32A-143 (13) 40 MAIN ST-SUITE 106-EYE PHYS BP-2017-0785
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32A- 143 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-2017-0785
Project# JS-2017-001305
Est.Cost: $3500.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 106006
Lot Size(sq.ft.): Owner: EYE PHYSICIANS OF NORTHAMPTON
Zoning: CB Applicant: VALLEY HOME IMPROVEMENT INC
AT: 40 MAIN ST - SUITE 106 - EYE PHYS
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
F LO R E N C E MA 01062 ISSUED ON:12/14/2016 0:00:00
TO PERFORM THE FOLLOWING WORK ADD 30"X48" GLIDING RECEPTIONIST'S
WINDOW IN NON-BEARING WALL
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 $65.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Filer BP-2017-0785
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 40 MAIN ST- it 106-EYE PHYS
MAP 32A PARCEL 143 001 ZONE CB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT r,
Fee Paid 7( /'
Building Permit Filled out
Fee Paid
'yoga Construction: ADD 30"X48"GLIDING RECEPTIONIST'S WINDOW IN NON-BEARING WALL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 106006
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INVORMATION PRESENTED:
(f 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 Variances
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 Permit DPW Storm Water Management
Demolition Del , �' " r /j /y/" /�/
7f 7/ �4L
Signature of Bui .ing 0'ficial 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
City at Northampton Status of Permit:
/ Building Department Curb Cut/Driveway Permit_._,,,
212 Main Street Sewer/Septic Availability
Room 100 Water/Weil Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-5$7.1240 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
--- -- This section to be completed by office . . .
1,1 Property Address: f
14t0l a_Li"y s\' 'Y,t�C- \OQ, flap Lot Unit,
\ac enc C. mc"-- Zone Overlay District
EMI St Distdct CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
c • • sit 44 r. `AC) CV-yencc- Ma. . tob2
Current Marling Address: ”
3f1 4P —514-6y��
n a �
.�/ 1^ .�L(A Telephone
Signature
2.2 Authorized Agent
Ske -, �ILYE( — : a P 0 ,4's (nocoa ) Florence Me 91o62
Name(Print) j , /�/ Current Mailing Address:
✓ fiY �1 (413- S8'/ 7522
Signature Telephone
SFC.MiNkl;-ES-FI:`£A_eD 00Nl,STRIUCT rOlE COSTS .. .....
Item Estimated Cost(Dollars)to be OEdat Cme Only
completed by permit applicant
1. Building r rad (a)Building Permit Fee
2. Electrical 3 (b)Estimated Total Cost Of
( E Constriction from{e),., .._
Pe'YP:.Fee i
4. Mechanical(HVAC)
S.Fire Protection � �.[J/}
6, Total-n.(1 42+3+4+5) 3 Coo Check Numberd - 46
THIs Section For Oficial Use Omit,
Soildina Permit klurtber: II`cta
Signature:
auilsing Cummissaner/trspector at Hi.dldings Dale
Section 4. ZONING All Information Most Be Completed_Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to 14.611ed in by
Bu ldin%Dep t-demi
Lot Size
Frontage . .
Setbacks Front .. ..
Side L . R:. L R:
Rear _.
.
.. .
Building Height .
Bldg. Square Footage % ". . - . . . _ _
Open Space Footage °o ,—
(Iutareamieusbldg&paveA / .. — '.
emkieel
4 of Parking Spaces _�
Fill:
(volume&Locaoion) '
A. Has a Speciat Permit/Variance/Finding/nen been issued for/on the site?
NO 0 DONT KNOW 0 YES Q _
IF YES, date issued: %
IF YES: Was the permit recorded attithe Registry of Deeds?
.... i!:'. r. re
ti YES
PF YES: enter Book %� Page and/or Document#
B. Does the site contain a brok body of water or wetlands? NO 0 DON'T KNOW 0 YES 0
IF YES, has a permit b n or need to be obtained from the Conservadon Commission?
1.,50,4,c th i>®nhra r.,a n txb ;,ned fete nccs:e±:
\.....;
ev
C. Do any signs existthe property? YES 0 NO C)
IF YES, describe type and location
n" Aro Itecro D vnrop+ 3 4 a+b g 'my /1 v!O (I.\
v
lF YES, describe size, type and location: _.
r. prm toe coessaudeon doodad return romanno,gracing,�^^� stun,or angs over t sere o it DT _of ion plan
thatm disturb overI eras? YES 0 WO )
IF YES,then a F2orihamgton Stem Water 1'Jlanam.nt&t Perrino from the DPW is required.
7
SECTION 5-DESCRIPTION OF PROPOSED WORK(check ell aaoticable)
New House 0 Addition 0 Replacement Windows Alterationfs) ® i Roofing E
Or Doors
Accessory Bldg. El Demolition C New Signs [[D] Decks ED Siding(6] Other(CZ
Brief Description of Proposed .�
Work: Attu 'Jo°x'd_ /6Co Li 6.6� iRATC Si)S;urd1SL) id) n_QpW is !�NA) IV l V;Co L,_
iiint, .
Alteration of existing bedroom_ Yes T No Adding new bedroom Yes i-2< No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet -
6a.if.New house and or addition to ersit tino housieg, cep 6ete the frsi6rre4no:
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 hearing? Fireplaces or Woodstoves Number of each _
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. k constwction within 100 tt.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
1. Septic Tank City Sewer Private well SWwater Supply_
SECTPO;d Ta-OWNER A€TTKORtZATION.TO SE COSOPLETED Arte.4
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, F-v/�e t'C1t L, i .'F a ,\-crs ac Stinter el die tL'Net
pro erU,
I hereb authorize Vi e e( '" kills A.„ at Jac piirAwat r'`A�-'�
to aeon my behalf,in all matte t re tine to work euG orixed by this building permit application.
rotilh
Signature of a ler Date
_NtererigiTaBigketirectodiedria.krile-itaiflerWknonewprietkritingittentrii.a: ---
rebs UC'Xl et alfa"YY'CL1'l as Cramer/Authorized
Agent( Signed under the pains and penalties of perjury.
1
i Pent e �r- � rI� 1 J/I/
•
SECTION 8 r CONSTRUCTION SERVICES
SA Licensed Construction Supervisor: Not Applicable D
Name of License Hoiden: .AA.Ilk J1 AAC:
City of Northampton 212 Math Street, Northampton, MA 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 150k
Address of the work: 1-10 awl l ( ' 60-e ID(v
The debris will be transported by: \10111,1m Pkxrt,4 Thtp (1v21 YkJa� •
—
G
The debris will be received by: Wp� C lcie,11 ns
Building permitnumber:
•
Name of Permit Applicant � ". tL I r iY�Cti d —
Date Signature of Permit A,oplicant
600 v/tshTrolon. St'ee!
Boston,MA 02112
v:sSJ ass..govIdid
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (UusinessfOrganizaeT
cr dividual): va\ CU l '`'(w .1-4`,el y Uv ',1 tri-- . To _
Address: ?j'-t, his,:'2V' '\L'\C iii�_.
nitCity/State/Zig: Acic (t ci t eu: Lttj �l v 1`022
Are you an employer? Check the appropriate box: Type of project(required):
1.13 I am a employer with 1B 4. 0 1 am a general contractor and I 6 El New construction
employees(fall and/orpart-this)." have hired the sub-contractors —
listed on the attached sheet. 7. 0 Remodeling
2.❑ I am a sate proprietor or partner-
ship and have no employees These sur-contractors have g. 0 Demolition
working for me in any capacity, employees and have workers' 9. ❑building addition
[No workers' comp. insurance comp. insurance.]
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MOL 12.0 Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
sAny applicant that checks box d1 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 showingthe name of the sub.connactors and state whether or not those entities have
employees It the sat-contractors have employees,they must provide their wetters'comp.policy number.
tont.sti3_;.,pay .- p.e]rviding '_s'co*, r _-•3,al.7 5PMICF.197 my emfilny2er, BeJory is the policy end fob site
information.
Insurance Company Name: we le ]�l . < 1X1. x,'CR.,f +�'2 vy" .,'0 _..
---
PolicySelf-its. Lie.# ' ,:~ G Cy _ 'i i s _.
. �.t�r *or Lre - t`;�: 4. � Ex�rarcc Date: cx i :�M�y.�....,��
Soh Si 4 {A :ss_: NCL ]in,.. ......._City/State/7in: filo/en r- / 0/602—
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to saw, coverage as required under Section 2of MGT e. 152 can lead to the imposition of eria n l penalties of a
lne up t_ $1 5w n0_M,/c - ent as 4 l n]. ..v 1- na the fort] c n QT.nlP WORK K O Jr. ...__?___..
of no to S.250A0 a day against the violator, Be advised d that a copy of statement maybe fm worded-in the O tic of
Investigations..f±e DIA for i:suranee coverage ufervea,.at
IS her.rby r.ra,,,rr+%Aiztth p _s Ind? nitie,§ . seryury that the information provided above is true and correct
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Corsi o Suoer/ 1:4s p Y.A
STEVEN A SILVERMAN i ':£i
258 FOMER ROAD zip:s
SOUTHAMPTON MA 01073 ' "fr
(�..nn � Expiration'
Commissioner 06/21/2012
8
rI//f' IcCi//!N//Tll/'f Cllr l)i 't !(L111%C/1 t/i ( '.:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite :170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
_._. Registration: 105543
Type Private Corporation
Expiration'. 7117.2018 Tr8 419291
VALLEY HOME IMPROVEMENT INC.
STEVEN SII VERMAN
P.O. Bcx 60627
FLORENCE. MA 01052
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O1Lcr of roirilMitr1 aTr, BtasIlic kr2I114in L%erase or reeis:n:ion valid for with'i'unl use only
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Valley Home Improvement, Inc.
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\feel itvS • RLNOVAH(
Louis Hasbrouck
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
December 3, 2016
RE:permit application for 40 Main St, Florence; Eye Physicians of Northampton
I am requesting that you grant a modification to waive the requirement for control construction for the project
@#2 Conz Street, Unit#60 in Northampton because the work is of a minor nature,will not affect health,accessibility,
life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable
when compared to the cost of the proposed work.
Thank you for your consideration.
Respe fully Submitte
J
Ste l ;man
•,
Valley Home Improvement
340 Riverside Drive
PO 8OX 60627
Northampton, MA 01062