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STEVEN A SILVERMAN
268 FOMER RD
SOUTHAMPTON, MA 01073
Exiwati■ul, 6i212012,
26868
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HOME IMPROVEMENT CONTRACTOR tu expiration (la it!„ II found return to:
Rogistration, 13' Board ■ IInitdinz
()ne Ibut ion Place Rut
ExPINItion Tr# 1'
018
Type: IncLv
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STEVEN A SiLVERVIAN
STEVEN SILVERMAN
,
208 FOMER RD
SOUTHAMPTON MA ,..11073 ‘tImintktrat Nut 1.N hd withuut ,,igni;turt!
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-4:2 DEPARTMENT OF BUILDING INSPECTIONS _��
•
212 Main Street "Municipal Building
Northampton, Mass. 01060 0, r S4
WORKER'S COMPENSATION MISURANCE, AvfnaAvrr
L / 1 0 kr ,v ! / ='j ---„, /f . ,/ _; ,v /f L%;r ,, L ,,i.--)-- .E= ` 1_,9I / ,1,2/
(licenseelpermittee)
with a principal place of business/residence at:
3 4f6) 7J,/;fr?: i 6 7),. „ffrl! / wi"l %'/u! em (phone #)_ 'fr `/- 7,22_
(Str r af F•, /tip) LI/ 66 0
do hereby certify, under the pains and penalties of perjury, that:
(X) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
/ -,`',/..,% SS L/'7.. (_ 0 . GI) (! (p 6 .:3' 1 <?/ / /�'/
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company /Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional shed ifnecrssary to include information pertaining to all =tractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself
NOTE: please be aware that while homeowners who employ persons to do nmaiitruauc; construction or repair work on a dwelling of
not more than three units in which rho hams ovmer resides or on the grounds appurtenant thereto are not generally considered to be
employers under the worker's ration Act (GL152,ss 1(5)), application by a homeowner for a license or permit may evidence the
legal status of an employer under the Wori&s Compensation Act.
I understand that a copy of this statnr,sot may be forwarded to the Department of Industrial Accidents' O!§oo of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to 51,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S 100.00 a day against tae. ��` i>
Signed this •2 day of / 4 6 1 ; 2 / o For deptrtal use only
C t / p Perm Number
1 hot # •
Signature of L e i -- •ermittee
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•
SECTION 8 - CONSTRUCTION SERVICES ti • .1 Licensed Construction Supervisor: Not r' p t:I, v _;
:t nF_e H3ide Steven Siiver:t ar 07727
( L:c_inso
268 FomerRoa , -.ut rnat-on, tom'..__0_107 _ 1 6/21/1
u: ss f F r= PrOc
/ ! 584 -7522
`grt:t a fele -
9,, egistered,Home Improvement ment Contractor Not Ar . i :art e L1
Steven Siiverman I 11,1Q45•
ComparayName Registration Ntumber
268 Fomer Road , a
Address Expiration iori Pa,
Southampton, MA 01073 - 1 - cc ph orv r, 584 - 7522
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
Workers ers C,.orripensatio'n Insurance affidavit most be completed and SUIDmittcd with tC s apat'.caJon. Failure to provide ';l11s atticai
will result in the denial of the issuance of the building permt. j
Signed Affidavit Attached Yes X No...... la'
111. - Home .Owner Exemp
"homeowners" �' • t o il l (J .
i l ?t' Ciliii.iai exemption for 1a1> .nt2,lC ed to include Owner-occupied � .93. � ot�0i1L' � i I) ft3 ,v.'(1t2
) Italrillc;
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the (miler acts
as supervisor. C.0 R, 780, Sixth Edition Section 108.3.5.1. -- -
Definition of. Homeowner: Person (s) who own a Parcel of land on which heishe resides or ints.nds to reside, u.t ti'Iuch tai +_rc'
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and or farm
structures. A person who constructs more than one home in a two -year period shall not he considered a homeowner
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required front time to time, during and i_pun
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liabilny o? 1-inpioyers to
innpl0yees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable fo ocrsUil (s)
you hire to perform work for you under this permit.
The undersigned "homeowner certifies and assumes responsibility for compliance with the State Building, Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
it.omeownl'r Signature
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Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENTED 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:
Renr
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# 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:
' ,
4 .
.
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-- __-
1 Department use only
City of Northampton \
Building Department
217 Main Street Sewer/Septic' Availability_ _ ,_ ill: '
Room 100
Northampton, MA 01060
phone 413 Fax 413
� | * ---
--
APPLICATION TO CONSTRUCT ALTER,REPAiR,RENOVATE ORDENiOL|SHA ONE OR`[YVO FAMILY DVYELLI0G i
- --- '
-- —
SECTION 1 - SITE INFORMATION
------- - -- This sioe to be corn n!eted by office |
1.IProporbLAddress:
��� �� ru� /�/�y��� Map Lot Unit ����~ w"- Pa SW) --- --- —
Zone Overlay District
Elm St. District CB District |
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
. _ - _ �_ _'_ ___ _ �
2.uwneroIRacoro: .
Pl u1oV P - N rbu.` /QL - ` C._
Name (Print) / Cu:on Mailing A [� �l�2 i
'
~ ���� L�� ___
��A.i~°��^_��^ � ^r Telephone
Ignature
.2 Author Agent: Steven Silverman
Valle II°zue Izu•zovezo§nt ,, ,nc P.O. Box GO637, Florence, MA 0I063
Name (Print) Current Mailing Address:
ArJi � �_ _ _ 584
Signature Telephone _
SECTION 3-ESTIMATED CONSTRUCTION COSTh
_
Item Estimated Cost Official Use Only
completed b i |i i )
| l. Building |
�� � ��fr� ) Building Permit Fee
- |
�
' ~� ~-`~ .
2� Electrical ^ (b) Estimated Total Cost of
- Constrocdonfrom(6)
3. P|umbinO ^___ Building Permit Fee
4. Mochanica|(HVAC) _~___
5. Fire Protection
- � ��� vii / 6. Total=(l +2+3+4+5) ��� Cho�kNumbo/ «�� ��9 | OW- ~ ~ w'~ ~, ' '
This Section For Of ida| Use Only
Building Permit Number: ____ Date Issued: ___ _ -
Signature: _ ____ ___ _-__ __-__ __'- ____ _ |
Building Commissioner/Inspector of Buildings - ___ Date ____1
t
i
File # BP- 2011 -0129
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P 0 Box 60627 FLORENCE (413) 584 -7522
PROPERTY LOCATION 32 GLEASON RD
MAP 18C PARCEL 092 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out }O (�.i/ G _
Fee Paid D� /0' `7 �P
Tvpeof Construction: INSTALL CEMENT LAP SIDING & DENSE PACK CELLULOSE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 060300
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOyAIATION PRESENTED:
Approved 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
I ovIle y
Si: . e 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.
.
.
32 GLEASON RD BP- 2011 -0129
GIS #: COMMONWEALTH OF MASSACHUSETTS
t I8G 092 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 -0129
Project # JS- 2011- 000221
Est. Cost: $10000.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: _ VALLEY HOME IMPROVEMENT INC 060300
Lot Size(sq. ft.): 11238.48 Owner: NEWKIRK MARTI
Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 32 GLEASON RD
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584 -7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON:8/20/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL CEMENT LAP SIDING & DENSE PACK
CELLULOSE
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 8/20/2010 0:00:00 $60.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner