44-010 (4) 409 ROCKY HILL RD BP-2017-0140
GIS if: COMMONWEALTH OF MASSACHUSETTS
Map:Block:44-010 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERVIIT
Permit if BP-2017-0140
Project if JS-2017-000228
Est.Cost: $8900.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 106006
Lot Size(sq. ft.): 85377.60 Owner: JEWETT JOSEPH&KIRA
Zoning: Applicant: VALLEY HOME IMPROVEMENT INC
AT: 409 ROCKY HILL RD
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584-7522 Workers Compensation
F L O R E N C E M A 01062 ISSUED ON:8/7/2076 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE 2 SKYLIGHTS,INFILL 2
SKYLIGHTS,INSTALL 2 SUN TUNNELS
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 8/1/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
-- T
„REG ENED Department use only
C'y of Northampton Status of Permit
�y
� Wilding Department Curb Cut/Driveway Permit
NE - 12010 212 Main Street Sewer/Septic Availability_,,,_
Room 100 Water,Well Availability
Marr or atones wssccnoN Norktampton, MA 01060 Two Sets of Structural Plans
NORThAMproN.mamma
pliutte 413 t57.1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 •SITE INFORMATION
1.1 Property Add
ress(:)) �\ a This section to be completed by office
tjd_1 ck r4\3\\ c Map ._.., Lot Unit
t 1oeen.c 1 r O\ o t Zone Overlay District
Elm St District CS District __
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1,(Owner of Record: n
�clYek,,>-..73.X , 3euxQ- 401 K tori RA Botencc Ha OTt�t,z
Name n Current Mailing Ao :a...0 3,L�
e 7
V. ��.Ld3�a% /� Telephone
S,Matura I, I A
2.2 Autho .ed A en :
1 I \°exit- h /// y n .,be c lo0(cr7 foreruc pr t bbl
Name(Print ! Current Mailing Address:
iib• ' l 4/G1A---- ....... -�g4 - 7522
Signatu - Telephone
SECTION 3-ESTIfBATED CONSTRUCTION COSTRh
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 8 a1 0 0 (a)Building Permit Fee
2. Electrical (J ` lJ L/ (b)Estimated Total Cost of
I _I Cenntruodon from(6) I
`3. Plumbing I Bulging Per mit Fee 1
4. Mechanical(HVAC)
5.Fire Protection ..�^ Pie
.,�
6. Total=(1+2+3+4+5) site ! Check Number ,,3-7✓ � "--
This
-This Section For Official Use Only
������""""
Date
Building Permit Number • _ Issued:_,
Signature,...... .......:
Building CommissolonerArzspector of Buildings Data
Section 4. ZONING AU Information Must Be Completed. •ennit 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: It: L: R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
N of Parking Spaces '
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ev tr been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Reg stry of Deeds?
NO Q DONT KNOW G YES O
EF YES: enter Book Pace and/or Document#
B. Does the site contain a brook, body of wat:r or wetlands? NO Q DONT KNOW O YES O
IF YES, has a permit been or need to be •btained from the Conservation Commission?
Needs to be obtained ("l n tamed ('1 , Date Issued:
C. Do any signs exist on the property? YES O NO Q
IF YES, describe size, type and locatio :
D. Are there any proposed changes to or a. itions of signs intended for the property? YES 0 NO O
IF YES, describe size, type and Intl. :
E. vviii the construction activity al=um (cieanno gracing, excavation,or Piling)over 1 acre or is it part of a common plan
that will disturb over I acre? YES O NO (9
IF YES,then a Northampton Storm Water M nagement Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition ❑ Replacemert +�lindows Alteration(s) ❑ Roofing E
Or Doors -�1.
Accessory Bldg. E Demolition ❑ New Signs [0] Decks ED Siding[C] Other[QI
Brief Description of ProposedL
Work: 1�k<e 25Kl\ifie IfkiCI11 2.5V)4L41 T Skil 2 5w. �s -/ NO
Alteration of existing bedroom Yes No Adding new bedroom Yes Q Nq-� ���'"
Attached Narrative Renovating unfinished basement Yes SL No fifthr ,-
Plans Attached Roll -Sheet
ga.if New house and or addition to existing housing, complete the followKzc7ing: I0[
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?
f. Method of heating? Fireplaces 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^ Cty Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION•TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. 1K1V0.�a-e ja - ....
_ Oe, tithe e.ibie
I +
property L
hereby authorize VlA)1A11x `C6A1 (ll QRse.x-n J`74--
to act on my beh, f, in all matte lative to work authorize.by this building permit application.
%,of est' /NM(to
Signature( of o Date
I, -,i /-`\.ye 1/y}�0✓-) as Owner/Authorized
Agent hereby d_o_r_that the statements an information on the foregoing application_re true and accurate.to the beet of my knowledne
Signedr the pains and penalties of perjury.
Nrsin \Qe.)(YnO[.r. a/
Fent an,- ._ r; L Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: )1>✓V' (l S,\' ecru t'n (Thi-Ia -I
License Number pp
Address 1)11 Expirafion Date
Allfin LI gal ,
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable 0
,\.\.=_' tti /05593
Company Name Registration Number
— QQ . t3o>c 4o;1 7/1X/8
Address \ - Expiration Date
O enFc )1/41A G\I I�9& Telephone 5a VTh
,
4
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 Q. No 0
11. — Home Owner Exemption
The current exemption for'homeowners"was extended to include Owner-oecapied Dwellings ofune(I) or two(2)families
and to allow such homeowner to engage an individual for hoe who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Seton 198.3.5.1.
Definition of Romeowner: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-sear 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 at such work performed ender the buihunn permit.
As ming Constrnerion 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 mall 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
City of Northampton 212 Main Street, Nor h mpton, L& 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 ail 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: Lf b
The debris will be transported by: 1 I � ��� _ dA ,f
The debris will be received by: \.)( et) 24JrL A 9 ,
Building permit number:
•
Name of PermitAppiican" 1. , i _ . Sys , + A
7 IC ii/ith ;l bilk
Date Signature of Permit Applicant
Tho Cc1„»,3;1,./.e„1th ccJ Mlassael,psens
__ ;a„ifnent,flndrzstriadAcis nts
Office o1l, rear aliL,;s
600 Washington Street
= Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/OrganizationIndividual):�ookeL 'lent -A-An(e,(U 4ti"1e1 ' , In L
Address: ?j`\O Q\i1Ve .b'C\C Ji `-C
City/State/Zip: ' \ KN'&
Dfera( Drph one Y #: (-1, 3—ccSk-k-1S22..
Are you an employer? Check the appropriate box: Type of project(required):
1.11 I am a employer with 1B 4. ❑ I am a general contractor and I
employees(full and/or part-time).*
have hired the sub-contractors 6. ❑ New construction
listed on the attached sheet. 7. ❑ Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑Demolition
workingforme in anycapacity. employees and have workers'
P y. 9. ❑ Building addition
[No workers' comp. insurance comp. insuratrce.t
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their 11.❑Plumbing repairs or additions
3.❑ I am a homeowner doing all work
myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs
insurance required.]' c. 152,61(4),and we have no ❑
employees. [No workers' 13. Other
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.
:Contractors 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 winters'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. (� /n
Insurance Company Name: PP/SDC, A0. 7Ml1),(rn 'l6e (.1 (7CLJP
_ _ t
Policy'or Self-ins. Lie.#:� Lp%�'.'`DC:0U1\�C'G ;t _ Expiration Date: g4 : 1 i t i
lob Site Address: 4b'1 COG. Tn\\ `I -oo.O City/State/Zip:2VeriCt \&G O\ -.)Z
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 e f_=
of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Oxime of
Investigations of the DIA for insurance coverage-frificatiori.
i
I do hereby certify r the pains apd penaltiej perjury that the information provided above is true and correct
�'A
Signature:
fr.gift �CN+z ?fir ^' Date: 2.A �Av
Phone w: t\���-i v i t.lc3i.
11
Official use only. Do not write in this area, to be completed by city or town official II
.. City or Town: Permit/License#
ii
Issuing Authority(circle one): it
I.Board of Health 2.Building Department 3, City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspeclpr �f
I, 6. Other
iContact Person: Phone#: id
L CeNs,- CS-077279
Th^eff,.aft1 SSuc J SCI I y'jf
f-Ne
STEVEN A SILVERMAN
258 FOMER ROAD {
SOUTHAMPTON MA 01073
�.,.v. U..� Etpeatian.
Commissioner 06/21/2018
, /r (Jj/uirr iu��rrr/77 c� 7err , ,rr11/c;c
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, ,Massachusetts 02116
Home Improvement Contractor Registration
Registrator.'. 105543
Type Private Comoration
Exphetion: 7/17/2018 Tr. 419291
VALLEY HOME IMPROVEMENT INC.
STEVEN SILVERMAN
P.O. Box 60627
FLORENCE. MA 01062 _.. _.. .. . __-
NANs < 4J1 Elnaikil.aenz L it nro
Office of if Clf.cinR Ru,niNN R:mdannn License or rfistratinn 43lid for in di'ii ual uae only
HCME IMPROVEMENT CCNTRACTOR o‘tOitt t.it a,Pirvii Inc.it, 1:fou.f.1 rztUtto
tt R.I'straron �4? T'19e: 0tIe of on,.unftr 111 ft11”nrisk ?armn
E - -., If. P Ife _ _. tv
Boston.A1.1 J`l In
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STEVEN SLI R*. .N
490 .'/stJJ
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