43-005 181 WESTHAMPTON RD BP-2020-0132
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mg.-Block:43-005 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:BASEMENT RENOVATION BUILDING PERMIT
Permit# BP-2020-0132
Proiect# JS-2020-000210
Est.Cost: $26950.00
Fee: $175.50 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq.ft.): 30927.60 Owner. LEVINE LEAH R&EVY BERMAN
Zoning: Applicant. VALLEY HOME IMPROVEMENT INC
AT. 181 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
P O BOX 60627 (413)584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.8/6/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-BASEMENT RENO -ADD BATH
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 Occupancy signature:
FeeTvpe: Date Paid: Amount:
Building 8/6/2019 0:00:00 $175.50
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2020-0132
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 181 WESTHAMPTON RD
MAP 43 PARCEL 005 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATIO
NCLOSENJEQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: BASEMENT RENO-ADD BA
New Construction
Non Structural interior renovations
Addition to Existin
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
INF9KMATION 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 Northampt n p Status of P rmli
Building Departm nt ► 1 ECE naew�y Pe{mit'
r� h 212 Main Stree U -Ad i[abi[ity
Y fi'F r Room 100 war/W"I'Avai 'biltty
JUL �� - • <
� > Northampton, MA 106 3 ets'f Structural Pans
phone 413-587-1240 Fax 13- 87-1272 F?lot/slte .fans
DFpT ofNO—
BUIL her$"sg;,ar
APPLICATION TO CONSTRUCT,ALTER,REPAIR,REN �^r7� MG711SH A NE OR TWO FAMILY DWELLING
SECTION 1 SITE INFOFMATION
ra This sectton o be completed by office
1.1 Property Address: µ'ms¢d + try
��1 �� ,M(�1^',v,�(^✓� �Map� "'�=k� 5 �ot�" � -
`/ 4.:� i L"•� :';;q:#i #i
Elm St_District CB D�strct t: M� T
SECTION 2:-PROPERTY OWNERSHIP/AUTHORIZED AGENT.
2.1 Owner of Record:
Name(Print) Current Mailing Ao,,R( O 83 _ (JZ/
✓`� +'— Telephone I Y,
ignature
2.2 Authorized Agent:
1 I P-O•�oX (.ouoan, U10C,,Z
Name(Print) Current Mailing Address:
4w, 41 &L -
Signature Telephone
..SECTION:3=ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official:Use.Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical f� (b) Estimated Total Cost of
vV Construction from 6
3. Plumbing �j/ t y�-}, Building Permit Fee
7s1
V
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3 +4+5) Check Number
This.Section:For.Official.Use Only
Date
Building Permit Numb r: Issued: -
Signature: ZDV
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 Windows Alteration(s) Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [Q Siding [O] Other[p]
Brief Description of Proposed 61 -, t
Work:Vll(4i/J'ZS(olz/l� r� d&j,L[C. t Mf S-'M*-'31� �,C:-�1. ktQ CWngvf- I-V t {"
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement _Yes No
Plans Attached Roll -Sheet
( Neuv-house artd.or addition.to existing hots r q, comRlete tF�e falfowinc#:
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 COMPLETED 1NHEN
OWNERS:AGENT OR:CONTR/ACTOR.APPLIE&FOR BUILDING PERMIT
as Owner of the subject
property
hereby authorizeT� ��sCn �l lyermccr�
act on my behaP " atters relative to work authorized by this building permit application.
ignature of ci ✓ Date
I, (SPA_)-r_ 1 yif i-maa, V WE E 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
AOX,
Signature of Own r/ gent V Date
i
City of Northampton
Massachusetts �' •. `''�'
DEPARTMENT OF BUILDING INSPECTIONS �=
212 Main Street • Municipal Building
r _ Northampton,_MA 01060 ��
AFFIDAVIT-
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 as 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 withh a corporation or LLC,that entity must be registered
Type of Work �h � �i1 G6-t 7 Est.Cost:
Address of Work
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reasorl(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:
(� �Gu V _e mrrr��'I n C. X055 y 3
Date Contract6r Name HIC 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
+T F Massachusetts
G'.
DEPARTMENT OF BUILDING INSPECTIONS
"Y 212 Main Street •Municipal Building
Northampton, 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:
(Please print house number and s reet name)
Is to be disposed of at:
�O-Uifj� PACQ01CYA-g, -
(Ple ` e print ndFde and locatron of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signatur of ermit Applicant or caner gate
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 employee 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 individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a j oint 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 einployer."
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. Be 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 in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license 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 applicaht 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 citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT'required to complete this affidavit.
The Department's address,telephone 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-MASSAFE
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
Cons t\-.�jctiV§bpe,rvisor
�J
CS-077279 Eit-s: 06/21/2020
STEVEN A SILI/ERMAN .; _
268 FOMER RO D
SOUTHAMPTOrTY.A-01073:% >�
Commissioner l/"
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement,.-Contractor Registration
Type: Corporation
VALLEY HOME IMPROVEMENT INC ' ,`, s/j;• Registration: 105543
P.O.BOX 60627 f Expiration: 07/16/2020
1
FLORENCE, MA 01062 M
�-k -� 1
Update Address and Return Card.
i 20M-05//1177
✓� [�M7/J7-LS2CLL^¢C°l�c�,/l�i¢�.j¢r�iudell�
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:�CoriDoration beforethe expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
07/16/2020 One Ashburton Place-Suite 1301
WO
\LLEYHOME(hMeROVEMEN ,IC Boston,MA 02108
EVEN A.SILVERMATI-0 t� t? A /w
'/2
RIVERSIDEDR' �� '
IRTHAMPTON,MA 010F62 Undersecretary Not valid without Signature
The Commonwealth of Massachusetts
Department of IndustfialAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
NVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Lealbly
Name (Business/Organization/Individual):
Address: 31-10 R��e✓s�ct �r't�rc �o�c (oDc�21
City/State/Zip:'Fkore Lc k 01002 Phone
Are you au employer?Check the appropriate box: _ Type of project(required):
1 I am a employer with t t3 mployees(full and/or part-time).* 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Z Remodeling
any capacity,lNo workers'comp.insurance required.]
J-11 am a homeowner doingall work nn self. 9. ❑Demolition
y [No workers'comp.insurance required.]t
..❑I am a homcowncr and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.❑1 am a general contractor and T have hired the sub-contractors listed on the attached sheet. 13.❑Roof t airs
Ths
These sub-contractors have employees and have worker'comp.insuranre.t
6. We are a corporation and its officers have exercised their right of exe 14.❑Other
❑ rpmption per MGL c.
152,§1(4),and we have no employees.fNo workers'comp.insurance required.l
*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.
tContractors 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. Tf the sub-contractors have employees,they must provide their workers'comp,policy number.
I ant an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name: �Y ��CL ��(1SUi0.►�2(� C—1,rU"D
Policy#or Self-ins.Lic.#:_0 15 C5 CE:>0 3 y 2\S Expiration Date: o?) I )a�
Job Site Address: I z 1 I k3,0-4�\ rv\ PA]Cn City/State/Zip: RcV el?C C (Ka—O 1 0(o Z
Attach a copy of the workers' compensation po icy 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 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify un er the pains and pe lties of p hat the information provided above is true and correct
Signature: Date:
3
Phone#: y J— c524 cJ2-2—
Official
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
b.Other
Contact Person: Phone#: