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LIVING AREA
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-1,--- Massachusetts - Department • • of Public S
1' itfet
Construction SUperViSOf LICeri5e
1
Board o Budin g Regulittions a.
License: CS 77279 nd Standards
I
Restricted to 00 I
STEVEN A SILVERMAN
SOUTHAlVIPTON, MA 01073 .. `ie "$40$
r
Expiration: 6/2112010 li
------ ---•---
..----7-7--- Tr#: 25795
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BOTi '
.`\ License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR
i.--7,-..-- before the expiration date. If found return to:
m --- Registration: 131945 Board of Building Regulations and Standards
Expiration: . 10/13/2010 Tr# 275412 One Ashburton Place Rm 1301
... — . _
...,., f. TType:—Individual Boston, Ma. 02108 ,
-
STEVEN A. SILVERMAW --. -... - /./
STEVEN SILVERMAN - --, . -•;.----•
268 FOMER RD.
SOUTHAMPTON, MA 01073 -
Administrator - Not valid without signature
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s � ; o ff $ Lxt Lif Nt7Ztila111pthn 1 = #=�
�J�; �fj Iasaaclinsetts __111'_
�' DEPARTMENT OF BUILDINCj INSPECTIONS , = _ `=
212 Main Street • Municipal Building = .
s �
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE A1'b'WAVIT
1_, /I, L5 opt ' EH / =? =L& i i v /rte fJ /fat7t 7_ Afts . 2-41 L
' (licensee/permittee)
with a principal place of business/residence at:
3`10 /2)1Z/65 /b 1)7 ✓' //D -7 7/7,70/1; /IV' (phone #) `18`/ ZZ
(street/city at 5/" C)
do hereby certify, under the pains and penalties of perjury, that:
1 am an employer providing the following worker's compensation coverage for my
employees working on this job:
/eZ, ,Le5s' l-r7S 6?). t-! C Z6 O 55� 1 zp7i
(Insurance Company) (Policy Number) (Expiration Daze)
( ) 1 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)
(Nance of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet if necessary to include information pertaining to all contractors)
( ) I am a sole proprietor and have no one working forme.
( ) 1 am a home owner performing all the work myself.
NOTE: please be aware that while homeowners who employ persons to do maintenance, coffiuuctioa or repair work on a dwelling of
not more than throe units in which the homeowner resides or ea the grow appurtenant thereto are not generally coo ideted to he
employes under the worker's compensation Act (GL152, s 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 fcswerded to the Depertmcoa of Dial Ai:cid:era Of oo of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to 51,500.00 and/or imprisonment of up to one year end civil penalties in the form of a Stop Work Order and a
fine of 5109.00 a day against me.
Signed this / � . /
day of &'ua For departmeotal use only
/+ �\ Permit Number
/1 [ _ ! ` Mai Lot #
Signature of ermittee
,
SECTION 8 - CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not App:.icablo ❑
Name of License Holder : Steven Si lyerman____ 077279 _
License Number
268 Fomer Roa ,.__.S uthampton._- MA 07 073 _ - - _ .___ -- 6/21/10
Address Expiration Date
/ is 584 - 7522 _
SIgnatu Telephone
9,;RegisterectHome improvement Contractor: Not Applicable ❑
S t even S i lve rmaxx 1319 4 5
Compan Na Registration Number
268 Fomer_..Road 10/13 L/
Address 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.
I Signed Affidavit Attached Yes No
0
. - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner- occupied Dweilini 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. 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 hone in a two -near 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 he
responsible for all such work performed under the buildinL 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.
'fhe 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
. 5 . PESCR.iPT1 eioR...KCckl.....°.ck }.
_......
Nt.rN It:: t.n.,t,t :.:. .t,ctliticit 1 1 Replan:went Viirdcwf, A ',...q.„Iti Rocitirr; 1 - i
fit ! .Thor : '
• i
Accf.-::ory Bldg. .....J Demlitio= ,L New Signs ' I Deck: ' S.dirg, ' ., Othet 1 I
7 o' '1/ • - .....t. .„ • 't I ot.: ,".. • , Pi 4 1.-Jut I-1(7,A Arr,sci / P2 , 1 2 -,-() sil 0 tk.c
,...:.„,„1.,..,-
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6.: If New house and or addition to existing housing, compete the following: 1
c-,-' ,,,, 11
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. '..., "..` to, 'i .v ...1; . ,..;;: '( ri ,%:-.: - Jr ..':ri :t , _ ..1. in, :....FiC ql l'i ': t :Ot: yi
' ; "t ' t :1;tt' :"--,•!;".. : • i r, t 1 ;tt." r . rr1',....: '1 ir ',k :
.111 -/... rm tr' r 1` '.' re , e, , / •
k _ c... 7,1; ::n.. P.: ;.•;-".."..t v.,..ttt.; :',:v s.r.irrti•- '..'....1.1, y
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SECTION "la - OWNER AUTNORIZATiOti ,, TO DE COMPLETED WHEN
I
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 4 '1/74 ..■c ;. A■ 1 5 7 F 7/15:Kl 6 0 4 1 Le'S 0 AT . Et3r '-..' .°. 4E: C' '.' i.. 1 . Jt. . ;: 1- :. ...t.11Y
'A■ ' ' i i: : , J f t± r,-, teven Sil, -rman, Valley Home Improvement, Inc. -...- , ... - .1 .,
!i•,, t.,-..--:•v ...„ -'0 -I .-- , v.1.. ,•• P• •.... t•tp•-, 1-, ., :•. ,-,,,, , ir' -..1.1 , •
...
. Stemen_Sibterman,_Valley_Home_Irapromemertt i_lac...,_____,........... •1•• :7-!“ ' ' •
'. E'ri.: t'f•".• ',tot 'I, - , - 0 `" FH'r' i'' : ',, - -. 0 , „"; t dtt, - to; '1,,te: -t. ,.i ,.1..1.,q--, 'ot 11,- .t-t."
tt r. n 7.1
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Steven Silverma „
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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
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:
•
Department use only
_ __ , ^ c C of Northampton Status of Perrriit:
� � , A� - i _ r ing Department Curb C ar /[dr Perm
2 Main Street Sewer /Septic Availa
�� / 2009 ,I R oom 100 Water/Well Availability
Nortt ton, MA 01060 TWo Sets of Structural Plans ,
phone 4131 40 Fax 413 - 587 -1272 Piot /Site Plans �w
C L (,,,P1.2.....______--4 y Other Specify
--- APPt1CATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address: j j
2). /27 i/ /e /.4- Map * Lot Unit ___
16/10,--/ii-,11717,k/t-- / k I b O/ Zone __ Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: z J rn
4 / $mr &/ S% ,i /, Ctt /t/ �✓ 9/
Name (Print) Current Mailing Address:
/ It ,, 9-
Telephone l
Signa dre 6-7,5-,... `
2.2 Authorized Agent: Steven Silverman
Valle Horn= Im.rove.ent :n_ P.O. Box 60627, Florence, MA 01062
Name (Print) , / � f / Current Mailing Address:
/rr! //TT, 584 -7522
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only _ T_ T_
completed by permit applicant
1. Building 1 ( K (a) Building Permit Fee
2. Electrical + (b) Estimated Total Cost of
(�J Construction from (6)
3. Plumbing �--- Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 +2 + 3 + 4 + 5) 1 Check Number 615491 4)O5
This Section For Official Use Only
Building Permit Number: Date Issued: ,._ _ _
Signature: 1
Building Commissioner /Inspector of Buildings Date l
File # BP- 2009 -1007
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS /PHONE P 0 Box 60627 FLORENCE (413) 584 -7522
PROPERTY LOCATION 235 MAPLE RIDGE RD
MAP 36 PARCEL 267 001 ZONE SR(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
t
Building Permit Filled out �� ( 4/ Fee Paid
Typeof Construction: ADD BULKEAD ACCESS,REMODEL 280 SQ FT BASEMENT
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 LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN 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_ Zc,
Signature of uilding Offi ial 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.
235 MAPLE RIDGE RD BP- 2009 -1007
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36 - 267 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- 2009 -1007
Project # JS- 2009 - 001450
Est. Cost: $17.50
Fee: $105.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 108900.00 Owner: GILSON STEPHEN & LYNNE M
Zoning: SR(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 235 MAPLE RIDGE RD
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584 -7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON: 6/2/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD BULKEAD ACCESS,REMODEL 280 SQ FT
BASEMENT
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: 4 fc G - -`o Q
Rough: Rough: �� / House # Foundation:
Driveway Final:
44
Final: Final:
d' 7— Q q Rough Frame:
rn
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: 9f q. g- O q , _-
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. / T ?
---------
Certificate of Occupancy v Signature:
FeeType: Date Paid: Amount:
Building 6/2/2009 0:00:00 $105.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo