22B-112 (5) 53 MEADOW ST BP-2021-0123
GIS#: COMMONWEALTH OF MASSACHUSETTS
MW:Block:22B- 112 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit# BP-2021-0123
Project# JS-2021-000196
Est.Cost: $11500.00
Fee: $75.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sa. ft.): 12806.64 Owner: BUNK BRIAN D&LAURA P SIZER
Zoning: URB(74)/URA(26)/WP(23) Applicant. VALLEY HOME IMPROVEMENT INC
AT. 53 MEADOW ST
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.81312020 0:00:00
TO PERFORM THE FOLLOWING WORK.-RE-DECK
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 8/3/2020 0:00:00 $75.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Detiartmej.nt qse only
r tw
City of Northa pton of Permlt k z
.�
Building Dep�rtmq e/ r Drtveway Permit >
212 Main St e ti°r, cAvadahlcty =
�( p Room 100 1 °9 1t11ate 8 A dabilrty n T G
es
Northampton, MA 01 a;,;o, w Se of Strii ural Plans
phone 413-587-1240 Fax 413 Pto tte Pl 3r'
�s , c
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVA O _DE ISH A ONE OR TWO FAMILY DWELLING
ffSECTION1TE INFORMATIONThis sectian to be compte2ed by officeddress: {{
Mai ' Lot 1 Unit =
Zoned 2� OverlayDistnct
Elm SLVitnct =CB Q�str►ct ;.:+ ,
SECTION Z-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
t ,� � k..- U&��-
Name(Pri Current Mailing Address:
_ c ( I�j 2c 'lc 10
Telephone
Signature
r*(Print : _
Current Mailing.Address:
Telephone
SECTION3-ESTIMATED CONSTRUCTION COSTS
Estimated Cost(Dollars)to be Officiat Use.Only
Item completed b permit a plicae#
t (a)Building Permit Fee
1. Building
2, Electrical (b)Estimated Total Cost of
—' Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) -
5. Fire_Protection 111
f
r`7 Check Number J(J
6. Total=(1 +2+3+4+5) f
This Section Frlssue6_
al Use Only
2
Building Permit Number, V / /
Signature:
Building Commissionerlinspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING A1.1 Information Must Be Completed, Permit Can Be Denied Due To Incomplete information
Existing Proposed Required by Zoning
'this column to be Titled in by
Auildng L7cpazGncnt
Lot Size
r
Frontage —
Setbacks Front
Side LI—1 R:=
Rear
Building Height -
Bldg.Square Footage -I %
Open Space Footage %
(Lot ara mions bldg&paved
arkin )
i
m
of?arking Spaces
Fill:
i
volume&Location)
A. Has a Special Permit/Variance/Finding ever beep issued for/on the site?
NO 0 DONT KNOW Q YES 0
IF YES, date issued:;
IF YES: Was the permit recorded at the Regisv'y of Deeds?
NO 0 DONT KNOW 0 ,' YES 0
IF YES: enter Book Page and/or Document# �
B. Does the site contain a brook, body of vaster or wetlands? NO DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained � �� Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type�nd location:
D. Are there any proposed chges to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, ype and Location:
3
E. Will the construction acoty disturb(clearing,grading,excavation, or rifling)over 1 acre or is t part of a common plan
that will disturb over 1 cre? YES 0 NO 0
I
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION$-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing F
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks";E . Siding [0) Other{Qj
Brief Description of Proposed -- „ {
Work: K-F. bf,(14, " •�tu grZ
Alteration of existing bedroom Yes No Adding new bedroom Yes -,4 No
Attached Narrative Renovating unfinished basement Yes -74— No
Plans Attached Roll -Sheet
SavI New house and-"ac addition=fo extstrr g houslng;complete the fol(ovr n4:
a. Use of building: One Family Two Family Other
b. Number of roorns 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
L 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 CONTR:ACTOR.APPLIES FOR BUILDING PERMIT
as Owner of the subject
property
hereby authorize c71 CSM
to act on my behalf, tters r ativs t r` uthorized by this building permit application.
Signature of Owner Date
MM
V l" 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 Ow-c lAgent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: cam- t � � � 0-17L)
et.. License Number
(`1C
114"C'Ii ' ( -T-7t<. !en(c,
Address Expiration Date
Sign a I AT Telep one
9 Redis#aced tome Iriprovement.Coofractor � � � `� ;: . � ;.:� Not Applicable O
Comnany Nafhe Registration Number
Q1ab2- 2-0
Address AMC� Expiration Date
Telephone 1� ��� —%`✓ZZ
tv
SECTION 10-WORK I ERS?COMPENSATION INSURANCE AFFIDAV"IT(M.G.L c.152,§25C{6})
Workers Compensation Insurance affidavit roust 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 Attached Yes....... No.- 0
I
i
i
City of Northampton
Massachusetts V.
x
e DEPARZ?MNT OF BUILDING INSPECTIONS
2 Main Street • municipal Building
.. 21 P
Northampton, MA 01050
AFFmAVIT-
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.
'Vote:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work_ Est.Cost:
Address of Work 55 _ pct cam ` I Cy'P._.P' ce Ila o tU to7
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(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 OVF'N PERVaT OR ENTERING LNTO CONTRACTS VYTTH 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:4I.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE LN'FOR-NIATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
Yl G 11 '�iT 7�C t Yltt'1 r '1 C 4 5 9 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
DEPARMSNT OF BUILDING INSPECTIONS
� �..
212 Main Street •Municipal Building
Northampton, MA 010655
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:
15� kAt-ad d4re rlu- olc*z-
(Please print house number and street name)
Is to be disposed of at:
I-eu RK�4W14L — ��c \D
(Pl e print n2te and loc 6 on of fadity)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
7 �
SignatuAPer plicant 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.
........_. ..............
4
The Commonwealth of Massachusetts
.11epartment offndustrialAccidents
I Congress Street,Suite 140
Boston,FNM 02114-2017
wrc,w.muss.gov/dia
"orkera'Compensation Insurance Affidavit,BuildersrCoutractorslElectricians/Plumbers.
TO BE PILED V TTH THE PER-NUTTING AUTHORITY.
Applicant Information {{ Please Print Le�ibl _
Name(Business/Organization/flndividual): 'M �t `i�f 1C'I t c C
Address: ?2t74 tQ c)
City/State/Zip: F\C>(enC_C, r4, C> (bb?_ Phone
Are you an employer?Cheek the appropriate box= T3pe of project(required):
1,6I am a employer with— t�,_employees(full and/or part-time) ?. F1 New construction
2.Q I am a sale proprietor or partnership and have no employees working for me in S. 21 Remodeling
any capacity.[No workers'comp�insurance required] 9. ❑Demolition
�.❑I am a homeoezrer doing all work myself[No workers'comp.msurnce required]t 10 t—t Biding addition
4.❑I am a homeowner and will be hazing contractors to conduct n all work omy property I will L1
11.❑Electrical repairs or additions
ensure that au contractors either have worker'compar sation insurance or are sole
proprietors with no employees. 12.0 Plambulg repallS OI additions
5.0 1 am a genual contractor and I have hired the Suri-contractors Hafted ou the attached sheet 13_F�Roof repairs
These sub-contractors have employees andhave workers'comp.insurance.* 14.Q Other_.
6,F1Ve are a cow oration audits o'£ftcera have exercised their right of exemption per;-SGL.c.
152,y1(4),and we have no employees.[No worker'camp.insurance required.]'
.Any applicant that becks box l must also fill out the section below showing their workers'compensation policy infomration.
I Homeov mcrz who submit this atEdavit indicating they are doing all woer and then l ue outside contractors must submit a new affidavit indicating such.
?Contractors that cheer this box must attached an additional sheet showing the tame a€the sub-contractors and state whether eruct those entities have
employees, ifthr sub-ceatractor Imre employees,they must Pro.1de their worker'ramp.polity rlumbtr.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance CompanyName:_
i
Policy r or Self-ins.Lic.#: (DC7` O�C''Z't� Exp'rationDate; !� C?r-?
Job Site Address: t ._s
city/State,/Zip:`�_1,
Attach a copy of the workers'compensation policy declaration page(showing the policy number and exTiration date).
Failure to secure coverage as required under NICL 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 under the pains and penalties of erjury that the information provided above is true and correct.
Si Date: f
ague:
Phone#:
official use only. Do not write in this area,to be completed by city or town offtcial.
City or Town: Permit/License
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.city/Town Clerk 4.Electrical.Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Commonwealth of Massachusetts
,j Division of Professional Licensure
Board of Building Regulations and Standards
Constr3?ck�' rflSr 'pe,ry s o r
rJ
CS-€377275 res:06121/2020
STEVEN A SIIVERM z
268 FOMER ROAD } i
SOLITHAMPT4W�i+IA U1fl73:f L
Commissioner
�.
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement'�-Contractor Registration
Type: Corporation
1,1 ' Registration: 105543
VALLEY HOME IMPROVEMENT INC Expiration: 07116/2020
P.O.BOX 60627
FLORENCE,IVDA 01062
Update Address and Return Card.
.i'�e �ora7i)7:tvtcu�czGer2�c�..�r^v�a¢4jrcc��.3a�t .
Office of Consumer Affairs&Business Regulation
HOME IMPROVE14E'dT CONTRACTOR Registration valid for individual use only
TYPE:Ccmoradon before the expiration date. if found return to.
Reaistsation_� Expiration Office of Consumer Affairs and Business Regulation
01-5Si 07/16/2020 One Ashburton Place-Suite 1301
4'ALL YHOMEP'AAaBOYEM :s C Boston,MA 02108 _
A
STEVEN A.SILVERt lltM o," Q CLQ /yy f
340 RIVERSIDEC)F
NORTHAMPTON,MA 01QPi2 Undersecretary Not valid without signature