38B-137 BP-2023-0707
72 COLUMBUS AVE COMMONWEALTH OF M S4SACHUSETTS
Map:Block:Lot:
38B-137-001 CITY OF NORTHA PTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A)
BUILDING P .RMIT
Permit# BP-2023-0707 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS 2023 Contractor: 1 License:
VALLEY HOME IMPROVEMENT
Est. Cost: 24000 INC 077279
Const.Class: Exp.Date: 06/21/202'
Use Group: Owner: S BRI S KER PHILLIP A&MARGARET
Lot Size (sq.ft.)
Zoning: URB Applicant: VALLE HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P 0 BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON: 05/31/2023
TO PERFORM THE FOLLOWING WORK: -
REMOVE 3 LALLY COLUMNS AND REPLACE WITH 7
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 NOR'FHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: n(
'' • r i .y . T tit
1 I
Fees Paid: S 156.00
212 Main Street,Phone(413)587-1240,Fax: 413)587-1272
Office of the Building Commissi ner 1
/;
' / -..cf,--'11 •
The Coaffoonweaith of Mass hus _ - a 0 /
wMassachusetts State Building Code, 786 �� l./VG/N ' rJSE.
Building Permit Application To Construct, Repair,Renovate Of'.-4,: ,ke s ReyisedMar•2011
One- or Tl4o-FaniilvDwelling °0„, J
This Section For Official Use Only �` f
Building Permit Number: .).3' 70 7 Date Applied:
ke�,� av,„ //� 5.31.2023
Building Official(Print Name) Si nature Date
SECTION 1:SITE INFORMATION
1.1 Proper Address: 1.2 Assessors Map&Parcel Numbers
.1_.c . .
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(act ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Prodded 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
Chick if yes0
' SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
eA0i.. r Ie hoar►a' ('h.1 cb, 11CQy ( 0 Oc'�
Name t) ity,State,ZIP
-12 COIL . (tt k-C-- `k 1'2-aLk1-1-bl'- a
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WOR_K1(seek all that apply) •
New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) ❑ Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units _ Other 0 Specify:
Brief Description of Proposed Virork2: n ci v t_. 5 ev,5 #-U 1_=.tC.D C O to 4-.._,1/4.S
aNK re plc-4.-E" L4 k-(4.‘‘ 7. Rc'ou k& 10&5c 4.-c..4- S fr2.r 5
SECTION 4:EST-MATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ Z2-K 1. Building Permit Fee: $ Indicate how the is determined:
2.Electrical $
0 Standard City/Town Application Fee
' '❑Total Project'Cost''(Item 6)x multiplier _x
3. Plumbing $ 2. Other Fees: $ •
4. Me wcal (IIVAC) . $ List:
5. Mechanical (Fire '
Suppression) Total All Fees: ,`
- /I Check No.'1-'b7 Check Amount: I
6. Total Project Cost: $ "Z'7k 1.❑.paid in Full. . . 0 Outstanding •. .
SECTION'S: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) o- 1 c..t 6/2! j_-O i—'
' '-,fir t\ ;vr v ---- License N imbc Expoatiun Tate
Name of CSL Holder
{} .7 List CSL Type(scc below)
�: �� Type Description
No_and St eet
r r r -'0 l O.f_/ U Unrestricted(Buildings up to 3 ,0 �?en.f.)
lr• P. Restricted I&2 Family Dwelling
' ' Cityffewn,Stat r4 M Masonry
RC Rooting covering
, 4 (t .________ __
wS : Window and Si ding _
7 SF [Solid Fuel Burning Appliances
1 Insulation
I e.1phone Emai; address U Demolition
5.2 Registered Home Improvement Contractor(Hit) 1.
,l i 61sy' 3 0120
,12 LL �°- teak
HIC Registration Number Expiration Llaie.
7 Compani�sN�fa�m,``e� or HICC P.eQistrant ame
No.and Street Email address
'F-tnrr9Trg..L ` - O1 aUZ--
City/TO Wn,State, ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152, § 25C(6))
j Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
I this affidavit will result in the denial of the Issuance of the building permit
Signed Affidavit Attached? Yes 1" No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Oikmer of the subject prope*y,hereby authorizeQ4ej l-e_ ,'-y} I l.,-kci'1j t-1 . V i-i-.L% _
to act on my behalf,in all matters relative to work authorized by this building permit application.
ff`: 2 `,/ /z3
Rim Owner's Name conic Signature) Date
SECTION 7b: OWNER'ORAU.LLIORIZED AGENT DECLARATION
•
By entering ray name below,I hereby attest under the pains and penalties of perjury that all of the information
contained ' this a plication is sae an accurate to the best of my knowledge and understanding.
. ,...c......---..._. ',/�/Z3
Prim 6wner's ce Authorized Agent's Name(Electronic Signat re) Date
NOTES:
1. An Owner who obtains a building permit to do kis/her own worn:,.or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(BIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c.142.A.. Other important information on the HIC Program can be found at
www.rrnass.ac ioca Information on the Construction'Supervisor License can be found'at wa w.mass. ovedos
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 Preject Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
� Department of Industrial Accidents
l ; � l 1 Congress Street,Suite 100
� Boston, ALI 0211 4-2 01 7
y j Www 1nass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
10 BE FILED WITH T13E PERMITTING AUTHORITY.
Applicant Information Please Print Lesib y
Name(Business/Orgacizauonllndivicual): Ia.l��tt�+ l-ri�i'Y1G -Tv..y, to er 'tcr--4 1-t'7�
Address: 5`-i0 ? 0. etc 4rr0t
City/State/Zip: V.iC>t-Crti. alO(o2- Phonet/: L �3- :,SDI—�JS22
Are you an employer'Check the-appropriate box:
Type of project (required):
l.�I arrr a employer with . __employees(full.audio:pa3-time)• 7. New constriction
2.❑I em a sole piopnetor or partnership and have no employees working fa:mein g. 0 Remodeling
any capsary No Worke:s'camp instance required.1 I
3.0I Pin a homeowner doing ale w:r u myself.[do workers'comp.insurrnce.required j t
q. Demolition
a. will ❑Building adr.iton
❑I ars a homcown=and wtu be aiag corn actors to conduca all a mil tea my property. I will
ensure that ail cnntrac:ors either I:ave.warkas'compensation instance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.❑!an a general contractor and i have hired the sub-contrsc:ors listed on the at<achcd sheet 13 DRpOf repairs
These:rate-eme rarmr,have cmn nveea and have wnriters'cnrnp.insurances t
5:0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El Other
152,V.ia1,aid we have no employees.(No workers'romp.insurance required.)
'Any applicant that check box.#1 mast also fill out the section below showing their wearers'ccvnpensadcn pot c'infarmadon.
l Homeowners who submit this affidavit indicating they are doing ell work and then hire antside coat-actors must submit a new affidavit indreathig such.
:Contactors that check this box mast attached an additional sheet sacevang toe name of the sub-contras:ors and state whether or not those entities have
employees. If the sob-conmacto:p�wc emplrl'cs.thew must provide rhe;r wars'com policy, rrber.
I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: -Ay- 'k,\& ray?Lk_ ✓Ot_.r�
Policy#or Self-ins.Tic.#: at)3 c O , b 2 \S Expiration Date: c , f , (`'
:fob Site Address: `. t `, ��C ir1(r City/State/Zip: ' 17 O(O2 O
Attach a copy of the workers'compensation policy declaration page(showing thu policy number and erg' don 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 ofvp to S250.00 a
day against the violator.A copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance
coverage verification-
r
I do hereby certify un er the pains and per ahies of p hat the information provided above is true and correct.
Signature: 4 1''? Date:
Phone#: J-SSq-� J2
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..CsityfTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
•
City of Northampton
sty{r�fey sus sc-
ax Massachusetts
mow. sue_1
_41
DEPARTMENT OF BUILDING INSPECTIONS';sew
212 Main Street . Municipal Building
Northanptcn, MA 01060 \
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROTECTS)
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: } C)✓-71-1tCL--r4�
The debris will be transported b.y:
Name of Hauler: tqr
•
Signature of Applicant: Date: 2,5-- 2 0;)
Commonwealth of Massachusetts
�� Division of Occupational Licensure
Board of Building Re ulations and Standards
Cons Ionfs rvisor
'4 l
CS-077279 ltpires 06/21/2024
STEVEN A SVERTN,A �� • rr { �r{
t i 6 yr �r.i, f111
PO BOX 606?A t,i�,I` ,).•" �' �' {,r"tir�• 't*„ ' i} {
FLORENCE 1f11�A O'106 S i F i tr,`i+
-•'' :i. •-.'4'.;:' ,.''' k•,— [,41'fitli.. i.4f,03
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairi„S atld Business Regulation
1000 Washingtortr ��- Suite 710
Boston Massachusetts-2118
Home Imfprovt=rri-� 07 ratvrjegistration
irn -7 ;�1 - --ddfJ� ,r
' SIT _ j'3 "- - = = ,'
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Type: CorporationVALLEYHOME IMPROVEMENT INC _ ' __ n: 08/20/2024
— I
FLORENCE, MA 01062 `� '\E.-,. -� I . . ,•
.. I" Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affai? &Business Regulation • Registration valid for individual use only before the
HOME IMPROVE V 1`'CONTRACTOR expiration date_ If found return to:
TYP-E,T6[p.[dt_ior Office of Consumer Affairs and Business Regulation
Registration _•. aEX iratiott 1000 Washington Street -Suite 710
1' F j: �"' oga 2,4 Boston,MA 02110
Mr-LEY HOME IMPRpj-aice1,!T�I = -, i-
rEvEri A. s{LVEs�nnt �4Y � J •
l0 R11ERs1DE DRIVE'`;7r < ' ;r
ARENCE,MA 01062 `-T' �,(.�NsYCG.��GG'�
Undersecretary Not valid without signature