25C-192 •
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new vinyl DH window Americast Tub z
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obscure glass/tempered Tiled shower walls '
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new shower va lve
17 x 13 niche in end wall R 1 Bow front chrome sf °' ri
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Marmoleum floor j o z
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Nu Heat mat on set back T-stat. ___ - I F I o
recessed shelves
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pipe Q c
framed mirror ; -T: vent p
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1 II,, remove chimney
new sink and faucet f X 1 1 1 CU
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Dual flush Toto toilet
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"� :..�_ DEPARTMENT OP BUILDING INSPECTIONS 47 _ -
212 Main Sheet~ ' Municipal Building ' 'M =5 '' ems Northainpt on, Mass. 01060
WORKER'S COMPENSA.TIION INSITRA_NCE Aifit'iDA.V r
I, /V L--5 c Atr si/ i i ii //M-/—- - ! ne-4- t7L 7 �i ° � fir^ /iL24 i, .%ii c
r Oiccnseevpermittee)
with a principal place of business/residence at:
3 'fo 1Zi? .5 i 6 _ ,r), ✓/c ,j4 A2t.�' Z4'7Yt A'2 (phone #) '5 7 Z2
(strs,,ticit isatezip) ",,Iiiii. o
do hereby certify, under the pains and penalt es of perjury, that:
V) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
z i. 55' --- GG . 60 ?6 G 55 1 _ 2///..1
(Insurance Company) (Policy Nuir:ber) (Expiration Daze)
( ) 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 Cornparry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Conzpany/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Comppany/Policy Number) (Expiration Date)
(attach additional sheet if necessary to include iafoc mation p n th..g to all contractors)
( ) 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 maintenance, construction or repair work on a dwelling of
not mote than three traits in which the homeowner resides or ca the grounds appurtenant thereto are not generally considered to be
employers under the worker's compeasaticn Act (GL152,sa 1(3)), application by a homeowner for a licens0 or permit may evidence the
legal status of an employer under the Worms Co radon A.....
I understand that a copy of this statemerd may be feawardn8 to the Department of Industrial AecidrntY Office of Inaurnace for the
coverage verification and that failure to secure coverage mckz enema 23A of AML 152 can lead to the imposition of criminal penalties
consisting of a fine of up to 51,500.00 aad/cr Epri of eta one year and civil penalties in the form of a Stop Week Order and a
fine of 5100.00 a day against tae.
� /
Signed this /) r
_day of J L G J � " L � '�' / Fordej-ratt luseally
! ,��f� Permit Number
✓I� C y � ' / MalY# Lot it
Signature L d C ermiUee
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vr
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08
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- /
SECTION 8 - CONSTRUCTION SERVICES i
i Licensed sed Construction Supervisor: N.a ,; p'iceblo t_.
' c o; License 3yot er :Steven Silverman -- 077279
L:- _n N -,
258 Fomer Road, ,Southa.^.:pt_or, M..k 0107.1 6 / 21 / 1 ' 2 -
i E.x0i/a0:1 Date
584 -7522
S,7 ne
. 5 /0 i L
9,_Re gistered Home Improverilent Contractor: ; Not April caile CI
' � I
Steven Silverman. 131 945
Company_ Name Reg st ,t,on f \itimoro
268 Fomer Road 10/13//2
Addr Expiration Date
Southampton, MA 01073 _ , - .Te cpfare 584 -7522
I
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) j
'/or`•cers Compensation Insurance affidavit must be completed and submitted with lh:s application. Failure to provide i5 af`icav t
will result in the acmal of the Issuance of the nui ding permit.
Sinned Affidavit Attached Yes...,... X i'o 0
11. - Home Owner Exem Lion
TI current exemption for `homeowners" was extended to include Owner- occupied hw'cllin s of (life ( l.) or tv liamill+
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner nets
as supervisor. CAW 780. Si\ th 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 , ,=:Inch 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 h ^!she shall he
responsible for all such wurkperformed 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 he advised that with reference to Chapter 152 (Workers' Compensation) and Chapter I5.? (Liability oh Fiupi ) - rs to
Employees for injuries not resulting in Death) of the Massacllusers General l.i.ms Annotated. yon may be liable 1u7 p e souls)
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 I,o 1s and State of Massachusetts Genera! Laws Annotated.
Ilomeowner Signature
'roTl.p,r:t 5_ o.r:,t'..:cruPTtDNLQ7 P5,CIPPS,E,P
Ipi L;
l'"kW AZ‘..CitiC4; ;;;;ritc.41(0 t
Signs
- -
Cf 21' 66 .,s kr4;1
-net or addition to oxistpt7 housing. coisnotote no foflowijo
, N
SECTION 7 i - OWNER AUTtIORIZATiON TO B CO.o1PLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR SUILDING PEF?t*HT
/% , / 5
Steven Silverman, Valley Home Improvement, Inc.
Steven_Silverman....„.Valley.,,Home_Improvement.,, Inc.
_ • °,_°
Steven Silverman , ,
/()"‘ /0 0/(,)
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
l
i
Fill: j
(volume & Location) /
A. Has a Special Permit /Variance /Findyng ever been issued for /on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorde. at the Registry of Deeds?
NO DON' KNOW YES
IF YES: enter Book/ Page and /or Document #
B. Does the site con ain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, h s a permit been or need to be obtained from the Conservation Commission?
Needs 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:
,
I Department use only i
NOV City of Northampton Status of Permit:
V 1 9 101 Building Department Curb Cut /DrivewayPermit
212 Main Street S ewer /Septic Ava ab
I iRoom 100 Water /Well Availability
Ntt#&npton, MA 01060 ' PI
of Structural Plans
phone 413-587-1240 Fax 413- 587 -1272 'Plot /Ste Plans
_ ! 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 I
2 < �/ /C.' /z /r-j i 1� M ap � Lot __.._Unit
ij ?Ve- /r /2777/1� / '/' O Zone Overlay District _
/' // /�7 Elm St. District CB District , i
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: i. 27 // /e1/ #nh ..
Gant n/2/'/Pf 5 r1 Cpl //74/44/, /161/47777/7'77/7-"Z)/C-1 / 0/C� 6 6
Name (Print) Current Mailing Address:
J_ --— Telephone 4/ _ J 3 - e
Signature
2.2 Authorized Agent: Steven Silverman
Valle Ho Im•rovement, Inc, P.O. Box 60627, Florence, MA. 01062
Na, (Print) ,, Current Mailing Address:
��! 1r�� 584-7522
Si tore Tecphone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
Building { oo (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
t (1(11_) (b) from (6)
3. Plumbing Building Permit Fee 6
4. Mechanical (HVAC) _
5. Fire Protection (l VI)
o
6. Total = (1 + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Only
Building Permit Numb- . Date Issued: _._
Signatur _-- -�=L --
. i ng Co missioner /Inspector of Buildings Date —
BP- 2011 -0473
GIS #: OF MASSACHUSETTS
L � n 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 -0473
Project # JS- 2011- 000776
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.): 5749.92 Owner: PHILLIPS CHRISTOPHER & SUCATI
Zoning: URC(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 27 HIGHLAND AVE
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584 -7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON:
TO PERFORM THE FOLLOWING WORK: REMODEL 2ND FLR BATH
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 $90.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner