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18-037 (4)
61 EMILYLN COMMONWEALTH OF MASSACHUSETTS BP-2021-1926 Ma p:B to ck:Lot: 18-03 7-001 Permit: Alts Renovations CITY OF NORTHAMPTON Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1926 PERMISSIONIS HEREBY GRANTED TO: Project# BULK HEAD Contractor: License: VALLEY HOME IMPROVEMENT Est. Cost: 5000 INC 077279 Const.Class: Exp.Date:06/21/2022 Use Group: Owner: SZLOSEK ALICE E & RICHARD W Lot Size (sq.ft.) Zoning: RI/RR Applicant: VALLEY HOME IMPROVEMENT INC Applicant Address Phone: Insurance: P O BOX 60627 (413)584-7522 0055030215 FLORENCE, MA 01062 ISSUED ON:09/23/2021 TO PERFORM THE FOLLOWING WORK: REPLACE BULK HEAD AND FRAME STAIRS 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. Signature: g i , .)23-11 • Fees Paid: $65.00 212Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner 1- ' - ----r-N ' vo Sep ,..S...., Thc Commonwealth of Ma 86aclitis itq ki o:lrd of Building Regulations and St. i ar 70x.s i•Ci lviL 1CIP WITY Masl.:;:,,IlLisetts State Building Code, 780 C , VG P r0A/ifAiisper IJ Building,ztil3i,iaiilldqunin:Lerie)piiii /1_1i-I Ilicitiiocil Tizto Corstrucpt,:i eci:iiiiRede:novate 01 Dorno, • !.oio6oltyised vial-2011 One- or Two-.Fam ii:y 73 wellin,z . , This Section For Official Use Only ____. L V 11J Ai -- -7 / — — C1.22-26Z) Bitilding Official(Th -e Name) Stgnature Date — -- _ SECTION I:SITE INTORMATION Li Property Address; ' I./ Ass..±ssors'Map k-Porcel Numbers (..p.t 17; IYN1. 1/4-1‘ k—anit..... I la is this 7r1-accepted sb ca'?yes -ri o Map N'untl-,...zi- Parcel.11rAber 1.3 Zoning Information: 1.4 Property Dimensions: Zoni-ig Er:17.1-',:t PCi)posed Use Lot Area(sq ft) Frontage(ft) IS Building Setbacks(It) Frr,t Yard — I fii-de.Yaltls : Rear Yarl Required 1 Provided Required ' Provided ' Required Provided I I 1.6 Water Supply: (\if.e.L.c.40,§54) i 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone? Public 0 Private CI Check i Municipal 0 On site o.:isposal system 0 if yeN0 SECTION 2: PROPERTY OWNERSHIP /,..).1 riw,-,erl of Record: t-_eiXf...CSZLO5rt--- 1__ __ _ alliA.144rn_____ni ,PL Ot 0 .G.P2- • Name rat) City, State,n., (ok b-ritkkA. th-rvc No.and Steet Telephone Emai3 Address SECTION 3:DESCRIPTION OF PROPOSED WORK1 (cheek all that apply) New Construction 0 1 Existing Building 0 i Owner-Occupied 0 Repairs(s).0 AlteraCoo(a) 0 Addition 0 ...._ Demolition Ei 1 Accessory'Bldg. Cl Number of Units _ i Other Li speey: Brief Description of Proposed WorK': c_gVy._._ ecLc_i ___ -ia. SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimeed Costs: 1 Item tcr ! Official Use Only 7-- !:••:!!! !vla ,!I ! I.13uilding $ 5ca i 1. BuLding Permit Fee: $ Indicate how fee is determined: 1 -0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost 3(Item 6)x muleolier x 3. Plumbing S 2, Other Fees: $_,,_ 4.Mechanical (HVAC) $ List: ' S. Mechanical (Fire . $ Sur•n:-/ sion) Total.All Foos: . Tce Check NojU"4 Check Amount: tic' Cash Amount: 6.Toial Project Cost: 1 $ te )r- . -0 Paidia FLU' 0 OutstandingRalan-ce Due: ..._._._ . SEC'I•lON 5: Co .ST.RUr')`l:ON SFRNiICb.,53 5.1 ( onstrsctioa Supervisor License(CSL) t�VL 1� A' J 1,(c'r lax-N License Nunibe_ Expu-a;iou Date Nara:of CSL Holder List CSL Type(see below) P.0) V'CJ ((P.:0C._1 — — No. and Street j�t/�` (�V Type j Description '� t__ S`� `P Ole l ( t.T Un;estri ed(Buildings tip,. L nr�3)cat ei R 1 Restricted 1 8t'L Pal-nil Dwell ing C:ty/Town,State,ZIP , Iv/ 11.4asoary WS Window and Siding • SF " Solid Fuel yarning Appliances 152 --------. _.