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49-032 679 PARK HILL RD BP-2021-1420 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:49-032 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-2021-1420 Project# JS-2021-002358 Est.Cost: $85000.00 Fee: $552.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sq.ft.): 80063.28 Owner: CANCINO FABIOLA Zoning: Applicant: VALLEY HOME IMPROVEMENT INC AT: 679 PARK HILL RD Applicant Address: Phone: Insurance: P 0 BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:5/28/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:KITCHEN AND 2 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. I I O . . Certificate of Occupancy Sianatur FeeType: Date Paid: Amount: Building 5/28/20210:00:00 $552.50 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner / /- / 6'' N/ �,,ir � The Commonwealth of Massachusetts °so c' 2 �1ON., J tiBoard of Building Regulations and Standards e I Massachusetts State Building Code, 780 CMR US q Do �0�/ Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2T�, '''sk, 6-0 One or Two Family Dwelling. QD a ts. This Section For Official Use Only Building Permit Number: •►1 l"/V 0 Date Applied; .6- . �► • ( 14-Val Buil ding Official(Print Name) Signature I1 SECTION 1;SITE INFORMATION 1,1 PropertyAddress; 1 2 Assessors Map,e,Parcel Number s b' / P(: ioc l-/-1// e �'��( r o 7 • 1.1 a.is this an accepted street?yes -no Map umber Parcel Number '1.3 Zoning Informatio : 1.4 Property Dimensions: Si It kI d Zoning istrrct Proposiall Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards I R.ear Yard Required Provided Required Provided Required I I Provided 1.6 Water Supply: (M.G.L c.40,§54) 1,7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private GIZone: .___ Outside Flood Zone? Check if yes Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP` 2.1 Owner'of Record: Kl_bt 01 O,CtQr C Inc,4 A i ric A 1' lry 1.aiiC ft C.�'�'s'k`C j'72G� Cal O ,2-- tiF"ia1) City,State,ZIP br79 Po.L1h i t i&ter ia(16-c 89-6,0'7/7 No.and Street Telephone Finaii Address SECTION 3:DESCRIPTION OF PROPOSED WORK''(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s).0 Alteration(s) Addition 0 Demolition 0 I Accessory Bldg. 0 Number ofUnits Other 0 Spec*: Brief Description of Proposed Work : itQ ice... be-fGer7 trail 14 i/ lv 11U>K v b o tz,(41 mod ; r 44( - 6,1u#-S,Cva s / M : to ke., Z ( Ariapvl tt' AC Ml) S+ &fii 3Oiti S- ke_".,! C-- st are a hi I, ,oiesrct r: SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) , 1.Building $ (I 7(A.S13 1. Building Permit Fee:$ Indicate how fee is determined: tl Standard City/Town Application Fee • 2,Electrical 7 2 Oft) p Total Project Costa(Item 6)x multiplier x 3.Plumbing $ Cjg) 2. Other Fees: $ 4.Mechanical (HVAC) $ j„7 List: ec auical (�nc� $ Total All Fees: $ / Check No.4 i7 9' Su pye ___ ...-- Check Amount: 5'2• Cash Amount: 6.Total Project Cost: $ 9t nit .p Paid in Full 1:1 Outstancleig.Balance.Due: , SECTION 5: CONSTRUCTION SERVICES 5.1 Constructionn Supervisor License(CSL) �-� g �Z S (� � C,\ (1 ,/t.4�f I ma \ License Number Expiration DE ate Name of CSL Holder (� Noo.and Street List CSL Type(see below) nd) SC�l� (cut) Type Description _ p n iJ Unrestricted(3uildirigs tip to 35,000 cu.t?.} '0 (`Pn-C 1`t v 01C(97✓ ( R Restricted I&2 Family Dwelling City/Town,S • . r; 1u1 Masonry/hill4 RC.: Routing Covering. /� WS Window and Siding ' SSF " Solid Fuel Burning Appliances 14V3..Sl.j `15ZZ 1 ' insulation Telephone \�� Email address D Demolition 5.2 Registered Home improvement Contractor(HIC) ���12 ��w� j A�e i (�Q ( ((�ti'rt'c'(1Q i1)" HIC Registration Number Expiration Date YC Comp Name or HIC Registrant Name .(c t00(02,11 f'LOlCnC Qt0t`9Z No.and Street l ` S'3C.--1 2- Email address City/Town,State,ZIP Telephone . SECTION•6:WORKERS' COMPENSATION TNSIiRANCE AFFIDAVIT(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 Attached? Yes No .❑ . SECTION 7a:OWNER AUTHORIZATION'TOBE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT - I,as Owner of the subject property,hereby authorize \-\-L t --t°.``ex j i t Vert"Ya.t1 to act on my behalf,in all matters relative to work authorized by this building permit application. ' t Owner's Name(Electronic Signature). Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION y entering my name below,I hereby attest under the pains and penalties of perjury that all of the information c ntained' this application is true and accurate to the best of my knowledge and understanding. c XPrint 's or Authorized Ag t ' e(Ele ;f•is Si•' ) t Date t'/,i -6 sit liv S 7.s-- c al 1. An Owner who obtain ' g p< .-.t ti I I- er 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 v,ww.rrass.rov/oca Information on the Construction Supervisor License can be found at www.mass.4ov/dos . 2. When substantial work is planned,provide the information below Total floor area(sq.ft) (including garage,.fin Lshed basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count . Number of fireplaces Number of bedrooms Number of bathrooms Number of half`baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" City of Northarnttoh 55 r�*�r ' Massachusetts * e �� �.:i /t DEPARTMENT Of BUILDING INSPECTIONS ^' 1 t4J�' C� fl x l I 212 Main Street s Municipal Building �. . �,� 'tc � Er Northampton, Mz 010£0 --.-1v i CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit ' of in a �• this work shall be disposenia i is that all debris resulting from tYli3 Number properly licensed waste disposal facility, as defined by MGL c 111, S 150 A. The debris will be disposed of in: Location of Facility: , The debris will be transported by: Name of Hauler: a.- .. ii „tit/ i . , ifY Date: �" Signature of Applicant: The Commonwealth of Massachusetts jI Department of Industrial Accidents ,,, ,•�r Fs} I Congress Street,Suite 100 l Boston,MA 02114-2017 141414)..mass.gov/clia Workers'Compensation Inslar ce Affidavit:.smilede s/Casrtractol•.s/EI.ecL?-irinns/Plurnber-s. Ti)RF Nl1,FT)WITH TFiF.vERMITTING A1iirit`Rill'. Applicant Information Please Print Legibly + ame(nci�incsvi trgani�ti,inn/adivithnd : et e(� `c' �f� -- f Y��ifs 4 (J_ � 1 Address: ?JAC) qiv f'x'�v � e t��st . . 0 . j ��nc (c>0 Cc)Z., - City/State/Zip c\-- 0r -2Cg_.V.1,G-01.0(©2._ Phone#: 114 )- SSLt--`1 S2 2- Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with t. employees(fill and/or part-time)." 7. 0 New construction 2.0I am a sole proprietor or partnership and have no employees working forme is 8. ®Remodeling any capacity.(No workers'camp.insurance required.) 9. ❑Demolition 3._I am a homeowner doing all work myself.(No workers'comp.insurance required.!` 10❑Building addition 4.01 am a homeowner and will be hiring contractors to conduct all work on any property. I will ensue that all otantractorr•eithcrhave worlaers'compensation insurance or are sole • - 11.0 Electrical repairs or additions • proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 i am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.012OOf 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 cheeks' box 41 rust also fill out the section below ihowrng 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 Mat check this•btrtmustattacdieda t'adclitiunaf sheet shuwing•rhe name of the sub-coatraeturs and state-whether ur•mrt these 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 k/beA r r Su. ri t� 6svrakf, #_. r:, #: pb SC7 b2. \ Expiration Date: C91 1 ,C7 aa►, Policy rr or Self-ins.Lr�.�tjr,. rj fJ,; c� Job Site Address: Ill°I (2&-I t 11 t Lo& City/State/Zip: 1o,A-haelkpr r tt 'r1\4 4 0)0 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expir 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 fom2 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 th ' and penalti f perj ie=information provided above is true and correct ) • Signature: Date: p;0 Phone#: 2D- .s4- Off cial 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 ofIleaith 2.Building Department 3,CityiTown Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Commonwealth of Massachusetts 1-1 Division of Professional Licensure Board of Building Regulations and Standards ConstyO-ti)AU' visar CS-077279 �3' ipires 06/21/2022 STEVEN A SpERMAN 4 PO BOX 6062:7 --atf i n .44 « - } FLORENCE M 01062 nr. Commissioner dot0• 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 C. 2OMM--pO5/1177 YZ Ut/7 mice C4'CCLGC/6�,� Lir.AGLJJ e:6,70 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 4N /� /P✓ 340 RIVERSIDE DRIVE a 4 - FLORENCE,MA 01062 Undersecretary Not valid without signature