30C-083 (4) 144 CLEMENT ST BP-2020-1084
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30C-083 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Bath reno BUILDING PERMIT
Permit# BP-2020-1084
Proiect# JS-2020-001830
Est.Cost: $22500.00
Fee:$146.25 PERMISSION IS HEREBY GRANTED TO.-
Const.
O.Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 32539.32 Owner., DAVIS J MICHAEL&ALINE LABORWIT-DAVIS
Zoning: SR(100)/ Applicant. VALLEY HOME IMPROVEMENT INC
AT. 144 CLEMENT ST
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.4/29/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-MASTER BATH RENO
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.)V. 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 Si¢nature:
FeeType: Date Paid: Amount:
Building 4/29/2020 0:00:00 $146.25
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Departmeht Ose only'
City of Northampton qA ac. u
/ Building Departmm'.f 9� Curb Cu?JDvivewayPermit—_---------------
212
.-212 main Street , Sewer,sar _� nv i t ii,ty_ --
k') a Room W
100 �.��,, at6rfVMe11 Avg.Lability _
\ : , -
Northampton, MA Q1060 T het a: ry7 n�
phone 413-587-1240 Fax 413-587-1272.< ;c,' .., i l:, I
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE O DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION, 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
Zip moo.
Zone Overlay District
Elm St.hisfrjrt CB D.srrict
SECTION,2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2..1�}Owner of Record: b
ike 4 It c
Name(Print) Current Mailing Address-
l `J'-I`t
Telephone
ature
2.2 Authorized Agent:
. n.n Si IQ C_K .a.t , Q,(�>" UCAoDl ROr.0Dc( 1Vt3- c+(:)t,-,Z-
j N:a^;e(Tlnnt) ,r Current Mailing Address:
Signature Telephone
SECTION-3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1, ouiiding0 pO (a)Building Permit Fee M
2. Electrical OUb (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 Official Use Only
l� ,
Building Permit Number. Date
Signature: LIP&_ as
Building Commissioner/inspect or of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Atteration(s) Roof ng
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [C] Siding [O] Other[0]
Brief Description of Proposed ���
Work:
} i' f existing bedroomYes No Adding new bedroom Yes wri�
Al,ora.ion o
Attached Narrative Renovating unfinished basement Yes No OPQ Iy
Plans Attached Roll �-Sheetr
sae If New house and or addition to extstiriq housing, complete the following:
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 cf new construction. Dimensions
e. Number of stcries?
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
i. Depth of basement or cellar door 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 WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
property
hereby authorize aET . r)
to act on behalf, in al matters relative to work authorized by this building permi�aplication.
Cir
Signature f Owner Date
as Owner/Authorized
Agent hereby declare that the statements and ir.formation on the foregoing application are true and accurate,to the best of my knowledge
and belief.
S;gn.ed under the pains and penalties of perjury.
Prink Name
Date
City of Northampton
•rry ) U Massachusetts
F DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
,_'_N- ." 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("HIC").
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 �Q2 u1'�n& 1 Est.Cost:
Address of Work tq( C1 0i O "
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reasou(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 RESPONSIBILTTES 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:
a ��r u ►�►� maIAr 51C 1055X13
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
Massachusetts
-, � _ � �.• _fes
DEPARTMENT OF BUILDING INSPECTIONS ?;
212 Main Street • Municipal Building JL't b
µ Northampton, MA 01060 s Y.....
Massachusetts Residential Building Code
Section 110.R5.1.2
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 who constructs more than one
home in a two-year period shall not be considered a homeowner.
Section 110.R5.1.3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5,provided that if a homeowner engages a person(s)
for hire to do such work, then such homeowner shall act as supervisor.
Such homeowner shall submit to the Building Official, on a form acceptable to the Building
Official, that he/she shall be responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to
time, during and upon completion of the work for which this permit is issued.
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.
i
City of Northampton
*z F Massachusetts
^� DEPARTMENT OF BUILDING INSPECTIONS
^ j 212 Main Street •Municipal Building �`�y., Com:
�.-..,rr. Northampton, MA 01060 bjY
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 street name)
Is to be disposed of at:
(Pie-de print ndrde and locatfon of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of Permit Abp lic'ant'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.
