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DRANN BY: CO Valley Home Improvement, Ind. CERIOS RESIDENCE REVISED:
N SCALE: 340 Riverside Drive, PO Box 60621,Northampton,MA 01062
1 /4" = 1'-0" Office Phone 413.584.1522 Fax 413.585.0820 I
DATE: 01/12/13 Find us on the web at: www.ValleyHomelmprovement.com
r , '
itt1AMP.7.
1O O QiiiT nt IIn p *°�-oi:i
eb W .�'1r. i B .asaacliasrtta MAIL
v`°T'-i DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, Mass. 01060 ='4%.
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(licensee/permittee)
with a principal place of business/residence at:
3Y-O /fr/ 'iSE__..i4I'S / '7 / ?Z3' /1/4 (phone#) -75 2 _
(street/city/statthip5
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: /
. (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 persons to do maintenance,construction or repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtnuant thereto are not generally coosidaed to be
employers under the worker's ocanixassatica Act(GL152,s 1(5)),application by a homeowner for a license or permit may evidence the
legal status of an employer underlie 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 MOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1,500.00 and/or imprisonment of up to one year and civil penalties in the fora of a Stop Work Order and a
fine of 3100.00 a day against tae.
Signed�4s' ' ,day of 'e J y, A y\ 3 For del use only
/ Permit Number -
ATP % /�1,'i//�� Map Lot#
ire of Li... `ermittee
•
t lG ' t ii-t r' ct it .
Office of ( onsumci A il'airs ;And usinLss RL ulatiot
!; I 0 Pa'k Plaza - Suite 5170
Boston Massachusetts 0/ 116
otn I ;< ri Iit Contractor Registration
Registration: 131945
Type. Individual
Expiration: 10/13/2014 Tr# 232370
STEVEN A, SILVERMAN
STEVEN SILVERMAN
268 FOMER RD,
SOUTHAMPTON, MA 01073
update Address and return card.stark reason for change.
,Address Renewal Employment Lost Card
o
` Office of t€�nsumer Affairs d l3 zaess t(;aalatinn License or registration valid for indiv°idui use only°
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: .131945 Type: Office of Consumer Affairs and Business Regulation
Expiration: 10/13/2014 Individual Ig Park Ptaia-Suite 5170
Boston.MA 02114
STEVEN A.SILVERMAN
STEVEN SILVERMAN — S f Mi J ,t
258 ROMER RD i s y /p, bt
SOUTHAMPTON,,MA 01073 /
l aderserrriary Not valid witlitiut signature
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I SECTION 8-CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Steven SilvermarL 077279
License Number
268 Fom-r 4 10 _ 1440 • * , MA 01073 6/21/1
Address Expiration Date
584-7522
Sign. r.. Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Steven Silverman.._. 131945
Company Name Registration Number
268 Forcer Road 10/13//t —_
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 No ❑
11, - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellints alone(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 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 he 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
• r PROPOSED wORK f _p'd
N nw Hcu.e t Acdition U Replacement Windows , Aiteration0.11A Roofing Ii
Of Doors X
Accessory Bldg. 21' New Signs I Decks Siding [ ] Other )
(7d, —
t(t' t,:t7 try
or t Pr;r.,,a4.ma KIENQ l,,Q1KDDIA;$ t4 .31161 - 1,13111)1■) Fg6r4f 1.Q.C1k) M AST-NA- C LOS IS
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62. It New house and or addition,to existing housing, complete the following:
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W '01.) 101-K cca kottCttftpt ;"%tl.d ? rttftt rt:ttit,-1.The`f;?
'• C y Sew:=:), l Zy water Soop y
SECTION 7a - OWNER AUTHORIZATION TO DE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
M , 4.'42 1_11.:.tt:C4. 1t.t."--D.ctitty
41Q'AV .ttxr.riroe. Steven Silverman, Valley Home. Improvement, Inc. ttAll
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.;3t7
.Steven lverman.,Salley__Home_Improvement,__Inc_a_, /A^11nr$ l AE61,1
v** Ii it 1orvg ctic . t.11-tt: :tut; caFtdoeLkiLlte, `liti t. e'
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Steven S. erman _
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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 -ver been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at t - Registry of Deeds?
NO DON'T KNO YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a bro'ik, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit seen or need to be obtained from the Conservation Commission?
Needs to be obtain-• Obtained , Date Issued:
C. Do any signs exist •n the property? YES NO
IF YES, describe size, type and location:
D. Are there am/ proposed changes to or additions of signs intended for the property?YES _
No
IF YES, describe size, type and location:
°. Department use only
(�E� City of Northampton Status of P �►t� .
� ® : ilding Department Curb Cut/D l��v�ay;P�tTriit �`'
212 Main Street Sewer/Septic Avail -r'f�'y � :
E________7— T Room 100 11 r1wetl Availability � tot . ��
N ►rthampton, MA 01060 Twe`Sets of, (ctural Plans BL1r�l_____ P ,k1!;'' s°mac
NonryaMgivar;; o N 41C•587.1240 Fax 413-587-1272 Flot/Site P� �' '''',,,,,,,,,,:42,1 ;
Mq oros Other Sped:'-n4.4,40;4'
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
5 ,A\(- - 0 ockooL) Ve Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
MrJ si R otS Taft, Apt,,,,.,( ,►J 8 II ) C (ri LiS UOv3 b),
Name(Print)j Current Ma ig3Addrgssct _ (5(e)�
X - '"'— Telephone
Signature
2.2 Authorized Agent: Steven Silverman
Valley H. 1 a Improv- , ent, n• . P.O. Box 60627, Florence, MA 01062
Name(Print) j Current Mailing Address:
irgi 1 Al. Jjj . 584-7522
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 3(/000 (a) Building Permit Fee
2. Electrical J (b) Estimated Total Cost of
506 Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total = (1 +2 + 3 +4+ 5) 3 (, 500 Check Number \-41.. a4,3' 490
O
This Section For Official Use Only
Building Permit Number: Date issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2014-0137
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 8 HIGH MEADOW RD
MAP 30A PARCEL 079 001 ZONE WSP(100)/SR(56)/URA(44)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 3/� ff 010
Fee Paid o
Typeof Construction: CONSTRUCT NEW MASTER CLOSETS&INSTALL REPLACEMENT WINDOWS
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
INFORMATION 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
Signature of Buil: ng •fficial 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.
8 HIGH MEADOW RD BP-2014-0137
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A-079 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-2014-0137
Project# JS-2014-000261
Est.Cost: $31500.00
Fee:$90.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 153766.80 Owner: SIROIS DAN&JARA MALKIN
Zoning:WSP(100)/SR(56)/URA(44)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 8 HIGH MEADOW RD
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:8/8/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT NEW MASTER CLOSETS &
INSTALL REPLACEMENT WINDOWS
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 8/8/2013 0:00:00 $90.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner