37-132 (6) BP-2023-1736
526 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
37-132-001 CITY OF NORTHAMPTON
Permit: Ails Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2023-1736 PERMISSION IS HEREBY GRANTED TO:
Project# KITCHEN RENO 2023 Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 70200 INC 077279
Const.Class: Exp.Date: 06/21/2024
Use Group: Owner: B.H, ROTH-KATZ, SURI
Lot Size (sq.ft.)
Zoning: SR Applicant: VALLEY HOME IMPROVEMENT INC
Anplicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON: 12/12/2023
TO PERFORM THE FOLLOWING WORK:
KITCHEN RENO
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: 5-3)
I
4 • • .y.2
Fees Paid: $456.30
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
. l /3C- ii/i,,,F
• QED, �'
& The Cononwealth of Massachuse• 2
rm <'0493 R
Board of Building Regulations and St arcIPPPr
ti eCAR--4/ — nt, IP ITY,�, Massachusetts State Building Code, 780 rir`n"Nil, USE
Building Pcrinit Application To Construct,Repair,Renovate Or Demobs} A 2.1 dM r 2011
One- or Two-Family Dwelling .
This Section For Official Use Only `
Building Permit Number: 2 .3•/7,30 ! Date Applied: `
ik uut-.)( , 3 7 /2-1 ZO
(PrintL�j
1 Building Official Name) Signature Date .
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
1.1 a Ts this an accepted street?yes -,o Map Number Parcel Number
1.3 Zoning Information: / 1.4 Property Dimensions:
/C45 ar / -to A�t..
Zoning.District Proposed Use Lot Area(so ft. Frontage(ft)
1.5 Building Setbacks(ft) Ni() `L1td"`f S ( Icy r/U/—
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?
Ct cck if ji5❑ Mumctpal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIPI
2.1 Owner'of Record:
S..1.-i Pam,-1 tZ--- 1�-er-1-C- OW/ a10(12—
Name(Print) City,State,ZIP
'32(0 'Fiof•,CC-
No.and Street Telephone Email Address
. SECTION 3:DESCRIPTION OF PROPOSED FORK'(cheek all that apply)
New Construction.0 Existing Building Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition. ❑
Demolition 0 1 Accessory Bldg. ❑,' Number of Units Other 0 Specify:
Brief Description o Proposed ork:r/�iL0i .- t l
intA - ej&�✓, -4ik_k'r.k 7,,.�h,
1~h?v — 1- I 2 P.�i 9 t+ .4..,...- _T r
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official UseOnly
(Labor and Materials)
1.Building $ j / r 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
. 2.Electrical . $ b
` '❑Total Projedt'Cost3'(Item'6)x multiplier z
' 3.Plumbing $ LI 740 2. Other Fees: $ •
4.Me uaa icaak (IIVAC) 1 $ ------- List:
5.Mechanical (Fire $J�� ' ` •
Suppression) Total All Fees:$ 't�
Check No.yyifeck.Amount:
6.Total Project Cost: $ —70i Wv v .0 paid.in Full. _ 0 Outstanding Balance Due: _
SECTION S CQN TTUJC'TiO i SF'RVIGES
Si Construction Supervisor License(CSL)cD tr t ( (v 12/ /20._,.yr
�C Lict e iJ o miler Expiration Date
Name of CSL Holder
-7 List CSL Type(see belcw)
-0 L%G
No. and Street Type Description
010
t.] Una estricted(Buildings up to 35,000 vu,ft.) I
Restricted I&2 gamily Dwelling
City/Town, ZI? is
Window and Siding
�^ ^} SF Solid Fuel Burning Appliances
1 insulation
Telephone Email address D 1 Demolition
{2 Recistered Home improvement Contractor(HIC) •
• HT Comp 'Name or-TIC Registrant'erne C Re: i.etl' ron NL;rl,cr Expiration Date
No. and Street Email address
nrr'.r1L '(ar C1 G C,2-
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6))
Workers Compensation Insurance affidavit trust be completed and submitted with this application. Failure to provide
this affidavit wi l l 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 APPIIES FORBU.I:LDENG PERMIT
I,as Owner of the subject property,hereby authorize germ l ue, yn•,Cki-1 V 1-1-1-7
to act on my behalf,in all matters relative to work authorized by this building permit application.
r' AA.
.er's Name Et
__ l
'Eec;zomc s� �at�.t,e
t >� ) Date
SECTION 7b: OWNER5 OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pain and penalties erjury that all of the information
contained in this application is true and accurate to tir fray ow d understanding.
Print Owner's or Authorized Agent's Name(Electromc S'gaamre) Date.
