17A-224 (2) BP- 2011 -0400
GIs #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2011 -0400
Project # JS- 2011- 000663
Est. Cost: $8500.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 6316.20 Owner: MCKEEVER JAMES P
Zoning: URB(100)/ Applicant. VALLEY HOME IMPROVEMENT INC
AT. 198 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584 -7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON :1012812010 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 10/28/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
/ , \ Department use only _
' City of Northampton Status of Permit:
' 0 Building Department Curb Cut /Driveway Permit
0�
, �12 Njain Street Sewer /Septic Availability_,: . -_
100 Water /Well Availability _ T
7 Northampton, MA 01060 Two Sets of Structural Plans I
one 413 587 - 1240 Fax 413. 587.1272 Piot /Site Plans _
Other
AP�LICAMN TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONCE OR TWO FAMILY DWELLING i
SECTION 1 - SITE INFORMATION
1.1 Proper Address �1 This section to be completed by office
Lot
Zone _ - _.____....._ Overlay District
Elm St. District_.._.____ _,.__ CB District—_—__�
SECTION! 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2 . .,I- , O wner o Record
Name (Print) Current Mailing, "Iddress:
Tefephcne �p _ z
O C_J
- Si - - — - �
2.2 A prized A ent Steven Silverman
Ma lley Home I marovemidA, Inc. P.O Box 60627, F 010_
Name (Print) Curren: .'ailing Address:
58 -_. - --
..___. __ --
Sigrnat " Teiepi� one
1 cEC TION! 3 - ESTIMA CONS C OSTS
Item Estimated Cost (Dollars) :o be Official Use Only
y
co! npleted a perrnit a polica m
. Building Q r (a) Building Permit l=ee
2. Electr'cal (b) ,Estimated Total Cost of
Construction from 6
?!_ - - ni - v nc, j Buildirp Pcrrnit Fer= I
' I
4. IViechanicai (HVAC) j
- Protection
_ i f
5. i ota; _ 0 + 2 3 + 4 = 5) L Check Number i V f 3 -�
This Sect Fo Official Use Only —_
Building Permit Number:_—, ,_. Date issued:___
Signature:
S;�i:d i�g Cemmissicner /Inspector of 3G�lc:ings vate
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This col to be filled in by
Building epartment
Lot Size
Frontage /
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg & paved
p arkin g)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever een issued for /on the site?
NO DON'T KNOW YES
IF YES, date issued:
I V
IF YES: Was the permit recorded at the Re Istry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, b dy of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit bee or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Gate Issued:
C. Do any signs exist on t property? YES NO
IF YES, describe siz , type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES _
No
IF YES, describe size, type and location:
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C;VVNr PS ACTNIT 0's CONTRACTOR zr;?'' r IF5 FC)rt r'r°€:°(417 w T O DE CO,"I'PLETIED
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Steven Silvezm:in, V llLey Hcome Irip Ovexnent, Inc.
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SECTION 8 - CONSTRUCTION SERVICES
.1 Licensed Construction SLIDerviso_r: Not A�Ojljcablc El
Name of License Holder - Steven rman
-1 _Siime
Address Ay_ Exwra�ion Dato
reiephone
Steven, Silverman 131945
Ro-istration Number
268 Fomer
Scn�thampton, MA 01073 Teiephone 584-7522
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, 25C(6))
Exempt
11. - flome Owner Tlw curren! e-xemption for"homeowncrs`�as cxtendcJ/oixClodo [nxc(|) or z*`(2)&odt,�_s
and m ���a�h hno�o�nc� w :u�u��au individual 6x6hrn'hu does ]lot pusm�xn license
— �� supe rvisor. CNIR 7 80.
Person who Own oparcc| of' land On kvhichhe/shc resides mioundsmreside, on Uerc
is. mcisimcoduJ/w be. u one urtwo I'Lioi|y dwelling, xuucbcdordotadcd structures accessory m such use m��urfarm
structu
Socb ^bnmauvncr' sAzU submit to the Building Of oo u mm' uccopmmu to the uuxux,gwu/`.u.
!'eSj)O1P"ib1e for aII such work pert�w1jim untler the building _permit,
lmurpn�ua�on±�jnbxi��;i6c�qu�u�Gmudm�u,6n�Juh^
pn:7b1i°nu[dovv± for which this permit i:,ioued
Also be advised that with rel't-'rence to Chaptcr 1 (Workcrs' Componsation) aod(C2mpor 153(1,ixbildyu[Era�|n�:n��
�opio�ccs�brinjur�aomccyxlbn�inD�a�)ofrhcNoxa6wucusGonua|Luxs�uwmuud� lbrpocmn(s)
you hire to perform work 6,r you Under this yocn',ic
Thc uodcooiancd ceni5:sand nsaomco responsibility rot comp|iuncc with tile Smoc DuJdinL C' ityof
l�onhs'n�wn�s!}na^ccyS/umunJ 7me\o an 8|-11cn[MaasodxncnaGonc,u!Lzn��noouucU
0t) ice ol'("onsumci
10 �- K a - elite 517
Boston, Nlassalchl~isetts 02 1
Home e 1mprc?v ement Contractor r Registr tion
F• eq stmt ";nn: 131 945
Type: and viou al
Extafratim 10113,12€12 Tr# 204590
STEVEN A. S LVER IAN
STEVEN SILVERMAN
268 FOMER RD.
SOUTHAMPTON, MA 01073
l lidate Addra ss and return card. Nlark reason for Change,
Address Re oval 1:11111111 % meat Lost Card
f)tl"ra c• iir t resssllntcl S6tsrirs � Ftrh+iaess Idt„�r1R.ttr+rrr T.ii olst° or registration v.rltil for i11s11% i11ta4 use 1111Ik'
HOME INIF€ OVEMENT CONTRACTCf1�
before e the e tlraratit�n date. It found return to:
if �� _ ti 4 r Office ofConsumer :affairs and Busines's Regulminn
� ��isfr�,tQr.: - f < _ Tye
Ex11ir ;i n: 1 a t3._ .,. dual 361 Part: t'lar, - Suite 51 7 0
Roston, MA Q116
S'lp. E E'_VER IA%
Q107'3
I nderwcro3lrs 'Not valid k +itlarant st z111t1tre
s1.1� 11 €1 1'9ls . Its t1.s € "E11= :3t llr is
I1111t 11 of tlrstldi Itt �11i tts {r�1� zr >Et sta €14l'4x i.•
77279
3 ig .t1£zt 1+
CO
STS FEN A SILVERMAN
COMER RC
SOUTHAMPTON, MA 01013
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DEPARTMENT OF BUILDrNC; INSPECTIONS
212 Main Street~ ` Municipal Building '
Northampl Mass. 01060
WOREER'S COMPENSATION INSURANCE A FFIDAVIT
TT jyj� SG / 5 U
-- �'L C�.7i l� r/ h'. =- / / L ^�� ..3��� / "�G. -� G ✓./�.L f �I��
(11CensW1PermitteC)
with a principal place of business/residence- aA:
_ `�� /�l//crf? S i �_ ��'�1�'�I�1✓"�tsi�i�/ �%�r (phone # }_ t
do hereby certify, under the pains and penalEes of pedury, that:
I am an employer providing the follo7vui g worker's compensation coverage for my
employees working on this job:
(insurance Compaay) (Policy Number) V (Expiration Daze)
() I am a sole proprietor, general contmclor or homeowner (circle one) and have hired
the contractors listed below who have th-e following worker's compensation policies::
(Name of Contractor) Unsurance Conrpany/Policy Numbcr) (Expiration Date)
(Name of Contractor) (Iasuance Cornpany/Policy Number) (Expiration Date)
(Name of Contractor) (IlWUaU(-- Company/policy Number) (Expiration Date)
(Name of Contractor) (insurance Conpany/Policy Number (Em?i.ration Bate)
(at arch additi shtee ifneocnary to inclutrz infarn:, Boa rtai�im; to arl ""t"otors)
(} I am a sole proprietor and have no or e Frorking for me.
(} .I am a home owner - n °-- rfonning all t� ;fork mye�"
NOTE: Pk-z%w i4 aawam tint viirile hc=oa=ra who esploy pcc�acs to do — hAe _B -, con&urziou cr repair work ou a dweUing of
not m-cre thin IL-- ;mitt- in tu:s hs � � � Y�,i�es ar ca is e -- lrtzn iheren are nct fgzsrerslty coi=i&-rm to be
- aployra U-tcr tl-, . as,,tcaa Act (GLI52, ! t3 >}, 4ppii--6on b a hc°n,�cv= for a Lim cc pesma may cvic she.
ctatia of an cmp9oyar zm& -rthc Workcna's Comrc M �,, �-
I =Izr nd drat a COPY of this 2tu—ni may b. f a q ttx, 17 at of Indn2tri at Arci&xr& Offica of Innunn e for th
v verifi - ico and that fai lura to atsr d covizr- uad: n 25 A of bIGL 15 can lead to the ikon of e; lams pr nalties
5M ay a phat me. to 31 SoO.C� s "cr 0 4 1 r� Of = one y � and civil pcaslties in ilx foam of a Stop Wor',c Order am a
Signed t dZi Of 1 �' 7✓ �' ../ For des l rase only
Permit Number
Lot #
Signature of Y 'eraTr?t` _..__