36-014 (7) 47 FOREST GLEN DR BP-2019-0214
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:36-014 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: BASEMENT RENOVATION BUILDING PERMIT
Permit# BP-2019-0214
Project# JS-2019-000351
Est.Cost:$76400.00
Fee:$496.60 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sa ft.): 13982.76 Owner: KAUSCHEN KAREN&ERIC
Zorj= Applicant: VALLEY HOME IMPROVEMENT INC
AT. 47 FOREST GLEN DR
Applicant Address: Phone. Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.8/30/2018 0:00:00
TO PERFORM THE FOLLOWING WORK:BASEMENT RENO
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: 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 Occuoancy Siena ure:
FeeTvne: Date Paid: Amount:
Building 8/3020180:00:00 $496.60
212 Main Sueet,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0214
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 47 FOREST GLEN DR
MAP 36 PARCEL 014 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION-CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TypeofConstruction- BASEMENT RENO
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 RAS 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: 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
Demolition Delays (�
Signature of Building Official 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.
Department use only
City of Northampton Status of Permit _
tip. �-
wilding Department Curb Cut/Driveway Permit
- 21 main Street SewerlSeptic Availabillry
Dom 100 WaterfWall Availability
AUG 1 7 2018 Noha pton, MA 01060 Two sets of Structural Plans
phone 413 87- 240 Fax 413-587-1272 Platlsite Plans
Other Specify
H - ,ALTER,REPAIR,RENOIrATE GR GEMOLiSN A ONE OR SV40 FAMILY DirVELLPNG
SECTION 1-SiTE INFORMATION
1.1 Property Address: � This section to be completed by office
q7 //�reSk hIr/7 rC.-OG,f,,/ Map Lot t)/ Unit
�(0r2,17C"L Tone Overlay District
Elm at.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORITED AGENT
2.1 Owner of Record:
llaeea �- LI? kn 2� FlcyPrxe H09--o100
Name(P ll-tL—s'�" — Cuntnt Mailing Address: "
Nya� 415— Sra'7- 9/70
71` Teleptnne
Signator
2.2 Authorized Agent: [
=v river Po 6oGlQoroa� Pio e rc NR oto92
Name(Pdt) Currant Mailing Address:
Signature Teleplmne
SECTION 3-ESTIMATED CONSTRUCT COV,COSTS I
Item Estimated Cast(Dollars)to be Official Use Only
completed by permit applicant
1. Building s/b O (a)Building Permit Fee
2. Electrical ) (,bo (b)Estimated Total Cost of
Consiucdon from 6
3. Plumbing Buildim9 permit Fee
y
a. miecnanical(HVAC)
S.Fire Protection
6. Total=(1 +2+3+a+5) $-4 100 1 Check Number
This Section For Official Use Only
Date
Building Pum it Number. Issued:
Signature:
Building CommisslonerllnsGectoroi Buildings Date
I
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
Itis colamu to be filled to by
Bondi s,Depamneut
Lot Size
Frontage
Setbacks Front
Side L R: L:' R:
Rear
Building Height
Bldg. Square Footage %
Open Space FooL=ge %
(Int on minaa bldg 3 paved
food-so
#of Parking Spaces
Fill:
(volume a Locadon) -
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW Q YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
n:0 __r.iT KNOrii YES U
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW Q YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained a , Date Issued:
C. Do any signs exist on the property? YES NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe si,e, type and Coca ion:
' s
that will disturb aver 1 ecce? YES O n NO Q
IF YES,than a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK fcheck all aotti cable)
How House ❑ Addition ❑ Replacement Windows Alterations) Roofing
Or D.." 0
Accessory Bldg. ❑ Demolition ❑ New Signs Di [M Siding[0] Other[ t
Brief Descrieti�on cf P(-�posed r,�
work: �tfJlShtN� bgSPfneNk✓ ad�.inly � �r�1n(llON" �. W(baMlNo c 9
Alteration of eisting bedroom Yes-'< No Adding new bedroom X Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Aftachhed Roll - Sheet
6a.If Ivey✓ house and or addition to existing housing. Complete the followlvi
a. Use of building :One Family Two Family Other
b. Number ofrooms 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 farm attached?
h. Type of construction
I. Is construction within 100 ft.of wetlands? Yea No. Is construction within 100 yr. floodplain_Yes_No
I. Depth of basement or cellar floor below finished grade
k Will building conform to the Building and Zoning regulators? Yes No .
i _ _ „ _ _
-ep&c Ta.^.r. ..:iy:ewsr` rriva.a p;
SECTION 8-CONSTRUCTION SERVICES
81 Licensed Construction Supervisor \ Not Applicable i]
Name of License Holden
License Number
V AG- l; C la �1 ,
Pddress v Expiration Data
Sign m I'J— Telephone
9.Realstered dome Improvement Contractor: Not Applicable ❑
�)\�o Ovcon 1o�sY3
Comoanv Name Registration Number
Address( Expiration Date
d�`kar'!/TC 1tl1 o�U>t i Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIOAI.NT QN.O.L.c.152,§25C(i
Workers Compensation Insurance af0davit must be completed and submitted with this application.Failure to provide this affidavitwill result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... Qk No—... ❑
41. - Howse Owner ExeMatimn
.,rs�aalto iso?udeO nee-ocunied Llweft,aes et .. ..A )
and to allow suchhoncowner to eagror an maividnal for huE who does not possess a hcense,uetoeded shat the oatee alts
as superrlior.CMR 790 ixth E'd tSr Section 109.3.5.1.
Definition of Homeowner.Person(s)who awn aparcel of land on which he/she resides or intends an reside,on which there
is,or is intended in be,a one or two family dwelling,attached or detached stmctures accessory to such use aud/or farm
structures.Aperson whot t titan one h same i n a r -v A period shod net he cromider-s!R hp const.
Stich"to vmu"shall submit to the Build -CitEdal, on a form acceptable m the baildiug OfficiaL that be/tile shsti be
respatra le far all such watt:per forcaed under the buiEdipsf permit
As acting Construction Supervisor your presence on the job site will be required nom time to time,during and upon
completion of the work for which this permit is issued_
Also be advised that with reference m Chapter 152(Workers' Compensation) and Chapter 153(Liability ofEmployers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Automated,you maybe bable for persot(s)
you hire to perform work for you ander this permit
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State aird Local Zoning Laws and Same of Massachusetts Gmetal Laws Aaambi
H3cao3T;nCrSt-y'u�t� c _
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: 4 Z J—[r`1PSI ��/rn 47Qoj
The debris will be transported by: Vhfn �OpnppQ I� KThC'rr1PX
The debris will be received by: QY l 1 �9 G A 1 YlQ
Building permit number:
Name of Permit Applicant3e-a-uaA+'
D ! 6
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
tlfjaee of-Investigations
�c
-C 600 Washington Street
Boston, MA 02111
www.mass.gorldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information —(' Please Print Legibly
Name (Business/Organizatioa/lndividual): A0 I�
Address:
City/State/Zip: ' 7�a,'t"Cl(C \ rte al�P6 no e#: X113 5��1-�S2Z
Are you an employer? Check the appropriate box: Type of project(required):
1.M I a n a employer with 1S 4. ❑ I an 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 mein my capacity. employees and have workers' 9. ❑Building addition
[No workers' comp.insurance comp.instrrance.t
requited.] 5. ❑ Weare a corporation and its 10.❑ Electrical repairs or additions
3.[-11 am a homeowner doing all work officers have exercised their I1.❑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 roost also Moot the section below showing ride wurkeD'compensation policy inwanatioa
t Homeowners who subnitthis a ftdavitindicating they are doing all work and then hire outside coon'acmmusterboit a new affidavit indicating such. '
TCwtraams that check this box most attached an additional sheet showing the name of the sub-contracmrs snit stale whether or Dot nose entities have
employed. If the sub-coutiadorn have®ployees,they must provide then wodam'comp.policy number.
I am an employer that is providing workers'compensation iraurance for my employees. Below is the policy and job site
information. ll�t
Insurance Company Name: pffbe-MG C111``.l 1.ff4J`Zee CfGt7O
Policy# Selfas L.C. cy�_,ac6Cz vs— Bxpiraticn DateCX i I I. 9 -
Job Site Address: U9 Fo/-eyr 6 )rr? r2d City/State/Zip: r _/2KC
k19 6J0462-
Attach
l0L' ZAttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requited under Section 25A of MGL c.152-casleadio-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 coveragefication.
I do hereby certify thepains a'd penalti perjury that the information provided above is true and correct
1
Sign
taro. _ 't Date' /rij
1, Cp
Phone#:
Official use only. Do not write in this area,to be completed by city or town affciai
F
City or Town: ParmiUZicense#
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: Thole#:
®� Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Const�idyY�ri I§Opervlsor
CS-077279
-� r3pIles 06/21/2020
M
STEVENDRMAfJ
26POMERIRO
SOUTHAMJPTTMP�A 01%u�?3
' ^
a
/tOISSH30A�
Commissioner V^"
.�� �6/�2/YLO2LCSBCGCG/L 4�✓ICL»C�C�l�l.CrsB��,
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvemerit Contractor Registration
Type: Corporation
�. . Registration: 105543
VALLEY HOME IMPROVEMENT INC Expiration: 07/16/2020
P.O.BOX 60627 _
FLORENCE,MA 01062
Update Address and Return Card.
$CA1 n tomaCn
Office of ME IMPROVEMENT
A Business Regulation
HOMEIMPROVEMENTation CONTRACTOR before
Registration
valid piratfor late.It al fond return
TYPE:Corporation before the expiration date. a d Bu return to:
Re105543 07I� Office
neAhConsumer
e-Suie 13 Business Regulation
105543:: r 0]/162020 One Ashburton Plaee-Suite 1301
VALLEY HOME IMPROVEMENT INC Boston,MA 02108 /////�
STEVEN A.SILVERMAN �R.,C{Q -- //I/ , �f�
340 RIVERSIDEDR Y -
NORTHAMPTON,MA W062 Undersecretary Not valid without signature
Cft
t AWOKuy4pion of Louis Hasbrouck<Ihasbrouck@northamptonma.gov>
47 Forest Glen
Louis Hasbrouck<Iasbrouck@northamplonma.gov> Fri,Aug 24,2018 at 11:48 AM
Draft To: Steven Silverman<Steven@valleyhomeimprovement.mmI
Cc:Andy Pelts<apelis@northamptonma.gov>
Steve,
We need electronic plans.You can email them to me.
Also, Since you are adding a bedroom,the whole house needs current code smoke and CO alarms.Send floor plans of the rest of the
house with locations marked so I can send them to the Fire Department.
The rest of the plans look OK.
Louis Hasbrouck
Building Commissioner
City of Northampton
Town of Williamsburg
(413)587-1240 office
(413)587-1272 fax
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Valley Home Improvement, Inc. 47 Forest Glen Drive EXISTING "'SEE°" 5HE"""MaEA
340 Riverside Drive, PO Box 60627, Northampton, MAO 1062 Florenee,MA 01062 �ATE asrmre A
olNce Phone a13s6a.7s22 Fax 413s6s.o62o CONDTIONS L
Find usonthe 13. at: 22.w.Valle omelm 41 B.58nGcom _j
Karen Kauschen R^" 1EEME
Iriar"an :the Mou- ,-1 pmdocldf leff. Noma lmerovemen(Inc.(VHI) If dervered for me limned and exclusive purpose of suppodeng the conecancleM ofVHI and cusfod—,od erone on.Warner.cf @Is oleo shau not.raennecedad e,p.r-.d in any
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Valley Home Improvement) Inc. 47 Forest Glen Drive CALE SEE NEW SME N 9ER
340 Riverside Drive, PO Box 60621,Northampton,MA 01062 Florence,MA 01062 D�BI.Wl Ao MAIN FLOOR PLAN4OINce Phone 413.564.7522 Fax413.50.0620 Karen Kausehen D 10
Find us on the"b at: w .VailewHomemprovement.com
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LOCATION FOR OUTLETS WI
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ELECTRICAL NOTES:
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I.ALL APPLIANCEES&UTILITIES TO MAVE DEDICATED Iii Sant¢] ]Gen95ui4A� ® I I LL �I C
q� CIRCUITS PER CURRENT ELEDTRIL LODE C t'F. Ra¢5sed LgnlG ReNsm Dwm Ligpll ALL V
STAN VARVE AT TIME OF INSTALLATION SEE HFfiS
E € 5PEL5 FO"THER REOUREMENTS
p 2.ELECTRICAL RECEPTACLES IN BATHROOMS
K TLHENS ANO GARAGES SHALL BE G. 01 ER
'ems XATIONALELELTRILAL CODE REQUIRE E S. I DLOA Da
$ 3.SMOKE AND CO DETECTORS ALL BE PROVIDED
9£E
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INSTALLEDINALLORDANLEWITHNFPA 4E
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4.L CLITssHALL BE VERIFIED WITH NOME OWNER I I TONSaeM1 l" �3� � Oy
T G PRIOR TO WIRE INSTALLATION. Fs
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Z– S.FI NAL SWTONES FOR TIMERS ANDDMMER5 J/ V
E SXALL BE VERF EO WITH ROME CANER I Hemssee 0—U'IA lF
S.ALL 5URFALE MOUNTED FIMURES TO AL Re �xsed�aui Ll"
5ELELTEDANDP0RLW6EV9YHREEBOPNEK V/ Q
[�¢ IJ DELORAVE FIMURES TO BE SELECTED AND
FB FURCHA5EDBY HO✓F iuru R \/` �� Rve ed Oay.L R LlgntO
g B.BATH VENTILATION TO BE EMM✓� —a \ I 1 Z
AX D IS PURCHASED BT OR HO us OwNFRERF V \ _
VNO-ALL SWITCHES TO BE 40"OIL ASF. OUTLETS _ p F,
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>� COUNTERTOPS TO BE 3'ABOIf COUNTER ,5T vE Sled OaunG M11ETS OVER
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CABLES
I LOCATION OF PHONDOADLEfDTHERNET
L— — — — DUDIe[ I, — — onTo�ple.
Ya DATA/GABLE: 15,
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=gym TO BE CONFIRMED WITH HOWE OWNER P0.10R TO
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STAL-ATION IF APPLICABLE. '� , I p, T y y
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