32C-063 (16) 20 HAMPTON AVE BP-2019-0220
GIs#: COMMONWEALTH OF MASSACHUSETTS
MarBlock:32C-063 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv,Commercial renovation BUILDING PERMIT
Permit# BP-2019-0220
Proiect# JS-2019-000360
Est.Cost'$3800.00
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License.
Use Group VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sp.ft.): 9278.28 Owner., COMMUNITY LEGAL AID
zonine:CB(100)/ Applicant. VALLEY HOME IMPROVEMENT INC
AT. 20 HAMPTON AVE
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522
FLORENCEMA01062 ISSUED ON.812312018 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD PARTITION WALL AND INTERIOR DOOR;
NO CHANGE TO EGRESS OR STRUCTURE
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: 21 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 8/23/20180:00:00 SI00.00
212 Main Street,Phone(413)587-1240,Fax:(413)5874272
Louis Hasbrouck—Building Commissioner
File ti BP-2019-0220
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413) 584-7522
PROPERTY LOCATION 20 HAMPTON AVE
MAP 32C PARCEL 063 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ZONING FORM FILLED OUT V ENCLOSED REQUIRED DATE
�G71)
Fee Paid
Buildine Permit Filled out
Fee Paid
Tyreof Construction ADD PARTITION WALL AND INTERIOR DOOR NO CHANGE TO EGRESS OR
STRUCTURE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 077279
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major ProjecC Sire 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
Dep 'tion Delay
re of Buil ng 7 ® e /
'Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
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.
Version1.7 Commercial Building Permit May 15,2000
Department use only
RECEIVENiri Northampton Status of Permit
Uildi 19 Department Curb Cut/Driveway Permit -
21 MainStreet Sewer/Septic Availability
AUG 2 0 2018 oom 100 WaterAi ell Availability
N Ihar pion, MA 01060 Two Sets of Structural Plans
oEln of tont. I 87 240 Fax 41&587-1272 PloVSite Plans
N HAMPTON,N61,01080 Other Specify
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property,Address: This section to be completed by office
Map 32 Lot Unit
v v Zone Overlay District
am St District CB Distrkt
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Own RIL91f Record:
rnmuny4.f " J� 4�1d t�1c 4(.fz f`a-Ln 4�' dour We ce64c 1 lw
Name(Print) C Current Mailing Address: O I(pOB
u�3-S81-1-u u�,t-1
6ignatu Telephone
2.2 uth.dzed am: _
511 P.U.P�o� tooto27 Pio er�cc M/� oto�2
Itk
N ma(Print) Current Mailing Address:�
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
cam leted b ermit a licant
1. Building 3r U� (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
8a) Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
O.0
5, Fire Protection
6. Total=(1 +2+3+4+5) 3 900 Cheri Number
This Section For ficial Use Only
Bui g P um at Data
Issued
urs:
a nding Commissioner/hspe of Buildings Date
i1-even® 1(yhmuiifKoo. C&�',
3
Versioul.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alteratlons"t Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building[]
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing[] Change of Use❑ Other❑
Brief Description Enter a brief description here.
Of Proposed Work: POTT 1 .J WA UL �" xr�o%ILL kA; N� CIVAN r�
Arps 11C
SECTION 5-USE GROUP AND CONSTRUCTION TYPE S -UTU�E.
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 1:1A-2 E3A-3 ❑ 1A
A4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ SA ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utllity ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: __. _ _. Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(so
1m is
P
4s
Total Area(sl) Total Proposed New Construction(sf)
Total Height(R)
Total Height IT
7.Water Supply(M.G.L c.40,§54) 7.1 Flood Zone Information: M7 Sewage Disposal System:
Public E] Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system E]
Versio0.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Eirang Proposed Required by Zoning
This column to be fi1t.4 in by
Building Derauaent
Lotsize
i'rOnta e
Setbacks Front
Side L: R:— L: R:
Building Height -
Bldg.&,gaze Footage
Open Space Footage % l
(Wterra mmwbWB�Pavod __ %
kin
dfofParkin S aces -
Fill:
vduvu�Lawtim
A. Has a Special Permit/Variance/Finding ever bl n issued for/on the site?
NO O DONT KNOW O /% YES O
IF YES,date issued:
IF YES: Was the permit recorded at the,Rre,gistry of Deeds?
NO e} DONT KNOW ,i 7 YES O
IF YES: enter Book // Page and/or Document N
B. Does the site contain a brook,/bgdy of water or wetlands? NO V DONT KNOW O O
YES
IF YES, has a permit been qr need to be obtained from the Conservation Commission?
r
Needs to be obtained / O Obtained o , Date Issued:
C. Do any signs exist on the property? YES O NO 0
IF YES, describe-size,type and location:
D. Are there any proposed changes to or additions of signs intended far the property? YES O NO O
IF YES, describe size, type and location:
E Will the construction activity disturb(clearing,grading,excavation,or filling)over t acre or is it part are commann plan
that will disturb over t acre? YES O NO
IF YES,then a Northampton Storm Water Management Penna from the DPW is required.
Version).7 Conuneroial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
-- Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area a Responsibility
Address Registration Number
Signature Telephane Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Dale
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
VlA-Q l/ �'� nlC T{'�PQOr�[.IrL�L^rJ� Not Applicable
Company Name: 7—
SfiUVE1v S/_i,U�j/1�'✓IrfJ
Responsible In Charge of Construction
3`E6 RWLkS)f3lJR . Nae �itilpTcfJ
Address
Signature ✓//V/ Telephone D
Versionl.7 Commercial Building Perout May 15,2000
SECTION 10.STRUCTURAL PEER REVIEW(780 CMR 110.11(
Independent Structural Engineering Structural Peer Review Requiretl Ves O No
SECTION II -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, __ . \1 'J�_ C ___. - ._.. _.. as Owner of the subject property
hereby authorize . `?VIt . A"L Ut�1f-'/W�0../�. to
as on my behaH,in a0er alive to coo prized lhi it application
� o �te (�
Signature of or Date
I, as Owner/Authorized
Agent h slay declare th t the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belie.
Signed under the pains and penalties of penury. _
P.yra t m
Pdn[Name //f, /a
/Ay(�/Y�IJI��- & Mr
lK� (5 21/J f3
SignaNre of(Ywner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction
\Supervisor: Not Applasible ❑ z�1p
Name of License Holder LZc n S(�l�✓ '1 _ 6-77�:!. / __...
License Number
2-� �Lcv Izn Pdq- Oto� 3 �12�_lao
Address � -589=1Expiration Date413Syz
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.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 bit
building perm .
Signed Affidavit Attached Yes 0 No O
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: 15 Oamfda lT e—
The debris will be transported by: \�111��2u
The debris will be received by: \/At:! Lj
Building permit number:
Name of Permit Applicant V
Date Signature of Permit Applicant
The Commonwealth ofMassachusetts
R3
----- - DepartmentoflndustrialAccidents
Office of Investigations
600 Washington Street
lr' Boston, MA 02111
•:r
�- www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information `_ Please Print Legibly
Name (Business/Organization/Individual): lk If 1.im v&)\Ywco±
Address: ILS-e—pp
City/State/Zip: •7 \(7f{'lrICe— alPbone #: q 7D--SSA--7�>2Z
Are you an employer? Check the appropriate box: Type of project(required):
1.M 1 am a employer with )8 4. ❑ 1 am a general contractor and I 6. ❑New construction
employees(full and/or part-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.any capacity. employees and have workers' 9.. ❑ Building addition
[No workers' comp.insurance comp. insurance.[
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#1 must also fill 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 most submit a new affidavit indicating such.
=Contmetam that check[lila box must attached an additional sheet showing the name of the sub-commuters=it state whether or not those entities have
employees. If the sob-contractors have employees,they most 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: Nybe, �6Y ai -e 11ma caq p
Policy#or Self-ins. Lic.#: ,� '(��cDebO502- iG` Expiration Dale:
Job Site Address: [6oftX�6T4w City/State/Zip: tr QjQleG
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 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 coveragerification.
I do hereby certify i the pains d penalf perjury that the information provided above is true and correct
Si®store: //.'� Date,
Phone#
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#:
Commonwealth of Massachusetts
t®� Division of Professional Licensure
Board of Building Regulations and 6111dards
ConslrySH�n�S`lSpgrvisor
CS-077279 J E�pires06/21/2020
STEVEN ASIL-VERMAf� F
268 FOMER ROf I
SOUTHAMPTON,MA 01073 N
/`t0/S5q
CommissioneC
r "It
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Qontractor Registration
tet` Type: Corporation
VALLEYHOME IMPROVEMENT INCRegistration: 105543
P.O. BOX 60627 i I' Expiration: 07/16(2020
FLORENCE, MA 01062
1
Update Address and Return Card.
SCA1 J 20M 05/17
Office of Consumer Affairs 6 Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration date. If found return to:
Reo'stral Expiration Office of Consumer Affairs and Business Regulation
105563 07/16/2020 One Ashburton Place-Suite 1301
VALLEY HOME IMPROVEMENT INC Boston,MA 02108
STEVEN A SILVERMAN �R..CC --
340 RIVERSIDEOR
NORTHAMPTON,MA 01062 Underseeretary Not valid without signature
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Palley Home Improvement, Inc. Hampton OFFICE Ave Northampton, SCALE see view srveer rvumsea
ogre p,l5Qg,9
340 Riverside Drive, PO Box 60621, Northampton, MA 01062 MA01060
Office Phone 413.554.1522 Fax 413.585.0820 Community Legal Aid MODIFICATIONSonawry ava.c.
Find us on the web at: w. MalleEIHomelm rovement.com