31A-244 (3) BP-2023-0106
67 KENSINGTON AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-244-001 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-2023-0106 PERMISSION IS HEREBY GRANTED TO:
Project# BATH reno 2023 Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 17000 INC 077279
Const.Class: Exp.Date: 06/21/2024
Use Group: Owner: PARASCEVE ATKIN MICHAEL P &
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: 01/31/2023
TO PERFORM THE FOLLOWING WORK:
TILE BATHROOM FLOOR AND WALLS
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:
(1(144"- _ 1/
Fees Paid: $110.50
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachu 'tts SON 3
I °. I Board of Building Regulations and S ndards 2023 //� "IVII/NICIPALITY
Massachusetts State Building Code, '7',, r1� • ! USE
Permit Application To Construct,Repair, Rerovit'e" '�� ..i visedMar 2011
One-or Two-Family Dwelling h•M�� 60 ....
2 This Section For Official Use Only --„�
60 3
Building Permit Number: 3 "' 1 0 C I Date Applied: .
44y �2 /-31-2 3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map &Parcel Numbers
cal S{pf,sk r, `r 1kr e--
1.1 a Is this an accepted street?yes no Map Number Parcel Number
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 CI Private❑ Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yesC
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: 0.,N k-N. OLOCs,O
Name(Print) City, ZIP
(Di k e3n . , -, • PA1C— trbg,-ot%-9.3t-�
No.and Street Telephone Fmail Address
SECTION 3:DESCRIPTION OF PROPOSED WORK' (check all that arply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:__
Brief Description of Proposed Work2: IF
—
Taz- b i-., -Roo r- 6Ce-, .� ksl
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only .
(Labor and Materials)
I.Building $ /2K 1. Building Permit Fee: $ Indicate Low fee is determined:
2.Electrical // 0 Standard City/Town Application Fee
$ `� '0 Total Proleet'Cost''(Item.6)x multiplier x
3. Plumbing S 2. Other Fees: $
4.Mechanical (ilVAC) $ . List:
5.Mechanical (Fire $
Suppression) Total All Fees:$ lilf0°
Check No 4 11 Check Amours ``-
6.Total Project Cost: $ Illt f 0 paid in Full. 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) �q e,12 i f G0�y
C. l7
a � (1�{?�,�r}-�Q,t License Number Expiration Date
Name of CSL Holder
List CSL Type(sec below)
No.and Street Type Description
�kor (-ha OW G7 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted I&2 Fami ly Dwelling
City/Tow �' i,., TP M Masonry
/����� RC Roofing Covering •
U WS Window and Siding
r� -} SF Solid Fuel Burning Appliances
(-5 2H- )Sls I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(FM)
RTC Registration Number Expiration Date
T-TTL Compa4 Name or HTC Registrant',Tame
7c tOa($ 1
No.and Street Email address
fthrerg..4- fYIG- tfXo01--
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(rsl.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 ., No........... ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
f.
I,as Owner of the subject property,hereby authorize _A ta4X1 Cl l ue,v h[X!-t . V J
to act on my bchag in matters relative to work authorized by this building permit application.
Print Owner's ame(Electronic Signature) I Z 3
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and p ties of perjury that all of the information
contained in this application is true and ace the of vledge and understanding.
--t vr" cl LU Rt) --7-7-- 07ca3
print Owner's or Authorized Agent's Name(EIectronic Si e) 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(HIC)Program),will not have 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
\;ww ntass.aov/oca Information on the Construction*Supervisor License can be found at www.tnass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor arca(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 halflbaths
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
P: gl Department of Industrial Accidents
_sue(- ?i, 1 Congress Street,Suite 100 .
!= Boston,MA 02114 2017
wwiv.inass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Numbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information t Please Print Letribly
`I
Name (Business/Organizntion/Individual): a I.t-e`J ti-.0tY1 C. -Em �e �1€im c'v I h C.'�-4 ,
Address: 5-10 Rkv-evS\At. )�r-t�re. ? 0. ?D i< CcO(c)Z1
City/State/Zip: t=1 Oi-e rg_G k& 01 O b2- Phone 4: - 43-SS(--l--I S22-
Are you an employer?Check
{t.e•appropriate box: i Type of project(required):
Liz I am a employer with t e employees(full and/or part-time).* 7. ❑New construction
2❑I am a sole proprietor or partnership and have no employees working forme in 8. Remodeling
any capacity.[No workers'comp.insurance required.)
01 am a homeowner doing all wok myself.[No workers'comp.insurance required.]I
9. 0 Demolition
10❑Building addition
a❑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 11.0 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 13.0Roof repairs
These.rah-contractors have employees and have workers'comp.insurance r
6. We are a corporation and its officers have exercised theirri t of exemption 14.QOther'
❑ omp right mpti on per MGL c.
152,§1(4),and we have no employees.[No workers'comp.insurance required.] .
*Any applicant that checks box#1 must also 511 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 such.
tContractors 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 suh-contractor 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 Company Name: Ar `,`OL 11, V1 SurC Y- c.,L �rl a-Ot,v
Policy#or Self=ins.Lic.#: 0.bGj5O 3 b 2,\S Expiration Date: 02) 1
Job Site Address: (d) 2A1SL City/State/Zip:k a y, yi o-d 1 M a'
Attach a copy of the workers' comp .satioon policy declaration page(showing the policy number and expiPation date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500 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. .
I do hereby certify un r the pains and pe ties of p hat the information provided above is true and correct
Signature: ��//? ? Date: 12. t2
Phone#: L -5— ug'-1-1S22
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);
11.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other •
Contact Person: Phone i':
City of Northampton
aYH"+K
Massachusetts - s ?
!` i l, I.
1 # l .c
, _� _y,
DEPARTMENT OF BUILDING INSPECTIONS ;,^,
212 Main Street • Municipal Building "r ;.,
--,. Northampton, MA 01060 s)yY ��\
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: ' PWt A, �g'ffjC,6-. ; MC1✓- LCLn'�- p v
i J
The debris will be transported by:
Name of Hauler: \ja,a0j 00(1A-k--- T-tlik-e' VOVerYLe---("4—'
Signature of Ap.plicant: :Date: %-
Commonwealth of Massachusetts
9Division of Occupational Licensure
Board of Building Re ulations and Standards
ti'
Cons ton$ rvisor
.P
CS-077279 1 � E-*pires 06/21/2024
STEVEN A S vER r lye
PO BOX 606 1 r It - �,f , ,a
FLORENCE I(f!'A 010s2 , e,
•
.v� •r }. {e, i. 41
r/r.1va,1'-
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affair. 'nd Business Regulation
1000 Washingtq ,tie, - Suite 710
Bosto -Massacfosett~, , 118
Home lm ro .t= ac or egistration
` ;
' - # ~~'_ 4,,,,.1 Type: Corporation
(rot r � e is ation: 105543
VALLEY HOME IMPROVEMENT INC 1J �" ; �-_ Eii ration: 08/20/2024
P.O. BOX 60627 f ; p;_ -
FLORENCE,MA 01062
`" r�—"'
��j,w�F"-.. �,./ IN. /
,
1�`" 1, Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affaiis.$Business Regulation • Registration valid for individual use only before the
HOME IMPROVE,A�E,11 ONTRACTOR expiration date. If found return to:
TYRE.�'C ftpontLion Office of Consumer Affairs and Business Regulation
Reglst'atf$ii` 7�E7ttfr :All 1000 Washington Street -Suite 710
" c L�.F•.41
la
Boston,MA 02118
VALLEY HOME IMP '4A. ,T 1 -• t
i,._ r. " 3.
II t'-? =`,. j'i
STEVEN A.SILVERMA 4c,_r - '•,
340 RIVERSIDE BRIVE'C,:. ' . ,7. ' .a.g
FLORENCE,MA 01062 ; f ; ,r; Undersecretary Not valid without signature