38B-025 (2)BP- 2011 -0493
' 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:
Permit# BP- 2011 -0493
Project # JS- 2011- 000808
Est. Cost: $3800.00
Fee: $55.00
Const. Class:
Use Group:
Lot Size(sq. ft.): 4138.20
Zonin URC (100)
BUILDING PERMIT
PERMISSION IS HEREBY GRANTED TO:
Contractor. License:
VALLEY HOME IMPROVEMENT INC 077279
Owner: ONEILL MARY E
Applicant: VALLEY HOME IMPROVEMENT INC
AT. 22 FORT HILL TER
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584 -7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON. 121112010 0:00:00
TO PERFORM THE FOLLOWING WORK.- REPLACE/REPAIR SHEETROCK & OAK
FLOORING
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W.
Underground: Service: Meter:
Rough: Rough: House #
Driveway Final:
Final: Final:
Gas: Fire Department
Rough: Oil:
Final: Smoke:
Building Inspector
Footings:
Foundation:
Rough Frame:
Fireplace /Chimney:
Insulation:
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 12/1/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
File # BP- 2011 -0493
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O Box 60627 FLORENCE (413) 584 -7522
PROPERTY LOCATION 22 FORT HILL TER
MAP 38B PARCEL 025 001 ZONE URC(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
T_ypeof Construction: REPLACE/REPAIR SHEETROCK & OAK FLOORING
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/ Statement or License 077279
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER:
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
j cl 3Q 1 o
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
City of Northampton
Building Department
212 r Street
Room 100
Northampton, MA 01060
phone 413 - 537.1,240 Fax 413 -537 -1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by of fice
1.1 Proper d Tess:
.24I ew/ 1114-1
Map Lot
Zone � Overlay District _
Elm St. District _ CB District_, _
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2,1 Owner of Record
LL
Name (Print)
Current Mailing Address:
Telephone — --
Signature
2.2 Authorized Aeen _t: Steven Silverman
V alley Home Imp In
P.O. Box 60627, Fl M A 010
Name (Pr' )
Current Mailing Address:
58 4- 7522
Signature
Telephone �
SECTION 3 - ESTIMATED CONS COSTS
Item Estimated Cost (Dollars) to be
Official Use Only
completed by ermit applicant
1. Building
(a) Building Permit Fee
2. Electrical
(b) Estimated Total Cost of
Construction from 6
3. Plumbing
Building Permit Fee
4. Mechanical (HVAC)
S. Fire Protection
6. Total =(I +2+3+4+5)
- �CrU
Check Number
i
This Section For Official Use Onl
Building Permit Number:
Date Issued: _ _ _ - - --
Signature:
Building Commissioner /Inspector of Buildings
Date a
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
A. Has a Special Permit /Variance /Frhding ever been issued for /on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit record d at the Registry of Deeds?
NO __ DON %I KNOW YES
IF YES: enter Book! Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES i
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, 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:
Existing
Proposed
Required by Zoning
This column to be filled in by
Building Department
Lot Size �
Frontage
Setbacks Front
Side
L: R:
L: R:
Rear
Building Height
Bldg. Square Footage
%
r`
Open Space Footage
%
;
(Lot area minus bldg & paved
r
/
p arkin g)
# of Parking Spaces
1
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Frhding ever been issued for /on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit record d at the Registry of Deeds?
NO __ DON %I KNOW YES
IF YES: enter Book! Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES i
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, 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:
l)N 40 rMrM �';QPK
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m or -,dd;fl�on to cXis"I"'s --omptc Vic followznq:
ot,
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SECTION Iii - OWNER AUTIiORJZAT40' - TO BE CO374PLETED WHEN
OWNERS AGENT OPICON7RACTOR APPIACS FOP (3L PERMIT
Steven Silverman, Vall ey Home IrLprovement, Inc
0,)9
| �
I SECTION CONSTRUCT SERVICES
.1 Lben:,ad lonstru :
Steven Silverman -------� ---
268 Fcme- R a"
/«
584-7522__
|
584-7S22
9,,Rt- ��qd_
-Steven
�qnip any-RELm e
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A
SouthamDton, MA 01073 Teicplori�
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0.772.79_�
Exnio�,nn Co�
Not App|'cab e O
R��is�rzhcn Nunbcr
IO/
Ex�irabon Datu
SECTION 10 WORKERS COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
� -
- )ismadAffidamitAttachad Yes--. gD Mo-- O
11. -1-lome Owner Exemption
lh'�curromc�omptivo for '`bomeo` nco'' was cztended|vinclude [onc(|) Or x.)(2)lunUleo
uyJ to uUwr such homeowner /o cn-age an individual Onhiowho dnm not poss�o u |iccnv:.
as supervism C '80 Sixth Edition Section 108.3.5. 1.
Homeowner Purson(s)vhoowooparoe|o[\oudoowhichhdsborcoidcsnrinrcndxmrns|du'on dmo
is, or is intended tobe, a one oi two. rarnih! dwellina. attached or detached structures accessory to such use and'' or I'ai
StRICt UITS. A persop who constructs inot than one honic in a two period shall not Ile comidered a
Such "lloillcowner" shallsubmit to the Buildin Offlicial, oil a form acceptable to the Building Official,
responsible for ill such work performed under the buildiw,' perillit.
As acting Construction Supervisoi your presence uu the joh site will berequired Unn dn/c1o/imc.dubll"'uudopox
um/p|chonof�� work for which this pconhis\oucd
Also bo advised that `viiholbronrem Chapter l52(VVortcm' Compensation) and Chapter 153 ((juhUkyn[Fmp|n"oo'o
I!rJlp|oVcesforinjuhcsom resulting in Deat o[ the \4axxuchuso/s6mcm| Lam &noomLcJ, pcaou($
you 6irum perform work For you under this pxnnit,
The uodcsiLncJ ^humonwucr' ccniDcx and assumes responsibility hrconnp|ionncn/iththc Stouc BuiNiniCodc. City o[
Northampton Ordinances, State and Local ZonkiL Laws wici State ol'Massachusc Cicnoral Lrws 'Amlouacd.
Homeowner 3iouotoro_______
'Y"
' and Ifusitiess Re�(- WIW6011
OM CC Of CNISLimer All,
10 1) a rk P I az-,'t - S u i te 5 17 0
Boston, massacil'u.setts 02 116
1 Nue Improveniciv Cmitractor JZq-',JStrmioII
Rebskatmm 131945
"("doe, lncivAjal
Exjimbom lW13MO12 TO 20&0,
STEVIEEINI A, SILVERMAN
263 FOMERI PAD,
SOUTHAMPTON, MA 0
U pdMe Addmm mW return mr& Mao rea"n Nr amyv,
Lost C"11-d
Oji�vv (n 4 'mlurflcr Afhirs o BiYjnv"z kcgvi'ttiou
HONIE UNIPROVEI'AENT CONTRACTOR
Registration; 131945 Type:
xpiravon:
STEV, S!"LVER'
STEVEN SiLVEiRW"N
AS FOMER RD,
SOUTHA%IPTON, N!A 01073 1 r�'8
Uk:cu!I: . "r rt-gktrmioc! vilid 1"?r imh"Wu! w (•
I)Jorc the eq)ivafion da!v. If found rmurn to:
Onlcv of ( uw'unler :Aff.07 and Busilles'! Re��ujlktion
10 Pmh Plan -Soo 5ro
B o0on Nl!k 021
'Nca valid a�iffwut i"ignllure
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KIC"I 14 Pum My
IS u•"I 14 Mudlum Inc 110361m,
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S EVE N A SILVER MAN
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DEPARTMENT OF BUILDr J.NspEcTloNs
212 Main Streett ' Mu Building
Northampton, Mass. 01060
WORKER'S COWENSATION INTSURANCE AFFMAVIT
with a principal place of businesslresidence za:
3ito (phone#)
do hereby certify, under the p aad pen;alfes of perjury, that:
I am an employer providing the following worker's compensation coverage for my
employees working on this JUD:
XSI11(a5s Jw-S l U . 6t),r- o � 55 / Z / Z/—/
(Insurance Company) (Policy Number) (Expiration Date)
( ) T am a sole proprietor, general con=ctvr or homeowner (circle one) and have hired
the contractors listed below who have the fallowing worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
lame of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Iasiumace Cozipany/Policy Number) (Expiration Date)
(Name of Contractor) ( Insurance Conpany/Policy Number) (Expiration Date)
(attach additicnal shed ifnecemLry to k4uzle kdbrmata.n p t all cca
I am a sole proprietor and have no crie working for me.
I am a home owner performing all the work myself.
NOTE: please be aware that while hc=ow=s who employ p== to do nm construction or repair work on a dwcUiag of
not meta than three units in which the bomem= re ca t gre wx
are not SzneraUy considered to be
empI under the worker's -mp=dion Act (OLI 5a= 1(5)), application by a homeowner for a Eows* or permit may evid tho
IeB21 statue of an employer uodarthe Worlwex Com ==a t loa A
I u that a COPY of this 5:±nf—=t may to f"wa t Lha DVuu=.t ofln�al Ac-idea& Office Of I-- for the
coverage Verifloatica and tha failure to semuv co &T&9 und= SeMcm 25A of MOL 152 can lead to the imposition of criminal Penalties
misting of a fine of up to $1,3GO.00 wxVcr of= 10 one year and civil pcnaltim in the form of a Stop Word. Order and a
film of :S100.00 a day against ax
4
Signed this dayof Li For dq=tmww use only
f 44
r A) Permit Number
l / -I Mao Lot 4
Signatmt Of IA