1
The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street, Suite 100
Boston,MA 02114-2017
,M swww mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): ;'I P(1 f i�ro1e n erO- t —Th C-
Address: Q.O �O� LoOln�1 C��U�rSe-�rly�
City/State/Zip: V kxenc-c, L(` y, C>\bb2 Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.E�I am a employer with JB 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. M Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.F—II am a homeowner doing all work myself.(No workers'comp.insurance required.]t
10 [J Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.F-I Plumbing repairs or additions
5.r7 I am aeneral contractor and I have hired the sub-contractors listed on the attached sheet
g 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.ins,,,-,,,ce.t
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'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.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: AY�11a a(lsuca Ye_ 6 y-a F 1
Policy#or Self-ins.Lic.#: 0 oc�—,&D 3 5 Expiration Date: ci
Job Site Address: City/State/Zip: '}
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$],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.
1 do hereby certify under the pains and penalties of erjury that the information provided above is true and correct
Signature: 011111 Date:
Phone#:
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
6.Other
Contact Person: Phone#:
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constr-,P-'- Upervisor
CS-077279 ~\ , 'rf
E ires:06/21/2020
STEVEN A SIL
VERMAN
268 FOMER R0_AD
SOUTHAMPTOU,VIA
j1,SS330�S
Commissioner
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement-Contractor Registration
Type: Corporation
�i __ _. � _r Registration: 105543
VALLEYHOME IMPROVEMENT INC -I ��U Expiration: 07/16/2020
P.O.BOX 60627
FLORENCE, MA 01062
v 4��
a
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Update Address and Return Card.
I 6 2OM-05/17
✓� �o��mcva�a�¢C°l�C �.��¢.i1¢�iaell�
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:
Reoistration� Expiration Office of Consumer Affairs and Business Regulation
T055-43
5=� 07/16/2020 One Ashburton Place-Suite 1301
VALLEY HOME(M2RQVENJEN INC Boston,MA 02108
STEVEN A.SILVERIviAN_qCGQ , 7// �2
340 RIVERSIDEDR' � J "�rj
NORTHAMPTON,MA 01062 Undersecretary Not valid without signature
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Q. PROJECT NOTES:
PROJECT PLAN 41 E "
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o- TH15 PLAN SET,COMBINED WITH THE BUILDING CONTRACT,PROVIDES BUILDING DETAILS FOR THE RENOVATION OWNER: Mike Davis
INDEX OF DRAWINGS LO p
mo PROJECT. THE LEAD CARPENTER SHALL VERIFY THAT SITE CONDITION5,AND DIMENSIONS ARE CONSISTENT WITH TITLE SHEET > Z' _
c o THESE PLANS BEFORE STARTING WORK.WORK NOT SPEGIFIGAL'_Y DETAILED SHALL BE CONSTRUCTED TO THE SAME PROJECT 144 Clement St. FROJEGT SUMMARY 1
..+ FRE5ENTATION 2 Z o r
QUALITY AS SIMILAR WORK THAT IS DETAILED.ALL WORK SHALL BE DONE IN ACCORDANCE WITH INTERNATIONAL ADDRESS: Florence,MA L cV
y _ _-..r l EXISTING GONDTIONS 3 �p ;
BUILDING AND LOCAL CODES. FROP05ED VV ANNOTATIONS 4 O
j t f - BLDG PERMIT: FR ELECTRICAL
P DIMENSIONS 5 x0 3
4 ELECTRICAL PLAN b � X: 33
°Q v i, f WRITTEN DIMENSIONS AND SPECIFIC NOTES SHALL TAKE PRECEDENCE OVER SCALED DIMENSIONS AND GENERAL O
nY..s m CV
NOTES.THE SALE PER5ONIDE5I6NER SHALL BE CONSULTED FOR CLARIFICATION IF SITE CONDITIONS ARE DESIGNER: 5A5
yl ENCOUNTERED THAT ARE DIFFERENT THAN SHOWN,IF DISCREPANCIES ARE FOUND IN THE PLANS OR NOTES,OR IF A
VJ (L r
o c • QUESTION ARISES OVER THE INTENT OF THE PLANS OR NOTES.CARPENTER OR SUB-CONTRACTOR SHALL VERIFY AND E `p
IS RESPONSIBLE FOR ALL DIMENSIONS(INCLUDING ROUGH OPENIN65). tYl N
ALL TRADES SHALL MAINTAIN A GLEAN WORK SITE AT THE END OF EACH WORK DAY.
C N
y o PLEASE SEE ADDITIONAL NOTES GALLED OUT ON OTHER SHEETS.
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This plan is the proprietary work product of Valley Home Improvement,Inc.(VHI).It is delivered for the limited and exclusive purpose of supporting the contract bid of VHI,and customer agrees that the elements of this plan shall not be republished or presented in any
form for the purpose of enabling or supporting the work of competing project contractors without the permission of,and compensation paid to,VHI.
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Valley Home Improvement, Inc. 144Clement Stt621orence,MA PRESENTATION SCALE:SEE VIEW SHEET NUMBER
540 Riverside Drive, PO Box 6062'1, Northampton, MA 01062 — DATE:4/14/2020
Office Phone 415.5b4.7522 Fax 413.555.0820 Mike Davis 2 DRAWN BY: 2
Find us on the web at: wuw.Valle HomeImprovement.corn C.M.S.
This plan is the proprietary work product of Valley Home Improvement,Inc.(VHI).It is delivered for the limited and exclusive purpose of supporting the contract bid of VHI,and customer agrees that the elements of this plan shall not be republished or presented in any
foam for the purpose of enabling or supporting the work of competing project contractors without the permission of,and compensation paid to,VHI.
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Valley Home Improvement,
Inc_ 144 Clement St. Florence,MA EXISTING SCALE:SEE VIEW SHEET NUMBER
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340 Riverside Drive, PO Box 60627, Northampton, MA 01062 01062 /`, DATE:4/14/202()
Office Phone 413.584.7522 Fax 413.585.0820 Mike Davis CONDTIONS DRAWN BY: 3
Find us on the web at: uuw.ValleL4HorneIm rovement.corn C.M.S.
This plan is the proprietary work product o/Valley Home Improvement,Inc.(VHI).It is delivered for the limited and exclusive purpose of supporting the contract bid of VHI,and customer agrees that the elements of this plan shall not be republished or presented in any
form for the purpose of enabling or supporting the work of competing project contractors without the permission of,and compensation paid to,VHI.
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144CIemen010621orence,MA PROPOSED W/ SCALE SEE VIEW SHEET NUMBER
Valley Home Improvement, Inc.
340 Riverside Drive, PO Box 60627, Northampton, MA 01062 r V Y DATE:4/14/2020
Office Phone 413.584.7522 Fax 413.585.0820 Mike Davis ANNOTATIONS DRAWN BY: 4
Find us on the web at: uAuw.1/a11e HomeIm provement.corn c.M.S.
This plan is the proprietary work product of Valley Home Improvement,Inc.(VHI).It is delivered for the limited and exclusive purpose of supporting the contract bid of VHI,and customer agrees that the elements of this plan shall not be republished or presented in any
form for the purpose of enabling or supporting the work of competing project contractors without the permission of,and compensation paid to,VHI.
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Valley Home Improvement, Inc. 144 Clement St. Florence,MA PROPOSED YY/ SCALESEEVIEW SHEETNUMBER
340 Riverside Drive, PO Box 6062'1, Northampton, MA 01062 01062 DATE:4/14/2020
Office Phone 413.584.1522 Fax 413.585.0820 Mike Davis DIMENSIONS DRAWN BY:
Find us on the web at: wuw.Valle HomeImprove ment.comC.M.S.
This plan is the proprietary work product of Valley Home improvement,Inc.(VHI).It is delivered for the limited and exclusive purpose of supporting the contract bid of VHI,and customer agrees that the elements of this plan shalt not be republished or presented in any
form for the purpose of enabling or supporting the work of competing project contractors without the permission of,and compensation paid to,VHI.
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1/alley Home Improvement, Inc. 144 Clement St. Florence,MA SCALE:SEE VIEW SHEET NUMBER 340 Riverside Drive, PO Box 60627, Northampton, MA 01062 01062 ELECTRICAL PLAN DATE:4/14/2020
Office Phone 413.584.1522 Fax 413.585.0820 Mike Davis DRAWN BY:
6
Find us on the web at: wwW.Valle Homelm provement.corn, C.M.S.