36-267 (5) 235 MAPLE RIDGE RD BP-2016-1042
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-267 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate,yory: ROOF BUILDING PERMIT
Permit# BP-2016-1042
Project# JS-2016-001766
Est. Cost: $3000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 060300
Lot Size(sq. ft.): 108900.00 Owner: GILSON STEPHEN M&LYNNE M SANER
Zoning: Applicant: VALLEY HOME IMPROVEMENT INC
AT. 235 MAPLE RIDGE RD
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.2/25/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
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 2/25/2016 0:00:00 $65.00
212 Main Street,Phone(413):587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
` ZL A09
City of Northampton status of Permit: apartment use only
Building Department Curb Cut/Driveway Permit
REC I 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability.
Northampton, MA 01060 Two Sets of Structural Plans
FB 2 5 2016 ho a 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
OF BUfLDINC iIV P
kOR7HAM (g T01 CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property dress:
This section to be completed by office
A�d,/ Q�
S t C U Map Lot Unit
2C Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Luarb,C, gem r &e nh-eo l-so� a.,o(t 140ke FC l��encr ory6
Name(Print) Current Mailinb Address:
Telephone
Signature
2.2 Authorized Agent: jJc�son
\� A� �00(oal 1Rarencc 1--(L ok ob?-
Name(Print Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (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=0 +2+3+4+5) lCheck Number
This Section For qfficial Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [Q Siding[p] Other[d]
Brief Description of Proposed // 7
Work:
Alteration of existing bedroom Yes No Adding ne bedroom Yes N
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.If New house and or addition to existing housing, domplete 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?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? PeplacLes
f. Method of heating? E5 or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr, floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the 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, -mac -ft �- 6.i Lso' ,as Owner of the subject
property (� 1
herebyuthorizewe` n
to4actmy beh in all matters relative to work autho ed by this building permit application.
Signat of Owner Date
I, c,*tL�\ekA �e- 76,pcc:►xcncr ,�flC- as Owner/Authorized
Agent hereby declare that the statements an nformation on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Ne1�:)on �ti:• �e'��
Print Name
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete 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 ® DONT KNOW ® YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 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. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: \\__ (C� -1 Not Applicable ❑
Name of License Holder: �� WN�-T,LT 0(.0 0 3c
UJe� vvann,c License Number
P.o _ Quo b2 9122116
Address Expiration Date
Signature Telephone
9.Re Istere Hom rovement Contractor: Not Applicable ❑
a� 10 5s(t3
Company Nahe Registration Number
Qb .&*)(, (z)C� . !IF V )renct VAa 0K062 -111-11 )�p
Address Expiration Date
Telephone\Ak&-, 941Cp2Z
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(ti))
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
2 1SSC ''amt 5 v� T a5t�Safe;
("rGWr I kC3t>) 63per3;)F+r K
'-,cense. CSFA-060300
NELSON A SHIEFLETT
1114 Shelburn Falls
Conway 11'1 01341 .b
Exct
G rtTr i it n 09/2212016
0f'fice of Consumer Affairs and Business ReLula ion
10 Purl: Plaza - Suite 5170
Boston, Massachusetts husetts 021 1 E
1lorne Improvement Contractor for Re,,ist ation
Registration, 105543
Type: Private Corporation
Expiration 7117/2016 Tr# 254029
VALLEY HOME IMPROVEMENT INC,
STEVEN SILVERMAN
P,O, Box 60627
FLORENCE, MA 61062
1 lydate Address and return card. Marl:reason for change.
Address Renewal LMI)lo%ment Lost Card
is ni
OfficeofC"u[r^s4€mer Pf in.1 130i tet.tZrirtaiion Licenser reg only
fl4ME IMPROVEMENT CONTRACTOR before the expiration(late. If found return to:
�tfl Registration: 1n5543 Type: Office.of Consumer Affairs
and Business ltc u[atia�u
.Expiration: 7il7f2016 rate Corperat of 10 P ark I'lara-Suite 5171)
Boston, 41.E 02116
`GALLEY HOME WROVEME T, ;NC
STEVEN SILVERMA.N
t
340 Pavers Kier
fff
Northampton,MA 01060 1 nalersecreaar} Not valid w ithout signature
City of Northampton 212 Main Street, Northampton, Na 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 665 M L e- 4� /�
The debris will be transported by:
The debris will be received by: &tj dAO,
Building permit number:
Mame of Permit Applicant '
Qj
Date Signature of Permit Applicant