37-079 (3) BP-2023-0971
48 PLATINUM CIR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
37-079-001 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-2023-0971 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOW 2023 Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 7200 INC 077279
Const.Class: Exp.Date:06/21/2024
Use Group: Owner: SCHI>'ELLITE KAREN MARIE
Lot Size (sq.ft.)
Zoning: SR/WSP Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: insurance:
P 0 BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON: 07/26/2023
TO PERFORM THE FOLLOWING WORK:
REPLACE WINDOW
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 Drive ay 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 12'7
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: 413)587-1272
Office of the Building Commissi er
• ,
T; e Commonwealth of Mass.chus4. , c,,, .
j ,v,.
�• � 'OR
rBoard of Building Regulations Md $g <9Q I CIFALITY _
i Massachusetts Slate Buiidin +:•__,/. USE 9 v�
! Building Perinit Application To Construct,Repair,Rens •-+ ,.+1ba�.:'fish a Re'iced Mar 2011
One- or Two-Family Dwelling .'yg0 C770
Ala
This Section For Official Use Only
Building Permit Number: 6,4'.1 3- 9 1 / 1 Date Applied:
/Ey i*--)7. 3 , i4 7-25-20Z3
Building Official (Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro erty Address: 0 1.2 Assessors Map&Parcel Numbers
(+8 �t# �-, G V-CU.— 31 07 9
1.1 a Is this an accepted street?yes no Map Number Parcel Nuntber
1.3 Zoning Information: • 1.4 Property Dimensions:
Zonina_District Proposed Use Lot Arca(sq hl Frontage(ft)
i 1.5 Building Setbacks(ft) _
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public 0 Private 0 i — Check if 37E50 Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP"
2.1 Owner'of ecord:
Name(Print) City,State,ZIP
La Q r(-)o C. - Lit 31026-3 ;E:,2- .
No.and Street Telephone F.mnil Address
SECTION 3:DESCR PTIQN OF PROPOSE. )WORK (check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Sprrify.
Brief Description of Proposed era,
: SS
• I r` Clr�l t r� n
S .La,$~ s r y.[1=
SECTION 4:ESTIMATED CONSTRUCTION COSTS i
Estimated Costs:
Item OfE ial Use Only
(Labor and Materials)
I.Building $ 9.��.y� I. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ l���� ' ❑Standard City/Town App ication Fcc
'❑TotalProjedt'Cost5 (Item'6)x multiplier x •
3. Plumbing rr77��ii $ 2. Other Fees: $ •
4.Mechsthcal (II AC) $ • List: •
5.Mechanical (Fire $
Suppression) Total All F 6 I�rr�
��-y�-� Check No. U�eck Amount: v tv
6. Total Project Cost: $ O! / ❑.paid in Full.. . . . ❑outstandiugBalance Due: ..
_ SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 0 ;)/ 1 69 f G%12'0 2-y
License Nt:mbu' Expiration Date
Name of CSL flakier
_ List CSL Type(see below)
c)- ' (; taUC6 -1 Type Description
No. and Street
ch. (ao U Unrestricted(Buildings up to 35,000 cu.ft.)
V R Restricted I&2 Family Dwell ing
City/Town,State,ZIP M Masonry
RC Rooting Covering •
WS Window and Siding
SF Solid Fuel Burning Appliances
.:7)S22- T Insulation
Telephone Email address D Demolition
5.2 Reristeted Home Improvement Contractor(-RTC)` •
6S5� S1 /u �
'��.(�� i'.k. 'Y`L_ HIC Registration Number Expiration Date
HT Compair7 Name or,HIC R e i str•ant Name
No. and Street • Email address
City/Town,State,ZTP 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 WREN
OWNER'S AGENT OR CONTRACTOR APPLIES FORBUILDING PERMIT
I,as Owner of the subject property,hereby authorize ..(1eer t l -e.vrk.f. 1-) . V 1-.l'
to act on my behalf,in all •.: i ers relative to work authorized by this building permit application.
-1/ i 7 ( e/.2,3
Print w s Name(' atonic Si are) Date
SECTION : 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 accurate a best o y i%` ledge and understanding.
csr>-V-(U 5/zv i4J. 1 q— 9'0- 3
Print Owner's or Authorized Agent's Name(Flea= c S e Date
NOTES:
l. An Owner Rio obta irrc 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 fond under M.G.L.c.142A. Other important information on the FEC Program can be found at
wv,-w.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.govidps
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
Numbet 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"
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The Commonwealth of Massaehuseits
1)epartnzent of Industrial Accidents
1 Congress Street,Suite 100 •
Boston, MA 0211 4-2 01 7 •
www,ratass.gov/dia •
Workers' Compensation Insurance Affidavit:Builders/Conn•actors/Electricinns/Plun hers.