NOTES:
'1. An Owner who obtains a building permit to do hiis`ber:own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program), will notliave access to the arbitration
program or guaranty fund under MG.L.e. 142A_ Other important information on the HIC Program can be found at
ay.-w.mass.tcvroca. Information on the Construction Supervisor License can be found"at www,inass .ov,`dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementtattics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halflbaths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
•
13. 'Total Project Square Footage"may be substituted for"Total Project Cost"
a
The Commonwealth of Massachusetts
_
-C'' . . Department of Industrial Accidents
• _'� `c I Congress Street, Suite 100
"" Boston, M4 02114-2 01 7 .
l' ems, ww'w.rnc,..ss.sovidia
Workers' Compensation Insurance Affidavit:Bui_lidlers,%Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant information ``� 'r
1 Please Print Legibly
Name(Business/Organization/Individual): Q I.
t� -ocri c. S m�Jf'Dy2 ry Cr' A , h c_
Address: Z - C Rkv-�re'S\G't —0,-r,,--r_. 4`?. Q. gozc 4CO(p27
City/State/Zip: t- \e er)(c. l D) 0(o2 Phone #: 413-S$(4-1 S2Z •
Are you an employer?Check the-appropriate box:
Type of project(required):
. 1.E I am a employer with 1 0 employees(full and/or ps:rt-time)." 7. Ej New conshuctiou
2.❑I am a sole proprietor or partae_ship and have no employees working for me in 8. j Remodeling
any capaciy.INo workers'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 properr' 1 will
eesrn-e that all contractors either have workers'compensation insurance or are sole 11.0 Electrical rep airs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 I am a general contractor and T have hired the sub-contractors listed on the attached sheet.
These suh-cw;tracmrs have employees and have workers'comp.insurance.4 13.0Roof repairs
6_0 We are z corporation andits officers have exercised their right of exemption par MGL c. 14.❑OCl]er , .
152,11(4),and we have no employees.[No workers'comp.insurance'confetti
•
*Any applicant that checks box#1 tuust also Ell 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 mast submit a new affidavit indicating such.
tContraccors 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: -Aybe\\C` �V')SL.)- >,'-t U C'1 rUi NO
Policy#or Self-ins.Lie. #: C(b'-3 .. b
2-
\S Expiration Date::_ oC 1 ( i 0 U `i
Job Site Address: 5ZLO l -eY'X.0 � C 2d City/State/Zip: ctC(f--)c.c- rh i 01042"
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$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day'against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify un er the pains and per ties of p 'r'' hat
�the information provided above is true and correct
Signature: /""f /'//l!%/1 Date; 1 2_1 ti `202.3
Phone#: `4 3- SSL1-1522-
Official use only. Do not write in this area,to be completed by city or town official.
City or Town:- Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
City of Northampton -
Vas achu.se iP
rL! %�F 6
tIi J DEPARTMENT OF BUILDIlvG J.7dS CTIONS zt m
�+ = 1 212 Main Street • Municipal Suildina
f Nort_ampton. MA 010fiO
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR AIL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of
in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: 11 ICE' ur k"-)
The debris will be transported by:
Name of Hauler: \JO t4_... (StN71(0\ XY1..,e.-A-A—
pp
of A licant; //) ----Date; . Ja °--3
Signature
Division of Occupational Licensure
�- Board of Building Regulations and Standards
Cons l" 1T •
Ion$
> t-visor
�
CS-077279 r J
"� cpires: 06/21/2024
STEVEN A S t+ 00;1j �ir4:
PO BOX 606l VERh+IA Jy, .. ,,`,,,�
i!fi ar` `, a I n (' £� ".fir't
+ ... *. +;
FLORENCE IVI�A O I06 �� � 1� ' '"`�
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affai �'�artq Business Regulation
1000 Washing d, . trgd,t,- Suite 710
Boston:pMassaohuse #sz-0. 118
Home !m ro rr,�
�r'�or�
,-t. ' � � _egis}tration
J
11
air `J -a fig .
HOME IMPROVEMENT INC • (^� +�-.:i---`' ». "` ,..c, Type' Corporation
P.O- BOX 50627 t e isf ation: 105543
- VALLEY �:-_. _
FLORENCE, MA 01062 • + 'T • E njRation: 0$120/2024
f•�� \} 'LEI . i.
\� IS� ' _:, _ lr�,
r 3_ ra�yy.;.;L
Update Address and Return Card.
•
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer AffafPs;B Business Regulation -•
HOME IMPROVEIVIENP.CONTRACTOR expiration
valid for individual use only before the
Tiyp.E�'Cgci tior� expiration date. If found return to:
3�gls Gatl '-`r-�'j'fi Office of Consumer Affairs and Business Regulation
4 F n•.,: 100o Washington Street -Suite 710
LEYMOME IMPR• I1 DiA92 Boston,MA 02118
4 tEJTi I s,..
•
VEI>l A. SILVERUIp •
d) ]
RIVERSIDE DRIVEV\ `:;` .F. .:=;�
RENCE, MA 01062 r •;`. -- -A �sGGr.l"
- Undersecretary Not valid without signature