23B-004 14 STRAW AVE BP-2019-0366
GIs#: COMMONWEALTH OF MASSACHUSETTS
MV Block: 23B-004 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2019-0366
Project# JS-2019-000594
Est.Cost: $18800.00
Fee: $122.20 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq.ft.): 11238.48 Owner: ROSS JO-ANNA
Zoninp-:URB000)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT. 14 STRAW AVE
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.9/24/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE GARAGE ROOF, INSTALL
GARAGE DOORS & OPENERS
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 Deaartment 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 Occupancy Signature:
FeeTyue: Date Paid: Amount:
Building 9/24/2018 0:00:00 $122.20
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0366
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 14 STRAW AVE
MAP 23B PARCEL 004 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED O
Fee Paid oL
Building Permit Filled out
Fee Paid
Typeof Construction: STRIP&SHINGLE GARAGE ROOF,INSTALL GARAGE DOORS&OPENERS
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
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
Demolition Delay
( �� �
Signature of Building Official Date
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.
Department use only
City Of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
ify.
APPLICATION TO CONSTRUCT,ALTE ,�E LIS€I A ONE OR TWO FAMELY 6DVVEfaE_Ii Efi
SECTION 1 -SITE INFORMATION S E p 2 S 2.018
1.1 Property Address- his s action to be completed by office
IL[� �1 `./ DEPT.OF BUILD1rVA . PECTIONS � Unit
4ra'� " rn e- NORTHAMPTON,r✓1
Zone Overlay!District
Elm St.District CB District
SECTION 2-PROPERTY O1,F4N€RS€IIPIAUTHORIZED AGENT
2.1 Owner of Record:
l4- 1,0r0. (Q,r�Mn /q T1- toren L:c HA o,o(aL-
1Nam e(P' t) Current Mailing Address.:
C Telephone ( sg'7 �7Saa
Signature
2.2 Authorized Agent:
Name(Pri it) Current Mailing Address:
Signatu I! Telephone
SECT 10M 3-F-STuni r.T€O CONST RUC T ION COSTS I
Item ( Estimated Cost(Dollars)to beI Official Use Only
completed by permit applicant
1. Building F(a, uilding Permit Fee
2. Electrical 0 p O (b)Estimated Total Cost of
Construction from (6
3. Plumbing Building Permit Fee
4, f-vlechanlCal(l i V AC) aD
5.Fire Protection
S. Total=(1 +2+3+4+ 5) O O Check Number .3
This Section For Official Use Only
Building Permit Number: D2tP
I issued:
Signature:
Building Commissionerlinspector of Buildings Date
p
t.
a
Section 4. ZONING /all 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 Deparhnent
Lot Size
Frontage ,
Setbacks Front
i
Side L: .. R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
arlcing)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever bee issued for/on the site?
NO Q DONT KNOW � YES 0
IF YES, date issued:
IF YES: Was the perrint recorded at the Reg' tl1y of Deeds?
F,0 �~ E�vrrT l NCr;;., SES (�`1
IF YES: enter Boot; Pate and/or Document#
B. Does the site contain a brook, body f water or.wetlands? NO � DON'T KNOW YES
IF YES, has a permit been or ed to be obtained from the Conservation Commission?
Deeds to be obtained Obtained . , Gate Issued:
C. Do any signs exist on th property? YES NO
IF YES, describe s' e, type and location:
D. Are there any oposed changes to or additions of signs intended for the property? YES NO
iF YES, scribe Si%e, type and location:
�. ciiii uic wi.����i.:iv�cru v�yu,_.,,<.� �i.:cc.+uyy:. �ii" e��oJ:i, ui�iiii �✓c�i i ci.:c�• :a:i N= Jl =...,:Ic[�IJ.1 N:_�
that will disturb over 1 acre? YES 0 1".10 4
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTIOI€ 5-DESCRIPTION OF PROPOSED 4,!LtORK(check all applicable)
New House ❑ Addition ❑ Replacemen Indows Alteration(s) Roofing
Or Doors U
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [® Siding[0] Other[OJ
Brief Description of Fropcsed
Work: 6SOPP � �IIN�� Iuc1 qv u'�t CodF, .tu5 `,��� �Aoars. a� � N Duni (
Alteration of existing bedroom-Yes g S}fuc+u�
?� No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes _ No
Plans Attached Roll -Sheet
6a.11f Mery house and or addMon to e)dsting housing, complIete the f0omlina:
a. Use of building : One Family Two Family Other
b. Number of rooms 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?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
L 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.
r. .-Septic Tank City.Se'vver "rlvate L.ell City v'atsr Supply
SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FORSUILDIi G PERMIT
I, I n u ra .I- Bian Q -I as Owner of the subject
property \1
hereby authorize V �� ��ZPJ('1 �`�PyYY1
to act on rrbehalf,in all matters relative to work authorized by this building permit application.
Signa ure of Owner Date
fia`iirdf 1=1 int!tl iul LLC
AGEnt herebv dEclara a 2i the staieMEntS and information Cin the foregoing aD0'ic2ti31'l 21-8 true and accurate:to the bast of my Lrio r,=dG8
Signed under the pains and penalties of perjury.
. Prnt Name
I
SECTION S-CONSTRUCTION SERVICES
3.9 Licensed Construction Supervisor: [Jot Applicable 0
Name of License Holder:
License Number
Address - Expiration Date
Signa r Telephohe
9. Registered Home Improvement Contractor: Not Applicable ❑
Company Marne Registration Number
Address Expiration Date
I ON [�� U'Z C; Z- Telephone
SECTPOM 90-WORKERS' COMPENSATION INSURARICE AFFIDAVIT(M.G.E,e.952, 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted vdth this application.Failure to provide this affidavitwill result
in the denial of the issuance of the building permit. -
Signed Affidavit Attached Yes....... [$. No...... ❑
11. - Home Owner ExeMfpgiin
r__�R 'id-� o ! 1P t hgs.n..f' i =/- i\:�v 71` i s
i lio C i"c'I cot ccnir'Oii ._i :i0i c .._� ='e8 E'ae:. c_t_t 1CIL�c _F CEEB'-EC C'TSNEfP l?E EF_EL._ Olie( (��,..r .i
and to avow such homeowner to engage an individual Ior hire vvho does hot possess a Lctase.,ri,Fio ikled thiLt One 0-1-w+.nen aets
as snperyiser.ClVM 780, Sirth Mition SecLfoa 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 w ho constructs more thorn one home in a two-year period shalill not be censMered a hameawner.
Such"1 orneOlF^lLcr"shall gab mit to the bud&-ig Ciifflicial,o a form acccptabie t0 the b-ail ding 0ficia!,that die/she sh21 ire
respanisclzle for all such hark perfGrmed under the Grulga6 pert.
As acting Construction Supervisoryour presence on the job site vrill be required from time to time,d-tH ing and upon
completion of the work for which this peiLit is issatd_
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 Annotated,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 Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws A-notated.
1S.C3lLFG11 Yr LILT JLgiLc�4 L
ill
City of Tlortha.mpton 212 Main Street, lyorthampton, MA 01060
Solid Waste Disposal Af idavit
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 15OA.
Address of the work: /q Sew 14Arr-at,.-e
The debris will be transported by:
The debris will be received by: V
Building permit number:
Name of Permit Applicant -�
Date Signature of Permit Applicant
laY �Qa�d9bdfli Fi'eahli of Massachose#s
Devarmi'ent of Indust I.l Accidents
600 Washington Street
Boston, AIA 02111
yvti w.mass.gov/dia
Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: j`�a
City/State/Zip: � Phone#:
Are you an employer? Check the appropriate box: Type of project(required):
1.M I am a employer with 4. ❑ 1 am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me inany 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 must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I ant an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site
information.
Insurance Company Name: 'f�Y)peMO, f QU12
u. rr_rr`G c,� r�� �� 1
D luny-.._ _l+" L l�u_,V.v_ �./-1.�._. --- ------irpiration Date: Ci e �.
t7- rr vi V�+1L-in t4.Tr. Lr- .�J
Job Site Address: a u� c� City/State/Zip: H6)1, /7(e /zA 0)0&2—
Attach
)0&ZAttach 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.-i 52 cari read-to the imposition of criminal penalties of?
fine up to$1,500.00 and/or one-year imprisonment, as well as civil_penalties in the fora of a STOP W0P1K 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 verification.
I do hereby certify i the papenalti perjury that the information provided above is true and correct
i
Simafore: ^' Date:
Phone#: -`l, cc,"Ay CJ c�
Official use only. Do notwrite in this area, to be completed by city or town
City or Town. Permitldeense#
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
.0 er
Contact Person: Fhaue+r:
®L Commonwealth of Massachusetts
� Division of Professional Licensure
Board of Building Regulations and Standards
Constrj4ctt6rO§iSpervisor
�I
CS-077279 �� E ires: 06/21/2020
STEVEN A SILVERMAN ,';•i _
268 FOMER 140�AD i O
SOUTHAMPTON%YVIA
'�7jj.SS330'�S
Commissioner CL
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement4Contractor Registration
Type: Corporation
lZ� Registration: 105543
VALLEY HOME IMPROVEMENT INC " Expiration: 07/16/2020
P.O.BOX 60627 � �
FLORENCE, MA 01062 p �
Update Address and Return Card.
SCA 1 i+ 20M-05/17
✓r�e ���nacicca-ea��z n�✓��a�sac�c�ell-�
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration date. If found return to:
Registration, Expiration Office of Consumer Affairs and Business Regulation
Q5543= 07/16/2020 One Ashburton Place-Suite 1301
VALLEY HOMEWQ-ROVEMEd M-`INC
Boston,MA 02108
k-P!
STEVEN A.SILVE�F�Mi4Tl ;rj
340 RIVERSIDEDFI :, "
NORTHAMPTON,MA`02 Undersecretary Not valid without signature