38B-163 (4) BP-2023-1057
20 FORT ST COMMONWEALTH OF M SSACHUSETTS
Map:Block:Lot:
38B-163-001 CITY OF NORTHA PTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGIS ERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARA FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1057 PERMISSION IS HEREBY GRANTED TO:
Project# SIDING 2023 Contractor: License:
VALLEY HOME IMP OVEMENT
Est. Cost: 80000 INC 077279
Const.Class: Exp.Date: 06/21/2024
SCHL NZ, JONATHAN, K&JONATHAN D
Use Group: Owner: RICHM ND
Lot Size (sq.ft.)
Zoning: URB .-applicant: VALLE HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON: 08/08/2023
TO PERFORM THE FOLLOWING WORK:
SIDING
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 NOR1HAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I 0
�1 - 7-1
li
Fees Paid: S60.00
212 Main.Street,Phone(413)587-1240,Fax: I' 13)587-1272
Office of the Building Commissio i er
uocuartin tnvelope lu:dLDosmoc-J4/13-4yesu-nuou-u I r*ocvoocon A
cFi
C
The Commonwealth of Massa us
W
Board of Building Regulations and 2� C ALITY
Massachusetts State Building Code, 780 o�ti SE
T ��
Building Permit Application To Construct,Repair,Renovate a Revi ed Mar 2011
One-or Two-Family Dwelling '41°,oT'
This Section Fur Official Use Only
Building Permit Number: Ge_).3 - 106'7 Date Applied:
.17
hEvit-) /Z,, 8-e-Z2z3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
1.l 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(tt)
1.5 Building Setbacks(ft)
Front Yard Sidc Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (hf.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
Check if yes❑ _
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Jon Schluenz Northapton,MA 01062
Name(Print) City,State,ZIP
20 Fort St. 413-561-6311 jonschluenz@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(cheek all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
Reside exterior of house
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ (7q Oar— 1. Building Permit Fee: $ Indicate how fee is determined:
ElStandard City/Town Application Fee
2.Electrical $
Ca� 0 Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (FIVAC) $ List:
5. Mechanical (Fire
Suppression) $ Total All Fees: $ ,.1
Check Nokf t/C Check Amount:
6. Total Project Cost: $ �1 �Oar- 0 Paid in Full 0 Outstanding Balance Due:
liocuSign nvetope IU:1:52tIti3tBE-34A.5-4M3U-Abtib-blt-4bZU85:13,01
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
011) (2t 12V
e_CvS14.kle_LIL\CLC) License Number Expiration Date
Name ot CSL Holder
qList CSL Type(sec below)0.0
Type Description
Nu.and Street
Ct.ofenu' 0\0- 0‘,°(-°Q
U Unrestricted(Buildings up to 35,000 cu.ftd
111A/
Restricted l&2 Family Dwelling
City/Town,State,7I1M m as on ry RC Rooting Covering
jar 4/
WS Window anti Siding
SF Solid Fuel Burning Appliances
4 5YeAlen 0),qiii.teglon‘,A. ILA.e.I.NeAru./1- I Insulation
Telephone Em64-iddress D Demolition
5.2 Registered Home Improvement Contractor(HIC)
Lt2)
‘3) 2024
V‘iS\e„. 34.1.40.-Cxx701611... — i I IC Registration -Expir20ation Date
RIC Compan 'ame or HIC Registrant Name
cl cyle., (f10/.0*21
No. and Street Email address
&Act 11\0- okoic,2-
CjtylTown. State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed arid 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 .0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I.as Owner of the subject property,hereby authorize Valley Home Improvement inc.Steven Silverman
r_,.riaiisiabtpy behalf,in all matters relative to work authorized by this building permit application.
I jOtit, SCititottlAll) 7/31/2023
''''fiqiiirMfin Name(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 accur • o the best tfniy knyfllcdge and understanding.
; -
57-6\ 0 MN 5)Lig06441J 2O73
Print Owner's or Authorized Agent's Name(Electronic Sipaa Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work. or an owner who hires an unregistered corm-actor
(not registered in the I lome Improvement Contractor(II1C)Program),will not have access to the arbitration
program or guaranty hind under M.G.L.c. 142A. Other important information on the Program can be found at
SVP,,,V,MASS,a0V/i)Ca Information on the Construction Supervisor License can be found at ,k,..vw.iniN,.gov dps
2. When substantial work is planned,provide the intbrination below:
Total floor area(sq. IL) (including garage,finished basement/attics,decks or porch)
Gross living area (sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number ofbathrooms 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"
DocuSign Envelope ID:B2B63EBt-34A3-yt3U-Ablib-b1r4b2UtlbZ3A
City of Northampton
Y N A M f tS
S
Massachusetts �►- .`ccc
(4 VA
I 4' DEPARTMENT OF BUILDING INSPECTIONS
f 212 Main Street • Municipal Building 0' *
Northampton, MA 01060 sl, .2/�1i‘�
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: kaj r. fL & i L rl -' \QOAVD-rik-e4t4—N
The debris will be transported by:
Name of Hauler: seti_AeL)
pP
Signature of Applicant: �� Date:
g
The Commonwealth of Massachusetts
A , I Department of Industrial Accidents .
=f _" 1 Congress Street,Suite 100
"cif , Boston,MA 02114-2017
~ law www.mass.gov/dia
Yorkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plnmbers. .
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information `' Please Print Legibly
Name (Business/Organization/Individual): V Q.1 t-6:. \ t1-C)+YI C tm y O YYl r.,-)-4 . -i-,C
Address: -it(;) R \Olt 1�,'t.s-r_ 4? 0. €rite (o)(oz1
City/State/Zip: \--7 Iof-ent[ R- Ol 0(02- Phone#: 4 13-G`84--i 522_
Are you an employer?Check the appropriate box: Type of project(required):
l.IZ)I am a employer with 1 f3 employees(fiall and/or part-time).* 7. ci New construction
2.01 am a sale proprietor or partnership and have no employees working for me in . 8. El Remodeling
any capacity.fNoworkers'comp.insurance required.]
3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9. ❑Demolition
10❑Building addition
4.01 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.D Plumbing repairs or additions
5.1::1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0hoof repairs
These gull-contractors have employees and have workers'comp_insurance I
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 3 4.Q 0ttlel'
152.41(4),and we have no employees.INo 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 affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
iCuntractors that check Ibis box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. if 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: -AY k \O.. rI SLr'Q.n Ll_. ( i'r0I.\Q —
Policy#or Self-ins.Lic.#: CEO S 5O 3 b 2 \S Expiration Date: o?) r tAo _
Job Site Address: AD 'FDA-- CityiState/Zip (( 0i�
Attach a copy of the workers' compensation policy declaration page(showing the policy number and espira on 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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify wn r the pains and pe allies of p r, hat the information provided above is true and correct.
Si afore: 7,/1 Date: l 202,
G
Phone#: 413- c�gC'`---IGJ22-
G ,
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone/1:
Commonwealth of Massachusetts
k ) Division of Occupational Licensure
Board of Building Regulations and Standards
Cons ions$ ,rvisor
FV ,f
CS-077279 lt ires:06l21/2024
STEVEN A SI VERMA • +I : '•`-
PO BOX 6062* : 'fit •
FLORENCE il'_A 01064► / V `'
Il
co^'—i IJtC1Ie r .Ft 4A- .1iIMW.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affaits and Business Regulation
1000 Washingta t - Suite 710
Bo sto rKMassasfwetyt ==.sq 118
Home Imroerit N racfor✓ egistration
�' - < M t::::17. 1• fr � l~i' Type: Corporation
t .' :_ ....... ,--•-- eg,WSt'ration: 105543
VALLEY HOME IMPROVEMENT INC . F-`-`'- ,-. Erfpifation: 08/20/2024
P.O. BOX 60627 A` = '" - -. ; ,-1
FLORENCE,MA 01062 c.: . 1. ,_ t. _.. � :•
r---N�+7
r J
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affai'r1s,81 Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE •: i i9ration Office of Consumer Affairs and Business Regulation
Registrattdtt' iratbn 1000 Washington Street -Suite 710
1 s{�4�3� _ g 24 Boston,MA 02118
VALLEY HOME IMPR•V-K-M Ai -
STEVEN A.SILVERMAISE '.mil:_` .l` :'!i ,
340 RIVERSIDE DRIVE'; `•' '.,' ;~` ,,,,ya /
FLORENCE, MA 01062 .;i_::.,,. .
Undersecretary Not valid without signature