30C-080 (3) INUM CIR BP-2011-0324
GIs #: COMMONWEALTH OF MASSACHUSETTS
:Block: 30C - 080 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-2011-0324
Project # JS -2011- 000531
Est. Cost: $15000.00
Fee: $90.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 36067.68 Owner: GRIMALDI NICHOLAS & STEPHANIE
Zoning: SR(100 )//WSP Applicant: VALLEY HOME IMPROVEMENT INC
AT. 42 PLATINUM CIR
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584 -7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON:101712010 0:00:00
TO PERFORM THE FOLLOWING WORK.- FIRE /SMOKE DAMAGE BACK TO STUDS
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 10/7/2010 0:00:00 $90.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
1 �
Department use only
City of Northampton Status of Permit:
�
Build' Department Curb Cut /Driveway Permit
C� .212 Main Street Sewer /Septic Availability_
&eso m 100 Wa /Well Availability _
Northampton, MA 01060 Two Sets of Structural Plans_ _
phone 4.13- 587.1240 Fax 4 -13. 587.1272 Plot /Site Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DVyELLiNL — i
SECTION 1 - SITE INFORMATION
1.1 Proper , Address : This section to be completed by office
2 6— Ile ez- _ Map -- Lo t_ -
�� A; C : f 1 !�jlll& Z— Zone __ _._-_____ Overlay District __.__.___ .
I
Elm St. District.. _._ CB District—__.
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1._ O wner of_ Record : �
Name (Print) Current Mailing Address:
VIM _ _ Te;ephone
` S i b nat re
! 2.2 Auth Agen Steven Silverman
val H ome Imp nc._ P.O. Box 6 06_2 7, Fl . . ...X& 01062
Name (Prim) Current %nailing Address:
58 47522
Signature Telephone
SEC 3 - E STIMA TE D CONS COSTS
Item i `stirna'ed Cest (Dollars) to bc; Official Use Only
completed by enriit a pplicant
_. Suiiclinr (a) Building Permit Fee
2. Electrical 1 (b) Estimated Total Cost of
Construction frcm 6) _
Ruildin€� Permit Fee I
I I
/S. Ivecnanicai (HVAC)
;.
- Protec` ion i
-- — - -?
6. Total = 0 L 2 - 3 4 = 5) Check Number r
This Section For Official Use Ontly _
Building Permit Njmbcr:_.___ -. _— ____ -- Date Issued:_.__
Signature: t -/ - -
I Er!a,ijg mrn;ssioner /In spector of Buildings �a e
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
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 %
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 been issued for /on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T 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
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:
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SECTION S - CONSTRUCTION SERVICES
i superviso 1 ---A --
_Licensed Cons ruction - SUpe
j 077279
Lccnso I'Agaher
2 Fomer Road, Southampton, -MA— 0 _ 1 . Q73_ 6 /2 1/ 12
584-7522
9.3.99istered Horne Im rovement Contract r:
-Stev Silverman 131945
I compwy Nalme Rcosk&on Numk;r
2 F rmer Road -------- D /13 /N'
Expkabor Dan.
Southampton, MA 01073 Teicpliont-
� SECTIONI 10- WORKERS' COMPENSATION INSURANCE AFHDAVIT (M.G.L. c. 152, 25C(6))
Insutarce affidavit must be completed and su•mittcd will"! application_ 1=adum to pion G his aMcavt
.•,ill resjit Iri the cenj of the issuance of the but cl permit. —01
Tgned AHAast AHachw? Yes.... 20 Na... D
1- - Home Owner Exemption
10 cuavu exwuption for -- ! - ,onso , ,v11c1 - s` w,1scxte11clCd to iflClUdC 0`iV118n T-H—irims of one ( I ) or 1NON) 110%;
- ind to allow such homeownur to crippan individual ( hire \vho does not powess a license, pTovkhmi that the covner pyt
Ltf
as snpervisor. C'.NIR 780, Sixth Edilkin Smdon M&1&1.
Demmkialf 110grallemomwancor: Person (S) who o%vna Parcel of'kmld on xhich hc,shc resicicsor in',Cnds to : o:-, v.hich Cili IC
i�, or is intcndcd to b a one or mo fiainilydwel!ing atinched or detached savaums amumvy to such me amll w Rm
'-C: ': ons cd i�
in a iwq4yay ljiq��
Such MMH 05mit to t h e Bunwing omciai, On a Corrir ,icceptable to to INIANg MciaLdy t €ct = B 4 nfall
rcsDausible Rw aH nwh %cork performcd under the buNing pumR.
Asactin« Conti jtctioji Sk�pervisor ymn presence on be oh site "11 be requircd frorn lime 10 linlc, during ;snd ilpon
completion of the work for 1t10ch this pc unk A issued.
Also be advised that. with reference to Chapter 152 (\korkers compensation) and Chapter 1�3 (Lial)Hit
010yes thr injuries not ivqihing in lhat) of the Munichoss (71'n ml hm q Amwwwl you lip lin'blv pere, Vs!
1 a nk a .1 P. loan " "I An " i"al 14 P a �:3.
Tl't2 cerlifiles mid asynnes lor woh SLk,c
sl,c4,Tc -and Loml ZoAng in"i and Stste oFMasFnhvwUF Gmvm! Laws AnnNavi
Mot"! (d H161di", Newtimi"ns vula n1judank
CS
to: 00
STEVEN A SILVERMAN
268 FONIER RC
SOUTHAMPTON, MA 01073
6`21,20
HOME NPROVEN" CONTRACTOR 0W, 0,1,dl-36 0 0 (Llte, lft"AW,(4 )°Chllll 10:
BoAd if jUng Reguhlbons and YN"dark
On As A&Wn Mme Rm I Nt I
E couwon: 11112010 TV 275472
Do S umn oil. UZ I N
ST E VE, N A, 5 1 L V E R f,1A N
-STEVEN -SILVERMAN
A,
268 FOMER RD
SGUTHAMPTON, NIA 01073 AdmWornmr u WwW synK re
Z' �t
Cr r ort4ailtp tor z
$ � sasaxcfansrtts
DEPARTMENT OF BUILDrNC I_NSPECTIONS
212 Main Streett ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION !NSURANC'E AFFIDAVIT
1V2 1..5 c .f S id
(lieenseel'permittee}
vrith a principal place ofbusiness /residence zt:
3 S j _ x'i1Z �1t1t - , �i�/� r.92 (phone #)_
do hereby certify, under the pains and penalEes of pedury, that:
j I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) ( Expiratfon Daze)
() I am a sole proprietor, general con=dor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies::
(Name of Contractor) (Lnsuranc Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Co>nparzyy/Policy Number) (Expiration Date)
(Name of Contractor) (Lla any Company/Policy Number) (Expiration Date)
(Name of Contractor) (fnsllrance Com3parry/Policy Number) (Expiration Date)
(anach additional sheet ifnecezary to iac iafbr a oa min n . to all o=ttac m)
(} I am a sole proprietor and have no one worting for rate.
(} I am a home owner per a11 the � myself.
NO;'E: pl=y be ssaarc i hEt veEle ho=o"m= wbo employ paw= to da muiLa� consty ou or repair work on a dwaHng of
no, ^ 8 +a__ -.^ thhm inziL^. is w Ech t .`Lou� xtsides or ca u,! goux�is azmAo --n t6_- a a= not mer� -1y caasidsrtd to b:
esaploy= un&x the wozrAzr� cam=iuticn Ac (GL152,m I (S)), ap�pllczth:on by a homwow= far a lice or pamit may cVi the
leegtl dabea of ate? ETi7, ployar ans'&rtha Worr;�'a Coma er--afi,-xa A—
I u_^. ad ttaat a c,py of this & t & N; =,:r may be f6iward ad to Lh d Dt of j,4,,- i al Arzi OH3c�j of Imr esac9 for tf s
c ovtmg vaific2tian �'nd &a faille to Soalre covcia urn zscica 25A of b1GL 152 can lad to tha impaesriion of mim val pmaliks
c--� of a fir-- of up to S1,500.C.0 sdxV.x of ten one y and cavil penalties in the fom of a Stop Work order and a
Em of 5100.00 a day iL, a . rp.
1gr3cLi $ 1i5 ^ d�:y 0a %G? }� "1' J For dpmtr ec?3I only
" Permit Number
Reap#{ Lot 4
Signaivat o #L�icns�lPerm3t
N I �t "N ,rk I I (I "k-I I s - I K I tarf mco f �it llkl I% I it: � ;tt t is
lai I rd a4 1 � I) i I i I i f I -�, k4 rl 1 .11 it if 10 t c I N I, t f t r
CS 77279
STEVEN A SILVERMAN
268 FOMER RD
SOUTHAMPTON, MA 01073
601201
— 7 - 7 —
mj 26868
I Ac( or retvstra tion tali( for indi% it] u I use ftrll�
HOME IMPROVEMENT CONTRACTOR Wove The expiration date, If found return to:
13flAeff J Building
One A �, ihirtop Pj�kcc R �p J,�O I
Fri 211��
Exp ratiotv
02108
Type
STEVEN A r� sLVERNIAN
STEVEN SILVERP
2 8 FONIER RZ) V,
0UT'IlANYTrjN4 MIA tiAid isilbout Sogfl�W'rc