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Office olConsumer Affairs and gusiness Re;2.ulation
10 Pa k Plaza - Suite 5170
• Boston Massachusetts 02116
Home Improvement Contractor Registration
Registration- 131945
Type: Individual
Expiration: 10/1312014 Tr# 232370
STEVEN A. SILVERMAN
STEVEN SILVERMAN
268 FOMER RD,
SOUTHAMPTON, MA 01073
update Address and return card,Mark reason for change.
Address 11.enesval Employment most Card
OPS-CA 1 Ca 5041-04M4-C-101216
,
rlite eranoptcowamaia ii,e,,,aae444.e,
Office of Consumer Affairs&Itufeiness Regulation License or registration valid for individul use only
PI;Ve HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 131945 Type: Office of Consumer Affairs and Business Regulation
-1- Expiration: 10133/2014 I ndond u al 10 Park Plaza-Suite 5170
Boston.MA 02116
SI'EVEN A.SILVERMAN
STEVEN SILVERMAN
268 FOMER RD,
v1/4'
SOUTHAMPTON,MA 01073 Underseeretar)
Not valitbvithout signature
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DEPARTMENT OF BUILDING INSPECTIONS _
212 Main Street • Municipal Building
Northampton, Mass. 01060 _0,
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, 571'P' iI 5/L j/ ill/ 1fZG f. /7)%j i )5P-,,-a/Iir`ZZ/1 i'yl-C..
' (licensee/permittee)
with a principal place of business/residence at:
/I- Giz �3YO ,6,1</ L'-5 1, -;,_. 74 t- , ' T, �lf2,t r 2,4 (phone#) J C/=7vZL
(stI;:t/cit l/stnf°/zinc
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:
/gG�1 ii.& V GZ az ,7)Z. % c`' z,/////
. (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 whi10 homeowners who employ persons to do ree intefmnrn corst action 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 worker's compensation Act(GL152,as 1(5)),application by a homeowner for a license cc permit may evidence c the
legal status of an employer under the Worker's Compensation Act.
I understand that a copy of this statement may be forwarded to the Departonant 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 51,500.00 and/or imprisonment of up to one year and civil penalties is the form of a Stop Work.Order and a
fine of S100.00 a day against me.
Signed�'e day of -,Li a/ 1'41\ ' Lick) For dgaata�tal use only
A f Permit Number
/�l, �� , b/ i f//i J 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 Fomer Road .� + - it. . ..,._112 01 d7 _6/21/11
Address F I Expiration Date
j /"
584-7522
Signature Telephone
p
9 Registered Home Improvement Contractor: Not Applicable 0
Steven Silverman. 131945
Company Name Registration Number
268 Fomer Road _ 1 O 13ji•Y•
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 !gl No ❑
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 ands 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, von may be liable for p ersontst
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
`FSTI N 5. DESCRIPTION *F PROPOSED WORK (check ;nil Palp_iic,,,bjc.,)
New Hcof.e ".....: ' Acclitien _1 1 Replacement Windows tV ter ation(s) r: Roofing I-
1 Of Doors :: l
Accessory Bldg. L-I Demolitio-,:i New Signs ' I Decks4 Siding r; "; Other , I
r -1..e on r'i: r, 'of,". ■,40,,,. arill-ftACji (0 X 1 dzj Di kfick.
Y . 77 Nr: rsr::*1 pp pt,tv: nt.-1,r,p.--- ),,,,-, 'Jr, ----is
-t %,..rr-.0.1-::
:13,-.1. Atlanc-.2 Ro'i ::°,r.--,
6a. If New house and or addition to existing housing, complete the following:
c-i:, 7,,,ro t,,,, 7,,s. 7.1rf
'..-.:
R. .1E-1 c' r,-,:',-F 1 r's'a 7:!`i *51-t ..,. :' t' ''',.
." :t":
'.I. r..G:.. , ..,,y_w- `,%t-.4:-1 .,, :,.:.t ,,f I :',11--- tt'.1 ;Fs•
`- t.'C",■""''...:°J 0' 'leo', 1.;,:;:` f r t r L'.:,.;:., .al (*.C.:,,P-,t.. 0,'.t.., Nix- I.,.,:- "J‘ VOCt I
Cr-scr,:A7::, r.-% .....„:7,f.--: ia-:`,:. t„,Ly,cf'I:.r..:;- Dtr:^1.,:y°C.:rn:k:.:11.-J2 `::orm ,e:ti:ci cc.' .....
tc-
1
;
. ',,c,;..e,t1s.:,tic 'i A r Uu L`. .7 \'k--,:-. _ sqr: l& r.:Aistr.,Ict :Ai %N 7,! t.' !00 yt ,:fA.i.:1 Yt7....,
-pi :.sw.!.-rCt.nt .:.° Cf.L:-,." I
:NI 1(.7'..r.::: cc:t -ri tc :t,c Bulf:LriE ;-:.-1,:i ?:• r fr?
. `,. . e. k, C (1 -1
SECTION 7a - OWNER AUTHORIZATION . TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT [_ ________
— -_____-_,Dan ''?-11at\QL,) j • as :t7.-A:i. c 7,-,.. 1,1L _ct
iii,:•'.'I';',' :Ii.r.`„rui?et. Steven Silverman, Valley Home Improvement, Inc.
e-,rl'ifrii`r-k; :r, ,f- '.'
I--
---1_ .
----- _ _
'N,:r r_ire or
, atemen_aily_erman, valley Home Imprskmernent, Inc.„.
'1" . ,,,.1.1ttfrIc'17:, :21Ir! 1,-11.4--ti...! :)11 43-` thu. l'ort.q-mr ii ii;ii:i c ., lw -p.p.,,,: ....vc.j ;11,:: ;J• tr., i. 1 -iit.,: `,.::-,' L" try
Lr C°.s1,-:Ct7C 7 rir. Dcficf.
I _
1 .......s:-E.:I _:--c,:.• 7::: - .e- -...i ,:..-..7- ,.! .I,..:':
Steven Silverman, r _
1 t ''-; i ',V, •
//r -;7271./
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-i:tl,.! ..........__...... ....___. .
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
LI15 50
Frontage
Setbacks Front
Side L: t 6 R: IS L: 15 R:
Rear 20 Z U
Building Height 301 N
Bldg. Square Footage p S %
Open Space Footage 1 I U
t
(Lot area minus bldg&paved ,700 J 7 Ai,
parking)
#of Parking Spaces 2`
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:
f- li \‘'7' ; l'—';`
' Department use only
D l ' City of Northampton Status of Pe.pmt:
� ) Building Department Curb Cut/Driveway permit���3 �'" 212 Main Street Sewer/Septic Availability Room 100 ."� r/Well-Availability
Electric,Plumbing t�Gas lnepecti• -I rthampton, MA 01060 TSets.ofctural Plans
Northampton,MP 01060 ,
-587-1240 Fax 413-587-1272 Plot/Site P '
Other Specify ,,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
la DX�� '1.C-- C -1 c �t h' '--e'�'_' Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) / Current Mailing Address: �� t���0(1
_--- Ll \3_ S` LI- I cic
____._—� Telephone
Signature
2.2 Authorized Agent: Steven Silverman
Valley Home Improvement ,Inc, P.O. Box 60627, Florence, MA 01062
Name(Print) Current Mailing Address:
JIM! / / a 584-7522
Signature Telephone
SECTION 3 • ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only j
completed by permit applicant
1. Building '.-j ,pup (a) Building Permit Fee
2. Electrical ,- - (b) Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) it'i 0 Check Number M(99
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature: _.
Building Commissioner/Inspector of Buildings Date
IN F6)
File#BP-2014-0369
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC SL /0Pco cf4c(")
ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 12 DICKINSON ST
MAP 24A PARCEL 090 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 306-6
Fee Paid 77((PP
Typeof Construction: CONSTRUCT 10 X 15'8" DECK
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
INF9B_MATION 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
( 4
Signature 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.
12 DICKINSON ST BP-2014-0369
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24A-090 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:Deck BUILDING PERMIT
Permit# BP-2014-0369
Project# JS-2014-000158
Est.Cost: $4000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq.ft.): 4748.04 Owner: BRADBURY DANIEL S&JOHANNA C
Zoning:URA(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 12 DICKINSON ST
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:10/3/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 10 X 15'8" DECK
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 10/3/2013 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner