23A-134 (25) BP-2023-1442
77 PINE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-134-001 CITY OF NORTHAMPTON
Permit: Agricultural All
Bldgs
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1442 PERMISSION IS HEREBY GRANTED TO:
Project# ALTER ENTRANCE 2023 Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 23000 INC 077279
Const.Class: Exp.Date: 06/21/2024
Use Group: Owner: HILL INSTITUTE
Lot Size (sq.ft.)
Zoning: URB Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON: 10/23/2023
TO PERFORM THE FOLLOWING WORK:
ALTER SIDE ENTRANCE
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.
Signature:
el • 6 )2 3-4,1 •
I ,
Fees Paid: $160.50
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massac isett d� ��a
rii(-°14 Board of Building Regulations an Stan ar C'�- R
k, Massachusetts State Building Co e, 780 CMR 16 ALTTY
l 0r nC^,. (90??' rui
Building Perinit Application To Construct,Repaiu;Reno -Deanolis17 a Revi ed Mar 2011
One- or Two-Family Dwelling < '^;,„
- -- - '��, SSA- - -
This Section For Official Use Only 111q o;c 70%0Ns
Building Permit Number:d3P 3./Cf L? ) Date Applied:
4,„_.) a..55 /// ` �7 lQ- ins
Building Official (Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 P- gyrty Address: c 1.2 Assessors Map &Parcel Numbers
1,1 a is this an accepted street?yes na Map Number Parcel Number
1.3 Zoning information: 1.4 Property Dimensions:
Zoning District Proposed Use l Lot Area(so ft) Frontage(ft)
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 -— ^heck ifyesC Municipal 0 On site disposal system 0 .
Ii
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
S.Ir15-,. JA cA0./ :r Ma_ 016(,2
Name(Print) City; State,
1" Qt.r L (3-5 -1- 1 . ---
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK1 (check all that_n�,13!)
rrvi
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑
Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief likkescription of Proposed Work2: A ur eV_ 5 1 0 14\ir. IRA � --a C 5 ki
LA•tv5 gall. C4-055 5-S',rui� �-LAr-v AT)oto ..
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 2 3 000 1. Building Permit Fee: S Indicate how fee is determined:
2. Electrical $ 0 Standard City/Town Application Fee
' '❑ Tdtal Project'Cost'.("Item'6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4 1.c_.I___-__t II'VTAC". @ r ist:
`t. :Vl Cl:llillltl:[L1 lil Y t]t,� .p
5.Mechanical (Fire
Suppression) $ TotaI All Fe -:-��}� ����
Check No.��r^Check Amount: .
6. Total Project Cost: $ 23 0 UQ Cl Paid in Full 0 Outstanding Balance Due:
/ 11
tt 00 I
DowSign Envelope ID:2E0083CE-8F39-452743036-9DB673CC9C62
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL) D7 {=7 i jzozy
-7 19
,L\\,1-eyyr\o.,a---._ License Number ape awn Date
Ns rm AA CSL Holder
List CSL Twe(set below)
10 .(,--... 6( (00c6. --3 ,
No.and Stitet . L. Type Description
It La:esti:1:d(Milli:lags up to 35,000
'PtOrriYICC- ,.(1-10- oC:1(.92.-- ft RestrictedFamily Dwell;n
City/Town,State. 1\4 10 asonry
PT i t FX.: R nofi ag Coven a g
• ' WS Wi rid nw and Siding
51, Solid Fuel%riling A 1)21 isnces
4,6-SS(1,---)S22-- 1 Insolation-
Telephone Email B ddreF,s i..) Dm-Onion
5.2 R 0 stered Home Improvement Contractor (MCI
ir% i h$ ...eri 6S54 3foizozy
'__.,,...._N,u_)zk..2*. x_r..e..._.__ eec>_e.rr-\„Lf--i A-- Hic.3.,:gistratial Norahat EniraCixn Da7e-
qc Comp Name° or,HIC R etst rant ame
f:..0._ . 1- ../() 1.0„CA ,,2_0,_.
__ ___.
No.ard Stroet Email address
fi C)(10lilk..41- 1rt,10^
City/Town, State,ZIP . Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers.Comp msaticn Insurance afro davit must be completed and submitted with this application allure to provide
this affidavit will rt.seit in the denial of:he Issuance Ville building permit.
Si an ed Affidavit Attached? Yes .......—X N o.... .... CI
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WREN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
,INcettritttbni the subject property,hereby authccize i , . 11,...'‘evrn.i:Xt—t , V jj toy all matters relative to work authorized by this building pertait application.
61346.0.757704ED 10/6/2023
pi un 0,.,TR.,'s Maine(Flec(ronie signature) Date
SECTION 713:,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 t. best of my knoE1ffi and understamdina.
5-rt-A-0 CYL*12Vvuivi -
Print Owner's or Authorized Agent's Name(Electra= 'ure) thil e _
NOTES:
I. An Owner who obtains a building permit to do"zialer own work,or an owner vim hires an.unregistered tionirLoo.-.
(not registered in the Horne Improvement Contractor(RTC)Program),will nvt have access to the arbitration
program or guaranty fund under M.G.L.c. 14.1A. Other important infirmation on the HIC Program can be found at
v, ,,,-w,ilasi, acvloca Information on the Construction Supervisor License can be:found at w-,,,,,w.mas s,„go v.di
2, When substantial work is planned,provide the information be:ow.
Total floor area(sq.ft.) (including garage,finished base-merit/attics.,decks or porch)
Gross living area(sq.ft.) , Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halFhaths
Type of heating system . Number of decks/porches
Type of cooling system Em..iroed Open
3. *Total rifect Square Footage"may be substituted for"Total Projec:Cost"
The Commonwealth of Massachusetts
rr Department of Industrial Accidents
s461.2-0-- l Congress Street,Suite 100
1' 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 ` 1 Please Print Leg-ibly
Name (Business/Q-ganization/Ind \ividual): (Q I`. l y 1#otyt C. rv- erC.v2 vYl z~ieYl , "7-1,-1 L
Address: 5'40 Q kv-zv ,\tit. z I\ c- t?. 0. gc_c COo(o Z1
•
City/State/Zip:-. ..1 or,er cc tLkii4 0\002- Phone 4: 413-cE c1-1 S22
Are you an employer?Check the appropriate box: Type of project (required):
. 1.[E1 I am a employer with a employees(full andior part-time)* 7. ❑New construction
2-D I am a sole proprietor or partership and have no employees working forms in 8. 2 Remodeli ng
any capacity.ftioworkers'comp.insurance requiter].]
3.0T am a homeowner doing all work myself.[To workers'comp.insurance required]1 9. ❑Demolition
10 ❑ Building addition
4.0I aro a bomcowncr and will be hiring contractors to coadret all work on my propcity. I will
ensure that all contractors either bave workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 1 am a general contr•actol and I have hired the sub-contractors listed an the attached sheet. 13.0ROof repairs
These sub-contractors have employees and have workers'camp. insurance.
6_0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Daher
152.§1(4),and we have no employees. No workers'romp.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 muse submit a new affidavit indicating such.
Contractors that check this 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: -A-1( 1v`GL --a)C-IS;.}r'0.v L._ C—�v-c )o
Policy#or Self-ins.Lic. #: Cab O 3 b 2\S Expiration Date: c7) f gOa4-1
Job Site Address: 4.4? QtflL (5 �!e�i4" City/State/Zip: Qccii(,G ina Ul0(02
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 11,500.00
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 un r the pains and per allies ofp r hat the information provided above is true and correct.
/� ivI // � a3
Signature: �j/' M_.:1
Date: tp •
Phone#: 4 3- SSLI—I c522_
I. d
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
h. rather 1
Contact Person: Phone#:
1
City of Northampton _`S ` Sr
Massachusetts k� :` _ f,
1,,; t r.: a -c
_ DEPARTMENT OF BUILDING INSPECTIONS �`, ,
\ y>.
212 Main Street • Municipal 3uilding vim, :e
Northampton, MA G1050 jli;i ;��
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 MGL c 111, 5 150A.
The debris will be disposed of in:
Location of Facility: sif) Uri V,r(b:L.......(u3 } `O✓ L Q r v
The debris will be transported b.y:
Name of Hauler: \laktO.j 7011 -- c-��- -(21,0
/ _
Signature of Applicant: _ H Date: l 0— 6 -Z3
t Commonwealth of Massachusetts
i Division of Occupational Licensure
• Board of Building Re ulalions and Standards
Cons lonfS rvisor
I
CS-077279r } L itpires: 06121/2024
STEVEN A SI)t-VER A ii r t'
PO BOX 606 i:1 1i ..1!f i 's n i i,lr '5, r�;,
FLORENCE IVI'A 01062i� ; d ! f
7 } t f 1 'v,f1 ;
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of.fvrto ,..
Cc .,--;- :o ne. '.. /J .' ..
�.[ ,THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affair; and Business Regulation
1000 Washingto Str' di,- Suite 710
Bosco ,--.Massachusetts-;02118
Home Im,pro I=_t nLC a itra or-..F:�egistration
I.j.) �_- . .;,1 ::=_._ i it- Type: Corporation
•VALLEY HOME IMPROVEMENT INC I^ii i_ -1 t ""fie sfl-ation: 105543
P.O. BOX 60627 '•'''' 3 T_- � �•--• ".-{ E i4atian: 08/20/2024
FLORENCE, MA 04062 {' l s,frr
/'•t,1 �
_IA. 'L-`ate._ i.."1
fir,` r is f%a'/
'.''. •�,• \`.F
`" Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affail'k,&Business Regulation Registration valid for individual use only before the
HOME IMPROVEI�ENT CONTRACTOR expiration date. if found return to:
T.YP_E:: ai orating Office of Consumer Affairs and Business Regulation
ffeuist'atloh _'_ER i�ltlon 1000 Washington Street -Suite 710
k�x ,EvM 4 . O 2oi 42,g Boston,MA 02116
'ALLEY HOME IMPR�7 T I
I •
VEN
140 RIVERSIDE
A.SI E DRMCC:7, v..`),-: ,(tea n/ L
140 RIVERSIDE DRIVE f// �A�2�'�j�J
=LORENCE, MA 01062 `•;<<' vL .
Undersecretary Not valid without signature