44-086 (101) 1157 FLORENCE RD BP-2021-1179
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:44-086 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-2021-1179
Project# JS-2021-001974
Est.Cost: $30000.00
Fee: $195.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 61855.20 Owner: CLOPTON SUSAN M
Zoning: Applicant: VALLEY HOME IMPROVEMENT INC
AT: 1157 FLORENCE RD
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:4/14/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIRS TO DECKS
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.
I .
3-11 .
Certificate of Occupancy signatur.l ' r >42
FeeType: Date Paid: Amount:
Building 4/14/2021 0:00:00 $195.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
F -1
"-C—Er"--------"'VED
The Commonwealth of Massachusetts
W
Board of Building Regulations and stan Massachusetts State Building Code,/180
nrt, SE,
Building Permit Application To Construct,Repair,'Renoy unry ' evis Mar 2011
One- or Two-Family Dwelling. -ToN,Ma 0. ooNs
This Section For Official Use Only
Building? rmitNum : •..ai'I(77 • Date Applied:
ka.Pid er>s /Z/ LI-M-ZOz(
Building Official(Print Name) - Signature Date
SECTION 1:SITE INFORMATiON
1,1 Property Address; �.� 1.2 sssYs rs Map&Parcel N��mber
% 1
I i 51 Florence- oa� l4
• 1.l a Is*is an accepted street?yes,./ -n o Map Number Parcel Number
'1.3 Zoning information: 1.4 Property Dimensions;
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Ra^^r :
2 r C\Opc-Q - -t lOferiCe MO, 01,0(0 Z_
. Name(Print) City, State,ZIP
1 k51 ' tOre,tnce 042A 4.4 - S'1 -- 5O S 2
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2 (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s).0 Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
. Brief Description 54Proposed Work2: ,► _., a -'r 4.kXrits Tr L '130 S
0.-e\� (6a.,t k t ra S C? m f t LD �c\c�A.t r �� CGS
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ ,0,ixxT 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ 0 Total Project Cost' (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire • ,�J
Suppression) $ Total All Fees: $�,d {,
Check No.t(1(j 'Check Amount: Cash Amount:
6.Total Project Cost: . $ bf) °CV"- 0 Paid in Full -Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) p.11 2,1 (•p tZ l (7 zo zZ-
e.VCirl C304 rriarN License Number Expiration Date
Name of CSL Hotder
(�( List CSL Type(see below)
P.O �e, .. r' (o2-1
No.and Street Type Description
n ,� O`� r� U Unrestricted(Buildings up to 35,009 cu..ft.)
• '00cnnC� 1WJ V �C� R Restricted I&2 Family Dwelling
City/Town,Stat-- iP M Masonry��// 71 RC, Rnoiing.Cuvering
WS Window and Siding
• SF Solid Fuel Burning Appliances
"ll c k.-7152Z T Insulation
Telephone Email address D Demolition
5.2 Registered Hume improvement Contractor(HiC) t� ��� g 12o�emu— •
, e Q �)N►`7°, 1-TICRegistration Number Expiration Date
ITTC Comp Name or ETC Registr nt Name
\i cf .6 (00(02-1 c-lorerice CYl,C b 1 o c92
No. and Street 413-Say 1 2. Email address
City/Town,State, ZiP Telephone
SECTION-6:WORKERS' COMPENSATiON INSURANCE AFFIDAVIT(M.G.L.-c.I52.§ 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 Attached? Yes No .0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property,hereby authorize \I a_ 1 -t Pecan Cj(
to act on my behalf,in all matters relative to work authorized by this building permit application.
leAAA-C3 rn 01,6-43(7WY - - 4 7. d-/
t Owner's Name(Electronic Signature). Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the f my kn le , understanding,
,S' w) s)L Vet lNP v y—',a °leaf
Print Owner's or Authorized Agent's Name(Electronic Si ) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program can be found at
www.mass_aov/oca Information on the Construction Supervisor License can be found at www.mass.cov/dns
. 2. When substantial work is planned,provide the information below:
, arage finished basement/attics,decks or porch)
Total floor area(sq. ft.) (including g
., �.
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halftraths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
tT `--s r/
Y« f Massachusetts �w? *y- �r�J
// ( k
�1, i `1. DEPARTMENT OF BUILDING INSPECTIONS `�, I,1
i ,..'i'l
�r F �' /r 'J bli
\\ s '5 212 Main Street • Municipal Building /
North 01060
Northampton,
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, a condition of Building Permit
Number is that all debris resulting from this work all be disposed of in a
properly licensed waste disposal facility, as defined by MG-Lc 111, S 150A.
The debris will be disposed of in:
Location of Facility: \d l& QCc1 � t '�E' \C) , c�.4l-\G'
,J
The debris will be transported by:
Name of Hauler: `1oJi � kyvo ✓N ►'YVA-4—
Signature of Applicant: 1 t Date: ( "la.2 `oW i
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
• WWW.711ass.gov/dia
Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers.
TO E FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (nuviness/Organization/Individuaij: .\,) �l,h `ryTh —Or( rCA-e't(yle —
Address: « -D{1`7l . Q- . (cD 0 Co 22--
City/State/Zip c\-A 0 XX2(e _\-Q, tC(d2. Phone#: [VD— <B 1-1 S2 Z
Are you an employer?Check the appropriate box: Type of project(required):
1. i
I am a employer with . , employees(full and/or part-time).* 7. ❑New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ®Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.n I am a homeowner doing all work myself.[No workers'comp.insurance required.]
10 ❑ 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 tither Jsa'.e worker'compensation insurance or aresole 11.0 EllcCthiGa]repairs<Or.additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.❑T am a general contractor and T have hired the sub-contractors listed on the attached sheet. 13.El Roof repairs
These sub-contractors have employees and have workers'comp.insurance.*
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 most also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
<Contrators that etieclt this box must attached-an additional sheet showing the name of the sob-contrauturs 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: A(heAcc,
Policy#or Self ins.Lie.#: `' a 1 I cO 2.�SC7 �C72� � Expiration Date:
Job Site Address: I t SI ectaci City/State/Zip: () kr), 1"41 r 01 OCcC
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expir ation 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 under the pain nalties ofp ation provided above is true and correct. •
Signature:
Date: j 1, IGVZI
� p
Phone#: till J 6 S`1- s 2—
Official use only. Do not write in this area,to be completed by city or town official
City nr Town: Pei-mit/i,ic_.ense#
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#:
•
•
City of Northampton
•
Sys .:'°':..s��
` i Massachusetts �c
•
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building , �.
Northampton, MA 01060 t iv` :��
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born (insert
month, day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a
parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption,
does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s)who owns 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 home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for
and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work
on my parcel, I am not engaged in co tstrriction supervision in connection with any project or work involving
construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any
provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my
parcel, I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this day of , 2-0 .
(Signature) •
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Const iS4Visor
CS-077279 -*Y i•; spires 06/21/2022
• STEVEN A SIOVERMAN !
PO BOX 60627
FLORENCE M9 01062 Z
•
Old•
330�� yet '��
Commissioner f• i. z7'•
nn4.�
Fo-./2-mnoimpeadlo-/ ac,ic,i-adMaa4-
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
VALLEY HOME IMPROVEMENT INC Registration: 105543
P.O.BOX 60627 Expiration: 08/20/2022
FLORENCE, MA 01062
Update Address and Return Card.
SCA 1 0 200MM--05//117
17 �o �/9
✓iie ( .22i,vevupeag c ✓Za-LvyeZeJellJ
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:
Registration Expiration Office of Consumer Affairs and Business Regulation
105543 08/20/2022 1000 Washington Street -Suite 710
VALLEY HOME IMPROVEMENT INC Boston,MA 02118
STEVEN A.SILVERMAN f'e AkiltjA340 RIVERSIDE DRIVE � � - /
FLORENCE,MA 01062 Undersecretary Not valid without signature