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the backsplash
CS anijet Tub
Toto 1.6
Window to remain �
granite top
Half wall with Granite wellcap Full width mirror
-- Tile Floor
Tile Walls
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Relocate new door
Frameless Glass Enclosure
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m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Buildingo
Northampton, Mass. 01060 '
WORKER'S COMPENSATION ENSUILMNCE A.FITDAVTT
I, Nelson Shifflett - Valley Home Improvement Inc .
(licerlsenJpermittee}
with a principal place of business/residence at:
340 Riverside Drive, Northampton,MA 01060 (phone;) 584-7522
do hereby certi �, under the pains and penalties of pe ' _y tips.:
()) I am an employer providing the following worker's compensaon coverage for my
employees working on this job:
Acadia Insurance Co. 0109302-12 2/1/07
(Insurance Company) (Pe.:c.Number) --- (Expimtion Dat-)
( ) I am a sole proprietor, general contractor or homeowner (c_cie one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Coa=ctor) (Insurance Company!PoLicy lumber) (E;cpiration Date)
(Name of Contractor) ansaranoc Co=ai v/PodcY Number) (Ea-pir:tioa Date)
(Name of Co=, ctor) (I2suranc:. Company Policy Numbi ) (Expiration Date)
(Name of Contractor) Unsumce Compaay/Policy Nuinber) (Expiration Date)
(aaxch additioaal sbect tfzeo=ury to include jafnnnaIIon pertaining to ail coat-= n)
( ) 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 award that while homeowom who cu=ploy pa-.Om to do rnainr�corsuurzion or rc,a r Work on a dwelling of
ant more than throo units is wbich the homoowncr reside or oa the grouac s appurtenant tbrrdo arc dot gcoaally ooasidat l to bo
eraploym under the worker"%ccapeasasion Art(GL152,m 1(5)�application by a homeowner for a lic=e or permit may n4dcoce tbx
leg21 stariaa of an employer under the Workeez Compcnset on Act
I undertund that a copy of this matemeai may bo forwarded to the Dcpwtmcat of IaduUial A=dca&Offioe of Inauaoce for the
coverage verification and that fadum to secure coverage under section 25A of MGL 152 can lead to the impositioa of cr=-I pena -
ooasisiiag of a fine of up to S1,500.00 and(or imprison of up to one year and civil peaah es in the form of a Stop Work Order and a
firm of 5100.00 a day agunst tae.
Of
Signed this_- day of f� �� For dg=tMC0r,l use only
Permit Number
rTLp# Lcr>�
°�" ��ie �rirrrorwnrueafC� c�� lr!�z.uar.�iusP,dts
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 077279
Birthdate: 06/21;1964
Expires: 06121/2008 Tr,no: 24270
Restricted: 00
STEVEN A SILVERMAN
268 FOMER RD
SOUTHAMPTON, MA 01073 i
Commissioner /
� �\ ��fze ��ain�r�ru«err"rCl -`," lta.:.:tzcfrusel�3
x =_ Board or Building Regulations and Standards
r r HOME IMPROVEMENT CONTRACTOR
Registration: 131945
~ _ Expiration: 1011312006
Type: individual
STEVEN A.SILVERMAN
STEVEN SILVERMAN
73 WHITE ROCK RD. _, �° ✓
YARMOUTH,MA 02675 Administrator
t
SECTION 8 - CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :_Steven Silverman _ 077279
License Number
73 Whitq Rock Roa , Yarmouth, MA 02675 6/21/08
Address Expiration Date
584-7522
Signatu Telephone
I
9 Registered Home Improvement Contractor: Not Applicable ❑
Steven Silverman 131945
Company Name Registration Number
73 White Rock Road, YyrVjouth, MA 02675 10/13/06
Address Expiration Date
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 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.x.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
'ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ 1 Addition ❑ Replacement Windows Alteration(sK Roofing ❑
j Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: AS tA ATN AIDDEL ALT) AL TlEyZAli 6 — Sce QOM
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet i_.
6a. If New house and or addition to existing housing complete the follow' ing:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
i
d. Proposed Square footage of new construction. Dimensiors
e. Number of stcries?
f. Method of heating? Fireplaces or Woodstoves Number of each
i
g. Energy Conservation Compliance. Mascheck =nergy Compliance form attacred?
Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. flccdplain Yes No
I
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT )
13 Sy/v-eb (� /�Orla �J j 7—,ti�S� /Ishlev fCili14AOwner of the subject property
hereby authorize Steven Silverman Valley Home Improvement, Tnr to act on
my behalf, in all matters r lative to work authorized by this building permit application.
17, 7 O (o
nature of Owner Date
I, Steven Silver as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Steven Silverman
Print Name
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zon'
This column to be ed in by
Building Dep ent
Lot Size
Frontage
Setbacks Front
Side L: R: L:
Rear owz/
Building Height
Bldg. Square Footage OX
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 N0�
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 Statusof Permit:
Building Department Curb Cut/Drl eway Permit
212 Main Street Sewer/Septcallabiilty
Room 100 Water/Well Availabilit -:
Northampton, MA 01060 Two'Sets,ofiStructural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site'Plans u'
Qtfier Specie. & ' '
Y e�`. ''�'
P�
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING j
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address: Q
139 Sy1-V1 STr�2 Ro4e) Map — Lot Unit
FL dGC Zone Overlay District
Elm St. District_ CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
i
2.1 Owner of Record:
(3b S'1'-eS4elL FA»2 V)fVJ �il/n l/ AA41leV�
N Print) Current M ilia Address:
Telephone
'Signature
2.2 Authorized Agent:
Steven Silverman P.O. Box 60627 FLnrPnce, MA Di nti�
Name(Print) Current Mailing Address:
i
413-584-7522 j
Signatur Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building 3 I DOO (a) Building Permit Fee
2. Electrical I (b) Estimated Total Cost of
1
900 Construction from 6
3. Plumbing 1OO Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5)
(D 5 Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
e•
File#BP-2007-0434
APPLICANT/CONTACT PERSON Valley Home Improvement,Inc
ADDRESS/PHONE P O Box 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 138 SYLVESTER RD
MAP 28 PARCEL 069 001 ZONE RR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
T peof Construction: REMODEL KITCHEN&MSTR BATH
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 FO WING 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 Commiss'
/a �
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.
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