17C-166 (9) 48 HIGH ST BP-2018-1284
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Mao.Block: 17C- 166 CITY OF NORTHAMPTON
Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category Deck BUILDING PERMIT
Penni(# BP-2016-1284
Project# JS-2018-002285
Est Cost:$18500.00
Fee:$129.50 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor: License:
Use Group, STEVEN SILVERMAN 77279
Lot Size(so.ftJ: 11804.76 Owner: OTT MILES
zoning:URB(f1001/ Applicant: STEVEN SILVERMAN
AT: 48 HIGH ST
Applicant Address: Phone: Insurance:
268 FOMER RD
SOUTHAMPTONMA01073 ISSUED ON:6/52018 0:00:00
TO PERFORM THE FOLLOWING WORK REPLACE DECKING AND RAILING ON FRONT
PORCH - NO CHANGE TO FOOTPRINT
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: OJi ; 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 6/5/2018 0:00:00 $129.50
212 Main Street,Phone(413)5874240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
File#BP-2018-1284
APPLICANT/CONTACT PERSON STEVEN SILVERMAN
ADDRESS/PHONE268FOMERRD SOUTHAMPTON
PROPERTY LOCATION 48 HIGH ST
MAP 17C PARCEL 166 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICAT IST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TypeofConstruction, REPLACE DECKING AND I ON FRONT PORCH-NO CHANGE TO
FOOTPRINT
New Construction
Non Structural interior renovations
Addition to Existing
Acccssory Structure
Building Plans Included:
Owner/Statement or License 77279
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQRMATION PRESENTED:
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
Dc olition Delay
.rR �®
Si of Buildr ciar Date
Now: 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.
City of Northampton status of Permit Department use only
RECEIartment Curb Cut/Driveway Permit
ain 'Street Sewer/Septic Availability
Om 00 Water/Well LAvailability�� 4 1pQ�a ton MA 01060 Two Sets of Structural Plans
-phone 413.587- 240 ax 413-587-1272 Pmusite Plans
Other Specify
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
48 �kyQh SA- Map_ C�, , Lot I&& Unit
Vi` fen e Zone Overlay District
1 Elm St.District CS District
SECTION 2.PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
� 1f4 + N �� O+1FhrhS4 �luience Cry oNo(o2
Neme(Print) Cu t4 gAd�1'�-ao3-3(oS6
Telephone
SignSignatu
2.2 Authorized Aaent: r
E
II er P•o 6owt0o(oa-) Ftuerxu: MA otof02
Name(Pnn[) Current Mailing Address:
413- 88�t-baa
Signature Ta@ph -
SECTloN 3-ES T MVIAT HD CONS:.^.UGSfON COSTS
Item Estimated Cast(Dollars)m be official Use Only
completed pby permit applicant
1. Building ) 0 5�� (a)Building Permit Fee
2. Electrical 1 (b)EsUmmad Te
e
l Costof
Construction from(6
3. Plumbing Building Pemtit Fee gyp/
4. Mechanmal(NVAC) I7—T5D
5.Fire Protection
S. Total-(1 +2+3+4+5) 1 J66 Check Number I
This Section For Oficial Use Only
este
Building Pa:mif Numb Issued:
Sigraw- : P
Buiidin ommissionerllnsGeaor or Bulldings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Erisdug Proposed Required by Zoning
itis.limn to be filled In by
Badr,DcPrrencot
Lot Size
Fronto e
Setbacks Runt
Side L: R: LR:
Rear
Building Height
Bldg. Square Footage %
Open Space FooL=ge IN
(Lot area minus bldg gPwed
m>vn)
#ofParki,gSpaces
File
(voiame as Loeaeon)
A. Has a Special Permit/Variance/Finding ev r been issued for/on the site?
NO Q DONT KNOW O YES Q
IF YES, date issued:
IF YES: Was the permit recorded at t Registry of Deeds?
ra0 LOi2-1,<NOv, ( , VES
IF Y-ES: enter cook Page and/or Document#
B. Does the site contain a brook, dy of water or wetlands? NO 0 DONT KNOW O YES O
,F YES, has a permit been r need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained Q , Data Issued:
C. Do any signs exist on t e property? YES Q NO Q
IF YES, describe si e, type and location:
D. Are there any or Deed chances to or additions of signs intended for the property? YES V NO O
IF inn, aesc be Slee, type ono Location:
that wAl di rb over 7i ane? YES y .NO}O
IF YES, an a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks- Siding[0] Other[Q]
Brief Description ct Pr.-,pcsgd p
work: KaY�A('k (IEC1C1(J � 2.AuNcON �'RrS� �O2rh1- UO Cd-�Ati�,e (D 9Rr�i-
Alteration of existing bedroom_Yes ?�- No Adding new bedroom Yes 'C No AID C ffAN,jE
Attached Narrative Renovating unfinished basement ,Yes No
Plans
Plans Attached Roll -Sheet N 0
So.if New house and or addition to existing housing. Complete the fallowing:
a. Use of building :One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
e. Is there a garage attached?
d. Proposed Square footage of new construction. /F7ir�ples
ions
e. Number of stories?
f. Method of heating? stoves Number of each
g. Energy Conservation Compliance. Compliance form attached?
h. Type of construction
i. Is construction within 100 ft, of wetlands? Yn within 100 yr. floodplain`Yes No
j. Depth of basement or cellar door below fin!shad grade
k. Will building con'orm to the Building and Zoning regulations? Yes No.
-ank :..hy C...._ =rives v.a:.,. 5-,pry
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETEDWHEN
OWNERS AGENT OR CONTRACTORAPPLIESFOR BUILDING
PERMIT
I,� V ` l� 00 : as Owner of the subject
property L,*1
hereby authorize V K
toactonmylachisf, all afters relative to work authorized by this building permit application.
Slgna of wne Data
�'✓"PY\ !aramiYfTKL� VN'Z . „i-oG_sd
a a,� I C
Aesnt hereby da 'ars"at the std emsnts and inforn,atlan on the forsccu':a sncllr^on a:-tide a�.rd accurst.tc the bast�`my knwfadca
Signed under the pains and penalties of perjury.
Pint Name
S,gra.,e of 9 merlr y.AOVPas
SECTION S-CONSTRUCTION SERVICES
6.1 Licensed Construction Supervise Not Applicable ❑
Name of License Holder
License Number
'� Pt' C a: �1 Q l Vd _ (Q —2,0
Address .,I^. /t EZPiration Date
Signature Telephone
9 R� hstered Rome Improv emant Contractor: Not Applicable El
Company
Nam Registration Number
— _�� ce, @P; .'7 9117 Zo
Address r Ezpiraiion Date
(O(f 2(� '/t ���t.Gs Telephoo.C: j `-1" Jai'
SECTION 10-UVORH'ERS' COMPENSATION INSURANCE AFFIDAVIT(ItA.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affdavilwill result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... Qk No...... ❑
11. - Home Owner Exemati ll
I _.___ � __ -.— � � •ivl r- :rer orae 1 -s s ,e Eiep. t", _ _ i_, _J!ce
a_d m adow such homeowner to enea� an individoel for hue v�.,k o does wt pos=gyres a Loeusa,R c mow[FS' a.± -e =nt
o CMR780, Sizth Edits S " n£08 3 5 d
Defdnttion of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which thele
is,or is intended to be,a about me family dwsUing,attached m detached structures accessory to such use and/or farm
structures.A person who constructs more than one he.-fir,a two- eer loei.d sh^II net he r ddev-d P he emvner.
Suchshall subnut W the Building Cff tial, on-ffe.acceptable to the Building Official rest be/she shah be
resoaas hle for of such wort:performed under the hutEdine nano/(
As acting Construction Supervise r your presence on the job site will be,equi,ed Som time w time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liablury of Employers to
Employees for injuries not resulting in Death)ofthe Massachusetts General Laws Ar omated,You may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton 0,dmances,State and Local Zoning Laws and State of MassaehUScM General La vs Annotated.
City of plorthampton 212 Again Street, Northampton, MA 01060
Solid Wasta 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 f2dlli_ty, as defined by MGL c 111, S 150A.
Address of the work: O Ct i GT 1 L3rt QP�'
The debris will be transported by: �n �OlnMQ c1Y�J�(Y1Q�l -
Tile debris will be received by: �Q�QIA 1 A,
Building permitnumber:
Name of Permit Applicantp 4ely Q%1�
Date Signature of Perrnh Applicant
,� The Commonwealth of Massachusetts
: Department oflndustrial Aceidents
,. .,, Office of Investigations
i 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information l \- Please
^Print LeOld
Name (Business/Organization/hidividual): �">�J e
Address: LVZVSdc (k\,(
City/State/Zip: T (Df-erY(e_ 0l Phone 4: 22
Are you an employer? Check ptithe appropriate box: Type of project(required):
L[N I am a employer with 19 4. ❑ I am a general contractor and I E ❑New construction
employees(full and/orpart-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g. ❑Demolition
working for me in my capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp.insurance comp.insurance.,
required.] 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑Other
comp.insurance required.]
•Any applicant that checks box#1 must also 1511 out the section below showing their workers'cow onsatioupolicy information.
t Homeawners who submit this affidavit indicanng Nry are doing all work and then hire outside contractors must submit arm affidavit indicating such.
rContmemrs that check this box mast attached an additional sheet showing the name of the sub-emtractors and state whether or not Nose caduca have
employees. If the sub-contractors have employees,they mast prwidc their workers'comp.policy aumbcr.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. tt //��
Insurance Company Name: ArybeMa_ i-Lxaraf- -e G (tx)g
r
/n .0. /'l2/1
C. .7 t� _ - .
u�kk.`r. CXpaanCn Date:� K
' 1 � � A_
Job Site Address: l b �1 'l 111'teP�- City/State/Zip: Weae if 1 CC OLCAOZ
Attach a copy of the workers' compensation Polley 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 51,500.00 and/or one-yen imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a frac
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 r2cation.
I do hereby certify I&Wthe pains/afl�d penal ' pie/rjury that the information provided above is true and correct
Date SI �iiOl l�
Phone": L\\J— lcbaD
Official use only. Do not wrile in this area,to be completed by city or town official
City or Town: Permit/License 4
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone 4:
i J
l®z Commonwealth of Massachusetts
� Division of Professional Licensure
Board of Bull ding Regula0ons and Standards
Cons tryftlSr §0peervisor
CS-077279 -> , h E3�ires. 06/21/2020
6 —
STEVEN ASIL-VERMAN /to
;�r 0
268 FOMER ROAD b X
SOUTHAMPTONP,A 01073
/tOyS.
Commissioner
C�We �(J9')2�712C177,LUG'Cl'��f1 d�� G.1SCY�C%fL�./QG'�.1
is
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: 7/172018 Tru 419291
VALLEY HOME IMPROVEMENT INC._
STEVEN SILVERMAN
P.O. Box 60627
FLORENCE, MA 01062
Update Address suit return card.Mark reason for change.
F] Address L] Renewal n Employment n Lost Card
scar c xcni wni
—ate--- ,
Office o(Comumer Affair&Businos Regulation License or registration valid for individual use only
J1' HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 105543 Type: Office of Consumer Affairs and Business Regulation
Expiration: 7!17/2018 Private Corporation 10 Park Plan-Suite 5170
�e>yy=" Boston,MA 02116
VALLEY HOME IMPROVEMENT INC.
STEVEN SILVERMAN /
340 RwersideDr.
Northampton,MA 01060 Uaderseeretary Not valid without signature