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DRAViN BY: VHI
This plan is the proprietary work product of V�Vley
...........---- Valley Home Improvement, Inc. JEANNE COMEAU Home Improvement,Inc.(M).It is
REV15ED: delivered for the limited and exclusive I)Umos,�of
340 Riverside prive, PO Box 60627, Northampton, MA 0 1062 46 PILGRIM DRIVE supporting the contract bid of VHI,and
0 customer agrees that the elements of this plan sholi
5-1q-14 fflcc Phone 4-13.584.1522 Fax 413.555.0520 FLORENCE, MA not be republished or presented in anylorm
for the purpose of enabling or supporting the work c i
Fjncw5onthewebat: WUAV.ValleyHorneimprovement.com
DATE: 5/1q/2014 competing project contractors without the
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DRAV4NBY: VH1 This plan is the proprietary work product of Valley
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delivered for the limited and exclusive purposo of
REVISED: 4b PIL67RIM DRIVE supporting the contract bid of VHI,and
340 Riverside Drive, PO Box 6Ob2l, Northampton, MA 01062 52 c tomer agrees that the elements of this pkfj shod
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Findusonthewebat: LUWLV.Vall,--YHOMC[mprovement.com
DATE: 5/1q/2014 competing project contractors without the
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This plan is the proprietary work product oi llalf,,),
DRAIAN BY: \/H1 Valley .Honie Improvement, Inc. -J--_E_A-N___N_E_ 0--_M EAU H_ome_1m_p_r_o*_v*_ement_,-In-c.(M),It is
. ................ -
delivered for the limited and exclusive purpose
46 PILGRIM DRIVE supporting the contract bid of VHI,and
340 Riverside! Drive, PO Box 60621, Northampton, MA 01062 customer agrees that the elements of this jifar�,Oi�,fl
5.1`I.14 Office Fhone 413.584.1522 Fax 413.50.0520 FLORENCE, MA notbo republished or presented in any lot i-,?
for the purpose of enabling or supporting 71c ww ,f
Find U5 oil the web at uuw.V,--IlieyHoMeiniprovernent.com VATE: 5/1 q/2014 i competing project contractors without the
permission of,and compensation paid to,VNI.
............ .... --------------
¢St1AMp�
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORHER'S COMPENSATION INSURANCE AFFIDAVIT
(1l0enseC/permlttee)
with a principal place of business/residence at:
. dv��LS���...�✓�i i� . ��.Gr�,�7t�i%�rf'i7�rZ 1,14 (phone#) j�
(stMt/city!r i>zip
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:
/Gl�511 l,4j , 0Z`�/
(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)
( additional sheet ifnecenary to include information pertaining to an ooatiadora)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:picase be aware that while homeowners who ernpioy pe som to do mahicaance,co&vctioa or repair work oa a dwelling of
not mono than three units is which the hotl=wncr reud a or on the grnjn6 appurtenant thereto are oot generally c ndcred to be
employers under the wor'„eft comV=s4on Act(GL152,a 1(5)),application by a homeowner for a liaise or perndi may evidence tae
legal status of an employer under the Worker's Compemation Act.
I understand tact a copy of this statement may be forwwdad to tike Departm=ad of y—h, ial Acad=d Offioe of hWuaseca for the
coverage ve i&sEioa and that failure to scree coverage ut3dar section 25A of MOL 152 can lead to the impos ioa of rcimmW penalties
000sistiag of a fine of up to$1,300.00 andlor impr isom of up to one year and civil penalties is the form of s stop Work Order and a
fine of S 100.00 a day against tae.
Signed sr day of 1v� 1�n: 1 ' Forte uaa ply
Permit Number
Ma LoMao #
ipature of Li ermittee
^
SECTION 8 - CONSTRUCTION SERVICES
Address Expiration Date
Sgnatur
Registration Number
Address Expiration Date
Southampton, MA 01073 Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(6))
Wor�ers Compensation Insurance affidavit must be completed and submitled with th's appkcation, Failure to provide -his aff"id"avit
will result in the denial of the issuance oi the building permit.
Home Owner Exemption
The Current exemption kn^hnmco*nrrs'was extended miuc|udu Coxc(l) or two(2) families
and to allow such homeowner tnonoug gcun individual for hire who does not posu�su \i:0000. provided that the Owner acts
as supervisor. CMR 780. Sixth Edition Section 108.1-5.1.
Definition of Homeowner: Person(s)who own a parcel of land on whichhe;slic resides or intends io reside.on which there
is. or is intended to be, a one oi-two family dwelling,attached or detached struci ures accesson. to such use and/or farni
structures. A Person who constructs-mor than onehome in a tvvo-vear period shall not be considered a homeowner.
Such"homeowner" shal I submit to the Building Official,on a form acceptable to the Buildin- Official,that he/s.he shall be
responsible for all such work performed under the buJIjjag_RLLMiL
Asacting Construction Superviso your presence on the job site will be required from time to time, during and Lipon
completion of tile 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
Ernployees for injuries not resulting in Death)nfthe Massachusetts General Laws/\nontated, von may he liable mrpersonp�
you hire N perform work for you tinder this Pcn»k.
� m hil`/y for compliance vhhthe S��BuiNingCodc` City of
Thcuodcrxi ` v
�om uchonCco:ru| Lon� �nno�u�cd�av � s
Homeowner Signature ___'_—__��� _ _______ ___
74: .i1 �
Elt:E I{ .e e.e: l.r(ttiuee _ r= l�[idreE-:t 4"rie elcvrs ! .:rwti regs;ti �C��ea'ir r; E'
r i
Accessory Slag DeMARK7 2 � New Sins I Decks over
r. 1. so J �Ie Car_ To k50L.v 1CA
sas If New house and or addition to existing housine complete the following.
Q.. t
Ir,;�!' �C"`i o'(" f ...`"'� 7 ..•=9:�'�{ -�i�'!;',g Ir' f� v,1 ,.,, . „-=G. l".R."...
I
t
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r'R�: �� o. M x 'R:� -- ._.a _, � '��: r �1 °Arr r..���r .. �°.tte .�.:., ��$ _.�➢C:1"i
-.F ',.t.`c., t._ i. : ._. -, bi-::. 14� ?.` . .. 7 «_fit .._'ir;;rl MM Wr ! MaCKLM
'. `� r,:9� r_I,� .�.-�,!•,'i :l=111¢'., ��:,,i �� :rf ....,. �I�i..`r_......�.._..._��� _.___°--- "�.. !G 3»;?Yt�.tt:3.:� .,tii tY wti`6: :�.�ti'p'f �I ... °;,�I3::S1 _...._.._.___�(u: v___,_ I :.
'0111 l . t , > ceIs r ..
' 11C
`^ ,x'" SIG Is;a-"' .. .�:1t`t�3 C:; ;' i' IF�lfl`.0 �. ) p � � .0.7 Yon P'.
Zap D ank � .__ sue• '.y vat me! no , <tex `u•i`p y
SECTION 7' -OWNER AUT14ORIZATION -TO BE COMPLETED WEIEId
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
r:.`:
9 —Av swAs wp _._Steven Silverman, , Valley Home_ Improvement, Inc.
:- _"T-o
Stey_en_.zi.lxexman,_Xa.ley Home_Imp=xenen.t._—Iac_.—
No _°L.ti Ac rM Vol • raw _.awmc ; snr,. Wr MIt u-, thu .tk+B.` ,stit,`. 1 W out ,s& Mq :r.,>w w Am .,. . W a `.r
r cy W cc -no rr hc-'_
i
r _ _
Steven Silverman
k
t e^ Z
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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 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 ary proposed changes to or additions of signs intended for the property?YES _
No
IF YES, describe size, type and location:
Department use only
i y of Northampton Status of Permit:
�A� 2 Bu Iding Department Curb Cut/Driveway Permit
&GaSG;o eect,on 12 Main Street Sewer/Septic Availability
Electric,Plumb�,on MA Room 100 W� rlWell Availability
�'°`jhamp Northampton, MA 01060 Two Sets of Structural Plans .:
phone 413-587-1240 Fax 413-587-1272 Plot/Site Ply
Other SpecKL
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
Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
T- tj� ow G-;M �i�� 01
Name(Prin Current Mail Address: l 3 1` , L
`IT7
Telephone
Signature
2.2 Authorized Agent: Steven Silverman
Valley Home Improvement, Inc. P.Q. Box 606:27, Florence, MA 01062
Name(Print) Current Mailing Address:
584-7522
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit a olicant
1. Building �2 Uzt) (a) Building Permit Fee
2. Electrical 3,3��� (b) Estimated Total Cost of
Construction from 6
3. Plumbin g Building Permit Fee
if ��
4. Mechanical (HVAC)
5. ;lire Protection
6. otal =G + 2 + 3 + 4+ 5) O �ro Check Number to)
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Cate
---
Building Commissioner/Inspector of Buildings
File 9 BP-2014-1253
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 46 PILGRIM DR
MAP 24A PARCEL 228 001 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
Fee Paid
Tyneof Construction: REMODEL 3 BATHROOMS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 077279
3 sets of-Tans/Plot Plan
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN 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
D mol' ' a
Si e 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.
46 PILGRIM DR BP-2014-1253
GIS#: COMMONWEALTH OF MASSACHUSETTS
M Block:24A-228 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-2014-1253
Project# JS-2014-002108
Est.Cost: $40150.00
Fee: $240.90 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sg.ft.): 29620.80 Owner: COMEAU JEANNE
Zoning. URA(100)/ Applicant. VALLEY HOME IMPROVEMENT INC
AT. 46 PILGRIM DR
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.512912014 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL 3 BATHROOMS
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 5/29/2014 0:00:00 $240.90
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner