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44-016 (3)
uao7luauaanoiduulauaoHfialleNmar :le qam ay}uo sn puid G Ll9V9O :31YCI �0z , �n Ot80'S0S'6lb Xed ttSL'b85'£lb auOL1 aolil0 t90L0%W'uo4dcueNpoN"Lt909 Xo$Od'2AIJa apls.ianlel OK ..0".i. = ..t/ I. o3SIA; i 3NACISAN 9 I g1H'd15 "9UI '4uawano.Idual awoH nall!A 9� �a NM'v'�la - „WI.£6 - „WI, „LE - ,.81 .,9£ - /,/, 7 - — F..t41-Z 1 =co 1 _„ /� co 1..... , _. 1 : m N CO 1 Lo L i m \ M 2 II� + II � - 1 l \ / /\ ) N \ // Q /--N. \ _ ZN . \/ N ,a°N ■ V \ CO m N "v (O / M / /� I _ N M / Cr) ln011nd L£Z4M i 1 o 1 \ / loot I `,- i N co , N I 1 1 ©©l 11 \\ . ..,..._ d_ I rro) •i r.,..r._......1 _cco M— I p co co M Li i co o co J Lrj (V N si===9 { v /N\ I II l ° it i � Ic � / M— M M \A II ag M slnolJnd I.69ZLn ° P`' II II 1_ ..:....\__7 !il I /\ .3-.010 9906 ril)::'s 4... • 7 \_-____ z - K 0 a /� 1 a N a • \ IL o ILw Q z G i m o v w w z o r o z? d. ' I / 1 11.1 II /OK J aC d z� O I /Qa Z o wz U � Iv w n0 v o PJliY L a w r>� zdz rn>wto`� ]0a_ u � I I YwDv z �mp -I-0 N 1-OIL-o0DKD w F-_va_ I 014<ln=wwwO w O.wa_ \ w zDooa_azatzzxc za.c)< T r Lc I . v r „LE - ..8 I. -. ..9E - 99oe „t7/1,Z „C-.g b/L E6 sq iAMP�. o a g A $ �ztg z f X 't} nt}tton . =Iv $Pte'/ `4, ..(�� aszariinsette MAIM �� - *-- =_=AI DEPARTMENT OP BUILDING INSPECTIONS -=`i= 212 Main Street ' Municipal Building Northampton, Mass. 01060 star' WORKER'S COMPENSATION INSURANCE AFFIDAVIT L S ;j///$IL fix 7-7v(', ///z/L,4-' /7' m E or ifr& fites4,.l%tz ' (lipermittee) with a principal place of business/residence at: 3Y-0 4:6/2'zi-';kb . i4 1 r, )G2/7ti 7f/i/ff, (phone#) ,--5 -7SZ2— (street/city sl t: -i) 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) ( ) 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 nec y to include information pertaining to all cootradots) ( ) 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 persons to do um into ante,construction'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 workers oaapassation Act(GL152,rs 1(5)),application by a homeowner fora license cc permit may evidence the legal status of an employer under the Workers Compensation Act I understand that a copy of this statement may be forwarded to the Department of Industrial Accidents'Office of insurance for time coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the ikon of criminal penalties consisting of a fine of up to$1,5O0.00 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 me. t -2,03 Signed ' / day of `�;Li r'�//�'t, ' For use only Permit Number (./t'/i , /.//' G•-,/:4if� 7/14/ Map# Lei# 'patine of LicenseefPermsttee 1 SECTION 8 -CONSTRUCTION SERVICES .1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Steven Silverman .- 077279 License Number i - „. •n.,=_MA 01073 ..._._. 6/21/1 268 Forcer Road,_ j Addres Expiration Date ,!I�' dii v 584-7522 ra n _ — Sgre Telephone 9. Registered Home Improvement Contractor: E Nct Appl Cab e ❑ Steven Silvermann_ 131945 Company Name Registration Number I 268 Fomer Road 10/13M` 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 afficav t will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes El No 0 11.:::— Home Owner 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-year period €hail oof 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 building permit. As acting Construction Supervisor your presence on the job site will he 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 7DTMN 5 DESCRTTION or PROPOSED ivoRff (eh f e:-,pilefepi_e) New Neu:A: Addition _1 Replacement Windows &teration0..)-K Roofinn E Or Doors Accessory Stdg. 3 Demo litier 2 New Signs " Decks 3 Siding Other __Rf741/1 l<11-Cle.44.00 CA h a e4AcipIA v- C ■°: 6:1 II New house and or addition to existing housing. complete the following. F, -y ..**F 0•;-, I ' t--0•0 .0. , • t r V . fso— 1:1 LC: • e.:,.;'0„4,1„',1,1', - ; -0 '0; •.-;•00-00! • et-1 0r ;+•.•10; 0•• "0"ts",to-••; '0`00 ng; :::t• t: Ti SECTION 7871 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN 1 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT a("•-• C--teiLl 4-ct■e\ \o-e 1(9 • L.; Steven Silverman, Valley Home Improvement, Inc. '1'; t„,"•,• ; 0t-‘, 0-01',0;-0,-0-00 11.0.0 ;, 0: 01.001 0r, -1000, 0 • • / 4 ao/3 zt.„.11 %Iv. It' • 10 Steyen_Silmerman.___Valley_liome_Inipromeraent, , .1c :r. uc u v.— f;: gic.ir ;00:,..;;01.4 • t.• .4 a 01 VI tit-% t.4# y :n7 Steven Silverman /ft 7/7,9/1_5 / 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 fitted in by Building Department Lot Size Frontage rl, Setbacks Front 1 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/Findin: ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded a the Registry of Deeds? NO DON'T OW YES IF YES: enter Book Page and/or Document# B. Does the site contain : brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a ►•ermit been or need to be obtained from the Conservation Commission? Needs to be •btained Obtained , Date Issued: C. Do any si 4s 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 City of Northampton Status of Permit: 16('j ilding Department Curb Cut/Driveway Permit �U QEc;co* 212 Main Street Sewer/Septic Avail�brt�fy Room 100 W r/Well'Availability �6= Northampton, MA 01060 TwdSets of Structural Plans NO' phone 413-587.1240 Fax 413-587-1272 Plot/Site Plai x' 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 115 D\ \j r\coon t`.oa \ Map Lot Unit \C9r �"1CC_— Zone Overlay District Elm St.District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �Y CL (Jl..tu Eta,■ ;0...V.,1\be rc) 115 Lk.),‘sue ( I or r'-i c C- - Name(Print) Current Mailing Address: ,. N_ c.,e '-tC' y l3 `�`��1- Z 1 lc�c Telephone Signature 2.2 Authorized Agent: Steven Silverman Valley Home Impr•veme'.t, Inc. P.O. Box 60627, Florence, -MA 01062 Name(Print) �� Current Mailing Address: � r� �. ,�� 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 0a) (a) Building Permit Fee 2. Electrical ? (b) Estimated Total Cost of Construction from (6) 3. Plumbing rl Building Permit Fee 4. Mechanical (HVAC) `'t✓ 5. Fire Protection w 6. Total =(1 + 2 + 3 + 4 + 5) 1 i 7(e) Check Number i1179 00; This Section For Official Use Only Building Permit Number:_ Date Issued: Signature: -- Building Commissioner/Inspector of Buildings Date File#BP-2014-0103 APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413)584-7522 PROPERTY LOCATION 121 OLD WILSON RD MAP 44 PARCEL 016 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 31 ii^ 61 (0), ,,,,,-2.0 c Fee Paid 1 ` Typeof Construction: REPLACE KITCHEN CABINETS 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 40., of ion Delay _.....-.....i " 3A/Z Signature of ui ding 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. 121 OLD WILSON RD BP-2014-0103 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:44-016 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-2014-0103 Project# JS-2014-000200 Est. Cost: $14700.00 Fee: $88.20 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sq. ft.): 30796.92 Owner: STAHLBERG ERIC&GAIL Zoning: Applicant: VALLEY HOME IMPROVEMENT INC AT: 121 OLD WILSON RD Applicant Address: Phone: Insurance: P 0 BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:8/1/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE KITCHEN CABINETS 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 8/1/2013 0:00:00 $88.20 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner