25C-228 (2) „ .
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Tile�
new sheetrock throughout
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Bow Frontsh® r ��rta o D
1
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Surface mounted fed Cab Bath fan on timer
Pedestal sip � \ , U - =��' �\ ' New ®ii t� ���d front
New fauce i �� \ �h
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re i i ra diator � i�it door
Box in ri lines
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Board of 1di/1 Re and Noattd.Ink
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LAcense CS 77279
Restrothid tn:,
STEVEN A SILVERMAN
268 FOMER RD
SOUTHAMPTON, MA 01073
Etptration: 6/2V2012
Tr.7: 26868
lioop4 of OrrihirrzpRettriktrntq6-tteiti Stfil ettri Itittott or n k1 for intik idol use tolls
HOME iMPROVEMENT CONTRACTOR btfort the expiration date, if found rourn to:
Registraton, Boit f fltug Itei anti Stantiorth
Expiration 10 0 Tr# 27.54 Ont: Att thttrion PI:tett Rol 1.39.1
Boition.14:71. 02108
<41
Type
STEVEN A SiLVERMAN
STEVEN SILME,RMAN t„,"
/2 t
‘TE8 FOMER ' ' /1'
SOU EHA MP FON MA 0101'3 Admintctrator Vt ithion /1 r
e.
041 pTO
.i ii fi r'` _:�_
a —
, 1,..� I( B ' sssRCEinsctts
:= _ t_ - ca - DEP�RP�f .TEI�1T° 4F BUILDING INSPECTIONS _
212 Main Street • Municipal Building
Northampton, Mass. 01060 ��M ow s'
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
'
/i/ � L-5 l iLt 571 / C'%- =� � - Tr - , �/,1i'% -'.- -� ff -' ;� 'i_ L ,.� /''o!-‘>'zr> s -fZ c9-ii", 2;4 (___
(licenserJpermittee)
with a principal place of business/residence at:
3 't() ,ji -. / 2 t�/% VZ ,A ?- -77d.%%'�✓'', A'7: (phone #) `, / :-- ?_
(str t/city/s a: Irip) eV h ()
do hereby certify, under the pains and penalties of perjury, that:
I am an employer providing the following worker's compensation coverage for my
employees working on this job:
/; �L4'.5, (C) . G , (-1(1- k('`.0 6 5 5 / zViv, /.//'
(Insurance Company) (Policy Nurnber) (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 additicnal sleet if necessary to include information potainingto all contractors)
( ) 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 aware that while homeowners who employ pawns to do rminsenawY, construction or repair work on a dwelling of
not more than three units in which the homeowner asides or on the grounds appurtenant thereto are not generally comidacd to be
employers under the worker's compensation 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 statement may be forwarded to the Department of Industrial Aoido& Oboe of lrreuuano for the
coves verificati and that failure to secure coinage under section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to $1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of 5100.00 a day against mix.
Signed this > day of 4 ,,26 For departmental use ally
Permit Number
;? ' ,/' ( ;°' // M.ap# lit
Signature' ofL s •ermittee
SECTION 8' CONSTRUCTION SERVICES
---- ---- --- ------- ---------- -------- — '�---- l
.1 Licensed Construction Supervisor: 0u1App/cab|c O |
No/neui Lice000 Haider .Gteven Silverman __- O77
L � h
6/�I/l�~
2 <�8 F �� ^ o, 'MQ�_0l073 _- __ _
| [xpira�onoas
/ 584-7522
9. Registered Home }
Improvement Contractor: NotAp7Loalte
1 |
bl]verAan ��
----- --� — �--- ���� — - - �--' - � — � — \
Company Name Rqg,istrai/on Nunhi:r
_10/13//0
Expiratiun Da�u
| Bout , MA 01073 Te�cpL�n� 584_7522 �
SECTION lO~ WORKERS' COMPENSATION INSURANCE AFFIDAVIT (KU�G.Lc152,§25C(6)
YYorkersCompensation insurance, affidavit must be completed and submitted with ihsmpphuntioo, Failure to provi
will result in of issuance of buUdin�pormit
F — — --
/ Signed /#fidavitAdachad Yes X No
11. - Home Owner E
The current usampdou for ^'homonnnun`was extended uo include Owner-occupied D`*el!\nps L`[ one (|) or *v0(2) i�mUim
and moUmr such homeowner |ocnfagcon individual for hire who does not p*ssiesvo license, provided nets
as supervisor. CV111780, Sixth Edition Section |00.3,5.L
Definition of Homeowner: Person (s) who own o parcel v[ land vu which huSsiluu.sidos inuodom reside, o,d`icbthere
is, or is intcndcd 10 be. o one ortwo Inn ||y dwelling, attached or detached structures accessory to such Ilse and./ or farm
structures.4 person who constructs more than one home ioa two- ear period shall aol ha considered u homeowner.
Such "homeowner" shall submit to tile Building, Official, on a[nnn acceptable to 11)0 Bnilding Officio], that hoishcxbuH be
responsible for all such work performed under the boQdinu,nenmit,.
Aaa:(ing Construction Supervisor your presence oo the job site will h:required fro/udm Lime. during mid won
completion of Lhc work for which this permit \sissued.
Also bx advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability ofFnp|ny;,` u,
Employees for injuries not resulting in Death) of the Massachusetts General Lu\Vr Annotated. lolLmuvho liable |brp000n(x)
you hirc to pertorn) work hr you uncler this perniit.
The unduraiuod^`horucnmncr` certifies and assumes responsibility for compliance with the State Do|Nioo,Cndc. City of
Northampton Ordinances, State and Local Zoning I .ows and State of Massachusetts General Lows Annotated.
P7,017()SED NOKc;!; ...11
N.,-...-• :Lz..t. ... 1"..;..d:ti,,,d ..: 1 ;I °A*1: 1.:. A
New Si
,
r Rif •C pcptAce oF is Ftwg 8o FixfuikEs I
sp,mt Loc,A ? A tp6
.. ,
'• ' - .. '' ' ' ' - - -74 WiN6CW I?J' ,
Now 11 „:111(1 or , t:':i. ° 11 C0 10 1 1 0"...." °
... : ... , z
"," ' ° ;- z ..-,..• :: z.: ',' '‘.. ! ,'. : ..".,.: ..:, .' ',. i',.: ,;,..1 ."" ';'',.. :',
',.
SECTION 7,A - OWNER AUTIIOREZAT4ON - TO E3E COMPLETED WHEN
OWNERS AGENT OP CONTRACTOR APPLIFS FOR 81119-01NG PERMIT
I
/71//777/j ..) <5.-agocz_
ven syverinun, Valley Hone Improvement, Inc.
Alp ' .
; , ,,: -. -- , 2 : . / 1", ■ , , ' - L.. ' . L , ' , ' '
400
41111: 4 " . 4
1 ■■,,'
Mr' . Eir
,
1
1 Steven Silvenvan, Valley T Home Irproventent, Inc.
1
Steven Silverzraa , J
,/
, , ............ ........ .........,.... .......... _
e
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning 7
This column to be filled fi 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 e -r been issued for /on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at th•• Registry of Deeds?
NO DON'T KNO YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a book, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a per it been or need to be obtained from the Conservation Commission?
Needs to be obt. ned 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:
` ` .
^
A "
^
- __� _ - _ -- "
---
(�itv0fN0rtharnptOn �Steb
Building Department
' 212 Main Street
Room 100
Northampton, MA 01060 Two Se
phone 413-587-1240 Fax 413-5874272
Other Spec
__- __ __ | ' -- - -���_
/ APPLICATION CONSTRUCT, �0TO CONSTRU� ALTER, REPAIR, RENOVATE OR DEK8OUSHA ONE ORTWO FAMILY DWELLING
� �� � ����
SECTON 1 .- SITE INFORMATION
Thiss�cbnmtn b*�ommp{eted by office |
1.1 Property Address:
~ � . ) JL <� /- Map Lot Unit
;�� et- J
���r -_----- --- - ----
.4 i ir O 4_"_ /41/1 0 /6(0 Zone __ Overlay District
[|m St. District CB District '
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
-
2.IJ Owner ofRecord:
�
�� � ' �� -/� ��/� ��/�/- 7 ��i ��C)
_ � _� � _-_
Name ~hnt-‘) ' ? Current Mailing Address:
'
t 4 4 - -.---f `�� . ii/ ay:p»�n / ��v/4� , 'ft AV ~~"_ ���'^^_��� �
~^.. �� �~ / . ~ _
—
�2Au orized Agent: Steven Qilve a
Valle . e Izu r �r�mzz � I��~ P.O. Box 60627, Florence, MA 0I062
Name (Print) Cu,mnL�aiiinoAud/eo�
����V �� ^ ��� 584-7522
__ ��mmm' __ �� -__ = � � _- __ -__ ___- -- '---- — —
Signature / Telephone .
SECTION 3 - ESTIMATED CONSTRUCTION COI |
Item Estimated Cost (Dollars) tc be Official Use Only
completed by permit applicant
_' -J
l� Building 1 ^l � ��/�) (a) Building Permit Fee
� ��`,�,
_
2. Electrical �����l (b) Estimated ��^/�/ Conotruotionhnm��
_
3. Plumbing �7 � u 'r\y\ Building Permit Fee J� c/ (, {-= ,
°w�� � � �
4. Msuhanica|(HVAC)
5. Fire Protection
-
6. Total = (1 + 2 + 3 + 4 + 5)
-
\ 5- 5�c-/� Check Number 2-7 4 c i' W
This Section For Of iciu| Use Only
Building Permit Number: OP Ao _-- Date Issued: __-- _ - _ _ -
Signature: d ___ _--- ____ _ ___ __
Building Comm\sinns//|nopwctu/n|Buildings _ _ uaf _ . _ ____
`6 ""m WA LbrOt ST I BP- 2011 -0111
GIS #: COMMONWEALTH OF MASSACHUSETTS
a Bl CITY OF NORTHAMPTON
t' ock. °2C �
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 -0111
Project # JS- 2011- 000196
Est. Cost: $15850.00
Fee: $94.80 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 4399.56 Owner: SUBOCZ MATTHEW K & JILL L PLOGGER - SUBOCZ
Zoning: URC(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 45 WALNUT ST
Applicant Address: Phone: Insurance:
P 0 Box 60627 (413) 584 -7522
FLORENCEMA01062 ISSUED ON:
TO PERFORM THE FOLLOWING WORK: Bath Reno
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 $94.80
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner