42-034 745 WESTHAMPTON RD BP-2017-0787
GIS#: COMMONWEALTH OF MASSACHUSETTS
Man:Block:42-034 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: KITCHEN RENO BUILDING PERMIT
Permit# BP-2017-0787
Project# JS-2017-001307
Est.Cost:$110.50
Fee:$110.50 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq.ft.): 123710.40 Owner: MOKRZECKY NANCY
Zoning: Applicant: VALLEY HOME IMPROVEMENT INC
AT: 745 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:12/14/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:CHANGE KITCHEN & BATH COUNTERTOPS &
FAUCETS, NO STRUCTUAL CHANGES, NO EXTERIOR CHANGE
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 12/14/2016 0:00:00 $110.50
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0787
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 745 WESTHAMPTON RD
MAP 42 PARCEL 034 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATIO CKLIST
ENCLOSED\ REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid \\O
Building Permit Filled out
Fee PaidZ.
Tvpeof Construction: CHANGE KITCHEN&BAT COU RTOPS&FAUCETS,NO STRUCTUAL
CHANGES.NO EXTERIOR CHANGE
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
IN_yORMATION PRESENTED:
V 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
Dem itio Delay
/
c, /a -N- ao/e
Signature of ad' gO ial _Z.
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.
Department use only
i• ' \\> City of Northampton (Status of Permit:
Building Department Curb Cut/Driveway Permit
�p z 212 Main Street Sewer/Septic Availability
Room 100 WaterNyell Availability
/ Northampton, MA 01060 Two Sets of Structural Plans
\�\ is ' phone 413-587-1240 Fax 413-587-1272 Piot/Site Plans
�<
Other Specify
PPLICATEON 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
'iyS t{ e yLf+C./) IGLC-vGl Map Lot Unit
Zone Overlay District
Bin)St District CS oiscict
I
SECTION 2•PROPERTY OWNERSHIP/AUTHOR/ZED AGENT
a 4 2.9 Owner of Record:
1` 1CCL1 �5 gMS1(jesThoys-pfa-n Fio'C✓/L - a(K. 610be-
Name(Prnt) ..J ( //�� Current Mailing Address:
✓�% ;A (,/-' M/3 S8b- 1373
p •.a /✓.?CL Telephone
Signature O
2.2 Authorized Agent:n
het €fl CDA
`7AUP vfrct r-. - Po- ( fl fl Florence (Yla oiot
Name(Print)kr Current Mailing Address:
4113- SgY -7522
Signature N d/ Telephone
i SECIlOti!2-EtTE@;,ATEO CCIPSTRUCTCOF COSTS
Item Estimated Cost(Dollars)TO be Official Use Only
completed by permit applicant
1. BuildingI r cub (a)Building Permit Fee
I
2 Electrical 1 ('� i (b)Estimated Total Cost of 1 1
d 1 Construction from(6) I
I Eui!'ircr
Permit 17-== I
�-
. Plue 1 )6U0
—
4. Mechanical ('r'wAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Cr) SCh Check Number 31 ,A yr 1/7g. SC
This Faction For
Off!cisl Use Crni{I
I
6uildin7 Permit Number Date
sued:
Signature:
Building Commissioner/Inspector of Buildings Bete
Section 4. ZONING All Intonnaddon Must Be Completed. Permit Cen Be Denied Due To Incomplete information
Existing Proposed Required by Zoning
This column to be tilled it by
Building Depamnrnt
Lot Size
Frontage
Setbacks ,Front j
Side L:_, R .. L: R: . �
Rear
Building Height
Bldg. Square Footage / / -
(Lo Space Footage
(Lot aces minus hidgfipaved I _
parkin)
#of Parking Spaces `
Fill: -.
(velum&Location) —__. ... . _ _...
A. Has a Special Permit/Variance/Finding ever ba-n issued for/on the site?
NO 0 DONT KNOW 0 YES 0 _
IF YES, date issued:
iF YES: Was the permit recorded at the R-•istry of Deeds?
iF YES: enter Book Paso and/ar Document #
B. Does the site contain a brook, bom, of water or.wetlands? NO Q DONT KNOW Q YES Q
9F YES, has a permit been c-need to be obtained from the Conservat on Commission?
Hee&to be obtained r; } ehtrinec t^'1 , t:fre tcetiadd:
`r �J _
C. Do any signs exist on th- property? YES Q NO Q
IF YES, describe si r, type and location:
D- AO"tnnin# any nm O v 4 ., .ec«ne dditinns of!Mins ingan:} for tire togas:Mr? v'ES l' NO /'1,
IF YES, deo se size,type and iodation: ..
ale 1 c tion a i s turo'c�in gre na, n . r ) acre or pen of=_COMMON plan
that knit ors ro ^`�.over' acre? YES l J { O �j
IF
YES. ien a Northampton Storm\Neter igancriement Pennk from the DPW is required.
SECTION 5-DESCR{PTEDN OF PROPOSED WORK check all appficablel
New House ❑ Addition ❑ Replacement Windows Afteration(s) ® Roofing C
Or Doors 0
Accessory Bldg. ❑ J Demolition ❑ New Signs In) Decks (O Siding ICI Other(❑i
Brief Description of Proposed,GtiAaq e �F ( N k BMti celkn+pn nos & 4vcrts. No S'>uctvi 7I alba ol y2,P1
Alteration cf existing bedroom Yes ?es No Adding new bedroom Yes No �i? i2)? C-1A-Wp
Attached Narrative unfinished basement Yes }C No
_.._
Plans Attached Roll -
de.6f New house and or addition to ealsetno housing, conyPete the faE6ocw2ttei:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
ce Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
r
e. Number of stories?
E Method of heating? Fireplaces or W oodstoves 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 i_Yes_, No
I. Depth of basement or cellar floor Sow finished grade
k. Will building conform to the Building and Zoning regulations? —,_Yea No.
I. Septic Tank City newer Prlia e well Clip;water spay
SECTION Pa-OWNER AUTROPEZATION-TO BE COMPLETED WHEk
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUPLDING PERMIT ILII
property 4� • _. e .\ . —._ ....
hereby authorize \ �R,y'"YLAi C��^A�
to�aacctt on my behalf,in all
matte? ative to work eutho" d by this building permit.^application.
4.7.2. ,y. � rC"..y,N/to.. /vi
Si nature of Own ® Date
'":^ --.�'.C`T-Divim'"" Y--- =^y,
Cn
t9tCVC,n Ssty YyL_CiAn as Oitner Autnoriced
Apent hereby dertrtre thatfinal eo .,yon tire=ridi
7 7
Signed under the pains and penai&es of perjury,
Past ir �� ./ /7/C/h
SECTION 8•CONSTRUCTION SERVICES
$.1 Licensed Construction`Supervisor: Not Applicable 0
Name of License Holder: 5k--eNN.rin E'fi1\k:crfiCtr'l _ 1 er
License Number
2_03 CGrt1P; r c$ ' l _, :A- 0 ,t 13 (0, \ 1 L
Addre . ' Expiration Date
/ e
‘"k CGDP`y ` coat
Si•iature Telephone
$,Reoistered Home Inromvetpent Contractor: Not Applicable ❑
cx ‘�ParIR?Cln _ ID5Sy3
company Rams Registration Number
Address/ I\ Expiration Date
F4'L<a- e a ..... C�\b& Telephone 5Zl{.-1'')eJ
SECTION 16-WORKERS'COMPENSATION INSURANCE AFFfDAVIT M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit wk result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes gc No 0 ' .�..
11, Name Owner E'xern r.C[on
The urren by Hipps,.for ,e wrier&' _x d ncude rierti cob '.eifie _ .:oi2r,-..u16ca
:. CP74c v.- "' - le/
and to allow such homeowner to engage an individual for him who does not possess a license, t ur d that due owner acts
as saner vise ,CMI 783 Rirth 125ittee Seellau t68.3,5.1_
Delicacy,of Romeeowmer:Person(s)who own aparcel 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
strictures.A neesese who mistreats mere than one horn ins twee-Tmanme rod AO net be carciRigered e homeowner.
Such'homeowner"shall submit to the Building Official,on a form acceptable to the Building Official. Char Ne/she shall lig
fecciedodele ad U.uch watch toe icamec(math the eer.lo-=us Del-7a%.
As acting Conetructfon mgwetvtor your presence on the job site will be required from time to time,String,and upon
completion Pfthe work for which this nerrisitis iaue±
Also be advised that with reference to Chapter 152(Workers'Compensation) end Chapter 15.1(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,You metro be Noble for person(s)
you hire to perform wort:for you under this permit.
The undersigned"homeowner"cen,Vfies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,Stale and Local Zoning Laws and Srain of hMassachuseas General Laws Annotated.
Homeowner SVfs-czcme
City of Northampton 212 Main Street, Northampton, 1vA 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: 'HS ft S'harx1'icn �J-
The debris will be transported by: Vu.0,1# p(Yytp LiTyuo, tnen,-- •
The debris will be received by: \IQUL..t,
Vtc cJ,
Building permitpumber: •
•
Name of Permit Applicant u . r . .0- w
Date • Signature of Permit Applicant
500 3/nslaig DII .Sr;sty
Basta; MA 02111
www.rnass.gov/dirt
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual)_ V('(Ue. _j`n e tort fc.NYV 1/iC`n-f- U
Address: it11'J€V`o\CAC \� --
City/State/Zip: '1'\o/t'Y CtCA e #: 1- j 5-,'D%(--1 1522
Are you an employer?Check the appropriate box: Type of project(required):
1.a I am a employer with 1B 4. ❑ I am a general contractor and I
employees (full andlcr part-time).`
have hired the sub-contractors 6. ❑New construction
listed on the attached sheet. 7. 0 Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp.insurance comp.insurance.
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself l o workers' right of exemption per MGL l
Y comp. 12.0 Roof repairs
insurance required.]t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp.insurance required.]
*Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all wodc 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 workers'comp.policy number.
I wn m t . y.!Dy . Jle 1 _ d as v _ cozva 9E59110.__ .431➢sr,co;Mg'WAV ,Thy25. Below k the policy rad fob site
informati0n.
Insurance Company Name: YIN( 31-1.5,J.,U?J t{,-C G f2J.J
Policy
#or -self-ins. Lie. _ 1':l.J' -`ICY% ?`% rdratian Date: :7
Job Site Address: qtic City/State/Zip: f cycvicc OICO2—
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 e. 152 can lead to the imposition of c;a:rmal penalties of a
time up to Sl,58O OO-m-id/or e year imprisonment,as well civil t .a lti.a ir the .o,.. of 6 STIbP ..Onv nPnra -L _ e
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigationsthe ! for in .
of /D.A insult:ice coverage r.r._ a on.
I do hereby her*,ri+±tg.+h !vim n Ido lr�ef�p t e?m SA.n11Fe 6;•?errns"ion provided above is true and correct
1'1
; f7v Dae. 12-j( ): Cr
Si�a?ur,,. ,r[� /7 : / ;--., tie.
Prone`Y.: 1 l l.J ✓ 1 ��'�^"1
I! f"rcmmim PerinitiLlemaxe
II . __-]rig r'. it ;ky Aun CAC 'flat,:1.Board of Health 2.Building Department 3, Ci,ay,Tov,-n Clerk 4 Electrical inspector s, lhimminds, I
nectetch
co:i spm; one-{.
E,noan5 o E‘u,wry Reg ans SEandares
t.:cense CS-077279
STEVEN A SILVERMAN 16-33 i �,
268 FOMER ROAD ,z. ,, r ry
SOUTHAMPTON MA 01073 ,
M(stan Exwratien..
Commissoner 06/2112018
%1!L' (lit1NI'',itir tlf/t
'11.! == Office of Consumer Affairs and Business Resulation
10 Park Plaza - Suite 5170
Boston.Massachusetts 02116
Home Improvement Contractor Registration
Re_,ktraSen: 105543
Type Private Comoration
Expiration. 7117/20/8 Tr' : 3291
VALLEY HOME IMPROVEMENT INC.
STEVEN SILVERMAN _._ _...
P.O. Box 60627 _..
FLORENCE, PIA 01062
lost Car 0
°frierof z'omomen affair, BLI.tneq=linsntmnin License or rnEns:rnzinn tfilid fur is disldual use cob
•11 1123E IDEP.OVEalEST Rr9(straiior 0554. +` Type: Office of Consumer n m s rid Busmen' K gala bon
Expiration: 711.71201E 0,0sta CcrEornesnina ^
"n
Bosom. % 0_tlo
'c64rVC JA4D 'Th‘tC‘127N-1 L'`:^ r _.
if _--- el /
L r •
/
4 R,` d r''r fi lY I l I.- /! f a; rF /'f
#arn� nk JL,..