35-207 (7) Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Reqistration: 131945
Type:
Expiration: 10/13/2008
STEVEN A. SILVERMAN
STEVEN SILVERMAN - - -- - - -------- --__ - -
268 FOMER RD. -------- -- - - - ----
SOUTHAMPTON, MA 01073 --- --- - ---- - ---- - - ----
Update Address and return card. Nlark reason for change.
_os__,_•, ,�_,, ;_- .address Renewal — Employment -- Lost Card
i Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
_- Registration: 131945 Board of Building Regulations and Standards
Expiration: 10/13/2008 One Ashburton Place Rm 1301
3
Type: Boston,Ma. 02108
STEVEN A.SILVERMAN
STEVEN SILVERMAN
268 FOMER RD.
SOUTHAMPTON, MAO!073 Depute.administrator Not valid without signature
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 077279
Birthdate: C6/21/1964
Expires: 06/21/2008 Tr. no: 2=270
Restricted: 00
STEVEN A SILVERMAN
268 FOMER RD f
SOUTHAMPTON. MA 01073
Commissioner
i
iD
i assschnsctts k
DEPARTMENT OF BUILDD\TG INSPECTIONS
i.
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 '
WORKER'S COMPENSATION RiSURANCE AFFIDAVIT
I, Nelson Shifflett - Valley Home Improvement Inc .
(l i censeeJpetmi ttee)
with a principal place of business/residence at:
340 Riverside Drive, Northampton,MA 01060 (pbonei=) 584-7522
(s-,r--U cit!%:. �,,in)
do hereby certify, under the pains and penalties ofpe.7ury, tlla-
( I an an employe:providing the follo-viuig worker's compensation coverage for my
employees working on this Job-
A. I .M. Mutual Ins. Co. WMZ8005610 01 2007 2/1/08
(Insurance Company) (Policy"'Jmber) (Expiration Daze)
O I aryl a sole proprietor, general contractor or homeowner (ci.cle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Nam-, of Contractor) (Insu=(--Company/PCiiey Nu nxr) (Expiration Date)
(Dame of Contractor) (Insurance Conmain•/Porten Number`, (-,r-,\ Date)
(Namc of Contractor) (llnsuraac;c Compauy/Policy Namhe:) (E:punnon Dale)
(Name of Contractor) (Insurancc Company/Policy Number) (Expiration Date)
(attach additioral shoes ifneocnary to include information permiain.g to an occ serous)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plcmw be aware that while homeowo=who employ persons to do mamma�� consm.,c ion.or repair worts on a dwelling of
not more than throe units is which the homeowner raids or on the grouacls appurtenwA tbereto ate not genemily comidered to be
employers under the woclCr's oea*camtion Act(GL152.sa 1(5)�application by a homeowner for a Gorse or permit may evidraoe the
legal status of an employer under the Worker's Compemation Ati
I understand that a copy of this sae tcmeat may be forwcuded to tho D epextn ee t of 1ndzu star Axidcnta OMs.of lrsn.n for the
oovcmge vmficauoo and that failure to s=, coverage under section 25A of MGL 152 can lead to the imps oa of MmfiW penalties
coasistitg of a fine of up to 51,500.00 and/or of up to one year and civil pmasties in the form of a Step Work Order and a
fine of 5100.00 a day against me.
Signed this _day of For dgactw=W uao only
Permit Number
AL...Jt t n1 K
. t
SECTION 8 - CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Steven Silverman 077279
License Number
268 Fome 6/21/08
Address Expiration Date
584-7522
Signatur Telephone f
9 Registered Home Improvement Contractor:__. Not Applicable ❑
Steven Silverman 131945
Company Name Registration Number
268 Fomer Road 10/13/08
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....... X 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 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 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
a
i
'ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ , Addition ❑ Replacement Windows Alterations) ❑ Roofing Z
Or Doors V�.
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding Other [ ]
Brief Description of Proposed Work: N hvf� `yt Sl01t'jG OIJ M,P1)A) j-jw(
Alteration of existing bedroom Yes No Adding new bedroom Yes 74� No
Attached Narrative � Renovating unfinished basement Yes No
Plans Attached Roll Sheet❑
6a. If New house and or addition to existirilthousing, complete the following:
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? r✓
d. Proposed Square footage of new construction. Dirnsions
e. Number of stories?
f. Method of heating? Fir aces or Woodstoves Number of each
g. Energy Conservation Compliance. ✓ Mascheck Energy Compliance form attached?
Type of constructior.
i. Is construction within 100 ft. of wetl s? Yes No. Is construction within 100 yr. floodplain Yes No
I. Depth of basement or cellar fl r below finished grade
k. Will building conform t he Building and Zoning regulations? Yes No .
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
i
G/L l ��`'�sG'rto' `�� �G %/ - /�'l f 'i %�/fG� _ as Owner of the subject property
hereby authorize Steven Silverman, Valley Home Improvement, Inc. to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date 1^
I, Steven Silerman, Valley Home Improvement, Inc 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 Silve=an
Prjnt Name
a ryry
/ �y
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 fillW.by
Building Depuwjei
/ l
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&L ation)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW 7— 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
r
IF YES, describe size, type and location:
epartment use:onl
City of Northampton Status of'F;,
Bli ding Department Curb Cut/bn ew4A �t
212 Main Street Sewor/SepticAvail� r ' • ,; =:
Room 100 W /Well Availability '
Northampton, MA 01060 Tw :Setso =V� §�tiaral Plans .Y
,. . .- r i
phone. 413-587.1240 Fax 413-587-1272 Plot%Site
Ofher Spee
-_
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:
Map Lot Unit
17-el-i � �. � ����„f�� ,� Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: r �ZSB �/��� p�7—
z
Name(Print) Current Mailing Address:
Telephone!
t
Signature
2.2 Authorized Agent: Steven Silverman
Valley Home Im rovent P.O. Box 60627, Florence, MA 01062
Name(Print) Current Mailing Address:
1w Z/o 584-7522
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 25b� (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 =(I + 2 + 3 +4+ 5) E '?00 Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
!jignature:
Building Commissioner/Inspector of Buildings Date
Alftil BP-2007-1038
CIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:_ BUILDING PERMIT
Permit# BP-2007-1038
Project# JS-2007-001672
Est. Cost: $25800.00
Fee: $129.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Valley Home Improvement, Inc 131945
Lot Size(sq.ft.): 71002.80 Owner: KOSSON JULIE&MARCIA MERITHEW
Zoning: SR Applicant: Valley Home Improvement, Inc
AT. 1238 BURTS PIT RD
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON.5/1/2007 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF & INSTALL SIDING
ON MAIN HOUSE
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 5/1/2007 0:00:00 $129.0022457
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo