23A-206 (4) .
i ,
/ ti i u ss:tcl�usetts - Department of Pu Safetl j
.. • � �I B oupervi Liceaiul nstane
License: CS 77279
00. ;:)
Restricted to; 1
STEVEN A SILVERMAN i
268 F.OMERR
'.0
SOUTHAMPTON MA 010734 ' " 44 "
Expiration: 6!21!2010
�- _�' i- 7r#: 25795 1
t i,mnt
c.
B ,Q ,I tg- RegnfiiiickAadgVitiftl f 1 License or registration valid for individul use only
� HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 131945 Board of Building Regulations and Standards
__ . One Ashburton Place Rm 1301
Expiration 10/13/2010 Tr# 275412
Boston, Ma. 02108
e
- -
,,,1:----,—: Type Individual ^ d STEVEN A SILVERMAN! �
STEVEN SILVER[VMAN lJ, // ...
268 FOMER RD. C 4w^C -2-1- --- 1 [ � � `1 t. = 4. t`, ��
' valid without si nature
SOUTHAMPTON, MA`0.9073:•; Administrator g
J•
4 'CttAMp 7 .
b �o of $ CTxi X f NOz# &rpt.an 1 _ * _°
1
j e t a55Rrllrisett5 r te_
�. . 9 DEPARTMENT OF BUILDING INSPECTIONS __`
212 Main Street ' Municipal Building ' a
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, 4/ LSa sif / /= -1 =t X77 , V//1--/- ,V ffti1Le_ .l�'' 0p/' A' i; !h c
(licenseelpermittee)
with a principal place of business/residence at:
3 `f U /2i// S 1.6 i) J✓ / 0. 1 -1 -7f il7A — ee ; rim (phone #) J` `/- 7Z t?
(street/clt lsta thip) eff 645 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:
/SL(LG S _1 Gv . C F6 v 55 / 2//�/..�
(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 sheet if necessary to include information pertaining to all contranors)
( ) I am a sole proprietor and have no one working for me.
( ) 1 am a home owner performing all the work myself.
NOTE: please be avnrre that while homeowners who employ persons to do maintenance, construction or repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thereto are not generally considered to be
employers under the worker's onion Act (GL152,ss 1(5)), application by a homeowner for a license or permit may evidence the
legal status of an employer under the Worker's Compensation Act_
I understand that a copy of this s» may be forwarded to the Dtve tmeed of roa Acddea& Ofoe of Insurance for the
coverage verification and that failure to segue coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a &ere of up to 51,500.00 and/or Imprisonment of up to one year and evil penalties in the form of a Stop Work Order and a
firth 0( 3100.00 a day spina the.
Signed this � day of 4 .9 For departmeotal 1Se only
Permit Number
d / ✓ J /77)a" . Map# Lot #
Signature ofLf4., ..- • ermittee
SECTION 8 - CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: Not Appicable ❑
Name of License Holder: Steven Silverman___ 077279
License Number
268 Fo �e Ro- �_ Southampton, _��A 0� 07'x____,... -- 6/21/10
Address Expiration Date
/� 584 - 7522
S!gnatur- Telephone
9. Rei istered Improvement Contractor: Not Applicable D
Steven Si lve rman.__ - _ 131945
Company Name Registration Number
268 FomerRoad 10/13//0
Address I 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 X No ❑
11 - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner- occupied L)wellini=s 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. C■'IR 780, Sixth Edition Section 108.3,5].
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 -sear period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the f3uilding Official, that he/she shall he
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 (Liahility of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable fbr 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
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'7CTION S. DESCRiPTION or. PROPOSED ViORK. fche-*: MI qpnc110
...
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New Ficw.,e ',....: ' Aeditien Li Replacement Wirdews A te tation() I: Roofint 17
Or Doors :: i •
Accessory Ed;. :3 DmoIitior New Signs ' I Decks I Siclirg i j Other . X .
1
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6a, If New house and or addition to existing housing complete the following:
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.',. SECTION 7a - OWNER 1-',UTLIORIZATION .- TO BE COMPLETED MIEN I —
I OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1
/ 7) orn Ifs .5,-e/ • ic, Dv,.0._: ...*:- _ i-,ILct
, ..t-1 . ...„. , ..:.e. - Steven Silverman, Valley Home Improvement, Inc.
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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
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
i
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:
FE8-10-2010 11: alA FROM: THOMAS 11 SHE A C908) SOB-735-907i 70 : 141.35e50820 P.1
r -
City of Northampton status of part; plit: pepartment use only
I
•'1'Irt,i
Bu ilding Depa rtrne n L Curb Cut/DriVewey,Fiptrit
212 Main Street Sewer/Septic Availabty .,'-, f
Room 100 WaterAVelt Availability
m Val
I Northapton, MA 01060 ....t: : . ,,
Two Sets of 5' ., Plans. ,,,•''
i phone 413.587.1240 Fax 413-587-1272 PiptiSite Priog_;;
1 . r ... A , , ..,9„, :, t 1: ,,• , . ; A t
______ Other Spec
r - - -- - - - "'"
; APPLICATiON TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION f
This section to be completed by office -- - :
1-1 Eros/tad doza:
1
Map Lot
1 4 .i Zone _ _ _Overlay District, i
Elm St. District_ __ _ CR District.
SECTION 2 - PROPERTY OWNERSHINAUTHORIZED AGENT
7 - - ----:- — ---- - -
2,2,_Qww_r of Record:
J7 LE 4' e-d-Ver
th a41.15 Sh X if- itnni "ram, Af sr 0172 z. (7 3
.....--
klu-ns {Print) Ca..rrerit Val:iris t.ddress:
A pi.. f• _
-11 ....Ardmide..A.Sta,________--______ TE eohona 73 ,-- 9 0 7/
s re . 4 ,
gaikuthorized Agent Steven Si lverman
Valley Rome Isjaroy : Incl... . P.O. Box 60627, Floxanae, NA Olak
i 2
rame (Print)
,
A.i..._ .._......_ . Cif( rrit Waling Aeciress:
584-7522
Sisnature Te•oph5 ,
___
iigcTi0/ 3 • L5VFOATEo coNsimucnamrasia d
_
-
Item Estirnateu Co; (Dollars) :c Le I Official Use Only
---- m leted oi emin a_p_plicaT. i
iitalding Q 5 01,to , ( , ) 13tnidin g Perm,t. Fee
2 Electrical 1 t Estimated Total Cost of
1 Construction from 6 ____
_.—.
3 '..-'iunitiirig Building Permit Fc
' Mechanical (HVAC)
1 - -ire Protection 1
— -
+ 2 + 3 , 4 + 5) 5 (2,)C. te. chock Numner
— This Section For Official Use Only
1 fkluresbors____ - 1 rPain Itrtlad• , — - --. -
-------
-----1—.— 1
_
—
_ . _._______ . _ _ _____.), ________
Buiing ConimiSSioner/Inspector of Biiiidines . die
Te'd WV G1:ee e;-et--&3d
2f10
Department use only
City of Northampton ,
Building Department Curb;Cut /Driveway Permit -
212 Main Street Sewer /Septic Availaitity
Room 100 Water /Well Availabilty>
Northampton, MA 01060 Twv Sets of Structural Plans
phone 413. 587.1240 Fax 413-587-1272 Piot /Site Piaps
Other Specify
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
/U /3 l ' //('0/e._ 5 Map Lot Unit
/2-G £ ,1 6604 Z Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: / ,5 7 ), IL L E w
� `C s ■f //79717 're) /(/ O g72 7— 2_ 5
Name (Print) Current Mailing Address:
lep
Te,., hone G [ J' - �? j '
Signature 6
2.2 Authorized Agent: Steven Silverman
Valle Home Im• rove ':�t P.O. Box 60627, Florence, MA 01062
Name (Print) / Current Mailing Address:
, �/ / 7\-' 584 -7522
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit 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)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) as 000 ({ Check Number .� 4 5 oz 7 ip /5V
This Section For Official Use Only
Building Permit Number: Date Issued:_
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2010 -0725
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
Fee Paid 1,6 0
Typeof Construction: REPAIR WATER DAMAGE (FLOOR,CABINETS, & BATH FIXTURES)
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 FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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
Demolition Delay
2/64 )
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.
t •
BP- 2010 -0725
GIS #: COMMONWEALTH OF MASSACHUSETTS
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: WATER DAMAGE BUILDING PERMIT
Permit # BP- 2010 -0725
Project # JS- 2010- 000985
Est. Cost: $25000.00
Fee: $150.00 PERMISSION IS HEREBY GRVTED 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 HOME IMPROVEMENT INC
AT: 90 BEACON ST
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584 -7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON:2/17/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: REPAIR WATER DAMAGE (FLOOR,CABINETS,
& BATH FIXTURES)
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 2/17/2010 0:00:00 $150.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo