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17A-203 (2) ' | � | | i ' | | | | | . / � � ' i � i / | ! | / i | � | | / i ! | | � . | . | / ! 12/15/2015 08:55 4135850820 VALLEYHOME PAGE 03/04 --. - , � v �•.W� 1�,.s�iry�r� NTON BL.L1 Dr-T PAGE 02/02 _ Propr�rkyAddress: �?3 Pow M ". �pre.�C,e— Name, � , 146me jarm 12� Warne: Address: )3jV I6ge TJr. City, State: Phone: L l3 - 5F Y-75 � � ;k— Property Owner Name; ( GOfan 6�Lv ) hr) Address: r�3 I)oWd 7 -- City, stag: Fore-nce MA 10(�ra (, k kn �il'`S i _-_(contractor) a0--st and al'firm that the building 1 intend to insulate dons not have arty open air(knob and tube)wiring in the spaces to b�insuiated and that I have provided the prop"owner with a copy of this affidavit. Contractor signature Gate Is . ' . � | . � . � ! | ' / � ! i � | | | ! ! | ! | | i . | | | ' | | ! � ' i | / . | / | . | / °7#1%�":tta .)L C'�f "}lt€?t G '3fa:'Pt, at< Boar Of)SW, mij st,tna 15 JOHN DEll.lERSKt tixc�rr�:arf r 7`2 DUNPHY DRIVE FLORENCE MA Ola62' i ;X'IW<'itr Qrl 07i2112019 Office r"rf'ConsumcRr Affairs and BL/ IIIC S 8011111-1 titft)rl 10 Park Ilk - Suite 5 170 Boston, N-lassachusetts 02116 f lame Im ro,,e n1;4'.1It C`ontrac;too Reg i trat n Peet lstration 105543 Type Private Cor�;orabon 7!17,112016 TrAf N' `>i EVEN SILVERMAN P.O. Box 6062 FLORENCE, MA 01062 1 ltd ate ialalres".aaeci retaaraY c-tr+'1_ Mark re:a,on for Offi e of( sere-iaaa3Yer 1af'air t3kE 1aaf5 itrM4alr#ti sat ii:ense or r9'gktration valid [lr't' ris�6b It�4#1 is3r cr Y11' . before the expir<dgm d-ve. if found return to'E IMPROVEMENT f NT A T ' Registrabora: 1,045 543 fype: Office oft"f,rYSeiarrar Affaai€g areal 13aa.irte�; Re;;aalation x itatla ra, i(`"s ;fa Pr,v ,,: :tir�ar.a.: 11) Parh Pkiy<a-Naha 5("ti -on.NIA 021 If, ",Y I- MA tint:c;�E g xaal.a .max-r fit;re" aaf taYtroaf st ft hc'i eYt s�iY;ttztturr�� � ^ � ' ^ | | ' | . i | i i | | ' | | ! i | / ! ! | | | i | / ! . | | ! / | | | / i � | Department ofIndustrial Accidents xe a��b"i u� p 600 VVauhingeon Street R_ Rcvtorr, 1VA 02111 < u....a...�� �...,..,,�.�•'d.�.���,r�;,_L �,�,..��:���C __I: !��cti��.. �LIZ�� t,.�;i C���c�L /`�i LC�c-��� AuTaUcant Inform,%tton Please Print Legibly Name (Business/Organization/Individual): Address: ull > City/State/Zip: Qf ',(IC'. 0 h one Are you an employer?Check the appropriate box: Type of project(required): 1. I afilT a et,�ployer with l 4. 1 am a general contractor and 1 have hired the sub-contractors 6. ❑ New construction employees(full and/or part-time). ❑ listed on the attached sheet. 7. ❑ Remodeling 2. I am a sole proprietor or partner- ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' 9 � Building addition comp. [1_�To workers' cor-p. insurance p ` I—s requtreu.] 3• Vv e are a corporation and Its ( i 0_C ia�s cage as aL r aca c i aeeiara,v,2a g all work officers have exercised their 11.[:] Plumbing repairs or additions I am a homeowner doin Myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] ; P. 152, §1(4),and we have no employees. [No workers' 13.X Other u�e� en comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. + ,^ Insurance Company Name: � l' rG` � '1` ),� J" L7, rJ L' Policy#or Self-ins. Lic.#: ( J )050` - ' Expiration Date: L Job Site Address: City/State/dip: �1o�2tice, M14 O(o(o� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of Lip to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify r the pains and penaltie 'perjury that the information provided above is true and correct Signature Q /� /4" / fs'^�' Date: Phone# 1 Official use only. Do not write in this area, to be completed by city or town official I Issuing-Authority (circle one): i€ I. Board or Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector E 6. Otlter is � . � | � | | | | � . / | ' | ! � | . ! | / | i ' | i i ' � / | i ' ! i / � i / | a-Z S{"`'#''= �GE3411 v.L`.C' _•,,.«,-.•� t�iw*.�i ,G Yws � 8.1 Licensed Construction Supervisor: Not Appl=.cabie G t �Name of License Holder E-Xpwafion Date r a ic{r to Telephone S.RecjisteMd Home?mgrovement Contractor. Not Applicable 0 a r tMm art a Registration Number Add-s- _ �-Xniztlon ante �11�-S�tl�75�z SECTION tti- t R.KER 'COMP N A Tta tsl INSURANCE AFFIDAVIT{M,G.L_c. 152,§25C(6)) Workers Compensation Insurance affidavit Must be w,#mpleted and submitted with this application.Failure to provide this,affdavrt will result in the den€al of the issuance of the building permit. Signed Affidavit Attached Yes...,... No C! 11. - Home Owner Exemption The current$xeruption fifr"tatatncowners`kv vs e{tcnded t„iaclud Ow nor-aatctiyietl#7 r c?ttitrrrs t f`ur,c t? c r ttaxt'r(a1 f°arniii s and to allov.,such h(3S'r#'0.il$+'7'icr tO an indi9u t,#ual ft}S s'ire who dues not"1.w-,. .`ss a licen,,e,provided that the 11'YY'ner acts, �.4srat�r�%isa��•_C'�t£�'?;'�4? tats ttx�t,r_:ra '�cciasr. ttt�t3.�.4. efinition of 110tr3#:*a;yr nor:?#er,,'.,o#5}`; w i�W11`r�,.Irc el of kxnd,or,wfiiuh ...:d.es or .fa:;nds(o t'f.si lc on iMiich `_�7cre r,x,or is 1n-u:x3ifi,'tt t+,a i5s:._,.;carte{ar tti4'{)tw Tr! d$. °elfin ,„.1"tai.°bcd oi'c..,t b.i€c `2trw1 t1:d C.5'!cc{:iS{e ,.t`#s"4z h u,`",Y;4nd its" —_3.,au%::;,,9 gerson whri constructs is more th.t,tr aria=la#ante in.a,t o-vtaar ivriod.0teat?not be coati-6derrtl a f o"Teowner a ea,p nsi ii f��.a?f swrh vs,aT k.lmzturrntd rartclrr t t #,atii?alirrt� cr aTrit. As cu:wn Cnustru t,ion$fiuj!t--.mi4t3['ycwr prt._':'sctu;t on the Job site 40i he? fr,e#tY,f 4'.dl frknn t.it"Y€c:8a.r taint?,durtt�!°-,uliu'ui'orl C#f?ha t�irat's t"YL, c1xa4 Y:v%4i 1.filit 4L'kti2 ir"'t t::t'M1.`II4'4:tt€ fi,.p''£z'„r I;l::{tit i':aY':'s t,8;a l„�i .�.r,.`..4c.;i1J a$11Sa t 'pt Cr i"'_ $L' c.....I .,',§f,S$Siz l£?)Lk'ea ik:': mfii;=,I?c,_l. for ivi,s,°ies n ?(.,°:!}.}a#=Irr in f.taltha tal 011 i` iiEis_rdm:';'t$4(.aG."ttt,.., 1.,,,:v;.Annot',:'. yint Xnay he liar j� t"au hire to?aerfthirn %,�o'i:I0r ou under this pt: alit. 'Tf.€c un€.crsi,2ned zeeoiraa:t}v,n u:r-Qu'rtilw-,avtct:Y"x^+$412�R..`x i t .czi?._YIf`'.ali tl €t Y tiuti:ft;j?aiz"ir7:4d„ L;id-LIB..S4.ut`te B,,ilklfinL, _nd t.,f.€c--d zot'4iY'„? "AiNs 3'Iaf ``r.it:t.'of i_lvvs AY$I5t7lauxi. i Haiarrco"nerSignature SECTION S.DESCRIPTION OF PROPOSEP1 ���Yale) New House Addition �Replacement Windows 1 At4` teration�s) ���n 0 Or Doom Accessory Bldg- Demolition New Signs tOl Necks [ED Siding[01 Otter _ Qtr U15U QjC ►C�rta?e�ti U1 Cabo c3 i-I�51: rttr� Brief Description of Pro c ed t York: Alteration of existing bedroom_—Yes, No Adding new bedroom �_-Yes �_. N,o Attached Narrative Renovating unfinished basement �__ _.Yes —Flo l Plans Attached Toll -Sheet sd if New hrtu a antJ or addition to existin housing.complete the foiibvLn � a Use of building : One Family Two Fancily Other W... b- Number of rooms in each fancily unit._-- Number of Bathrooms-- c Is there a garage attached? x � d Proposed Square footage of new construction � Orntenslons e Number of stories? f Method of heating? Fireplaces or+.Ric odstoves � Number of each g. Energy Conservation Compliance__ M asscheck Energy Compliance farm attached? h. Tyfae of construction i Is coast uc;t€tan within, 100 ft of wetlands? Yes No is construction within 100 yr floodpla n 'yes �No Depth of basement or cellar floor below finished grade m k Will building conform to the Building and Zoning regulations? __Yes No 1 I. Septic Tank_ City Sewer Private well City water supply E i SECTION -OWNER AUTHORIZATION TO BE COMPLETED WHEN r OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the sublet#. faroTaerty ,_ r y autr3 r e Jebrn Dm( 5Kr i0cz.l1 pomp 1 t. 'st7 std matters reiats'4'=`e' se4r la,iLattaor b- th4 taCislCl'19 t=;,32s,«application 3 t0 acl oil my e as_, _. E att � z•3 $ee �orTE �a Signature cif Owner bate John arrleoki 1i f Nome veger as Owner Authca zed _. 1{;�ent hereby declare that the, rv7r _. stsd rnforrnalfw, snit the fore'go�r S a-PP` RtF�;::rl pare fCu �.^;C gccu si#`.,:'.?.�':l�ae best'..7"f rn§`�t}r-,+#c.:;�.d �a and bel€ef Sianed un tfr the,)ams of -. ., a -:S Of Perjury • ! P-in!. 4r'{Ie. r /C- Wle lax rsa €st trrar €t Section 4. ZONING All l(1fC)M1,dtT0n MA."St be CUMNeT(•e PerTwt Can Ea-Deri'n-d'pue To tricomplete ilifoMlat 100 Lot Silc Frontavc Svihacks I ront Side L: Rear 1691- Bldg,Squarr I oolage O'X'n Space[-'ofq'1gt: Cold a& A. Has a Special Permit/Variancel FUdInveever been issued for/on the site? NO 0 DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON-r KNOW 0 YES 0 IF YES: enter Book Page and/or Docurnent# Nr-11 B. Does 1he site contain ab!uok, body ofwate.- ol -wetiands'' '40 K rZN7 If"Now 0 IF YES, has a permit been or need to be obtained from the Conservation Commission,' Needs to be obtained 0 Obtained 0 Date Issued. C. Dt-i 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 0 NO IF YES, describe size, type and location: E qt In _jr� Mon piar, e Cons4tu-ti--� �ci-��Pnng,gTadin atIr (jr fiftttJ3�over �)r IS tt Part of a c"Orri -.�j 1 -1 tivity dtsf1j trat will disturb over 1 acre-, YES NO IF YES, nen a Norlherrp',--,S'Orrrl walef Management pe'm'-t'�jm the DpV"v Teq4we�l 411tts `{•. I �1 Stt�`!)Lr•gPLtX �� sC:, DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street -:Municipal Building Northampton MA 01060 U S HSBRLO AOUCK BUILDING P RMIT FEES Phone: (413)587-1240 BUILDING COMMISSIONER Effective My 21,2008 Fax: (413)587-1272 DEMOLITION $ 20.00 ACCESSORY jSTRUCTURE $ 35.00 PRINCIPAL BOILDING—Residential $200.00 PRINCIPAL BUILDING-Commercial *NEW CONSTRUCTION $ .50 per square food for 1s0 floor .30 " " " " 2nd floor .20 ` 1A floors,attic,basement,garage STRUCTURAL ALTERATIONS IN ALL USE GROUPS $6.00 per thousand dolifars of estimated cost or fraction thereof, with a minimum fee of$55.00 $25.00 WOODBURNINO STOVE *NEW ACCESSORY STRUCTURES one hundred twenty(12 )square feet and over $ .20 per square foot wi'ha minimum fee of$25.00 *NEW ACCESSORY STRUCTURES under one hundred twenty(120)square feet $25.00 per inspection *SWIMMING POOLS $30.00 for above ground $60.00 for in-ground *SIGNS&AWNINGS $30.00 *DECKS $50.00 i REPLACEMENT WINDOWS $35.00 SIDING&ROOFING Residential $35.00 per structure Commercial $55.00 min.per structure OR$6/K of estimated cost TENTS $25.00 *ZONING REQUEST FORMS $15.00 (includes home o0cupation registration) REISSUE OF LOST PERMIT $25.00 CERTIFICATE OF ANNUAL INSP. $100.00 (minimum) Temporary Certificate of Occupancy $25.00 PERMITS REQUIRING ONLY 1(1)INSPECTION WILL BE A MINI UM OF$25.00;ALL OTHERS WILL HAVE A$50.00 MINIMUM. PERMIT FEES SHALL BE PAID TO T E ORDER OF THE City of Northampton AND SUBMITTED,WITH THE COMPLETED PERMIT APPLICATION,TO THE OFFICE OF THE BUILDING INSPECTOR. WORK STARTED WITHOUT PERMIT IS SUBJECT TO DOUBLE NORMAL FEE. !! NO CASH -CHECKS OR MONEY ORDERS ONLY!! *Filing deadline is 12:00 pm(noon)on Wednesday. Department use only _, _-6ity of Northampton Status of Permit �r.� : ull ing Department Curb CWDriveway Pzermlt =' 21 Main Street Sewer/SepticAGailability oom 100 Water/Well Availability R K r rA%Ao ha pton, MA 01060 Two Sets of Structural Plans phone 4 7- 240 Fax 413-587-1272 PIot/SiCe Plans r 3 .._ Other Specify X 4 `# c e. VRPtICATION 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 3 powe 1� Map Lot Unit Ftcx-once) �-V\ C.(C of Zone Overlay District Elm St.District CB District SECTION 2'-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: C aoI t-pug h1i n a3 paoct 1 fe" t�� bt©t�a- Name(Print C rren Mailing Addre - 6i 7-x'77 -3911 Telephone Signature 2.2 Authorized Agent: Join 1Jern r lVallal udneIm aveft�'if 3110 Riv ,-.0e Dr• 1=or�ncP Name(Print) Current Mailing Address: Aov�-' L113--�Bq-- Sig ure Telephone SECTION 3:m ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building D� (a)Building Permit Fee 2. Electrical <J (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) ,3 s C7z-- Check Number This Section For Official Use Only Building Permit Number. Date Issued: Signature: Building Commissionerlinspector of Buildings Date | � / | . ! i | / ' | ! ' | | | | / . ' ' / ' ' File# BP-2016-0788 APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC ADDRESS/PHONE P O BOX 60627 FLORENCE01062(413) 584-7522 PROPERTY LOCATION 23 POWELL ST MAP 17A PARCEL 203 001 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 ypeof Construction: INSTALL EXT WALL INSULATION New Construction Non Structural interior renovations Addition to Existing- Accessory Structure Building Plans Included: Owner/Statement or License 108772 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: roved 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 Sign 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. i I I i 23 POWELL ST BP-2016-0788 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-203 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: 1NSULATION BUILDING PERMIT Permit# BP-2016-0788 Project# JS-2016-001330 Est.Cost: $3800.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 108772 Lot Size(sq. ft.): 18251.64 Owner: O'LOUGHLIN CAOLAN Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC AT. 23 POWELL ST Applicant Address: Phone: Insurance: P O BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON.1211512015 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL EXT WALL INSULATION 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 12/15/2015 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner