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31A-300 (5) 25 JAMES AVE BP-2021-1485 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A-300 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-2021-1485 Project# JS-2021-002467 Est. Cost: $16500.00 Fee: $107.25 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sq. ft.): 11412.72 Owner: HAMMERSCHMITH JAMES Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC AT: 25 JAMES AVE Applicant Address: Phone: Insurance: P 0 BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:6/1 5/20210:00:00 TO PERFORM THE FOLLOWING WORK:RE-DECK, REPLACEMENT SLIDER 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 6/15/2021 0:00:00 $107.25 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner / 'f c\\\\'•0 do o9T - The Commonwealth of Massachusetts y G �,>� Board of Building Regulations and Standar �o. cO 0dR 't ✓ Massachusetts State Building Code, 780 CMR °ti2sA �� 1. UA 'ITY Building Permit Application To Construct,Repair,Renovate Or 141A a Revis Mar 2011 One-or Two-Family Dwelling % This Section For Official Use Only Buildinr it Numbcr: 13A-a I-I e4�s Date Applied: J +� /10,5 ,z.,2 ,,`, .Z Buil di ng Official (Print Name) Signature Dan. SECTION 1: SITE INFORMATTON 1,1 Pr jn'.'to Address: I 1.2 Assessors Map&Parcel Numbers 73fn-cs4XLuI _ 31 1- i.1 a Ts this an accepted street?yes -no Map Number Parcel Number '1.3 Zoning Information: 1.4 Property Dimensions: i Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1 1.5 Building Setbacks(ft) i Front Yard I Side Yards - 1 Rear Yard Required Provided Required Provided Required 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 0 Zone: — Outside yes Zoue? Municipal 0 On site disposal system 0 Check iff yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of_Record: S0.mes k- S (e -1 t .mmer5rivnt'�-, C:i Yal MA- O\Dt3C) Name(Print) City, State,ZIP OS .-vtA y(2-S'S(o-Irs . No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building❑ 1 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 1 Accessory Bldg. 0 f Number of Units Other 0 Specify,: Brief Description of Proposed Work2: 1 r— ®t'Gc. of ETC fir'a t 11 o' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) , 1.Building S i (0 5 i 1. Building Permit Fee: $ Indicate how fee is determined: - ' '❑Standard City/Town Application Fee 2.Electrical S ------ ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees: $ Check No (/Sd heck Amount:IC h rash Amount: 6. Total Project Cost: S 1db 0 Paid in Full 4D Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) D..- 1 2,1 �p(21 (Z �, t 7 C22 ev-c_ ti J11\le Mar\ License Number Expiration Date Name of CSL Holder ��,,, + List CSL Type(see below) P c6(:3i�t%2.1 Type Description No.and Street WA 0,`0 (* U Unrestricted(Buildings up to 35,000 en.ft.) _ R Restricted I&2 Family Dwelling City/Town, .l IP M Masonry , i! R:, RtioIi rig Covering WS Window and Siding SF Solid Fuel Burning Appliances 4 - 1S22— I insulation Telephone Email address D Demolition 55.2�Registered Home Improvement Contractor(HIC) ©SS(A3 + ( � V,C'7...\\e '` '1 r.V�rrNQA HIC Registration Number Expiration Date kIC Comply Name or H Registr nt Name ,r,. Gle L 0(o J c'kOfC_t^2C•e.-Cr1Ps b 10(02- No. and Street Email address 4t?J SS(4--iS22- City/Town,State, ZIP Telephone . SECTION 6:WORKERS' COMPENSATION INSURANCE 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 V. No .❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property authoriz Os-Z `,--e` r1 S i‘Qe_r -•••\ to act on my behalf,in all matt s relative wor' uthorized by this building permit application. 10)( tin Owner's Name(Electronic Sign e) Date SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby atte-t under the pains and penalties of perjury that all of the information contained' pplicatio true ate to the best of my knowledge and understanding. Print Owner's Authorized Agen Name(Electronic Signature) 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 th.e 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 tllilv.rnac ,uov!oca Information on the Construction Supervisor License can be found at www.mass.f(:ov'dns 2. When substantial work is planned,provide the information below: Total floor area(sq.A.) (including ear age,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number ofhalfbaths Type of heating system Number of decks/porches Type of cooling system Enclosed Open i 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton >_ , Massachusetts DEPARTMENT ���, l t hV . T ' DEPARTMENT OF BUILDING INSPECTIONS ,� i ;;,' 212 Main Street • Municipal Building \� 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 I t II 1 1 • 1 t I I 11. 1 disposed Number is that 2.11 debris re ultting from this work shall be of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: Li The debris will be transported by: Name of Hauler: kalei \s-ONU IliliT a'' . v Signature of Applicant: Date: 7- The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 � '"' Boston,MA 02114-2017 www.mass.gov/dia IA:arkers'Canipe.nsatian Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. To RE Eli,Ell WITH THE,PERMITTING Al/l ORIT Y'. Applicant Information Please Print Legibly - `7'P�C Name(R isines %tirt�anrixiinniindivicivai)' \ICa��(�y �r1n�i ;"�yh �� i�oY4,� C Address: C_ t vZ , Q. 0 . c ,c (ca 0(,n 2 - City/State/Zip:44 C?.rr_"t( P -'1AG-G106Z Phone#: �-},�2j- S�9-- ( S2 2— Are you an employer?Check the appropriate box: Type of project(required): I am a employer with t Pj employees(full and/or part-time).* 7. New construction 2.0 I am a sole proprietor or partnership and have no employees wonting 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.' I IOU Building addition 4.0I 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 wile. • 11.1:Electrical repairs.or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.12 i am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 6.a 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#I must also fill out the section below shown their• orkers'compensation lic'information.y t'P" t g h.:. policy t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Cunuaetors that cheek this'bcct 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: �hA t'heA1.a_ �. ry r� 61),-(1-& Policy#or Sell ins.Lic.ir: V13���j(� �j b2 1 S Expiration Date: t i I I+ O Job Site Address: ( j(;l l Y l{S ice` City/State/Zip: \()A-iYlebtpt h, 01 O`C Attach a copy of the workers'compensation policy declaration page(showing the policy number and eapiirntion 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 p and penalties " perjuty th t t information provided above is true and correct. Si£nature: `!-'e-f 1'"''i/date: 1016 i Phone#: 2j- 6 22_ Official use only. Do not write in this area, to be completed by city or town official City or Town; Permit/I,ieense if Issuing Authority(circle one): I.Board of Health 2.Building Department 1 Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone 4: Commonwealth of Massachusetts 1.17� Division of Professional Licensure Board of Building Regulations and Standards Constrf2c`-ti'Qn'Sb rvisor j. CS-077279 � cplres:06/21/2022 STEVEN A SERMAN'�_: PO BOX 60627 -S n {• FLORENCE Mg 01062 - Z ? 0 �.,/ Commissioner �j� ° I3 < ? . Eont • • 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 20M-05/17 K/).W,/Vac(v///X ,�. ��..:4,/ir,:</i, 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 ,J -/t' 340 RIVERSIDE DRIVE r(GG(QG(0.04' ! ✓,.�j FLORENCE,MA 01062 Undersecretary Not valid without signature