TO BE FILED WITH THE PERMITTING AUTH PITY.
Applicant information , 1 `I _ Please Print Legibly
-Name (Business/Org \1aoiaation/lndividual): Q 6 -c3 gray)c. 3..r'r t er o -e nri zr'l-1 - ��c.
Address: Z-lo \dt —0 `P. 0. xcac C1:702-/
City/State/Zip: I of. t-&A DI 002- Phone#: t3- S2�
Are you an employer?Check the-appropriate box: • Type of project(required):
I am a employer with t,8 employees(full and/or part-time).• 7. 0 New construction
2.01 am a solepropneto=orparmership andhaveno employees working forme in 8. El Remodeling
any capacity.Rio workers'comp.insurance requireg
3.0 T am z homeowner doing all work myself.[No workers'comp.insurance required.]T
9. ❑Demolition
4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will I ❑Building addition
ensure that all contractors eidrer have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
s.®I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
Th CAC.cuh-cnntracrr,rs have employees and have workers'comp.insnmnet 1
6_p We are a corporation and its officers have exercised their rightof cxen>ption per MGL c. 14.O Other
152,§1(4),and we have no employees.iNo workers'comp.insurance required:I
*Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy informavon.
?Homeowners who submit this affidavit indicalg they are doing all work and then hire outside contractors mast'submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and arawe whether or not those entities have
employees. Tf the sub-contractors 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: -AYb�\.0_ ran C.i 6 1 v O ',o
Policy#or Self-ins.Lic. `: Ob55O 2 b 2\S Expiration.Date: off) !
Job Site Address: %AS QV:1 l City/state/Zip:VI Cuex (t M f) G\06 -
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 foam 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 per alties of p ' hat the information pro.'ided above is true and correct.
- Signature: .' r17 /s' Date: [ 1 ‘o\a3
Phone#:
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 Realtb 2.Building Department 3..City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
C.Other
Contact Person: Phone fir:
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City of Northampton _
L sachusetts w ���
itr f. / t: R C .G
�`C�{`] j �-+ ` DEPARTMENT OF BUILDING INSPECTIONS , yJy
�x- T 212 Main Street • Municipal Bui_dir.g 4` ``
�� Northampton, VA 010E0 r,sfrW— `mod
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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 MGLc 111, S 150A.
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The debris will be disposed of in:
Location of Facility: .i `Ii1,(" ,i, rl� ' 10/ QJ'71-,P� i7 •
The debris will be transported by:
Name of Hauler tqa.U.0j L.XI/--k-- a li-
Signature of Applicant: _ Date:7~ 1 -)
' Commonwealth of Massachusetts
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• ` ) Division of Occupational Licensure
\ Board of Building Re ulations and Standards
Con-..?
onte ionf� isor
s
CS-077279 _ I tpires: 0612112024
STEVEN A Si VEI3 lFr; .IV ',e --.
PO BOX 60G t:f Et,i S..:r;. ; r I. ; .hi, hl f
• , FLORENCE IVPJt O1O62 ,.tr i t"i 4 I.1_ ` Nt° I�IF
,. fj l' �i 1 J ti�` .I( •l• .
b .ao-.'r:.ti J r
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THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affai � h1 Business Regulation
1000 Washing k Suite 710
Boston a�cWset =
lyQ 118 -
Home im ro . e 0 ' _rac,vxrt. egistration
( -- _ ":nit,„�" _ Yt Type: Corporation
VALLEY.HOME IMPROVEMENT INC F t"" e is ation: 105543
P.O, BOX 60627 4
.-- E 6 ation: 08/20/2024
FLORENCE, MA 01062 _ +;,,;
t� _ Ems' 1.„
.• _ _ - -__ ---z----7 1
--/
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"' „— Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer AffaiFsje,Business Regulation • Registration valid for individual use only before the
HOME IMPROVE( N ''CONTRACTOR expiration date. If found return to:
7Y E posibor] Office of Consumer Affairs and Business Regulation •
Segistiat— '-s: ., i t •i 1000 Washington Street -Suite 710 -
lqgt -r" 4' . j:7i2dZ Boston,MA 02110
AlrtEY HOME IMP ow tit = _. :,..1.
t _ fl
it
TEVEN A.SILVERMA 't- 74t- 1 -
1D RIVERSIDE DRIVE -• '` „%
A- I-ORENCE,MA 01062 t: '''-' `t �// iii/em
"7'-'`;.'' Undersecretary Not valid without signature