24A-119 (10) 26 CALVIN TER BP-2019-0124
ms#: COMMONWEALTH OF MASSACHUSETTS
Maf,:Block:24A- 119 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category' KITCHEN RENO BUILDING PERMIT
Permit# BP-2019-0124
Project# JS-2019-000202
Est Cost:$39819.00
Fee:$260.00 PERMISSION IS HEREBY GRANTED TO.-
Const.
O.Const.Class: Contractor. License:
Use Group VALLEY HOME IMPROVEMENT INC 112166
Lot Size(sa.ft.): 6450.64 Owner: Marvbeth Haberkom
Zoninw URA(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 26 CALVIN TER
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:7/3112018 0.00:00
TOPERFORM THE FOLLOWING WORKKITCHEN RENO WITH EXPANDED CASED
OPENING, NEW CABINETS & FIXTURES & NEW BAY WINDOW
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: O01• 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 7/31/2018 0:00:00 $260.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0124
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 26 CALVIN TER
MAP 24A PARCEL 119 001 ZONE URAf 100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENC SED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildine Permit Filled out
Fee Paid
TypeofConstruction: KITCHEN RENO WITH A D CASED OPENING NEW CABINETS
FIXTURES&NEW BAY WINDOW
New Construction
Non Structural interior renovations
Addition to Existine
Accessory Structure
Building Plans Included-
Owner/Statement or License 112166
3 sets of Plans/Plot Plan
THE FOL OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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: Sita 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 Etre Street Commission Permit DPW Storm Water Management
D oftion Delay q
ve of Buil ing OtTi Date /U
Note: Issuance of aZoo/ing 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.
U Department use only
ity f Northampton status of Permit
U1�r11 gDepartment Curb CuVDnveway Permit
JUL 30 2018 21' Main Street Sewer/Septic Availability_
oom 100 Water/Well Availability.. .
a pion, MA 01060 Two Sets of Structural Plans
�rpT Rfll mN .INSPE4
®`pomm 98- - 240 Fax 413-587-1272 Plai/Slte Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, 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
0.� l.l.Lty lY� \2✓talc Map �'`'�� Lot -!/� Unit
Zone Overlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Z(o �S1Y1 1 pX'YC�c fWr`�'�10..1n �R
Name(Print) ' Cunent Mailing Address: 01OIcQ
I� 4 �6 Q,$- g�U- csta ;
Telephone
Signature
2.2 Authorized Agent,
2C2 AA Qbkxt-A56 Q.0. 604 (otlidxl Fkx ni Mg o?C)
Name(Print) Cunent Mailing Address:
YH/ 1A l',- Sg4' )S22-
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Oficial Use Only
completed by permit applicant
1. Building 3 2 11 (a)Building Permit Fee
2. Electrical (, 9 60 (b)Estimated Total Cost of
r Construction from 6
3. Plumbing .l 5D Building Permit Fee
4. Mechanical(HVAC) ��
5.Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued
Signature: XB
Buildin mmissioner/Inspector of Buildings Date
Section 4. ZONING AR Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled In by
Building Departrneat
Lot Size
Frontage
Setbacks Front
Side L R' L R:-
Rear Rear .. _.
Building Height
Bldg.Square Footage
Open Space Footage %
(Let area minus bldg&paved
dcw )
N ofParking Spaces
FFill: ..
vnwme&[Avatioia
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O 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 O
IF YES: enter Book Page; and/or Document N'.
B. Does the site contain a brook, body of water or wetlands? NO `4J DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO (Q
IF YES, describe size, type and location: r�
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is It part of a common plan
that will disturb over 1 acre? YES Q NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION On
eck all applicable)
New House ❑ Aeplacemer LtAWdows Alterationis) � Roofing ❑
r DoorsJ�Accessory Bldg. ❑ Dew Signs I0] Decks [M Siding joj Other[pJ
Brief Description of Propo d
Work: K Kin Ra+ wl pt ca! P�� 2 rn6M� 1 f rizvw h At 6 wn LJ r
Alteration of existing bedroom_Yes —No Adding new bedroom_Yes _�No
Attached Narrative Renovating unfinished basement _Yes No
Plans Attached Roll -Sheet
sa. If New house and or addition to existing housing complete the following:
a. Use of building:One Family Two Family Other
b. Number of roams 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?
I. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
F. Type of construction
i. Is construction within 100 ft.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. Septic Tank_ City Sewer_ Private well_ City water Supply_
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTORAPPLIES FOR BUILDING PERMIT
I Nobel, I(Qensj ,as Owner of the subject
property
hereby authorizey aCkUD yC"DEA-S
to act on my behalf,in all matters relative to work authorized by this building permit application.
i
Signature oofO ,,r Date
I \ -, Q(n bQyTJ as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed u der the pains and penalties of perjury.
Print Name
✓ai a F-Z6 /'
Signature of Ovmerent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor. Not Applicable ❑
Name of License Hold. f d ld 110/&&
License Number
Ib Cbap(1- i Asmc fef( sk-k „ 1,1l 12021
Address I 01027 Expiration Date
ne.QiyYJ?--(/H/ 413-
Signafure Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
\ Q 110.0 yyl& �XNy✓f'Y.IC rv11 �-+ '�1r'x-]L 1b5S 113
Compo vName �— Registration Number
eb t,00m2�2 1 (wee2tr Mg D)oii 711f-l202,6
Address Expiration Date
Telephone4 ` 9-7522
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152,§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...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(l) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)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 person who constructs more than one home in a two-year Period shall not be considered a homeowner.
Such"homeowner'shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall be
responsible for all such work performed under the bu0din2 permit
As acting Construction Supervisor your presence on the job site will be required from time to 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 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Amounted,you may be liable for person(s)
you hire to perform work for you"der this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Amumated.
Homeowner Signature
City of Northampton 212 Main 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 150A.
Address of the work: r & CO h i n
The debris will be transported by: 6LUOLA r yrvlorc rCmP✓
The debris will be received by: \)alb
Building permit number: I • n.
Name of Permit Applicant V(, n LJ 5tt"M DIOIP� ,A—
672b iS�
Date Signature of Permit Applicant
®� Commonwealth of Massachusebs
Division of Professional Licensure
Board of Budding Regulations and Standards
Go ns NE$>3rNS`Ifp�rvisor
Q
CS112166
1Ld{ E�Ires: 06101/2021
RACHEL K ROBERTS h
10 CHAPMAN7� E
EASTHAMPTONVM_A 01027
h-r)ISS'IJOn���s.
Commissioner CIL /3
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
s
Home Improvemeintt;Contractor Registration
EWWWO Type: Corporation
�/'I Registration: 105543
VALLEYHOME IMPROVEMENT INC I�� i `.7 Expiration: 07/16/2020
P.O.BOX 60627
FLORENCE,MA 01062
=y,>
Update Address and Return Card.
SCA t 0 20M osry
OHice of C'maturneraireirsa Business Regulation
HOMEIMPROVEIMEEMENTCOnTRACTOR before he expiration date.
late.Ifuo found
only
TVP :.Comoration before the expiration thrue a d Road
return e
Reaistra'T,n. ire ion Office of Consumer AHalrs and Business Regulation
1053.4a
The Commonwealth ofMassachusetts
-" — r Department oflndustrial Accidents
Office of Investigations
1
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricfans/Plumbers
Applicant Information --(� Please
^Print Legibly
Name (Business/Organization/Individual): � C
Address: � (� e 1\S p
City/State/Zip: \Of�rl(� \ ' (� 04hh e #:
Are you an employer? Check the appropriate box:
pp Type of project(required):
1. I a employer with U 4. ❑ I am a l contractor and I
general 6. E]New construction
employees(full andlorpart-time).* have hired the sub-co¢tractors
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 any capacity. employees and have workers' 9.. ❑ Building addition
[No workers' comp,insurance comp.insurance.t
required.] 5. ❑ We are a corporation and its 10.❑ 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 41 must also BE 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.
rContractors that check this box most attached an additional sheet showing the name of the sub-cormuctors and stale whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workem'camp.policy wether.
I am an employer that is providing workers'compensadon insurance for my employees. Below is the pofiry and job site
information. t� �a
Insurance Company Name: '6beM0— 1111S(>.22Y�-2 L7 fCk iP p
Policy#or Self-ins.Lid.
C2 Lid.#: oy:- � o 6 uz ]� Expiration Date: a I I 1
Job Site Address: II n Q J VIF7 }{o-nef, City/State/Zip: l`�+y}h/y
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 imposifion of criminal penalties of a
Fete up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK 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 rification.
I do hereby certify i the pains a>d penald perjury that the information provided above is true and correct
Si®ature: � c p�(/( �j'L�/o^t Date:
'Ai
Phone#: Ai\-7 J'
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: