29-297 (7) 120 BROOKSIDE CIR BP-2017-0865
GIS d: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-297 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-0865
Project# JS-2017-001463
Est. Cost:$3000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 108772
Lot Size(sq. ft.): 14287.68 Owner: ANDREWS BEVERLY R&RANDY K&RICHARD A&KENNETH D&
KELLY V& SUSAN B DOYLE
Zoiinng: Applicant: VALLEY HOME IMPROVEMENT INC
AT: 120 BROOKSIDE CIR
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ONa/18/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:AIR SEAL ATTIC/BASEMENT AREAS, INSTALL 2
GABLE VENTS, INSULATE SILL, INSULATE ATTIC 14" CELLULOSE TO BRING TO R49
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 Si 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 Occu.anc Si nature:
FeeType: Date Paid: Amount:
Building 1/18/2017 0:00:00 565.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2017-0865
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 120 BROOKSIDE CIR
MAP 29 PARCEL 297 001 ZONE„
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 1
Building Permit Filled out V
Fee Paid
Teo
vofConstruction: AIR SEAL ATTIC/BASEMENT AREAS, INSTALL 2 GABLE VENTS, INSULATE SILL,
INSULATE ATTIC 14" CELLULOSE TO BRING TO R49
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Build Plans Included:
Choner?Statement or License 108772
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
j Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Han
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
gem ition Delay
F 7g- /
tu '
Signare of BuildiOfficial 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 of Northampton mat*of Peri-nit:
Building Department curb Cut/Onveway Permit
212 Main Street Sewer/Septic Availability
' JAN ( � 201i Room 100 WaterM ell Avaiianriny
Northampton, MA 01060 Two Sets of St-neural Plans
L_ phdne 413-587-1240 Fax 413-587-1272 Plot/Sire Plans
.—� 0th r;SPedfy,wF .
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property
t This section to be completed by office
lab rs tete- Cir(;k Map Lot Unit_.........
F iore kel f‘'IPt C UD(‘-t Lone Overlay District
Elm St.District cB District
SECTION 2.PROPERTY OWNERSHIP/AUTHOR[ZED'AGENT
g.1 Owner Of Record:
&venin Andrew . lac Srcaks rle C rcir %(orerxc MR
Name Current Address-
(
— �YV/)1 lr,uicc_ Telephone
Sign u
2.2 Authorized Agent:
ti ,,. e- . * s T 11 Riverside- fir. is Fmk twt �7
. Current Mailing Address:
Name(PrG r
7d-rieic4,(4. Or.Kl ezA " 9/3 -5fl-75a -
9Igrature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
t_ Building (a)Building Penni(Fee
2. Electrical (b)Estimated Total Cost of
Constriction from(6)
3 Plumbing Building Permit Fee
4. Mechanical(HVAC)
5, Fire Protection C ,./ .
S. Total=(I +2+3+4+5) --1,30CCe. 60 Check Number -'
This Section For Official Use Only
Building Permit Number Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Cagy of sNor'.t7tunpton
(✓A iittssartrusetts / • ,
1 •,�+ricy
! DEPARTMENT OF BUILDING INSPECTIONS
212 Mao) Street a Municpai Bo3I31ng r_;'?n
Northampton, MA 01060
I.Ouls HA5ea9uCK BUILDING PERMIT FEES Phone: (413)587-1240
BUILDING COMMISSIONER Effective July 21,2008 Fox (413)507-1272
DEMOLITION $ 20.00 ACCESSORY STRUCTURE
$ 35.00 PRINCIPAL BUILDING-Residential
$200.00 PRINCIPAL BUILDING-Commercial
"NEW CONSTRUCTION $ .50 per square foot for V'floor
.30 " " " 2"a floor
.20 " " " 'A floors,attic,basement,garage
STBVCTURAL ALTERATIONS IN ALL USE GROUPS
$6.00 per thousand dollars of estimated cost attraction thereof,
with a minimum fee of$55.00
$25.00 WOODBURNING STOVE
`NEW ACCESSORY STRUCTURES one hundred twenty(120)square feet and over
$ 20 per square foot with a 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 ft AWNINGS $30.00
*DECKS $50.00
REPLACEMENT WINDOWS $35.00
SIDING 8 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 occupation registration)
REISSUE OF LOST PERMIT $25.00
CERTIFICATE OF ANNUAL INSP. $10000 (minimum)
Temporary Certificate of Occupancy $25.00
PERMITS REQUIRING ONLY 1 (1)INSPECTION WILL BE A MINIMUM OF$25.00;ALL OTHERS WILL
HAVE A$50.00 MINIMUM. PERMIT FEES SHALL SE PAID TO THE 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.
I! NO CASH •CHECKS OR MONEY ORDERS ONLY !I
•Filing deadline Is 12:00 pm(noon)on Wednesday.
Section 4. ZONING Altatterma:mrt tette Bemoteaa r.r Cab!:e.x 1 e. , „ .
,,, „ar�n.
East _ Pepper.] I Ihy,vL / ,
i jfth .. i f
Ilot Soc.
I ronbou
C.tt'mke tont
ISale I R: I I. It:
j Dice ,
` 'lullding tic ht I
I ,
ttldy Square Isestage
bed' _
I
i_ lark e Seco,.
1
A. Has a Special Permit/Vanance/Findon ever been issued for/on the site?
NO Q DONT KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW Q YES Q
IF YES: enter Book Page and/or Document n
b. Does At':& site (clean : o ao ..xhod, of water o' r to 5.,. N6 baN, t.J4ES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Qr . Date Issued.
C. Do any s,gns exist on Ore property' YES Q NO X
IF YES. describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO
IF YES. dcscriot,size, tape and iodation_ia YYYX���'
Val'theon sce attbastcostarbt ;^e ng Tata be; va[on. or'Meg; rye• ' ;toe et s 'pee,eta _„z.
leap tell*seam over cE YES NO �
L'. YES a',tanner-atter :Pore Weler Mabagteser I t pool AFAK'. .i . t .. .._.
SECTION 5-DESCRIPTION OF PROPOSED WORK (check all applicable)
New House 7 I Addition n Replacement Windows l Alteration(s) I I Roofing I '
Or Doors Cl _ ,/ J
Accessory Bldg ' Demolition El New Signs ID] Decks IC] Sidng Dl Other i j I
_ __ _. - �d�__...el..lS
pIr seal �1 >tient arxt_, instal a hie Yerrb,
Brief Desatp w Pf Proyosed `�
Work IncJAeSill, /nvditte_a i.. _ / -, by WA
Alteration at existing bedroom______Yes X No Adding new bedroom Yes >< N
Attached Nanat ve Renovating unfinished basement Yes 1.7% No
Plans Attached Roll Sheet
Ca.If New house and or addition to existing housing, complete the following
a Use of building One Family Two Family _Other
b Number of rooms in each family unit Number of Bathrooms
c Is here a garage aitecnedn
d Proposed Square footage of new construction Dimensions
e
Number of stones"
f Method of heaaoo> Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance _ Masschetk Energy Compliance tone attached'
h Type of construction
Is construction within 100 ft of webands"1 Yes No. Is construction within 100 yr floodplain Yes No
Depth of basement or cellar floor below finished grade
k. Will buiiding conform to the Budding and Zoning regulations? Yes No
I Septic Tank City Sewer Private well City water Supply
SECTION ]a -OWNER AUTHORIZATION-TO SE COMPLETED WHEN d
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I__ reut)ii _ _ ___-_____ as Owner of the suhect
Prolherty
her by a thorlde _ 7.ik, iT.f fills Denier-ski
d n
to act onmybenal! all! atleis re atve to w rK but opzed bys bu di ion
Signature of Owner 1 J Date --
k1"Y(.� _miniveXYIe 1 1 John bell'teas I as Owner/Authorized
�'_
Agent he oec3i that s aiemen s and mt nal un on the Corea,;ng apP ,afw'c ate true a-d accurate to he best at my.rtowleoge
and belief
Sig ec rmarrt+he pe .-natt hh penury
Join Daner,?Ki
] ] /5-117Sufi Jw -As i a e
ECT,..,.C CCUS,...,C.,C..SERVICES
I 8.1 Licensed Construction Supervisor: No:Asp¢able ❑
--r, : -
Name of License Holder Jhaj (y ! (
917 ` --
Ibe s Number
I Ia Dun{oh� C olola 2 I 7/2/j/�
Adda.S ` i OctI /:r - I Expuabon Date
II i_ -. G.-- 'ai3 5r ti- 75aa
s�a ierethone
9.Registered Home Improvement Contractor: Not Applicable ❑
t W t... J-4
o mc— io6%43
Com san a•.e Reglsranon Number
P.D . c (60(0)- fO(erce HC oJC/2- •7/17 Pig(
Addres �� ENplaObp Date
!'dE'" = 7elephnneliS�ti'�5�� 1
SECTION 10-WORHERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152,§25C(6)) I
Workers Compensation Insurance amda It must be completed and submitted with this application Failure to provide tis afdava will result
inthe denial of The issuance of the building permit _
LSgned Affidavit Attached Yes 1
11. - Home Owner Exemption
7hc ou rem exemption tie-homeowners-was es did.. include Owner-occupied Dwelt!nns of one II klr uni 2) lamui es
and a,ald.S such homeowner L cneage an indit idual for hire who does not pip.sess a'teens,: provided that the owner arts
a, upen icor.CMR 7S0. Ni-.h Editan Section 108.}.-4_
Definition at HHaneowner Pcn.on{H,..ho cAr,a,..tcei ot kmd on utiro i s,e rctue t .. . c!, on‘‘ii,,,,,-,ehc -
.._orp.-.niendcd .:,Pc. r tte m two.fit 1 i,t:..CYachcd t b det.bm t tt..0.n<c n.
-__is.A pen on who Cr,n,^.rarb mere!han one home in a two-year period hill not hee id rn.! + homeowner.
<< ...- .., , mitt. :-crc:1.3..t ., e. .+r,I s rat. bab bnIbbe nail_im_
resonsibIefor all soeh workperfrrrmed under the buildin_permit_
As acud(:'instruction supervisor your presence fin'Inc Is,site %, ii kn qurp !run lit -IL coria ip.
urs
lteb the'vm r'i, for whim:J<permil is Issueu.
lc.d:utt sv(tr stats 15.1 N nr b_ (umpumudNon, annChapt -u ub
Imam dar;c's zlet n rtD m!. t Me bLissbcbusb L.Gosbn0 Lau 3v ..._ may br avle6- _. >.
".0 i:ire to -orm rror.for)pu under tis pera:k.
Tbe . n., L:er .esa !.btu:c:-. espn.! r _ lural phuccssiLh We S :e U. ..;ine Code l ,
Orli ...._ _--:1,11 :LH l csg I ss's pl,I. •I,..!,.,/,,! \1ar c ..>v s(.knee I nnnutc(co
Homeowner Signature
etz t t,n.won i£'Naui o L - LIVSwiu:vL“NC:ZE.:
.... Department of had,ust€ia?Accidenes
nr<_.. � ;;.e,.�__.-
Ss Hca i . r,.tg.,e ddu4
— - 600 vs'nshanglon Cgreet
c tera. MA 0111
w^ww.rnass gev/titin
-.::: uzz:ic , La..un_., )fid .,. ufIda..,/c_ act, r ,J ecc_caa .t_rsers
Anes€icuct Information Pkase Print Le ¢b€v
Name(Business!Organizaziontlndividuat): `.Sit MCC\ YV:.NCIV .1ly1.06CKfl'slef4-` . skri(--
) C
Address: 31-00 �k'f,yI i\e \\�,"c-(
City/State/Zip: 't- \, )fef,Ce- 1phosfe#-`: 4!3-:..c:u%k4-2]CO2Z
Are you an employer?Check the appropriate box: Type of project(required):
1,r I am a employe.with 1 e 4. ❑ I am a general contractor and I
employees(full anJorpart-time).* have hired the sub-contractors 6. ❑New construction
2_❑ I am a sole proprietor or partner-
These
on the attached shoot. 7. 0 Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees cud have workers' 9 9 Building
addition
[No workers' a;mp.insurance - comp.insurance,-
--air
_ required.] 5. El We are a corporation arca its i r 1v.0 �,o,.1.a.a..�i,�as.,�.-1«:.file,,"„
3.id/ I am a homeowner doing all work officers have exercised their I in Plumbing repairs or additions
myself. [No workers' comp. rightofexemption per MGL 12 ❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no t
employees. [No workers' 13 Other _i-DSL�I,,, 1� -.
comp-insurance required.)
'Any applicant chat checks box al must also fill our the section below showing their workers'compensation policy information,
, r 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 subcontractors and state whether or not those entities have
employees. fare 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: ii'7°-\. 'lam lI.' n nc2 C(td/P
e
Policy#or Sclf=ins. Lie. b: CC'.>C3"30502, VS---
Expiration Date: Oh i i 7
fob Site Add'css: IaC) 5f z4SiCie (i rciL City/State/Zip: Foflu1ce M4 016e,;,...
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 WORD ORDER and a fine
of up 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 uierification.
I do hereby certify Ai .the pains a 'd penalties%,l perjury that the information provided above is true and correct.
1/4/ Alf r Ls„f
`5immtme: I ff,P2 i /�U'-PCtad.�^' Date: /75-47
Phone k: t'l,-J-'sStl-1`3 �a
Official use only. Do not write in this area, to be completed by city or town official
P�: -ry m-'. r.:-,'-_—, :Pe?'=cdn_�eexi,se#I
Issuing Authority (circle one):
1. Board of Heaith 2.Betiding Department 3.City/Town Cierk 4. Electrical Inspector 5. Plumbing inspector
I6. Other
t
Coe"i person: Phelan 4: ..m ��
•
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-108772
Construction Supervisor
JOHN DEMERSKI
72 DUNPHY DRIVE
, FLORENCE MA 01062 ,
••I
N-1— ,—, CA__ Expiration:
Commissioner 07:21/2019
r\ `✓ ��/ L^��y�iy�/dy � /G ��1_��V N.C�u�i(iYL'�.Lr .r/�'y
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 105543
Type: Private Corporation
Expiration: 7/17/2018 Tr# 419291
VALLEY HOME IMPROVEMENT INC.
STEVEN SILVERMAN
P.O. Box 60627 --
FLORENCE, MA 01062 --- --
Update Address and return card.Mark reason for change.
scar camas:, -_ Address r i Renewal 7Emp!oymert i—1 Lost Card
"-7,//,- �Ia,./7rb„hm2
License or registration valid for individual use only
Office of Consumer Affairs A:Business Regulation ag
:' HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
3 Registration: 105543 Type: Office of Consumer Affairs and Business Regulation
4 �Ay
Expiration:' 7/17/2018 Private Corporation ]O Park Plaza-Suite 5170
'YYY=^' Boston,MA 02116
VALLEY HOME IMPROVEMENT INC. / /
�/
STEVEN SILVERMAN f
a_ Phresi eDt J ,./t .. f� 1,11 :4 //e
Northampton,MA 01060 Undersecretary Not valid without s gnature ��