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29-031 (3) 14 PIONEER KNLS BP-2020-0033 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-031 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING P E R M I T Permit# BP-2020-0033 Proiect# JS-2020-000050 Est.Cost: $4600.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sq.ft.): 11979.00 Owner: HANNULA CATHERINE Zoning: Applicant. VALLEY HOME IMPROVEMENT INC AT: 14 PIONEER KNLS Applicant Address: Phone: Insurance: P O BOX 60627 413 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON.7/12/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE ENTRY DOOR AND AWNING WINDOW IN EXISTING ROUGH OPENINGS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspec I or of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough; House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire D artment Fireplace/Chimney: Rough: Oil: Insulation: Final: Smok Final: THIS PERMIT MAY BE VOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND GULATIONS. Certificate of Occupancy Si nature: Feer e: Date Paid: Amount: Building 7/12/ 019 0:00:00 $65.00 12 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner C� N 00W1 DepaFtm -nt use only' City of Northampton status ofPem,'T: Building Department Curb Ctit/Dfveway Permit s z -= 212 Main Street Sewer/SepticAvailabllity Room 100 W6ter/WellAvaijabdhy — t\ Northampton, MA 01060 Two Sets of uctural Plans str �,- ,�• - phone 413-587-1240 Fax 413-587-1272 Plot/sfte Pl ns Other Sig-C177 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLI A E OR TWO FAMILY DW LIN SECTION 1 TSIE INFORMATION JUL " 9 2019 }fes' Thrs. ecti to be co d 1.1 Property Address: y' r a{ ,� rDFPT 0, butt t�ia ikt`F Ma t LOtopow, t�T+ T #DRQ a r rA4 Zonefi Overlay©cstri � NO i s Ely SECTION 2:-PROPERTY OWNERSHIP/AUTHORIZED AGENT',: 2.1 Owner of Record: p� p &&-id -7 �LL11/ R l 1/ k./t is Name(3nnt) Current Mailing Address: X tip+ -�� C� `7ts-aay Qi1Y1 LI Telephone Signature 2.2 Authorized Agent: c�►-e�2 c1 S I l\jerrn a-n P c�. x t�o�a1. $'l ore�-�c� (� o►c�C�Z Name(Print) Current Mailing Address: i'd/01 - 4t3-59q--j522 Signature V IV IV IV rVil Telephone SECTION:3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Officia[.Use.Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (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) Check Number This.Section:For.rOffic al Use:Only ' Date Building Permit Number: lssued: Signature: L I h.- Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition Replacement W' lows Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [Q Siding [ED] Other[Q] Brief Des boo of Pro p�p°s L / \ Work: mace lC ea7T / f" (4 Awo fVA (AWGIOA) iN C. 6jLyk� aw i1 cvem'9j s Alteration of existing bedroom Yes No Adding new bedroom Yes No `! Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa._If.Neuv house and..6 ac dttloWto ex s66_ `l ousing: complete the folfov�iing: 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 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 COMPLETEb.WHEN OWNERRS'AGENT OR CONTRACTOR.APPLIES:FOR BUILDING PERMIT I, County 411"'w 1OL as Owner of the subject property hereby authorize T I i-eQren Gi hie rry7cc 7 to 2Qt on my behalf, in II atters relative to work authorized by this building permit application. Signature of Owner. Date I, l� �t'1 cel Ikier- jan, V 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 under the pains and penalties of perjury. Print Name 7 Signature of Owner/Agent Date City of Northampton Massachusetts ' s''f M Y DEPARTMENT OF BUILDING INSPECTIONS ' 212 Main Street • Municipal Building `ski ,- Northampton, .MA 01060 AFFEDAVIT- Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR')regulates the registration of contractors and- subcontractors performing improvements or renovations on detached one to four family homes.Prior to performing work on such homes, a contractor must be registered ad a Home Improvement Contractor("FEC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation,repair, modernization,conversion, improvement,removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: 6-alac-M 0 - d o S O W rrQw Est.Cost: Address of Work � X_ P/✓ �� � + Date of Permit Application: I hereby certify that: Registration is not required for the following reasoll(s): _Work excluded by law(explain): _Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury. I hereby apply for a building permit as the agent of the owner: p Gu 124640 VA nA�ab C 1055 y 3 Date Contract6r Name MC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts £, DEPARTMENT OF BUILDING INSPECTIONS ,4 j Y 212 Main Street •Municipal Building JbsY c?: r Northampton, MA 01060YD 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: -d 0 I-M n* (Please rint house number and street name) Is to be disposed of at: eke \C) ��hc+?�� (Ple ` e print n�Fde and locatfon of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of ermit p icant or Owner Dab�4t 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. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employ a is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written.' An employer is defined as"an indi 'dual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. $e advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out' the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permi 'cense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.where a home owner or citi�en is obtaining a.license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT'required to complete this affidavit. The Department's address,telephgne and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-NUSSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Commonwealth of Massachusetts ®� Division of Professional Licensure Board of Building Regulations and Standards Const\ ct1 Sri pervisor �J CS-077279 E ires: 06/2112020 s I � L's_il 'f s STEVEN A SIL-VERMAN-rr:i ^ _ 268 FOMER RO D J1-�� y SOUTHAMPTON=YVIA 01073.: G 7.SS Commissioner 1 Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement..-Con\ractor Registration Type: Corporation VALLEYHOME IMPROVEMENT INC i T�U. Registration: 105543 P.O.BOX 60627 �'r Expiration: 07/16/2020 FLORENCE, MA 01062 `-k v 4�� Update Address and Return Card. i 20M-05117 ✓/� �in�m-cvzcct�¢CG�cy�.%�¢i1¢�cdelli Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:�Cornoration before the expiration date. If found return to: Registra`tion\ Expiration Office of Consumer Affairs and Business Regulation 05 07/16/2020 One Ashburton Place-Suite 1301 kLLEYHOME(],"BIRGVEMEN :II C Boston,MA 02108 EVEN A.SILVE RMAN 4 •./ (? /� lG!// ��/ RIVERSIDEDFT �!% RTHAMPTON,Ma 0106,2 Undersecretary Not valid without signature