38B-153 BP-2023-0173
75 COLUMBUS AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-153-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2023-0173 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS 20232 Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 9000 INC 077279
Const.Class: Exp.Date: 06/21/2024
Use Group: Owner: TIDSWELL MARK A& STEPHANIE "'OSIECKI
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: 02/14/2023
TO PERFORM THE FOLLOWING WORK:
REPLACEMENT WINDOWS
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.
Signatu re: y? -
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
/~
/ �;
7/1 2';',,
, The Commonwealth of Massacl�trsett FOR
Board of Building Regulations an Stan rds 8 3 7CALITY
�,414);� Massachusetts State Building Coe, 7� USE
Building Permit Application To Construct,Repair;Betz tf b,. olish a Revised Mar 2011
One- or Two-Family Dwelling --7bA,�'vs/.
4Ly oecTicN
This Section For Official Use Only .�o :
Buildin Permit Number: 6 P- 01 3_/ 73 Date Applied:
K��(v � J / 2-I -U23
D 5
Building Official(Print Name) Signature a•te
SECTION 1:SITE INFORMATION
1.1 Pre Iirgerk Address: 1,2 Asses sots Map&Parcel Numbers
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 Usc 1 Lot Area(sa ft) Frontage(It)
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.40,554) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private El Outside Flood Zone? Municipal 0 On disposal system 0
1 Checkif yesa _
'SECTION 2: PROPERTY OWNERSHIP1
2.1 Owner'of Record: _
b\e,tto��C- LrIv� ',-c G (L AIL r}GIl rrt t °woo
Name(Hint) City,State,ZIP
qc Colt—. • yam... 4(3-,30- 2102
No.and Street Telephone Email 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 ❑
Demolition 0 Accessory Bldg. 0 Number ofUnits Other ❑ Specify:
Brief Description of Proposed Work2:
L►+ O`-' Cn►
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
item (Laborand Materials) Official Use.Only
1.Building $ C\C. - ^ram I. Building Permit Fee: $ Indicate how fee is determined:
�� ❑ Standard City/Town Application Fee
2.Electrical S •❑Total Project Cost3 (Item 6)x multiØlier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (IIVAC) $ List: .
5. Mechanical (Fire $ Total Ail Fpfiliit I, '
Suppression) � �J"`
Check N . heck Amount:
6.Total Project Cost: $ Ck jay' ❑,Paid in Full. 0 Outstandiug Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor I,icense (CSL) to D 77?+1`3 /2/)2cZ.f
''1 C�I. .L' ,y-.. License Number Expiration Date
Name of CSL Holder
(}�� (�,/'�'/' (s��}�//C List CSL Type(see below)
No.and Street Type Description
^t,.�� � �� ����Z. U Unrestricted(Buildings up to 35,000 Cu.tt.)
�V R Restricted 1&2 Family Dwelling
City/Town,State,ZTP M Masonry
RC Rooting Covering •
WS Window and Siding
`tom j ���.� SF Solid Fuel Burning Appliances
i p l T Insulation
Telephone Email address D Demolition
5.2 Re stered Home Improvement Contractor(HIC) + 655L2 8) i262y
' •`!� r e nA- HIC.Registration Number Expiration Date
HT Comp Name or HIC Registrant Name
.0 . 60C: i09(o 1
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 .X No........... ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize$ !L}P kerika .. V s- -:
to act on my behalf,in all matters relative to 1 s building permit application.
PQ h,t n (e 051e G T I 244 3
Print Owner shame(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 occur to to the best of my vledge and understanding.
g- J 511) 2 ,fir') 1 ?�- a-a
P-3
Print Owner's or Authorized Agent's Name(He . .•;yt 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 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
VAS"kV mass.povlocz Information on the Construction Supervisor License can be found at www.mass.uov.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 Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
Department of Industrial Accidents
Milli v 1 Congress Street,Suite 100 •
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 kI `` _ Please Print Lezi i ly
Name (Business/Organization/Individual): 1Ct.[It 1�tin G e t €once-0
Address: 3+-1O R --Ork\rt. ?• 0. 6OK (20(OZl
City/State/Zip:-Ft o[i r X✓ . 114 e- 01 O02 - Phone#: 413-SV-1'-7 c 2 2-
Are you an employer?Check the appropriate box:
Type of project(required):
I.23 I am a employer with t employees(full andior part-time).* 7. New construction
2.0 I am a sole proprietor or partnership and have no employees working forme in 8. J Remodeling
any capacity.(No workers'comp.insurance required.]
3.0T am a homeowner doing all work myself,[No workers'comp.insurance required.]t 9. ❑Demolition
4•DI amr 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,Q Electrical repairs or dditions
proprietors with no employees.
12,D Plumbing repairs or dditions
5.0 I are a general contractor and T have hired the sub-contractors listed on the attached sheet 13.0 Roof repairs
These sub-cnntratxora have employees and have workers'comp.insurance?
6_0 We area corporation audits officers have exercised their right of exemption per MOL c.
14.DOther
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 afEdavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicator such.
#Contracrors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities ve
employees. Tf the sub-contractors have employees,they must provide their workers'comp.policy number.
I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and j site
information.
Insurance Company Name: -Ay'b i`1CL -3x-)SUrav-2 t_i_ (�rvt.`o
Policy#or Se]f-ins.Lic.#: 015 3 b 2.\S_ _ Expiration Date: d I t
Job Site Address: '15 (o\UYYvI) Psvc City/State/Zip. vl o,o43,G
Attach a copy of the workers' compensation policy declaration page(showing the policy number and espir do date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1, 00.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S 50.00 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 hies of p hat the information provided above`is true and correct.
c'
Signature: f� Date: 1'7 t2>
Phone#: LiI-5- CJgt't--1cj22- --
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 Inspe or
6.Other
Contact Person: Phone#:
City of Northampton
� , ,. \ SA,.. .,
` St
." Massachusetts �� .._
r� 1F * e�
( I DEPARTMENT OF BUILDING INSPECTIONS
41 4' 212 Main Street • Municipal Building u ,a
•
Northampton, MA 01060 srj --. �`•
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: 311163 ix^` 1'Jc.),v4kQy r'
The debris will be transported by:
Name of Hauler: \ia.akj 0011A-A--
Signature of Applicant: Date: __ i0-
•
Commonwealth of Massachusetts
Division of Occupational Licensure
Board of Building Reg�ulations and Standards
Consvt tlQAT Irvjsor
fr
r.
CS-077279 a,' l pires:06/21/2024
STEVEN A 8fl.VErt • :,,. -- •: r
l'O BOX fi0ti 1.1 ) + ) '' -ya
. FLORENCE l 010ti R•
ut-f vaa 3'
'o,::T „ ner -4 (J I �.. :e
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washing � jrr et -Suite 710 •
Bostoo;EMassachusett .U2118
Home lmnro a-" rW "�' r o: a istration
j.
rjjjj 47.----•w� 4�.4i
_ J 1.;,,1 Type: Corporation
s�� ---
VALLEY HOME IMPROVEMENT INC t �' ' `i=_:_ e 15t ation: 105543
P.O. BOX 60627 i-'�i ter- �F I ation: 08/20/2024
FLORENCE, MA 01062 4`1 1 ,j= f,-..
tiy,.r - f
` _, Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affai?'tq 8 Business Regulation Registration valid for individual use only before the
HOME IMPROVEME 1t CONTRACTOR expiration date- If found return to:
TYP__E: iiporritiog Office of Consumer Affairs and Business Regulation
is --fr 1000 Washington Street -Suite 710
-� _ Boston,MA 02118
!ALLEY HOME IMP + =M T I w'
sTEVEN A.SILVERMAiI t ' -:." ':277. - A- / %/Q/�
140 RIVERSIDE DRNE`;> ':_ t -�, / •
�� 't/
=LORENCE.MA 01062 " ' �1 c
,''''`j`.. , Undersecretary Not valid without signature