24D-033 (3) 29 WINTER ST BP-2019-0956
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D-033 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateaorv� INSULATION BUILDING PERMIT
Permit# BP-2019-0956
Proiect# JS-2019-001592
Est.Cost: $2576.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group VALLEY HOME IMPROVEMENT INC 077279
Lot Size(so. h.): 4878.72 Owner: NIEBOER FREDERICK 1&ROSE-MARIE
Zoning: URB(100)/ AppUcant: VALLEY HOME IMPROVEMENT INC
AT: 29 WINTER ST
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:3/6/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:AIR SEALING BASEMENT BLOW CELLULOSE
ATTIC/ INSULATE BASEMENT DOOR
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House ft Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy signature:
FeeType: Date Paid: Amount:
Building 3/6/2019 0:00:00 565.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Depertinent�Nuse�only
�/Q///
RECEIVEcityo Northampton Status of Pam,t
uildi gDepartment curb'11Fut/D)ivawayPermit
212 Main Street SewEr/SepYle Availahlllfy
MAR 1 2019 F oom 100 weter"ell AVallabillty
No hary plon, MA 01060 Twp Sets of$tn{ctural Plans -
DEPT oP euam 7- 240 Fax 413-587-1272 Plow- fte Plans NORTHAMPTON,MAoloso Otherupeclty
M
-APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I -SITE INFORMATION
1.1 ProoerN Adtlress: This section to be Completed byofffee
MA
1 _ Lot 3 Umf
NorrT a�Ap}ow F 01Obo' Z23({ Zbne Qve lay Dlst ct
ll Elm SL Dls ret LB Dlstru+t 'I
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) - Current Mailing Address:
I lyi O R .'t9 11'u.r-o c+ (,) ..o�oln nu)40
Telephone
' V G _
9gnatum ! LG S
2.2 Authorized Aaent:
Po Box 6062,- _ 640 r2;VP Cie, a),
`t� r A10 1P a ka" KA nincz
Name(Pdo{ Currerrt Mailing Ad k.
(4lalg �szz
Signature Teleph— ah)
SECTION 3.ESTIMATED CONSTRUCTION COSTS
Item _ Estimated Cost(Dollars)to he Official Use Only
completeLby permit.applicant
1. Building. 2J 1 SS (a)Building Permit Fee
2. Electrical "f (b)Estimated Total Cost of
Construction from 6
3. Plumbing - Building Permit Fee
4. Mechanical(HVAC) _ '✓
5.Fire Protection
6. Total=(1 +2+-3+4+5) 2-$4'6- 55 Check Number
-This Section For Official Use On `.
Date
Building Permit Numbe//r issued p
Signature
Building Commissioner4nspeclor of Buildings Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows ARerstlon(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signa IO] Decks [O Sltling[p] Other[El
Brief, ai l tion of Proposed AnIp /�y'�c[� 3 8 er. •,�n d e/.i�sd�la b&Zwljlr
Work' `v _CP�11 r.n n
G•PsD
Attache n Tf arr tlng bedroom_Yes_ o Addingaing unfinished
nishedbedroom_Yes No
Attached Narrative Ro Renovating unfinished basement _Yes No
Plans Attached Roll -Sheet
6a.If New house and or addition to existing housing. complete the following:
a. Use of building:One Famiy 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?
I. Method of heating? Fireplaces or Woodsloves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance farm attached?
In. Type of construction
1. 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 Buliding and Zoning regulafions? Yes No.
I. Sepfic Tank_ City Sever_ Private well City water Supply_
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ,as Owner of the subject
properly
hereby authorize
to act on my behalf,In all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, ,as Owner/Authorized
Agent hereby declare that the statements and Information on the foregoing application are We and accurate,to the hest of my knowledge
and belle(.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
City of Northampton
Massachusetts
Q-
OF BOZLDZNG INSPECTIONS Z x
212 Main Street *Municipal Building
ng
MA 01060
Debris 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.
The debris from construction work being performed at:
°C9 WiwtQJr S+ ` yy 0 f ^^g
o
(Please print house number and street n e)
Is to be disposed of at:
(Pie Q�
as6print name anct!qtation off it )
Or will be disposed of in a dumpsler onsite rented or leased from:
(Company Name and Address)
(4- 2 —
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
77te Commonwealth of Massachusetts
Department oflndustrialAccidents
7 Congress Street,Suite 700
Boston, MA 02774-2017
www.mass.gov/dia
N1 tickers' Compensation Insurance Affidavit:Builders/Con( .ctors/Eleetricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Orgaaiation/Individuaq: �0.lhu �4orvle Smlora�e rtilzn-i "fine..
Address: .'2--10 —brlsrc.
City/State/Zip:FlowenccVAR 01 Oil Phone#: 413-SSq--iS27-
Are you an employer?Check the appropriate box:
11 gg Type of project(required):
l.J@lnmaemployi,,rx�employces into and/or pan-yore).• 7. ❑New construction
2.MItor a rale prupnetor or partnership and have no employres working Car as,fir g. Z Remodeling
any capacity.IN.woNers'comp.iwmance required
3Ot am a homeowner doing all work myself.[Noworkcr,'ramp.insurance required It 9. El Demolition
4.�Lm ahmucoumcr and will be hhin tmdommeonduct au work onm I,a,ip l0❑Building addition
g con Y OroPcr0
aswc mat all connactors either have workers'comperavayw insurance or are sole ILE]Electrical repairs or additions
pmprlelors with no employees. 12.[]Plumbbrg..pairs or additions
5.r7 1 on a general corbuctorand I have hired the sub-conoacrom listed on the attached sheet.
'for,sub contractor,have employees and have wort—rornp....mance( 13, Roof repairs
xM Weare a coryoratiod and mail h..exercised melrright of exemption per MGL,. 14.❑Other
152,$1(4),and we have no mnployees-IN.workers'cusp.insurance teq.Imdl
'Any condition mat chocks box 41 must also fill out in section below showing Ther,-coker campensmion policy information.
i Homeo son's who submit no,affidavit mdratlng they are doing all work and men hire outside...tractors must submit a new affidavit indicauug such.
lContracmm that check taus box must attached and urtion.n d ebeer showing Ne name of the sub-connacton add sum whether or not trust entities have
employees. IrtM1c sub<onna¢ors have employees,racy must provide IM1nr workers`comp.pohcy,ombm.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy marital,site
information. ((tt
Insurance Company Name: tSY�`�C� �X1SurCLv7 t.!_ C-I u,ao
Policy#or Self-ins.Lic.#: Ob5502 \S Expiration Date:
Job Site Address: a9 WI„-lefC SCity/State/Ziportlhamlnn MA olobo
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a from,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 fore of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance
coverage verification.
Ido hereby certify un r the pains and pe /nes of p hot the information provided above is true and correct
SSi�ture �� Date:
Phone# -J- CS22-
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: PermiMeense#
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#:
®c Common.e a lth of Massachusetts
� Division of Professional Licensure
Board of Building Regulations and Standards
Constr3(¢p�$0p�rvisor
CS-0]7279 �> , { Etpires: 06121/2 0 2 0
i r
STEVEN ASit ERMAFId
268 FOMER R0�40
SOUTHAMPTOK,,MA 01073�r aC'
/I`G/,SS�dO�S
Commissioner
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Mas$achusetts 02108
Home Improveml nt:Contractor Registration
Type: Corporation
VALLEVHOME IMPROVEMENTINC , - II. Registration: 105643
P.O.BOX 60627 °l EpIration: 07/16/2020
FLORENCE,MA 01062 I ~ffi
� Update Address and Return Card.
SCA1 0 20MDvI7
�ova�i in.a R.Ja1L1
OXiH of Consumer Affairs 8 CONTRACTOR
Regulation
HOME IMPROVEMENTTation beorethionvalafor Inddate. dual Iffouneonly
etur
TYratio,Corporation before the expiration date. If found return to:
Reols[r'ztia n. EE ix� Office of Consumer Affairs and Business Regulation
1A55�— 07/16t2020 One Ashburton Place-Suite 1301
VALLEY HOMEIrMPROVEMEN -INC Boston,MA 02106
STEVEN A.SIL V R
340 RIVER SIOE
NORTHAMPTON,Md'01062 Undersecretary Not valid without signature
Work Order
Community Action Pioneer Valley Job Number: 18-1130
P.O.Box 1432 Work Order Date:2/4/2019
Greenfield,MA 01302 Ownership:Owner
Phone:413-774-2310
Valley Home Improvement Inc Auditor:Alexandra Sullivan
P.O.Box 60627 Email:asullivan@communityaction.us
Florence MA 01062 Cell:413 834-3618
Phone:413-584-7522 Phonc:413 376-1116
Frederick Nieboer DOE WAP 2018 $2,576.55
29 Winter St Total $2,576.55
Northampton Ma 01060-2234
413-586-0461
Safety Issue(s): Lead Paint Possible
Additional Contractor Instructions:
1950 Cape-NO BD until you verify NO VERMIC.Need to cut access to cap,client prefers via outside.Owners do not want access cut into
hidden KWs.Asked me to wear booties to enter bedroom/bath/laundry addition(added 2014)where domestic water pipes freeze,told them
we can not fix.
Authorized Actual
Measure Description Comments
Attic
Price Total Qty Total
Attic Insolation
R-18-20 restricted-slopes/floored 264 $1.79 $472.56 slopes:32'i.mar+26 in front=58 x 4'slope
fill./cellulose
R-38 unrestricted-settled cellulose 160 $1.90 $304.00 INSPECT FIRST TO VERIFY NO
VERMIC>Bring attic cap to R49-assuming
additional insulation will be needed.Take
pictures of aimealing,use depth markers.
May need lots of soffit vents,please add if
needed,count and take pictures.
Attic Ventilation
Propa vent(extension above 15 $2.64 $39.60 1 1 ranted 8 circle soffit vents in front,4-7 in
insulation) ce ..plane add more if needed,count.
Basement Insulation
Sill/mudsill seal&insulate to R-19 +7 $392.04 prefer foam board& I part foam method
Doors
I"THERMAX or equivalent on 1 $66.00 $66.00 basement out.see Labor measure to fix door,
door corroded.
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