036-240 .
1
1 SECTION 8 - CONSTRUCTION SERVICES
License.d Construction Suipervisor: Not Applicable, Li
Name of License Holder : Steven Si vent 077279
L;corote Number
268 mer J oln71 6/21/12,
4',ddress Fxp;rat'on Date
584
tu Telertnene
rt ,
Re..qistered irnprovernent Contractc, n
t: ; or hnt carue
Steven Silvel 131945
Cornpaily Narte Registration Ntimbor
268 Famer Road 10/13/12.
Abel: ess ittxpication Date
Southal ItEA. 01073
, Telephone 5 - 7 52 2
SECTION .10- WORKERS' COMPENSATION iNSTIRANCE AFFIDAViT 1L. c. 152, § 25C(6))
Workers Compensation Insurance affidavq must be completed and submitted with thls application. Failure to provide this aificavit
result in the denial of the is of the building permit.
I Signed Affidavit Attached Yes..,.„.. No.._ 0
1f cmc 0VEIer 71'rt
The current exemption Ibr - homeowilers" was extended to include Ownc'-occa pica oi one (1) or twen2) families
and to allow such homeowner to engage- an individual For hire who does not posstess a license, provided that, owney ads
-as suncrvisor, CNIR 780, Sixth Edif,,Inil Section 08.3.5.1,.
HOnle(111'Llei:: Person (s) who ov,, a parcel of laud on which lle/sh;.: nesides or irdtmels io n--2stcle, which there
is, or is intended to be. a one o two family dwelling, Lttached or detached structures accessory to such use and/ Or jbnll
Si 41re S r“.!' \ Lo c:11': Sr r LET LL. 're Inf.; LTI tr,VC.V.VC
Such "homeowner" shall submit to the Buildin Official, on a Conn acceptable to the Buildina O3icirl, tot Ritrkl
'01-' Cor fin sttch Y.:et unc.'-e the buirdina, pertuit.
Its acting Conqraction SLE oervNo 'your itnasence on the job site will be sequireti From lime to time, during atia t:non
completion oldie work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Eitt;2loyers
finployees for injuries not resulting in Death) of the Massrtcluisetts General Laws Annotated, vca; may Ittt liatic 'for persoMs)
00 J6t yertt thiS
0nfi assumes retatonsilm,' corrmilane. t , ne
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Section 4.
; - ALL INFORMATION MUST BE CW, , or PERMIT CAN BE
� TO OF DENIED DUE �� LACK �� =`F~^RMATION
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 rninus 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
BF YES, date issued:
Kr YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
UF YES: enter Book Pane
and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ���a|�e� '
C. Do any signs exist on the property? YES NO
!F YES, doscribe size, type and location:
D. Are there any proposed changes to or additions of s|gns intended for the property ?YES
No
IF YES, describe size, type and location:
rF 9
}
.•
•
r r ,
.,upartment use only
jitEalY111 C ty of Northampton Status of Permit:
B Aiding Department curb Cut/Driveway Permit
a 2 1 lel 212 Main Street Sewer/Septic Availability
Room 100 Water/Wel! Availability
I *an OF WHAM INSPECTIONS Northampton, MA 01060 Two Sets of Structural Plans _
" 4 13-587-1240 Fax 413-587-1272 Plot/Site 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 - Map Lot Unit
_ /0 / ,16 .._ / //7 4._ 0 6) 6 .. zone Overlay Dist:Het
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTI-IORIZED AGENT
2.1
_Owner of Record:
,i-Liffit °1-- il 6//a S777/ /- /tG-Z:- /1/..4 ic,)6 z.
Name (Print) Current Mailing Address:
W / A t e , L , , , 1 1 7 7 1 g i . : . _ Te„,h on e
Signature ,
22 Authorized Aent.. Steven Silverman
/7
Valley Hone imprs,venie ' Inc. P.O. Box 60627, Florence, VIA 01062
Name (Print) I Current failing Addre.ss:
A / 547522 . .
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION! COSTS
Item Estimated Cost (aoilars) to be Olficial Use Only
completed by permit applicant
_ _
._. ---i•
1. Bonding (a) Building Permit Fee i
----j
2. Eectr ____.
ical (b) Estimated Total Cost of r
Construction from (6)
'') P! F,'Fiffili.- PAsymii F*(-. i
.
I
•
/ ,,:---•-;-,-./-..--' IH/Ar;') 1
1 1._
3 :ip Protectiol
- .---
1 G. L ola!, ( 1 ÷ – 3 + L = 5) 5-.0r0 Ci iurriber -- id d
i This Section For Officiai Uz.. Or.tv
. — I
builcing Peimit ii...irriPer: Date issued:
...IV ......... _ _ - i
i lipopp.• IP' .--,...
I Sig:lature: --
oiiT Commissioner/Inspector of Builciings Sate _
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76 PLATINUM CIR BP- 2011 -0863
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36 - 240 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2011 -0863
Project # JS- 2011- 001420
Est. Cost: $9500.00
Fee: $57.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 36546.84 Owner: BAUSTIN ALLAN P & BARBARA E THOMPSON
Zoning: SR(100) //WSP Applicant: VALLEY HOME IMPROVEMENT INC
AT: 76 PLATINUM CIR
Applicant Address: Phone: Insurance:
P 0 Box 60627 (413) 584 -7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:4/29/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR SHEETROCK FROM 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 4/29/2011 0:00:00 $57.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner