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24D-238
. . . ) . , / - Board of Buiding R , . . ::._.. Massachusetts - ,,...7,-* N„:4 Construttion Supervisor License Dep I .1,.,,i-rtuni-lactlilotnost. aPntidhslitc...iSnIttitelrt:.:Is \ 1 License: CS 77279 1 . c-zczitt Restricted to 00 I STEVEN A SILVERMAN 01073 . --:-. -,--,e- --------"--- SOUTHAMPTON, MA ) Expiration: 6121/2010 Tr#: 25795 " .------77----.. ( 01111111SSIM .." * . \ J . , . . BigLodispild.ing-Regul License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 131945 ., ard of Building Regulations and Standards Expiration: 10/13/2010 Ti Tr# 275412 One Ashburton Place Rm 1301 , Boston, Ma. 02108 1 - :T9ri_elnOiviclual :: •:--_ --, ,17- .,:::'_-.„::-:, :; 'i ,/,/ / STEVEN VEN A. SILVERMAN :, -.....' ' / , / .:- . STEVEN SILVEr<MAW- — _---- , . -. ' ---1 -7 : ..:' ,. .• - - . : - - SOUTHAMPTON, MA 01073 .L. Administrator Not valid without signature - . . ' . / 4 . . . . . • ' . - - ' . 01. 511AMp2 o # a, r./ $ l'Lx of Nor 1IY I QTT *_'° ` 'j� y ;.j` ' assactinsetts �W =— DEPARTMENT OP BUILDING INSPECTIONS 212 Main Street • Municipal Building ' o V Sv , - Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, /f/2 LS off' sw i rk - r/ /fib 1 //" L . P� 1/'"' dne4 i, /7/1 (licenseelpermittee) . with a principal place of business/residence at: 3 ' O ////f. -.s i.b I)/i✓`Z / ,f/� -7fg,w,/ ,` i,M (phone #) 5 - 8 1 / .-- 7 ZZ (strerticityls lzip) eNem C) 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: n /(L '5s _2-7l'S, 6'0 . 1 C 76655 / 2////.� (Insurance Company) (Policy Number) (Expiration Date) ( ) T 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 ors) ( ) 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 pawns to do m++int'nxnr , o st uction 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 compensation Act (GL152.ss 1(5)), application by a homeowner for a license or permit may evident the legal status of an employer under the Worker's Compensation Act. I understand that a copy of this statement may be forwarded to the De sermaca2 of Industrial Accident Office of Insurance for the coverage verification and that failure to seine coverage under section 25A of MZOL 152 can lead to the imposition of criminal penalties consisting of a fine up to S1,S00.00 and/or nupriwranen3 of up to one year and civil penalties in the form of a Stop Work Order and a fine of 5100.00 a day against tae. Signed this day of /4 ,___ c 4 ,76),, 0 For depaltaratal use ally /� Permit Number f f , Map# hot # Signature of L - . . ' ermittee , SECTION 8 - CONSTRUCTION SERVICES .1 Licensed Construction Supervisor: Not Applicable ❑ Name of License : Steven Silverman -- 077279 License Number 268 Foul= �• d. - + -,,. on,___MA t11Q73 6/21/1 -- - - -- Address Expiration Date �� / 584 -7522 L._ Signature , • Telephone 9. Registered lame Improvement Contractor: Not Appl cab:e ❑ Steven _S i lve rmn_.__ 131945 Company Name Registration Number 268 Fame r Road 10/131/0 Address Expiration Date Southampton, MA 01 ©73 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 I will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes 1KI No 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two( 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, von 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 DESCRIPTION OF pROPOSED Addition Li i Replacement Window!, A,teiLition(f) F. 1 Rootinr r 0: Doors I Accessory Bldg. :3 Demolitior,I3 New Signs ' I Decks ' I Siding i ) Other ,. I .. ,.,../.://1 5/ ;%tr, 4. ' ,14',.: %.',..t.' r itt;.: ';' r: n 'il'A4i ;Ai:. t:Ilt • t 1 7.1....., _ ■1'... F ..0 . ', 6,, If New house and or addition to existing housing, contplete the following: , H ., :).1 „p 1.c...; c-f - , , ,m 1, Tv, l '.,...cr - 1, 1 , , I c... F -1 rt..71"..!1 ",'-:1 -.„, I '" I '';;;', r -;.",:,,,'-' ;"':' :^:•'-'1":7. ""'' - 1;„ ' r; -. ;- .V:1, ; I ,-- 1t.) 't :4 °=%.:-.t. -....,.' .."t;;;-,, "1 L, ',.,■1 ii...tr..::„t 4; ';;, :, I; : or,f, y; 1„.:-,,,L,Ii .; ft:, , ,`„ -;;-.1;',;,; 1 0,tr - ..E..- ,--" ;' r i",;. r ;";' '1',".,, i SECTION 7a . OWNER AUTLIORIZArCII , TO DE COMPLETED WHEN ; OWNERS AGENT OP CONTRACTOR APPLIES FOR BUILDING PERMIT _ \ 44 ,1 -;!--:::1* nJi Steven silverman\ Valley Home Improvement, Inc. N i -, \\*\\„ ‘4■ \N. s 0 1 k () tt . .. . Mill1111.1111111111111.1111.1111111111.115 - , , - ..1, - ;,. ,..L:c . ..n..: : '.' ',.- '....afit Inc ini....1-- k3.-. the rfr ;-: ,!;)1.: ;,.1t1 ife ...ee ,'zj :H +,, r ,;",.., H ,l:kCire 7 nc .-A: - c.....1 .„ L.' . .r _ :..ci :i .1. - LI % `.:.'.t L p:'1,..''. / ./, Steven Silverman , ____,__ 1 _ i 1 1 -- / / j 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 • 1, 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/ i"ssued for /on the site? NO DON'T KNOW S IF YES, date issued: IF YES: Was the permit recorded at the Regi ry of Deeds? NO DON'T KNOW / YES IF YES: enter Book ; 1 Page and /or Document # B. Does the site contain a broo) 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 arty proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: I Department use only City of Northampton Status of Perrot: Building Department Curb Cut /Driveway Permit tc\;\ 212 Main Street ,--, Availaility \!":>''i '-' Rbom 100 Water /Well Availability Northampton, MA 01060 Two ' Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot /Site Plays -'. 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 2-- / . ,X. , :� ,7-" Map Lot Unit __ / t/a/Z_ 77 /4/4- 6 / ))0(' ,(J Zone Overlay District Elm St. District CB District _ SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2 O?ivner of Record: /' _z iacc"r: / --- ?/-- Name (Pri t) urrent Mailing Address: �� \\ft., `� 1., \ -1-=-1-1 \ Telephone / Signature C�' 2 97 2.2 Authorized Agent= Steven Silverman Valle Home Im•rov went ; P.O. box 60627, Florence, MA 01062 Name (Print) , Current Mailing Address: / j /1 / � / � 584 -7522 Signature ' Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only _________] completed by permit applicant 1. Building I (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) // �C G' Check Number 1" ( 7 This Section For Official Use Only Building Permit Number: Date Issued: __.. _.__ Signature: - -_. Building Commissioner /Inspector of Buildings Date _ 182 PROSPECT ST BP- 2010 -1073 GIS #: COMMONWEALTH OF MASSACHUSETTS 1014D 44 „' 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 -1073 Project # JS- 2010- 001577 Est. Cost: $1200.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sq. ft.): 7056.72 Owner: SONN DONALD J Zoning: URC(100)/ Applicant: VALLEY HOME IMPROVEMENT INC AT: 182 PROSPECT ST Applicant Address: Phone: Insurance: P O Box 60627 (413) 584 -7522 Workers Compensation FLORENCEMA01062 ISSUED ON:5/27/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS 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 5/27/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo