23A-206 (3) (;:,s 77279
kestrwted to: 00 7
0 73
53UTHAMPT04 V\ tTh
Lict-ns or registration t
HOMr ifelPPOVE”E NT ''ON TRAC MR
fan',Mr1— - before the: expiration date. I: found retnrn
board or Re1401.1tintp; and StAndnrric
-nf:31
RegirAration: 13 1.r
'7'S-7011411? ExPirati3n: 1 is.a 275412 Abbuttcm hwe Urn 1
Boston, Ma. 02108
Type.: in(,fivd
4
I/ /I
STEVEN A. SVER
O_MAN 2 ;"(
STEVEN SILVERMAN
268 Fr.7,40;' RD , „.., t
SOUTHA,APTON. iritrann ohd without .sign.iturc
. The Commonwealth of Massachusetts
(' ' Department of Industrial Accidents
;7_ Office ofInvestigations
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
. 1x5!.6 E1CL'ELII ILL!_ 1 nf, fl fl 7 '" ` .t trr- a (tf ?:'T"^+.a+ " '.X' aa: s#" --s -. r. i' '' • ,.ji
name:
location:
city phone #
0 I am a homeowner performing all work myself.
0 I am a sole proprietor and have no one working in any capacity
': , i, t ;v7 f itici r .,4 4 111" N1 ci ' r.,r gue.,. ;, .� z r..' aY ;.,- rt7 `
I am an employer providing workers' compensation for my employees working on this job.
!/
company name: fizz /
Address:
vo / � f ' / l f� 4/'6r .
city: /t/L're-, 7fv> / T77(- ."'. , ' 106 p hone # ; '--5 - er 5 2
insurance co. Ai -5 J Cam p olicy # 1 -» ::: ✓
u.4 5 t> VA alL*44 b kt' nPiWiv ' 9x2" z ` d r t Y� is ss w s 6 �� r<;� t ' Xu w Y x r<r 4u
I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
company name:
address:
city; phone #,
policy# .
insurance co, _..
+�F` ,0,: e4440 t i i" 't, e,`d 1r .z0.i"s "` . s"iorii$`,� V1 flee, 's.'In,4,
company name:
address:
city: phone #:
insurance co. � . w�a a paltry #
�5' -ai e ..z t z ' �L` t,' 7 A%LG? ,�.°" s F M ' d2
� ����,��, . fir a�� ��, 1 ;�r""���a�, �`���~44
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and /or
one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under l tthee pains and penalties of erjury that the information provided above is true and correct.
Si J /�� / /A 4 J' / -0 , Date ' / 3 �
Print name /1 $/f // Phone # *3-6–
— 6 – ! - 75
2
rte.; -. sf:.- .. sat rtes
official use only do not write in this area to be completed by city or town official
city or town: permit/license # °Building Department [i
0Licensing Board
0 check if immediate response is required OSelectmen's Office
°'Health Department
a contact person: phone #1; ❑Other
(revised 3/95 PtA)
•
SECTION 8 - CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Steven Silverman _ 077279
License Number
268 F.,,er Roaril._..,, , , ,■ • •n.,_._MA p1 073 __ ._._ 6/21/10
Address Expiration Date
• 7‘,/ 584 -7522
Signatu e Telephone
9. Registered Rome Improvement Contractor: Not Applicable ❑
Steven Silverman.. 131945
Company Name Registration Number
268 Fomer Road 10/131/0 - - -__.
Address Expiration Date
Southampton, MA 01073 Telephone 584 -7522
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes No ❑
1 — Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner -- occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there
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 be 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 from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(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.
Homeowner Signature
TON j . DESCRIPTION or PROPOSED ViORK_rshittk all appNdsitilsn ,
i New Ilcusd L.: i Addition LI Replacement Windows ; Aaetion(s) L 1 Roolint: n.
1 Accessory Bldg. D DemolitioX New Signs ' 1 Decks : 1 Siding [ 1 Other .. 1
„ 1
Dr:"IC on ,', r'r ',. r .0 4C,',., WATEV, 0,61 fP(.42 BuiPq Pile ' Ot kr op,K ok
th.: :/ft1,-T Y.F. /., NO tol Erp, orfty: 'It-.10or‘,. Y0 Nr, ., 1 STF
;Lt,,Lhe;.: ,, :r..1 0 1,1E1'.:: l'0. ,P, ,11'''w..01ri !.;07.:1',",ntl 't
Ga. If New house and or addition to existin housing, complete the following:
ii" C' :y Tr..7):Thrn.iy
.-..:, 10,...11',"*.: r'," il`..7. ■1;.:',V.:il ',711 ir,,i' %^1^n..7:77,'" ! :
L'.. 1 ....te ?
' '..i ri4::-.r.,.1.f., :7,;,:,4. ,, ,-:, I 1 ,', 11 ,,,,, t :t)
'. Lr` •10...00'. i i Li: .,: ....--, ..r ,VG0'00,..tn . Porn 1..:°,-- ,,, vocir
cr.:5- 1,7,v::!orr ...:;or io N.'::::, i.11 sr:010 fw : cc'
I on, 1c,-
(r...Jr,''t .t Iii r it 1 :4 ,1 , - , o10.;-. , '" __ 'Sr*, ". . „ ,N , t 100 yr - 1 , :.,j , ialo..1 ft:
r
I cw,r t 0:0 'I -1 i
',,` f: .,'.: (r i,i !:':111,`,,,, :1':f1 ..:•,t
t
1'1 ..,,„--..,, k.:, f..:t..„ ,..*,
SECTION 7a . OWNER AUTNORlZATION . TO DE COMPLETED WHEN
t 1 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
u1,;:c k .:,...:Lri?
........_
Steven Silverrftan, Valley Home Improvemen.t , Inc .
tr, L-,--,-V i ...1 I -- lzu, ,,-. -L.,- ttl w /I .-Aith4:-1, :r., hif, b,..1';,:. ir,, . r: ,'::writ;:itr,
III Y i tot 0
Si",f 2:..11' Col 0041 `,/(r•
, Steven—S1.13te,rman,__Valley_Horfte_Impent,_Inc_. , .,,, ,.....: /Al it t.fl t/f-'I
nC siCC":"P".* 7. :-,',.' 'z'Ar.:11".'„2"1`,2) IIIC 1 ir” the foRfRotr ,:-.: :tor ; citic;' .:.P:; '.''t:0...: 0 iik::.;. itt,t, l',) liti ',,',:.',":, F,' n y
rlf`CCC' nc ticlic-.
..A., A _, :t-. :Ji",'L" .1 r..:...rti !.V...z. L
Steven Silverman _...., _ _
I if .
F r,tin:
*
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:
J
Rear
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 eve been issued for /on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the 'egistry of Deeds?
NO DON'T KNO YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a b sok, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a perrilit 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 arty proposed changes to or additions of signs intended for the property ?YES —
No
IF YES, describe size, type and location:
R
T Department use'orfly
l._ City of Northampton Status or Permit:
Building Department Curb Cut /Driveway. Permit
rp'�C
' Main Street Sewer /Septic Availability
,Cr "Room 100 Water /Well Availability
V Northampton, MA 01060 Two Sets of Structural Plans
phone 413.587.1240 Fax 413 - 587 -1272 Plot /Site Pans t
Other Specify ;tr
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: -,'This section to be completed by office
9C.7 of -art Sr -- Map Lot Unit
,ZGs " j , Zone Overlay District
Elm St. District, CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
-- Name (Print) Current Mailing Address: /'j,1 M P rom / N`/ 0 8104;3-
C1 sr I /`! , Cf Telephone . G)
Signature
2.2 Authorized Agent: Steven Silverman
Valley Home Improve = t, Inc. P.O. Box 60627, Florence, MA 01062
Name (Print , Current Mailing Address:
/ 584 -7522
Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 44 3 r, r�; (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) 4/ x3 i< Check Number 9/6 -1 2sr
This Section For Official Use Only
Building Permit Number; : ' Date Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2010 -0672
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS /PHONE P 0 Box 60627 FLORENCE (413) 584 -7522
PROPERTY LOCATION 90 BEACON ST
MAP 23A PARCEL 206 001 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 3
6 ;24 Y � � ��
Fee Paid Y
Typeof Construction:_DEMO 1ST FLR WATER DAMAGE _
New Construction
Non Structural interior renovations
Addition to Existing
Accessory 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
INFORfVIATION 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
// 21 2- 4't
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.
.9 0 Bt.A ` BP- 2010 -0672
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:B ock: 23A - 206 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- 2010 -0672
Project # JS- 2010 - 000985
Est. Cost: $3000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 18905.04 Owner: SHEA LAWRENCE D MAIL TO: THOMAS M SHEA
Zoning: URB(100)! Applicant: VALLEY H .QME IMPROVEMENT INC
AT: 90 BEACON ST
Applicant Address: Phone: Insurance:
P 0 Box 60627 (413) 584 -7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON:1/27/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: DEMO 1ST FLR WATER DAMAGE
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 1/27/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo