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FEDERAL STREET
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PORCH ADDITIO
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292'TO PROPERTY LINE
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Cr r of Xarf4amvton
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m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building- '
Northampton, Mass. 01060
WORKER'S CONTENSATTON INSURANCE AFFIDAVIT
�, 5 I-V r ,/t/f�'v�
' (iicenscelperm;ttee}
with a principal place of business/residence at:
1,1114 (phone#)
(�f/city/5' {P'L1pS
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:
fGi�TZ�"i�l %�G� i,L�I� Uzi ire z 1 05
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors fisted 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)
(anaclt addidonal shad if nee eery to include information pertaining to all cactraetors)
( ) 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 v6lo homeowners who employ persom to do m_i+++__M_a�caosuvcdon cr rcpair work on a dwelling of
not moue than three units is which the hon=t kmw resides or oa the vvjzkds appu[tnusnt therdo errs not gcoerally 000sukmd w be
employ=under the worif4es, ion,Act application by a homeowner for a iiicease or pemili may evidence the
legal statue of an employer under the Worms Compamatioa AcL
I uoderatand that a copy of this sratemmt may her forwarded to the Dcpwtmca of rndtshia!Aodd=&dfsoc of&m==for the
oovaage wificaiioa and that failure to segue oowmgo under sectioa 25A of MGL 152 can lead to the imposdiot of ociminsl penalties
oomistiag of a fim of up to$1,500.00 attdlor of up to one yt w and civil penalties in the farm of a Stop Work Order and a
fma o(5100.00 a day against me.
'z c
signed _day of ,;�L l^,. " L�) /
For dq=tmmw use coly
Permit Number
Mao Lot#
91gnature of La w ertaittee
�p
' Office o Consumer tf irs and lsiness Regulation�
10P,=l k, Plaza - Suite 5 I70
Boston�n Massac usetts 02116
Home nipr v'c i'ient Cqrktr4ctor Registration
istration
Registration: 131945
Type: Individual
Expiration: 10/1312014 Tr# 232370
STEVEN A. SILVER AN
STEVEN SILVERMAN ._._-
...
268 FOMER RD.
SOUTHAMPTON, MA 01073
r .
Update address and return card.Mark reason for change,
Address Renewal i Employment Lost Card
DPS-CAI 0 was o a- r s
{?€five of Consumer affairs Business Regulation License or re+�istratiou valid for individui use only
rHOME IMPROVEMENT IENT CtJNTRACTt tR before the expiration date. If found return to:
m Office of Consumer AtEairs arttf Business Be ulatiosa 12egistratisrn: 131945 Type:Exptratian, 1t3t13/2o14 Ittd+vtetuaE 10 Dark Pts -Suite 5170
Boston,NIA 02116
STEVEN A.SIL1JIwRMr1
STEVEN SILVERMAN � �� {
268 FOMER RD,
SOUTHAMPTON,MA GI073
Undersceretary !ot °sfa!-without signature
f f
�' 8.Y u --fink k5'�k r...a-.A:`'^ai•''� s`Y.$'G�"`
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SECTION 8-CONSTRUCTION SERVICES
Name of—Licen�eHoLcLer : Steven_S_jJVe_rMan
1-7conse Number
Address Expiranon Dare
Signatur'eVU" Telephone
Steven
---S—ilverma 131945
qpmpany Name
Registration Numbcr
268 Fomer--RoAd
Address Expiration Date
Southampton MA 01073
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(6))
Workers Compensation Insurance affidavit must be con-pleted and submi"ted with th"s appitcation. Failure to provide this a-ficavit
will re-sult in the denial of the issuance ofthe building permit.
The current exemption for^homco.wnecs' was extended^uinclude [one(>) or uxn(2) fam3ics
and to allow such homeowner to enaa ge an individual for hire,,vho does not possess a license, provided that the owner acts
as supervisor. CN4R 780. Sixth Edition Section 108.3.5.1.
Definition of : 9exxon(x)`vhon*nupmrc} o[|vn600whichhei'skuosidcsorbn/codxtorcsidc' unnhicbthero
is, or is intended to be, a one or two farnfiv dwellin,,attached or detached mruciures accessory to such use and/or I'arm
structures. A person who constructs more than one home in a two-year period shall not be considered a honteowner.
Such "homeowner"shall submit (o the Buildin-Official,on u [bnn acceptable/o the BuiNiog Official,
responsible for all such work performed under the buildini! perynita
Asactinc,ConstritetionSuperN,iso your presence nn the job site will hr required from time to time.during Ind Upon
Completion uf the work for which this permit ioissued.
Also be advised that with reference to Chapter 152(Workers' Compensation) undCbapler lj33 (Liability^fEn`yinyrry /m
Employees for injuries not resulting in Death)of the NIIuxxuohxyetmGcncrx| Laws Annotated, vott may be liable/Orpursvn(s)
you hire/operform work for you under this permit,
The undcnioned ^^homou*oe,^'certifies and nuwo pnnxibUiry for compliance with the State Building Code` City of
Nonbannpu»nOrdinances, l�av, and �rn,cnF\;oeuchxs�nsGcomo| Laax �nnn`mcd�
Homeowner Signature
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6�-. If New house and or addition to existing g ousinr complete the follow .
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ft•:ry
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SECTION as •OWNER AUTHORIZAMN •TO BE COMPLETED WHE14
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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t { t .,r Steve ilveratian, vall Home Improvement, Inc.
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Section 4e
ALL INTORMATION MUST BE C0 EPLETED9 or PERMIT CAN BE
DENIED DUE TO LACK OF IlF'0RMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
3 8i `�
Lot Size
Frontage
7s �
Setbacks Front LA LD
Side L: 17 R:Z S L: 17 R:t-Sr
Rear Z1L 21 Z
Building Heights 1
Bldg. Square Footage �)y y 3 % if-00
;� 1
Open Space Footage r % f Q•
(Lot area minus bldg&paved 1 j,?31 9 310't 91(0.1
parking)
#of Parking Spaces L'
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 arly proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location:
1 , Department use only
g4 City of Northampton Status of Permit:
APR 112a uilding Department Curb Cut/Driveway Permit
ons 212 Main Street Sewer/Septic Availability
„�.
Room 100 Wbjr7Well Availability x
Northampton, MA 01060 4 bets of Structural Plans
phone 413-587-1240 Fax 413.587-1272 Plot/Site Pi
Other Specify,
F- 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: (�
8� Fed erg l y�� _ l Map Lot Unit
1 �Q— Zone Overlay District
Elm St. District_ CB District _
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current afl r�Add
�—
Telephone'
��–
Signature
2.2 Authorized Agent: Steven Si verman
Valley Home Improvement- P.O. Box 60627, Florence, MA 01062
Name(Print) Current Mailing Address:
584-7522
Signature Telephone
SECTION 3.- ESTIMATED CONSTRUCTION CASTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit a olicant
1. Building � �l C� (a) Building Permit Fee
2. Electrical �Cl� (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
I
5. ,ire Protection,
6. Total = (1 + 2 + 3 + 4+ 5) )�J Check Number I
I This Section For Official Use Only_._
I
Building Permit Number: Date Issued:
Signature:
Buildirg Comm;ssioner/Inspector of Buildings Date
�J.� ,� 4
File#BP-2014-1049
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC .X
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 184 FEDERAL ST
MAP 23D PARCEL 123 001 ZONE URB(100)/
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_ypeof Construction: ADD 7 X 8 TO REAR PORCH
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
INFg 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
o 'tion y
Signature of Buildi g ficial 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.
184 FEDERAL ST BP-2014-1049
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D- 123 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2014-1049
Project# JS-2014-001805
Est. Cost: $24600.00
Fee: $147.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq.ft.): 38681.28 Owner: WINN STEVEN A&LESLEY FARLOW
Zoning:URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 184 FEDERAL ST
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:412212014 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD 7 X 8 TO REAR PORCH
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 4/22/2014 0:00:00 $147.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner