31A-019 (2) 14 SANDERSON AVE BP-2021-0098
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:31 A-019 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: KITCHEN &BATH RENO BUILDING PERMIT.
Permit# BP-2021-0098
Proiect# JS-2021-000150
Est.Cost: $42700.00
Fee: $277.55 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq.ft.): 6098.40 Owner: SHERR RICHARD J
zoning: URB(100) Applicant: VALLEY HOME IMPROVEMENT INC
AT: 14 SANDERSON AVE
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.7/27/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-KITCHEN AND BATH RENO
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:
FeeType: Date Paid: Amount:
Building 7/27/2020 0:00:00 $277.55
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
p0fy 5 ft 26(-(
------_ Department use only ,
City of Northatnpto f
Building Departure t JUL Curti C Drty way Permit g
x
212 Main Street 2 4 wer eptic vailabt[tty
" Room 160 Water eii atlability
Northampton, MA 0�'�} ?°F�IJILDi�r;iris of tructural Ptans
phone 413-587-1240 Fax 413-'; - °N r"a pl
OtherSpecifjr ��..--
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: This sactton to=be complete Y office
L4 s�-ncte�'"'�J�"�"`'> 0-0 1,. .' Map
Lot,
' Unit
Zona - OverlayDsstrtct
Elm SL Distnct - = CB Distric
SECTION 2-PROPERTYOWNERSHIP/AUTHORIZED AGENT "
2.1 Owner of Record:
� tc�1Ct4�ear"r i'-tt -, � 046
Name(Print) Current Mailing Address:
_ Telephone
Signature
2.2 Authorized Agent:
Name(Print) / e !t e Current Mailing Address:
413—5&Af 52.2
Signature s x y Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official.Use Only
complete by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from S
3. Plumbing Building Permit Fee
7`7"4. Mechanical(HVAC)
5. Fire Protection
5. Total=(1 +2+ 3+4+5) Check Number
This Section.For Official:Use Only
Building Permit Num r: .. Date
tssuec:
Signature: -7- 2-7-
SuRding Commissionerltnspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING Alt 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 Depart hent
Lot Size
1
Frontage
Setbacks Front
Side L:{ l R" L:= RI
Rear [—?
Building Height
Bldg.Square Footage I —— % 7
k
Open Space Footage _ % _
(Lot area minus bldg&paved j i
a
it of Par Spaces
Fill: k
(volume&Location)
A. Has a Special Permit/Variance/Findin ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry f Deeds?
NO Q DONT KNOW C) YES 0
IF YES: enter Book Rag r and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the t9nservation Commission?
Needs to be obtained 0 Obtained 0 `,, Date Issued:
C. Do any signs exist on the property? YES Q NO 0
IF YES, describe size, type and location: �+
k
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
E. Wil{the construction activity disturb(clearing, grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
i
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: �{?
License Number
Address Expiration Date
r
Signature el phone
9 fZeiaistereri#iome tmpcovement Contractor:_ Not Applicable ❑
Company NaffieRegistration Number
(o()(0;1-7 r'tC)(et X1 U1Dbz `1 � 11 � 2b
Address f "
a rl. Expiration Date
f 'iV �� Telephone
SECTION 10-WORKERS'COMPENSATION IN SURANCE.AFFfDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and.submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit A'tached Yes....... No.._... ❑
I
3
i
(
I
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition Replacement Windows Alterations) Roofing ED
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks (E:J Siding(o] Other DW'
Brief Description of Proposed
Work: 140 C LY "�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa_Cf.Neinr'hatise,and''or addlttOil to existing houstizQ cgrrlRiete the`foltowrrfg:
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 WHEN
OWNERS AGENT OR CONTRACTOR.APPLIES FOR.BUILDING PERMIT
(11aA S)h&r as Owner of the subject
property C t
hereby authorize\)iflf c7>t'�rGn c71�V CF'r']�lCt�^
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
i. ek +nq �ttfrrnQr7� V R-z 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
Signature of eAgent Date
............._____........... .
City of Northampton
, <- Massachusetts , ,
DEPARTMENT OF BUILDING INSPECTIONS a
212 Main Street •Municipal Building
.1.....- ..,i,..
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:
t So.
(Please print house number and street name)
Is to be disposed of at:
� -Q� - XoNk—r— �D
(Pleaje print n9f4e and ioc ;on of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
r
I r�J
Signature'of` ei- it 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.
City of Northampton
Massachusetts
_zt
= ,t.
DEPARMENT OF BUILDING INSPECTIONS :
212 Main Street • Municipal Building
Northampton, MA 01060
AFFIDAVIT
Rome 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 Rome 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 f the homeowner has contracted with a corporation or LLC,that entity must he registered
Type of Work k OdLf-A Est. Cost:�2
Address of Work: i q
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reasoa(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 CONTR4CTS WTM UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME LMPROVEMEN'T WORKARE NOT
ELIGIBLE FORAND DO NOT RAVE ACCESS TO THE ARBI'T'RATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNTRS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER TIME 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 �Ino 00Mc iN V�'«A l" C. '1055 9
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
}
6f_\ The Commonwealth of Massachusetts
Department of Industrial Accidents
I Conti ess Street,Suite 100
Boston,MA 02114-20.17
q www mass.govldia
V,orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers,
TO BE FILED VFTTH THE PERMTTTMG AUTHORITY,
Applicant Information Please Print Lep
ibiy
Name(BusinesdOrganization!Individual): ; (}�}f ��T1.�Y�.� r}�Pr r—In c—
Address:_p,0.bcx, 100(0� 1, -61Ab
City/State/Zip: b(P....nc.e '(4, o`c�b2 Phone#: t3-C 5Sq--1c�>D'�;L
Are you an employer"Check the appropriate box: Type of project(required):
1,gi am a employer with_-0—employees(full andlorpart-time).* 7. E]New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in $, 0 Remodeling
any capacity.[No workcrs'comp.insurance required.)
3.E]I am a homeowner doing all work m myself 1 ❑BuildgDemolition
y (NO WpZ�eZS'Comp.inSl3IaneC ZCQU3red_)t
i0 Building addition
C F❑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.r Electrical ICpalIS or additions
proprietors with no employees.
12.E]Plumbing repairs or additions
5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13. Roof repairs
These sub-contractors have employees and have workers'comp.insw-ancc l
6,RWe are a corporation and its officers have exercised their right of exemption perMGL c. 14. QtheI
152,¢1(4),and we have no employees.[No woikers'comp.insurance required_]
*Any applicant that cheeps box#1 must also fW out the section below showing their woi ers'compensation policy information.
t Homexw mors Who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such..
*Contractors that cbeck this box must attached an additional sheet showing the name of the sub-contracton and state whether or not those entities have
employees. If the sub-contractors have employees,they must pioNide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy an d joh site
information.
Insurance Company Name: &btf oa .1 nSLS �� 6 yn:e
Policy#or Self-ins.Lie.#: (���d O�. 5 Expiation Date: a , _
Job Site Address: i Q .7a,1 [ GLin_aAxi''?_ City/State/Zip:Q0(00
Attach a copy of the workers'compensation policy declaration page(showing the policy number and eapir tion 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 ane 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.
Ido hereby certify under thepains andpenalties of erjury that the information provided above ris true ra-�n/dycorrect.
Signature: rr� �fir Da*e �4`7 1L..tc1�
Phone#:
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/lAcense 4
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:9:
z Commonwealth or Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Cons?rj titl't�rryySri5peryisof
lJ
CS-077279 �� "+ Ea Aires:06/2112020
STEVEN A Sit VERr,4
268 FOMER RO D
SOUTHAMPTO.Ii. A 0473%y ?O
�GCI.SS�3O�S .
Commissioner
e../z `!i� � /1iilf
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
r.
Home lmproveme t`-Gontractor Registration
Type: Corporation
VALLEY HOME IMPROVEMENT INC
Registration: 105543
P.O.BOX 60627 :��=' Expiration: 07/1612020
FLORENCE,MA 01062 "; +
,b
-05hUpdate Address and Return Card.
1 Cr 2��oM7+ p
J1iC C�M1i7LGYLfG'tLZ��(��Q,116C./ICIr3C�I.1
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:,C orporation before the expiration date. If found return to:
ftgistratron Ey
ofration Office of Consumer Affairs and Business Regulation
1
� 07/ 6/202i�� One Ashburton Placa-Suite f 3Dt
VALLEY HO ,E(jMeFiJVE@9E , NC Boston,fvtA 02108
�= ay
STEVEN A.51LVERM%Tla1
340 FflVERSIOEO4��'.,y��
NORTHAMPTCN,MA 0 2 — Not Valid WIfhOUt Signature
Undersecretary g