25C-057 Z
0
r
rn
rn
A - `
rn
-i
O 0
F rn
rn A
rn
A
N { rn
A
iTI X rn rn
O --I
A
z A
rn O CD
zi p d
O _ -n -
A - , A ssz�zz k) Ti
d ��
(gyp)
Z
-1 T rn rn Z L °I® _
` O .0
rn = N D
C rn
ul
zx1 6 4, < r n (.0 SAD ` _ J �/ z O e
r-- ---I n r- V• A Z
--- rn
D °D 'OO C3 CO
C1 A
rn
O z A
d
1
in D u rn Y p i v
_ z r 11 O 4 2 0 . _ A C3 N O
l< 7 p -1
9 ' -
rn d
A
3 cn
n Z d r
A -
0 < 70 0 9. A
z Q°
RI to 0
x33
ni C7.1 = D N �` + `\
A Z !--�
A
N z 1 I
"
1
N II
k
Valley Home Improvement Inc. ROSE MARIE LAROUCHE
ammell 340 Riverside Drive, PO Box 6062'1, Northampton, MA 01062
DATE:
Office Phone 413.584."1522 Fax 413.585.0820 TITLE: 2ND FLOOR BATH SCALE:
DRAWN BY: 5A5 1/4= 1' - 0" 02.1 S.2013
Find us on the web at : www.ValleyHomelmprovement.com _ —_
4 THA 4P2,
!t / a � \Yxi rif Nartilantlytnn . _* ° a fa• r4 ��' li ' t r't B a i5-11111 -
iPit �t'� saacnnsrtta - -_illI_
4`Ji -.ram _
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, Mass. 01060 NO '
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
1, 572 !/Z / 5/LV Ar l4/1 ,') /t674 7/4J C. .
(Lcenserlpermittee)
with a principal place of business/residence at:
3 -U fiee:/e -$ /.F ,74 4 : r /= J ‘- 7 /7/7/a/7/ .- /Z` /64 (phone #) ,-
(street/city!state/zip
do hereby certify, under the pains and penalties of perjury, that:
0 I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(insurance Company) (Policy Number) (Expiration Date)
( ) 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)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional shed ifnecessary to iaciude information pertaining to all contactors)
( ) 1 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 persons to do maintenance, construction or fair work on a dwelling of
not more than three units is which the homeowner resides or an the grounds appurtenant thereto are not generally considered to be
employers under the worker's wave mauler Act (GL152,ss 1(5)), application by a homeowner for a license or permit may evidence the
legal statue 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 Accidents' Office of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MQL 152 can lead to the imposition of criminal penalties
consisting of a fee of up to S1,S00.00 sad/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S100.00 a day against me.
Signed
A ir • d a y of ' 0 i 4 ; , \ . « ) ' 3 F - dgact al use ally , Permit Number _
/ /f /✓ i i Map# Lot # .
ignature of Li.. - `ermittee
•
SECTION 8 - CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License. Holder : Steven Silverman_ 077279
License Number
268 Fome R. -. • - .., MD. 01073 6 / 2 1/1
Address Expiration Date
i r� / f 1 584 -7522
YI 4 f
Signature ' Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Steven Silverman 131945
Company Name Registration Number
268 Fomer Road _ _ 10_/13/i 2
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.
Signed Affidavit Attached Yes 181 No 0
11, - Home ()caner Exemption
The current exemption for `homeowners" was extended to include Owner- occupied Dwellings 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 home in a two -vear 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
1
. cCTION 5. DESCRIPTION OF PROPOSED WORK fcheck all ap.pjicatls)
New HeLme ,._.:" t Addition 1 1 Replacement Windows AIteration(s)7‹, 1 Roofing n '
Or Door ::
Accessory Bldg. .7. Demolition0
ix
s
New Signs ' ]
Decks ,' ) Siding r 1 Other j
G : C ' ' ' - 1 , - - N. - D a - - - 41 g in ot E - n 0
.:.,',■:.ri“1:',71
''is!:i tilli:fr: ___ ...,_,,,._ Nr) ,^4 up,
1..`1Ct; %tclirldtivt,* Rt•-tj.i ,tif,nrIt,1
b "..ttzti:t Pot'
6a. If New house and or addition to existing housing, complete the following:
Dr Oti:IC■ng C'e 7 :a tIl ty
1 rc:;-rs n P.ach - 711 , %y cr,r,t
' t'... k t, ,:-: ueaRe alachec?
J r!L:pot,, Scu i:= Icc-14:e c't ne-A. Lor::tr
,...: T.1
Vett o' 'leotIne 1r tp Ltt;t...:, ur "NcedfAlAeL, IN. w o' each
7cry Cc Ctor ia ts, Elic-gy LThtnDran:c form a:tzct cc?
r,Irl.;Ot 101
• :.Cr.. W4tIri10..2 't °,11 wet, .aile:S? 'fes "1.3. I:, uonstruct vi..:h1( 100 yi. 'kx";Iplao
f 0■3',f1T1tIft1f C:E'lli:lr l'OCIr t.:rel:vi 'Inp:.hect gf.i0f.. t
k 'A l' Mr td171,,,, ::c nr (. Bwicinp, c-ind ? t :Inc' ' ,..-,?
f
,
: . SLI:tic - Ea'IK D'tv Se Pt Vat'e %St'l ..,_, ,.. v.ate r Son y
1 _I ------
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
L A Povc,he, . as J.4 c't "'„ Luhect,
i1J1, op Steven Silverman, Valley Home, Improyemen , nc .
rr,,° L ' ' - " , ,'`,tet,t)";:t.,tt■.°, v..)1 ■.-.41.itiCr I,.e6 '0 It itf, t:.:1!•,: itp,
'
__ —
Stii: Ye Or 0.c.1_r
, .
• „S_t_e3tert—SilY_W:=1.4_,Yall_eY_HOXag__IMPr_OVeraentsInC . , ,'E', ':;^Nrif!riAilinfri71-`1 APA,t
ne" dcc L4to :h-n". `;' !)taicrnit•e...,, t.*nd ir/forr trt Ow ilni' str,j Yu t; c ivd iii,:;;.or,tt, l'j lit tot-,;,.. t,; try
t r nd bclic:f
Sq s - cd . :I "L'ii' ar c.--
Steven Silve .I-; ,, .
47/ it
I Emit,:
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zonin
This column to be filled)n 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:
2 A' ?"'; ')''\
it ) ity Department use only
m Status of P t B uilding of Northa Department pton Curb Cut /DtvewayFR �
cF���e 212 Main Street Sewer /Septic: Avarla Ity ,,, .
;:\\,-"*".---
F
° `' Room 100 W t Availability , ° • ,
Northampton, MA 01060 Tw Sets of ctural Plans
phone 413. 587.1240 Fax 413-587-1272 Plot /Site E$l r p„. g
Other Spec
APPLICATION 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:
6 1 L° i N COL 7■ f , J J Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
p -. >;,� i, Q0itc
Name P ' - Current44 J,jjj ng Address :s 'l e , r — can
, i./ ____ . , " Telephone
ti_ ture
2.2 Authorized Agent: Steven Si lverman
Valley Home Improvement, I c P.O. Box 60627, Florence, MA 01062
Name (Print) Current Mailing Address:
/ tI / l �' .4 / ._ 584 - 7522
Signature F Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building a 070 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing 1, Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection 3d I( it21
6. Total = (1 + 2 + 3 + 4 + 5 ) / / �
� Ch Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature: `
Building Commissioner /Inspector of Buildings Date
File # BP- 2013 -0764
APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413) 584 -7522
PROPERTY LOCATION 31 LINCOLN AVE
MAP 25C PARCEL 057 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 3 l! ; 0//
Fee Paid `t /
Typeof Construction: REMODEL 2ND FLR BATHROOM
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 FOL ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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
7
II - - po 97 1 - , y
/ ( 5 - A0' - -. /
Sign. r: • 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.
31 LINCOLN AVE BP- 2013 -0764
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25C - 057 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- 2013 -0764
Project # JS- 2013- 001314
Est. Cost: $14000.00
Fee: $84.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 27007.20 Owner: LAROUCHE PETER
Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 31 LINCOLN AVE
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584 -7522 Workers Compensation
FLORENCEMA01062 ISSUED ON :2/25/2013 0:00:00
TO PERFORM THE FOLLOWING WORK: REMODEL 2ND FLR BATHROOM
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 2/25/2013 0:00:00 $84.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner