23A-199 BP-2022-1409
49 BEACON ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-199-001 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-2022-1409 PERMISSION IS HEREBY GRANTED TO:
Project# 2022 RENO Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 111300 INC 077279
Const.Class: Exp.Date: 06/21/2024
Use Group: Owner: GRINNELL, WILLIAM D. WEAVER, DANA
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: 10/31/2022
TO PERFORM THE FOLLOWING WORK:
RENO 2ND FLOOR BEDROOM & BATH,ADD CO& SMOKE DETECTORS
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 VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
14 ! . .
Fees Paid: $723.45
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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-C E V 9 ''
The Commonwealth of Massachus tts 202 jFo
Board of Building Regulations and St dar OCT 8 C ALITZ'
Massachusetts State Building Code, 7 .0 . r r z
Building Permit Application To Construct,Repair,R no _ Re ised a,!2011
ICDING INSPE TIONS
One- or Two-Family ily Dwellin -- NORTHAMPrON MA 01 lI
This Section For Official Use Only
Building Permit Number: $Q ZO2--I L4-O Date Applied:
dt�
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Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pr gierty Address: , 1.2 Assessors Map&Parcel Numbers
1.1 a Ts this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
/Ai ,3 ac4z-
i,ys J
Zonine.District Proposed Use Lot Area(sq ftl 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.T_c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public 0 Private 0 — Cheek ifyes❑ Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP1
2.1 Owner'of Re rd:
U.l lltawt r l n lntU c tcye r cC X Q- Ca O(o�
Name(Print) City,State,ZIP
Lk.C1 Ca•-,Sk- Love- 5 g 2�
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION nE PROPO-SEED WORK1(cheek all that apply)
New Construction❑ Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) Cl Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work2: 2. (W oO�1_ C r-OOP.., f3
1•i 0 S t4Ci 1..'ML L1464i 6c5 . CO 4- 5),�OZc E-C---_
'c Gj r J ' c CoVe-, .
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ $� 00 1. Building Permit Fee:$ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ 41 30D ❑Total Project'Cost3'(Item'6)x multiplier x
3. Plumbing $ (a, S O O 2. Other Fees: $_
4.Me auicai (II AC) . i t t O D O T ist:
5.Mechanical (Fire V Total All Fees:$
Suppression)
Check No.N 3 L(,j'Check Amount:.?a3. 115.
6. Total Project Cost: $ I 3 0 0 ❑:Paid in Full . . 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL) 0 i 3.Plq 6/2/ 12oZ.-y
Nf.i�s-rek c...r l ,4'n-s, ,4—,- Li CMS e Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
V `':' CA (6DU Dfl
No. and Street Type Description
LiUnrestr.cted(Buildings up in 35,000 cu.fl.)
r am" �� r R Restricted i&2 Family Dwelling
City/Town . IP M Masonry
RC Roofing Cove,ing.
WS__._ Winslow era Siding
i`` c � SF Solid Fuel Burning Appliances
1.So'iT152 I insulation
Tel cDhonc Email address I D Demolition
•
5.2� ered Rome Improvement Contractor(HIC)
r , Ti- ,�. -,� Igt54 x
�-� HIC Registration Number Expiration Date.
HT Comparjy Name or HIC Registrant%ame
No. and Street Email 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 affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ., No . ❑
SECTION 7a;OWNER AUTHORIZATION TO BE COMPLETED WHEN
OS ER'S AGENT OR CONTRACTOR APPI,IFS FORBUILDLNG PERMIT
I,as lwner of the subject prop ry hereby authorize$ eXM cat I�..)tif -r, V t- y
to on b in all matt lative to work authorized by this building permit application.
Print Owner'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 perj t all of the information
contained in this application is true and accurate to. knowla ge• erstanding.
-- i- 8e3 if Si L V k4 if fir) 4 ?--zse.;_;t ,
Print Owner's or Authorized Agent's Name(Electronic Signature) Dare
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 fund under MG.L.c.142A. Other important information on the HIC Program can be found at
wv,w.mas .gcvInca Information on the Construction Supervisor License can be found at www.rrass _;v•dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementiattics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half7baths
Type of heating system Number of decks!porches —
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
The Commonwealth of Massachusetts
gil�: _ Department of Industrial Accidents
-t_firtm I Congress Street, Suite 100 .
V,14—) Boston,Mil 02114-2017
�F www.n:ass.gov/dla
Workers' Compensation Insurance Affidavit: Builders]Contractors/Electricians/Pluntbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information • Please Print Legibly
Name(Business/Organization/Individual): \Q f l-Cc) t'rOcn G 'TYv't er-0.4 e r n z r' i . 'Tr-IC-
J
Address: -\O R1/4 ✓ ,\Gkz ri�cc. P. O. Fpcc CAO(c21
City/State/Zip: t-\Drencc k 0) 002- Phone#: t-t,t3-SS4-7 S22-
Are you an employer?Check die-appropriate box: Type of project(required):
I I am a employer with !e employees(full and/or part-time).* 7- 0 New construction
I am a sole proprietor or partnership and have no employees working for me in
S. El Remodeling
any capacity.[No workers'comp.insurance required.l
9. ❑Demolition
3.0T am a homeowner doing all work myself.[No workers'coma.insurance required.)t
10 0 Building addition •
4.01 am a hom:owncr and will be hiring contactors 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. 12.0 Plumbing repairs or additions
5.0 I am a general contractor and T have hired the sub-contractors listed on the attached sheet. ]3.nRoof repairs
These sub-rnntiactora have employees and have workers'crimp.insurance?
6.0 eareacorporationanditsofficershaveexercisedtheirrightofexemptionperMGLc. 14. Other
\
152.§1(4),and we have no employees.[No workers'comp.insurance required.l
*Any applicant that checks box#1 must also El out the section below showing their workers'compensation policy information.
t Homeowners whe submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating su:h.
tCootractors 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, If the sub-contractors have employees,they must provide their workers'comp.policy number,
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Comjany Name: -Aybe\,\C_ "lf1 Sti.tr0.y-2 ( i v C t \O h
Policy#or Self-ins.Lic.#: 0b cDC O ' (2 \\S Expiration Date; o?) € C)e.�3
Job Site Address: '1 q eCk.0 9- City/State/Zip: FtC.vey'tCC ma U t 0627
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 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.
Ido hereby certify un er the pains and pe ties of p r hat the information provided above is true and correct.
5iEnature: �- /�j? ,#,(/? Date: CA I 2V22
Phone#: Lk I J-S 4---1 S2 2- .
Official use only. Do not write in this area,to be completed by city or town official
City or Town: -PerrmitiLicense#
Issuing Authority(circle one);
1.Board of Realth 2.Building Department 3:City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector
6. Other
Contact Person: Phone#:
•
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City of Northampton
Massachusetts �w� ef
3 j c A=7 dint .c
`- 1_ DEPARTMENT OF BUILDING INSPECTIONS
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212 Main Street • Municipal Building j_.
s `
Northampton, MA 01060 r1�T�h
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CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, 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: LIC,t3
The debris will be transported by:
Name of Hauler: \ICLUQ,j 00(1A-_. UG
•
Signature of Applicant: Date:
Commonwealth of Massachusetts
�� Division of Occupational Licensure
• Board of Building Re ulations and Standards
Cons y Hilelivisor
f
CS-077279 i }} Ikpires: 06/21/2024
l.4 F� •( r M + `.•,.
STEVEN A SIA.Vir,stll ,� J
PO BOX 606 r I t r.f i I (' 5 3 `. •.%�
FLORENCE IAA 0106 l + •f,,' .r ''; -I d r+
tW 1;.
Co...:ussio ner .a9,. 0- e Y.. .A•• I ..�s' 1
THE COMMONWEALTH OF MASSACHUSETTS
,�1
Office of Consumer Affaiis at l'IN nd Business Regulation
1000 Washing Eyre- Suite 710
Bosto ;-MassaGhset •u 02118
Home Im roe tb... ra of F egistration
. � _ . M' wy j f 7 a iw .+
i ='.: .;;, _ „..0 Type: Corporation
VALLEY HOME IMPROVEMENT INC ,� t•--•- -..`' - e ist ation: 105543
+.A , :..n: ,:: :::: E pj ation: 08/20/2024
P.O. BOX 60627 \'�1 " ' • i ; . :,,
FLORENCE,MA 01062 - ^ "_:--.��:' i,, d
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ft
..._ Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affaile,$Business Regulation - Registration valid for Individual use only before the
HOME IMPROVEth ''CONTRACTOR expiration date. If found return to:
TYPE: &orittioil Office of Consumer Affairs and Business Regulation
Regist ate �iERbui'ati 1000 Washington Street -Suite 710
$ '�'_ 2UI Boston,MA 02116
VALLEY HOME IMPR .. Trn1 -_ l�;''
STEVEN A.51LVERMAit '� b
340 RIVERSIDE DRIVE',:. --} / " C�
FLORENCE,MA 01062 =.;`• -
'"`A�'`"`?'.,. Undersecretary Not valid without signature