17A-158 (14) 53 FOX FARMS RD BP-2017-1185
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A- 158 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2017-1185
Project# JS-2017-002004
Est. Cost:$12000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Grotto: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(so. ft.): 28793.16 Owner: RONDEAU PATRICK D&KRISTA S
Zoning: URA(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 53 FOX FARMS RD
Applicant Address: Phone: Insurance:
P O BOX 60627 (4131584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:4/21/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE 18 SQ FT OF ASPHALT ROOFING ON
BACK OF HOUSE
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 ft 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 4/21/2017 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northampton Status of Permit:
n�4
1 Building Department Curb Cut/Driveway Permit
�1r 212 Main Street Sewer/Septic Availability
.' �. ''+ Room 100 Water/Well Availability .._.
Northampton. MA 01060 Two Sets of Structural Flans_„
' phone 413-587.12 0 Fax 413-587-1272 PlotSitePlans
Other Specify
\Iv-4PPUtCATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1•SITE INFORMATION bit 17 • 6-
1.1PraoerteAddress: This section to be completed by offms.. ..
S Thc1 -�1v-1 flop t 74 Lot l7? % Unit
Zone Overlay District
c'im St DIsnlct CCS District
SECTION 2•PROPERTY OWbIERSHIP(AUTHORIZED AGENT
2.�1 Owner of�R� ecordp: ���
Tu -CAI5L Q?n- cau.L- � m (2d +Cc>AQxxc mG (01
Name(Print) / Current Mailing Address:
A yt? ,12-1 - 534 C.
// 't i Telephone
Signet e
2.2 Authorised Avant: } �j
l V)1 11. "i!
T
. -o -8,Clc (DO<O3Q / fcwncr. Ma t (slot
t) Current Mailing address:
— — 4//3- S8 y- 7527—
.
Signature Telephone
F,cc7c, 7cr:ee r<rChLFT2t.iC11 1 cosT.S I
item Estimated Cost(Dollars)to be. Official Use Cray
completed by permit applicant
1. Building J (a)Building Permit Fee
, Electrical I !b)Estimated Total Cost or F
i Construction from(5)
.
- I re
ling meii Fes
_v
9, Mechanical (HVAC)
5.Fire Protection // 11
E. Sot;(1 +2e-3+4 5) LO
r 'O Check Number ;/ {,,/ 117� /f}
I Mir Section For°Morral Use Orin! `��
i Date
i - a --- i Issued:
47—a d;/'(
L .a uamn2.Coral issione1 ns 5stcr of 3uildinos Date
Section 4. ZONING Ait information N:ust 0e Compteted.Permit Can Be Denied Din To Incomptete Information
Existing Proposed Required by Zoning
ibis can=to be flied in by
Building Depamnmt
Lot Size . ..
Frontaee
Setbacks Front
Side L:- _.. R.. L R: .
•
Res'
Building Height
Bldg. SquareFootage
Open Space Footage I
(Lot area minus bldg&paved 1
parltiri l
4 of Parking Spaces
Fill:
(vdnme&Location)
A. Has a Special Permit/Variance/Finding ev been issued�for/on the site?
No 0 DONT KNWW Q YES �..1 _ _
IF YES, date Issued:
IF YES: Was the permit recorded at th Registry of Deeds?
.)
....5 ,Fy
v,
tF S enter POOk Paxe vdThr Document
B. Does the site contain a brook,opoy of water orwettands? NO 0 DONT KNOW 0 YES Q
IF YES, h:s a permit been 1-need fa b:obtained from the Conservation Commissirn:
.k-eeds to be Crbtxjned 'rhtxFned f✓ , Darn Ecc"ed:
C. Do any sins exist on t . property? YES (3 NO 0
IF YES, describe sty-, type and Location:
D. vr.^th re any nit rh_n ee [ at`[`.7 f e :run YE /Th._ Yo. 0
._. __..__: ste
., , ..ti... e_- , type and tac'ra9:
ctst ainii a over acre? YES CD NO�l(�.J
CS YES,then a Northampton Stoma Water Man_oemant Penna from the DPW is reo.uired.
SECTION 5-DESCRIPTION OF PROPOSED WORK/check all aooQicabte)
New House 7 Addition ❑ Replacement Windows Alteration(s) ❑ Ma
Or Doors ❑
Accessory Bldg. n Demolition ❑ New Signs [D] Decks (D Siding(01 Other[q]
Brief Description of Propose /7, r
Work: ! live_ lb (�f �51I �CtIJ�� fM, �JfrGk tftk
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative _ Renovating unfinished basement _,,,_,_Yes ___No
Plans Attached Roti -Sheet
. . _ ._. - _ _.. .
Se.1f New hoose and or add€then to etzsstinct h *sheet rvm.Set the foflen tne:
a. Use of building:One Family__ Two Family Other
b, Number of rooms in each tamity unit: Number of BathroomsY,
c. fs 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 cnnstmcdon
i. Is construction within 100 ft of wetlands? Yes Mo. is construction within 100 yr. floodplain Yes No -
j. Depth of basement or cellar floor belowfinished°rade
lc mill building conform to the Building and Zoning regulations? Yes No.
I L semi. TanaCity Set/Jar Pataie ve`efl ri,ii ar,,NOc., ty
SECTION Pa•COMER AUTH tZkTION•TO BE COMPLETED WHEN 1
OWNERS AGENT ON CONTRACTOR APPLIES FOR BUILDING PERMIT
�lw
o op ert
I '
I en .-a t II: tat, �ii. 0 u..`it •
to Schad,in m t e to work auth• Ned by this building permit application
2--m.
Signature of Owner Date
i I d .� is S r1CI� asOum r/Auficr2ed
Preen1 _c, _that thentersivems - > e
( Signed r r the pains and bati@ies of parjurv.
( fire• • v •f• LA / —.._. _.
. /f/l 4' 7 _.
SECTION 0-CONSTRUCTION SERVICES
8.1 Licensed Construction Suoerrisor: Not Applicable 0
Name of License Holder:_Sk'-tifffiliettich „Lir \droner r-1--1 an 9.
License Number
2k-a vku CAt-13 \d 1
Addre s
Eapiratlon Date
:III l )7 �Yr �1J' 7 J.
Signa ire Telephone
9,Reaiste€ed Home tmnrotement Contractor: Not Applicable ❑
10 Stt\infra t^ /05593
Company Nam Registration Number
_9.0 . ye)Ox -406cal9171/
Address Expiration Date
1
f _icien(c yo,o`(✓ ;"es Telephones ' Ie);
• SECTION 10-WORKERS COR EEFISATION INSURANCE AFFIDAVIT(M.G.L.c.162,§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 % No...... U •
E.ri'Rothe Ow er Itzetantihri
The our ent emprion far"horsetdriners" _e ude Chthergicentyled . .!hr of one tit or reihrtil families
and to ati.. . _ ch..3rit.n, _ __ individual ..,_ e mho does not porrss a licefire,ritrawittealter e owner xraq
as Sunere ca ChIR?8@ tib Eitlifirm Se-as ettliffithig
P2effmicb n of Homeowner;Person(a)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 berms who porta mets more than one nonce its a Mrs-sear nar Lod she/rot be cormtfieryd a homeowner.
Such"homeowner"shall submit to the Building Official,on a foam acceptable to the Biding Official. r}agt he/she shall be
,cG. . ebbee tha gets*,Per. } —ar4 Eitritr wilib
As acting a.onstntctton Serengeti your presence on the job site will be required from rime o rime, during and upon
completion of the taork for which this permit is issued.
Also be advised that with referenceto Chapter.t52(Workers'Compensation) and Chapter 153(Liability ofEmolayersto
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you me be liable for persou(s)
you hire to perform work for you under this permit
The undersigned'homeowner'certifies and assumes responsibility for compliance math the Stare Build ng Code,City of
Northampton Ordinances,State end Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeric
City of Northampton 212 Math Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of NGL 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: 53 .Fpsc
rrrl .
\
The debris will be transported by: i Qlltpp incera f W A�
The debris will be received by: Vo 1�eedacis
Building permitpumber: 0
Name of Permit Applicant C J 16(y1 p iThel�rdOrk-ne'11
Oats 51_cc,nai_irar',rPermitApplicant
Boston, MA 02111
ti. iw.:->,?-"rs'S. filmisrtd
Workers' Compensatoo Mr:manse A' rlav6t: Theatl rstaniractor5/ lectsi aana/Pismbers
ApDHcant Informstion Please Print Legibly
—r,_
Name (pusisesar'Oc„am afiumnad;vcua t v w.„ ..r-eN1,0VV_ Bi M;'],'ler14- . din
Address: �,} rsttre,Cottkc (\ '
�^n Din2-
City/State&Zip: _'Y i 7f£'a'1,C.t ic . O Phone# " S5'.:n'A-1cS 2.
Are you an emmioyer? Check the appropriate box: Type of project(required):
am a employer ger with 9 0 4. 0 1 am a general contractor and I
4= s 36. C New construction
employees(fall and/orpart-time).' have tired the sub-contractors
2,❑ I en a sole proprietor orpartn - listed on the a'zached s`eet. 7. 0 Re o -I +4
ship and have no employees These sub-contractors have o. C Demolition
working forme in any capacity. employees and have workers'
Tag c"'- 9. 0 Building addition
conce-
[No workers' comp.insurance We ar inszvaporat
required.] 5. 0 We area corporation and is 10.❑ Electrical repairs or additions
3 d 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 MGL 12.0 Roof repairs
insurance required.] c. 152, §1(4), and we have no
employees. [No workers' 73.0 Other
comp.insurance required.]
"-Any applicant that checks box Rl must also rill out the section below showing their workers'compensation policy information.
t Homemvners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
`:Contractors that cheek this box must attached an additional sheet showing the name of the sub-cont actors and state utehmr or not those entities have
employees, lithe subcontractors have employees,they must provide their workers'comp.policy=tee.
'r_stS ry vu gone ro i:, . _ 9 w.ron''",f "Vda ere up_. . ,...-;:yr;5 t+�
Insurance y Name: ';u" 11 c l C=;. K da L t (C:k. ✓ l f 1+I qq }.
Boling or Self-ins. Lit. r^i� J _1.._a- � acomate O! / l .1 G(5
Job Site /€frit' Q Z
Address:, cCJ� ��Cl !'rVt M1^� 1:ity/State./Zine 10(U
*;::c`2 n neny the werB,271B _„ Y 73:SeOn•702,By iBeela, _ .hkv,L__ th n'Oe4 runner anile ton rate).
1iLre � . ,.,r.,i.,. under __� F., t;, c. 152 can lead tothe imposition.,... tai �l .,s of a
fine up to $1,530.00_ Co '_eyew lanprisontnnin,vs well ee e? 3 t3.1ins in the .. .m of a f TOP ih rO VO D -d .a C... .
of up to 5250.00 a day against the violator. Be advised that a copy .this statement may be forwarded to the Office of
lawetheaDonz tithe DIA for innurance cover« e
e ro hs e"ten16,e. ._7,V2'2,5 .niece,- e 0 ,icon 1>'aZise kinrneraioniwov'ded above is true cod correct
r - tone. [1I
.c. _._ _ — ».M _-
- ._,
•
t art at eu Kuno 4 anJ 'ras
L.:e:sse- CS-077279•
_e =. Sure/J
STEVEN A SILVERMAN
259 FOMER ROAD - .zgee-m '"'1; ".
SOUTHAMPTON MA 01073: —7 --
Expiration:
Commi sioner 061212018
r,f.7<'Ci' � , ii 71( f). 'ft
Office ofCons mer affairs and BL;;ine ., F station
ID Par: Plaza Suite 5170
Boston, Massachusetts 03115
Home Improvement Contractor Registration
pew;recti 105543
Type: Private Corporation
Ex.iration: 7E1712018 Tte. 41:221
VALLEY BOMB !MPRs/_ +ENT •\1r
Box- 60627
OP= ;' 0178? _.
F a^o r i,t C rd
._. ,. r In:IP ideplase nnlc
--._ c3E.ii. Type. Ceipp11
doe
I.Leet.-et. Nx.i t7ilti
/ t