ilh'A 010621 .i :$ `
i4I ;: ,i�,1,
4'011.Vt-03-
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pp ,
Cc--issioner I. N...,..•
_
THE COMMONWEALTH OF MASSACHUSETTS
r
Office of Consumer Affairs a'nd Business Regulation
1000 Washingt - rgpt,- Suite 710
BostorwMassachlsetts O2118
Home Improvemenfractor egistration
_L �z r
1
i
:s")t ,-; .ir,r,,.f, 1 i rr 1,Type: Corporation
` t.tI .:: 1 I = .14egist1mation: 105543
VALLEY HOME IMPROVEMENT INC l
• s 0l l ,�,,,-.1 , l E fiifation: 08/20/2024
P.O. BOX 60627
FLORENCE, MA 01062 ., ,.1, - , ,z;: ::j '"„ .!'
\;,:,,l ti` Y• .-N •
V
r Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affaii e.8 Business Regulation Registration valid for individual use only before the
HOME IMPROVER Effi?CONTRACTOR expiration date. If found return to:
TYPE:7`drporiItioni Office of Consumer Affairs and Business Regulation
Realst atio'H tgbiratin n_ _ 1000 Washington Street -Suite 710
54$ 0$01201 0 24 Boston,MA 02118
VALLEY HOME IMPRp, ,EMP.NT!FIt
Y
STEVEN A.SILVERMAki tlit1
340 RIVERSIDE DRIVE 4‘.„fa.4„4,' I/141(1/ 7'
LORENCE, MA 01062 ;_i,:a ,i,..
Undersecretary Not valid without signature