35-270 (17) 27B WEST FARMS RD BP-2017-1497
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:35 -270 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit# BP-2017-1497
Project# JS-2017-002493
Est.Cost:$9000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft): Owner: Nancy Bak
Zoning: Applicant: VALLEY HOME IMPROVEMENT INC
AT: 27B WEST FARMS RD
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:6/23/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE VINYL FLOORING AND CARPETING
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: OI: 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 6/23/2017 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
o:=p_ r, r<-,ee only
.1 1 City of Northampton (Status of Pnnl.`:
Building Department ;Curb Cur/DrivewayPermit
212 Main Street Sewer/Septic Availability
Room 100 IWaterNJen Availability _
Northampton, MA 01080 Two:Sets.of Structural Plans -
phote 413-537-1243 Fay,413-587-1272 PIOJSite Piens
I APPLICATION TO CONSTRUCT,ALTER,ReP'AIR,RENOVATE OR DEMOLISH A ONE OR TWO PALMY SMELLING
rSECTION 1•UTE 1NFORI�tiTIOP1 �,9- t7-ctio7
- Is section to be corn l_ted h office.._.
1.1 P`oa_tvAda+_ . _ _. . ____. _._ /': p`/•� y
a? t5 Wes} ctza'm {' od Map 36 Lot ol70 Ur t
N o.'ea.c-c
Zone._..._ Overlay District
__ Ebm St.rattrict .^.'E bt_+hlet I
Iy SECTI3ii 2.PROPERTY OFhfJESSRIP/AUTHORIZED AGM'
$.5 Owner of Recor4:
\.1 1 ._,, 71V-. 2l$W& c ins(ca\ `-thiert_c_ O1.A \Ob2
Norse( run ConantMailing°ddr-_s
4132- 588- (0-137
4skTelephone
jiant“Signature Z2 Auhorzed Acent: - -
i ,` - Ilk Lte V u.. a = /Yr./ e o £zckeoctai FtcYerux°- N.A
l V
Nan' erica) .' ���7 rnl NilingAddr3ss: — ._...
� � lH/ !111!1 � kl 584 `1t3a
'LSlgntm_ Teteottann
i sit r tU se I _rripial Use Only
! ciAmmeeaci by pe,m lit canlicant t
1. Einilding
d,(�3-6 - (a)Building Pea
a c hi¢i I -. I p a r, --
DCO I Con Itotioir Bi -
I Irl nT r._o 'ff
_- --.._ ral,r.
4, Mechanical(f'+lA }
SFire Protection
o, Tom! (t : 3Td=5) Vi Check Number '304'7.2 I C/3"
) 'TIs Pnotinn FOC'Ca-Slcial Use,Gnla 1
at
de
rove „
�I fcEnOrL 4. oNu G All;n o matim MU.17. Comp(et .Permit Can Se Denied Do.To lnomp_mss ls'"or,-ctinn
Existing Proposed 1 Rcqued by toning
- This not=robe n➢:d in'by
EuiiSgD-rye ent
Lot Sizc
Frontage
Setback; Frau.
Side L _: R. - L Pa..__
•
Rear
Budding Height ^A— ---.--
Bldg.Square Fooiag , _ /
I /Y
Open Sparc rootage _
( cu ro ..
(Lma�enublc;@vs-d
1
f rafPa' d ng -naeeb. ..
(vols GLo¢rcnl
A. Has a Special Fermst/Variance/Finding ever been Ns -d for/on the site?
ND Q DONT KNOW 0
IH VES, date issued:
IF YES'. Was the p „F.recorded at the?egistry ci reeds?
Y.
B. Does the site contain a brook, body of wate• or.wettands? NO 0 DONT KNOW 0 YES 0
YES.. _:uf" .7bnined from the Conservanan Com, iasfyin?
n -5 `_ d is p.;stefGCOeA.
C. Do any signs e dst bn the property YES 0 ND 0
IF YES, describe size, type a,.. Location: -
ry&FE _tL InPC r trk pct - -H 1 -
_. i desti 1.0CC±or9
_ _-.iv p ..,Swim tiictriter I4_I_oerne r C,ii the r•DIA Listiccitit_
{ .E h C 3-3ESCRIPTiON OF F. C O$E6 ihORK r. .. dl ego itttSi t
,New House AddPlnn r— 1 Replacement Windouws ,Atere5on(_) — Roofing E
Or Doors ❑
Rucea€gry Bldy. J 6em•,lidon New Signs (fl — Decks i'D Siding(pJ OfErsr7 iso. •NJb
grief Description of Proposed I
Alteration of existingbedroom es No A Lngunfinished b � �!(�,�Ily . ND o )x) '.+� 70 �RJ i(
d(a m Yes` ' No X00 `STPT K1Tk i Coif ,n z
Attached Narr=gve Rnov=' basement �Ye No
_ _ _._
Piano Aftached Roll aheo,
S.Cr P.ew house and or addreoc to sois.6rc houshrsh cure t;Eo`tto the btOntinkoll
a. Use of budging:One FamilyTwo Family_ Other
/
b. Number of roams in %oh family unit.. ___ number of Bathreems_
a is there a garage attached?
d. Proposed Square footage of new construction_ Diman :ons
e. Nummb%r of stories?
f. Method of heating? .. P regia• -fir Woodstoves _, Number of path—__
g. Energy Conservation Compliance. i sscheck Energy Compliance fttrn attached?_
h. Type of%nemczon_
L - Is construction within IODR. otwetands? YeS Mo_ Is construction within floe yr. iloodpl=_in: Yes __No -
7. Depth of basement Or natio floor below finished grade_—
R Willbuilding 00] arm io the'Studding and Zoning r gul lo. ? .,,_. :'es... _..Pin
t
u a=CM:MGR ALETHC RLFT R=TO.SE COMPa_ETE?S ::p=_3 7
OWNE«,S AGENT OR CONTRACTOR APPLES FOR&U6t OIHs P!F!.rt'l t (
i
I Hereby t oa _ S1.Llcl`ConlA.i. {1-
ito oottea my t„hal` it all matte=naive to work suthred by this building permit application.
ii _ 6'16 t0 _.
signature of Owner - f D&Se
t—St1 _L .Y1
fill__._ / // ' 647
$cC71Lsln S S.CONSTRUCTION UERF`t'•CE`a. ._..—�
LI Licensed Cen ttturron Supervisor: I Not.Applicable 0 y�
Nam=_naLicense Potter t Skc:,:_rn fit V'(WirrdLr tai )A
,(") \L/ License Number
L,`f'„ i G l s'r':= hi p^!t ';i rt.'11 e ("_1 ICS. CAL. i 0 4 G-1 \ !C?.
Addrem / t Epratien Cats
.11 I f',(/� i &A y14 CH,2frk41d='^
Signature Telephone
9Bedste'ad Home tmbrovemen Cant-nctx. Not:.aplrcebls 0
I
r
Cpmoanv News Registration Number
.Address -._.- Kept-anon Date _
... i"jeic'.P�,',r'e _ b}Ir UiII) I Nit Telephone"l&IL\-�();3- + H
?2CTION 16-WORKERS'COMPENSATION PfuSUmnANCE AFFSDAYSY KCl.c,952,9'25C(6)) <
Workers Compensation Insurance affidavit must be completed and whetted with this application, Failure to ie amide-this affidavit will result I
L
in the denial of the issuance of the building permit —
ISigned Amdsvit Attached Yes Na....., U
11. - f Uffie Owner itifremIS't,a.€En
IS=ek5_v r r
li 'l„t:.mn ao tTorahawwet Person(a)who own ammo!of land on which h /-he resides or intends to side, on which there
is,or is intended to he,a one or two family dwelling,attached or detached stuctures accessory to such use and/or iamb-
structures A nerves whe caustrwris mere limp erre home in a nainverg Alas Mt 11¢.tthe e .¢ rrd a tOirasrvi.m.
Stash`e _Alinatt it il s alpilaus: .n a:..epunt to the 3L dir C0AAPsylatut be The _. FSa
_c Paton Demi Penerepea year LA-cense on the job cite wig be required lionany SO Sillt](rn
o. reon af the work for h1:i Astuatt
`-'so be advised taM with reference to Chanter 152(Workers'Co._npewation) sad Chapter 15 (L:, ,illy of Entloyers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,von Man he N hiefor persou(s)
you hire to perform work for yea under ibis permit.
The wadereimed'homer mer"certifies and assumes respoosihuryh for compliance with the Sime Buil`g pods,City of
NoriMampton Ca Emmen_Stars twg Looz s Tags mil Ram orWassail-mews bncral 1 Assa amemestst,
City of Northampton 71P Main Street, Nonha;ton, ."1\1.A. 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54; I acknowledge teat as
a condition of the building permit all debris resulting fromthe construction
--- activity governed byt-iiis Buildingrermitshall be disposed ofina properly.___
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: a—, ', s C6
The debris w ll be transported by: \Ir t i + (1)
The debris will be reoeived by! \to, ,, ,/
Building permit.rwmber.
Name of Permit Appiicanr rAfiy2cyi74--
Add
or; _ _:.n
-i , `;ro,
300000,N,A 02111
a o-2c.s&gov/iiia
Workers' r'"C},,..De'..35ttde Tt Tinderedece 's :I av1 v.ddee:../CCsn'uen3a ' r' a r�2fio1 ambeirs
Atunrocamt Trfor 7atio'i ?tease PrInt Le u_v
sC;ergareaddazandduad.. du,ll+r arhi 'ciP+}tiC. 'i1.`1G!'i= r 3,k-1C_..
City/State/Zip:_. Y \Q cf(t c`i Clfyhone0: LA—
.tae ®n oe e �1®y ex' Check the zpoprcrr TMlz¢e Qoos T ¢mf tcoyF<cd(nseganfivea➢):
1. aim e. ,.Ioye with °. ® I a I ar and!
Iil Y✓y (Pall dadpr e I hided t s.l. ou actors
� G. F New construction
2 e prr ro, -oS .n the attathed eat. 7 I d
ship d have roemployees
These ub con lac.or have 8. 0li„m itr-don.
owl for ty. employees and have workers' 0 LI Biding adli ou
[Po workers comp. su - e comp. ¢ ura c
requindl 5. 0 We a corpoiation d ft 7 10.0 Electrical repairs or additions
3,0 T homterxrder doing all work officers have exercised their 11.0 PlOrnbir,2.ep adds ior;s I
myself. [No workers' comp. right of exemption per MOL III 1
*_ t. 110 Roofre_is
insurance reddi e d.]; c. L2, F:t".),and we have no
ex'aployees. [No workers' 131 Other
camp.cisur]mee required.)
*Fay applicant that civets'Dot d1 madd ales fill we the sectien below showing their wm±rers'cadvmxsation inlicy in;bnnafica
t 3omeiumers who nbmll tide sifiidnvitindicadng An are fl work and Then hire ontide contractors must delimit a new aMdavir indicating such
-Conn'etodd that dealt tai box must meth d a addidoral Sbeet sheddiue nave of the shb-codshrters and stale whether or nuttat-7Se al-,cos have
employees if the subcontractors have employees,they must provide their wonder-s'comp.policy number.
_ Qrz . ra_r Thai.]., n ,uz, leer, .. erre _ _
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_ c%icy r . C,X> r c ! s -a ca Date: a I i 12..0 16
.—.
ss: _, A(' 6 JAW lawn f --I-- P'(c v 1a- OiO I0Ze
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.ni S« .rilec. 1.tfl C_;_lead t the 14oe .1d-1 -_a,,_a
circ up to y. :O.3.59 addlor`'n_ yea. ._1'c - n- well as civil iin the, _C ORnER drd4n_
of up to 5250.00 a day agraist the violator. &advised that a copy of This statement may be forwarded to the Office of
Inver d, cf theL r Marts: age g . xzuif ..
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Boson, Massachusetts 02116
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