31B-315 (3) ,, � iitzn ' a� ��� 'i . S�� a' ` ° iro
Office of Consumer Affairs and usiness Re2ulatiotn
10 Park. Plaza Suite 5170
Boston, Massachusetts 02116
I-lorne Improvement Contractor Re istr-ation
€ egistratian. 131945
Type: andividual
Expiration: 10/13/2012 Tr# 204590
STEVEN A. SILVERMAN
STEVEN SILVERMAN
268 FOMER RD. ;
SOUTHAMPTON, MA 01073
epdate,Address and return card. ,\lark reason for change.
=address ; R enewal Emplo yment Lost Card
Ps.: ms ot64 s1 ..r.
s, late I1 rsieteptoeien?a.r4)t ok d#:r rrezL.$ -v License or registration valid for itrtliktdul use only
., ()ni of Consumer: Aff 13dm tiess it et;rststiara
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beore the expiration th te. If found return to:
H{}Pr IMPROVEMENT CONTRACTOR t
��' Office of Consumer Affairs and Business Regulation ;, � Registration. 131g45 Ty1s
Expiratiorn. 10/1 Individual 10 Party Plaza- Suite *170
Boston, .N1A 021 tta
STEVEN A SILVERMAN
STEVEN SILVERMAN t`I l / /
268 F ME Rr . .: , :„ . _, /
SOUTHAMPTON, MA 01073 �,_ �. _.
t"nderserre at v.it, witho it signature
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°L .ea'tse: CS 7727E
STEVEN A SILVERMAN
263
SOUTHAMPTON, 1x 010/3 '
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- DEPARTMENT OF BUILDING INSPECTIONS -
212 Main Street • Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, 4/ L50 Af ski / P) //,1 il y /xe___ .,G�7/'�G'l/ . /4--A 1, J L
(licenseelpermittee)
with a principal place of business/residence at:
3 'fo )//24.5 /b ‘) i/� j/ f/0�21 tort ; "Pi (phone #) 5 zz___
(street/city/st {P zip) 4/ 0
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:
Acadia Insurance Company WCA5029908 2/1/2013"
(Insurance Company) (Policy Number) (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 additional sheet if necessary to include information pertaining 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 pe zaons to do nn. mt.namY, c onstrue/ion 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 worke's compensatien Ad (GL152zs t (5)), application by a homeowner for a license or permit may evidence the
legal status of an employer under the Workers Compensation Ad.
I understand that a copy of this atatemcn may be forwarded to the Department of Indu tri al Accidents' Office of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MAIL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to 51,500.00 and/or iropris.onmerst 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 me.
Signed this ® Si" day of fi 20/4 ' For depsit luseonly
; Permit Number
4o. Map# Lot #
Signature ofL,G_. •ermittee -
SECTION 8 - CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Steven Silverman_ 077279
License Number
{ 268 Former t.o • hampton, MA 01 073 __ 6/21/11
Address 7 Expiration Date
584 - 7522
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Steven Silverman_ 131945
Company Name Registration Number
268 Fomer Road 10 /13 /it
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 X No ❑
11. - Home:Owner. Exemption
The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (I) 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 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, you 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
. 7 OTION 5. DESCRIPTION OF PROPOSED W_LORI±Et h . a_ualic
Now Hu .o __ ' /sedition Li Replacement Windows Ateizition(s) I: j [goofing X
Or Doors
Accessory Bldg. „D Demolitior New Signs ' I Decks --:- 1. ' 1 Siding ) Other
fe twil
T j
rcce ct v(c eyhor6 • fr LA; i d Li f a: if.) ‘ptfrit PORCh
1pi sJ
62. If New house and or addition to existing housing. complete the following: No 04012, ±0 f C.. bTPf i
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SECTION 7a . OWNER AUTHORIZATION . TO BE COMPLETED WHEN
1 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
— -- ----
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Steven Silverman, Valley Hone Improvement, Inc.
rr t.:(7 • - -1 tu , ,A.' , 1-..A.Lt. ,,,, ..-1.. , t-1.: :A<., vos t'...e:-. 1., .,f-- - r. 1,1,,..-,
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. Ste_ven..._Sibterman, Valley_Home—Tingrsame.raent..,—Inc,_ :Is :,:n:.'f1-1 /A it '''''‘' ili
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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
f ;
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 arty proposed changes to or additions of signs intended for the property ?YES _
No
IF YES, describe size, type and location:
Department use only
City of Northampton Status of Permit:
c4�� 12 Building Department Curb Cut /Driveway Permit
212 Main Street Sewer /Septic Availability
Room 100 V erJWell Availability
G�N
Northampton, MA 01060 Tw. 'Sets of
p Sti.t.ittural Plans S
oF e t° 1 one 413-587-1240 Fax 413 - 587.127 Plot /Site
N° � 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
( ` s � s: L'lL4, H 1 i r{ Map Lot _Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
{t, ray V•1 ; (Qr 5 A n� ►a, �, rz,�. <.l
*- Name (Print) Current Mailing Address:
- - 0 ;7
`.` Telephone
Signature
2.2 Authorized AEI Steven Silverman
Valley Home Improv -lent c. P.O. Box 60627, Florence, MA 01062
Name (Print) ,i / Current Mailing Address:
�j�� • 584 -7522
4 . 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 i Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection /
6. Total = (1 + 2 + 3 + 4 + 5) /�, (oZ) Check Number ( 0902 0440
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2013 -0516
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413) 584 -7522
PROPERTY LOCATION 84 ROUND HILL RD
MAP 31B PARCEL 315 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out r
Fee Paid
Typeof Construction: SHINGLE 3 SQ FT ROOF & PARTIAL REBUILD FRONT STEPS & PORCH
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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO .M*TION 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
emo " •jay
: 7 . /2
Si: ature of Building Official 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.
84 ROUND HILL RD BP- 2013 -0516
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B - 315 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: RENO WIRING BUILDING PERMIT
Permit # BP- 2013 -0516
Project # JS- 2013- 000825
Est. Cost: $1600.00
Fee: $96.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): Owner: TYLER KELLY
Zoning: Applicant: VALLEY HOME IMPROVEMENT INC
AT: 84 ROUND HILL RD
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584 -7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:11/2/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:SHINGLE 3 SQ FT ROOF & PARTIAL REBUILD
FRONT STEPS & PORCH
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 11/2/2012 0:00:00 $96.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner