29-585 (5) BP-2023-0515
103 WOODS RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-585-001 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-2023-0515 PERMISSION IS HEREBY GRANTED TO:
Project# BATH RENO 2023 Contractor: I License:
VALLEY HOME IMPROVEMENT
Est. Cost: 20300 INC 077279
Const.Class: Exp.Date: 06/21/2024
Use Group: Owner: K BALDWIN MARK J&MARY
Lot Size (sq.ft.)
Zoning: URA Applicant: VALLEY HOME IMPROVEMENT INC
Apalicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON: 04/25/2023
TO PERFORM THE FOLLOWING WORK:
2ND FLOOR BATH RENO
POST THIS CARD SO IT IS VISIBLE FROM TILE 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 • 'ir • y9 3-1
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Fees Paid: $131.95
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commissi ner
' SC.1: ''-
ki
l ,IN� The Commonwealth of Massa use. A
Board of Building Regulations d Stan Ids 5 2023 F°R
•Ii ii$ Massachusetts State Building Co _?8 i MUI C]PALITY
Building Permit Application To Construct,Repair,Reno a fate-Qt ri a�J Re,AsedMar 2011 '
One-or Two-Family Dwelling r°`o Ns
This Section For Official Use Only I .
Building P 't Number; P A 3- i i 15- Date Applied:/ ,,...,,i6-3 (00-05
7
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Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.] Propertype Address: S � � 1.2 Assessors Map & Parcel Numbers
1.1 a Is this an accep d street?yes X no,_ Map Number Parcel Number
1.3 Zoning information: • 1.4 Property Dimensions:
Zoning.District Proposed Use Lot Area(sq ftl Frontage(ft)
i
1.5 Building Setbacks(i't) i
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 Cltock Ifyes0 l
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
hai k.A(1ftt,r". d.w.r-. -AOren(L Ma-- 0\ -Z '
Name(Print) City,State,ZIP
. 10s U XDC S td L113."a o-c t 1
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied 0 Repairs() 0 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. ❑ Number of Urdts Other 0 Specify:
Brief D s iption of Pr osed Wo l: iitlAel 1-, ° Ft 43113.) - lvo
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SECTION 4:ES I]MATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ l' (G/ 000 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical • $ 8L/ 0 Standard City/Town Application Fee
'O Total Project'Costs'(Item'6)x multiplier x
' 3.Plumbing $ 3)50O. 2. Other Fees: $
4.Metarrical (II AC) $ List: .
5.Mechanical (Fire $
Suppression) . Total All Fees;$ 431 I Q6
�!' Check No.4� ' 'Check Amount: (3 '
[.1�0�
6.Total Project Cost: $ 300 CI Full. ❑OutstaudingBalanceDue:• . —
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v ICES
I CONSTRUCIION SER -:--—- ----i----:;75-
67/211.2°--7 •
_ '----- - '
5.1 Corutruction Supervisor License tCSL)
1-
07- F
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<-ire.),.....-tirv_Dl‘.,_11,174)._,A70-‘,.(i.a----• _ — -------Lii.eese Numbee aipsratioo Date
Name of CU.Holder List rst Tyre Gsr below) _
m
,;() 0 ,G6.<1 too(L3 -3. .. _ Type Descr lotion
to0 3S 30 cu.ft.)
No and Street U th.7"restnt1-i-C131".("is uP 4
---ii Re.sti fried 1&2 Family Ouielling
..s:-.Aoloilkx,„ 0-10 Ok 0
1,44s0Hry —
CuyirTown Stiate,ZIP
Roofio_ Covent's
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al
il3c1S(i-lie0. 2;:-7-' sulatinn lnin In
N- — IIIMIWS SWoil7ndiZe8Intiod Srna4n1 Appliances
— D Demolition
--Entail and ess _Te1ephore_
1 Si Reuistered Rome Improvement Contracuir (HIC)
1 FOC Rtgt5tilsq,t3 Munbot'
1 i\k/ILLt. • Ir.,L1._-•4-_,- Trh....r0-e-n"s-_t_-tr__IA-
IRic •Name or WC Regratrant amt
i4oTand Street
...ficeL.- ..
Email dress
City/Town,State,ZIP ,. ..
crl,IZE Ok(24,2.--
Telephone
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ad
SECTION 6:WORKERS' COMPENSATION rNsuRANCE AFFIDAVIT(rif.G.L.,c. (52. § 25C(6))
Workers Unripe-matron Insurance affidavit must be completed and submitted with this application. Failure to provide
i this aftdavrt will resift in eve denial of the Issuance of the budding pcinit.
Signed Affidavit Attached, Yes ,. ,. . -pir
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SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN i
OWNER'S AGENT OR CONIRA.CTOR APPLIES FOR BUILDING PERMIT
L as Own= of the subject pi°perry,tie:eby alrthoria-ekte -NC--)t t i„)es,t22, .. V
, to act on alY behalf in all matters relative to work autonZed by this building permit applicari.rin
14, ..,2 ill •1 ,
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Print Oweers Naine t ' * - :. ore Dart t
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SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hesc,by arrest under lc pains and pern1tje o ijy that all of the information
contained in this appbcation is rae and accura:e t ,. mt ofpby , and widerlanding
, , / , , ,
yr-Lin:0 S7 L 1J L,* 1')0- 'iii,/ ,, ' ' 1" /
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Prix Owner's ar Authorized Agent's Name(Dear t -1s.,--=a 4, -
Date
NOTES: ^-1
I An Owner who obtains a btailding permir to do'nJs'll ex own work, or an owner uto hr. es an unregistered conzastor I
(not registered in the Home Improvement Contractor(IBC)Piograzi), will not have act-cos' to the arbitration
program;cr guaranty fund=der Mai, c. I42A. Other laFollaal infOrruilibil On the RIC Program can be found at
wwn niaos zoo`oca Information on the Constriction Supervisor Liz.tase can be found at v,,,w\y tiliks,s
2 When substantial work is planned, provide the infamau al bel 0-c.- I
1
Total Goof area'sq. ft.) (including garage,tnished basement/attics, decks or poreb)
Gross living area(sq. ft.)
.... Habitable roort count Number db./enlaces
Number of bedrooms I
Number of bathrooms_
fype of heating system
_
rype of cooling tiysteal
_ Number of hallitseris --
Nuttlat,t of deal/poi L 44-- -
_
Eatleseri
_ .
. ___._____ ..... .....
i 3 -To taj Ploina Square Footage"may be subsututed for-fool pr3Ject case, ,__—_____ _
__ The Commonwealth of Massachusetts
- . Department of Industrial Accidents
7. - I Congress Street, Suite 100
Boston, MA 0211 4-2 01 7
Workers'Compensation Insurance Affidavit:Builders/Co.Builders/Coun-actorsiElectriciaus/Plunabers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information I l' _ • Please Print Legibly
Name (Business/Organizationllcdividual): \V 0.t t-e3 1'rcitY)G..3.Yrm eeza•-•12 Yv1t-r-1-1 . 'h (-
Address: --O g0-..\-e.trs\GtC --0 r 1\SC- ?- Q. 6cac Gocg0Z1 •
City/State/Zip: t-lC;r u. e- al 002_ Phone 4: LI l3-S L1-1 S22
Are you an employer?Check the-appropriate box: ' Type of project(required):
1.23 I am a employer with 16 employees(foil and/or part-time).*
7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working forme in 8. IN Remodeling
any capaciy.)Tlo workers'comp.insurance required.}
3.❑T am a homeowner doing all work myself.(No workers'comp.insurance required.)? 9. ❑Demolition
4.01 am a homcowncr and will be hiring contactors to conduct all work on my property. I will
10❑Building addition
ensure that all contractors either have workers'compensation insurance or are solo 11.0 Electrical repairs Or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs
h These cu -cnntrarmra have employees and have workers'comp.ingot-Anne.;
6_ We are a corporation and its o racers have exercised then ri t of exemptionI4.❑Qthet'
❑ gh per MGL c.
152,k1(4),and we have no employees.No workers'comp.insurance required.)
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'Any applicant that checks box 41 nmst 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 anew affidavit indicating such.
:Contractors that check this box moor attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees, If the sub-canb-actors have employees,they:rust provide their workers'comp.policy number.
I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: fiY'Y `\0._ -,:sY-1 o ►n CA___ el rUt_,P
Policy#or S elf-ins.Lic.#: C.).O -J 0 3 b 2 \S Expiration Date: (9) f ).
Job Site Address: •1C) woca.9 \ City/State/Zip: AA0(eici( __.V'O 01.0 bL
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 tlhi c statement may be forwarded to the Office of Investigations of the DIA for insurance
coverageserification.
e
I do hereby certify 7 ,ipains and pe ' ofp hat the information provided above is true and correct
Signature: /0/? Date: `4 12O2:
Phone#: • LA1.3- E 4--i 2Z
Official use only. Do not write in this'area,to be completed by city or sown official.
City or Town: Permit/License#
.Issuing Authority(circle one):
1.Board of Aealth 2.Building Department 3.'CitytTowu Clerk 4.Electrical Inspector S.Plumbing Inspector j
6. other •
I
Contact Person: Phone#:
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City. of Northampton _
Ma s s achusetts
r XJ.;.A %CMG
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
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CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROYECTS)
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.
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The debris will be disposed of in:
Location of Facility: 4) 116i
)
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The debris will be transported by:
Name of Hauler: \ICt.Th.j VCVCAYLZA. "--)
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•-• 020—,
Signature of Applicant: At 1/k ) Date:
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Commonwealth of Massachusetts •
Vir Division of Occupational Licensure
Board of Building Re ulations and Standards
Cansi tlo�nT rvisor
-, .r •
CS-077279. t cpires: 06/21/2024 •
STEVEN A SI VEIL i;:'J " ( ltP>r .
PO BOX 606 IR f';.f"i'• i,r.i `,,,i
At..
FLORENCE NeA 0100 : F• ;.»lr := 5, 1
VC1(.LVd.1'3� i1it
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THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affa�i d Business Regulation
1000 Washings fi x kSuite 710
BostogplAgssaglzuse 0 118 '
Home Im ro d' erT T ;" 3O:r- egistration
. ri — — VC - -4----z=r I (A.,' .
r. 79— . ,,... ..,.... ________ {,:.,,,,
, c„, ..=.. ,,, ,,..:„.„.„, ,,i. . •
F. .., ..t.•:.4... hi Type. Corporation
VALLEY HOME IMPROVEMENT INC i 4 ---Y,e . ation: 105543
P.O. BOX 60627
�'r1 i'" T " E jration: 08/20/2024
FLORENCE, MA 01062 •
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Update Address and Return Card_
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affall &Business Regulation • Registration valid for individual use only before the
HOME!MPROVE11Il.� ONTRACTOR expiration date. If found return to:
TY$E.F'G�r_p`ljo Office of Consumer Affairs and Business Regulation
- Bo 1000 Washington Street -Suite 710
m"��'�-:-AO -cT 71 Boston,MA 02118
ILLEYHOME IMP
EVEN A.SILVERMANA) .- '7-7 - .
A 1 I •
0 RIVERSIDE DRIVES;,,•. `=
ORENCE,MA 01062 %ti. 1"`-"' ::'�. °�""�'r
Undersecretary Not valid without signature