-•----...._.__ I'__ i 'insulation Telephone t.mail address D Demolition 5.2 Re<*istered Flume Improvement Contractor (PIC) xO4t te at e- IUC Registration Number Expiration De IIC Cornp Name or I-tIC Regi�t Name No. and Street I - ,,d,7.• 4t -S-1--M2.2. �. City/Town, State, ZIP Telephone - SECTION.G:WORKERS' COMPENSATIONTINSIIRANCE AFFIDAVIT.(M.G.L.c.152. §, 25C(6)) 'Workers Compensation Insurance affidavit must he completed and submitted with this application. Failure to provide this affidavit will:result in the denial-of the Issuance ofthebuilding permit. Signed Affidavit Attached? Yes W No ❑ SECTION 7a: OWNER AUTHORIZATIONTOBE COMPLETED WHEN OWNER'S AGE!OR CONTRACTOR APPLIES FOR BUILDING PERMIT.- I,as Owner of the subject property,hereby authorize `\\ to act on my behalf,in all matters relative to work authorized by this building permit application. • Yitcte 5/ .eet'au A r;c.,e. ose 9/0 21;, ,3-1 Print Ovmer's NQ (Electronic Signature). Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest udder the pains and peuaiti s of perjury that all of the information contained in this application is true and accurate e best of ge and understanding: S) 1,1)otUA4k0 -a./ Print Owner's or Authorized Agent's Name(Elec i ature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires en 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 HE Program can be found at Wvw.r•la s.eovicca Information on the Construction Supervisor License can be found at www.mass.zov,dos . 2. When substantial work is planned,provide the information below: Total floor area(sq.f.) (including,garage,,finished basement/attics;decks or porch) Gross Living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms • Number of bathrooms Number of lzaifbat&rs 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 L\Torthampto id massa.chusetts ,,,,, .,` << :iii- 1 t. fl ..'it . !l((JrYY.`` ', ;4A!: ;1: DEPARTMENT OF BUILDING INSPECTIONS 4 ;" ;,,.r,,'�n• 212 Main Street �� Municipal Rviiding b! CONSTRUCTION DEBRIS AFF]iD VIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) . in accordance of the provisions of MGL c 40, 554, a condition of Building Permit Number is tha t all debrisresulting from thiswork s a:: �e c �spcsed�f ina pfapei~1y licensed waste disposal facility, as defined by Mac 111, S MA. The debris will be disposed of in; Location of Facilty: \ i 1 ocu.�ck (1. 11 tikes • \C) . �i •'`-I"�'1C -�- The debris will be transported by: Name of Ha Lifer: \1 'yq A VIA,itc t'l'} CwIt,-J-- _ j / / Signature of Applicant: J Date: 2 i/6 o\7/ The (_.o2i111.0rrweeft of iii`f:cS'?t De ar•iintertt of Industrial Ace dents fili r ess Str ee4, S; rte 1(jU Roston, .M.E1 02114-2017 7.1)14444rnas-y Willa tit erker IP ut'.ance. liir7 t st; Roilitez r'Coat-a rags El ethhIl uslPl halbert, Tr)P71T F,11, 'il ; , a s': v4ir r.itiC; .TITH R1TV. Applicant Information P.eawe Print Legibly `1atile(TS tit L'trron; \i l „I,�-1 t t i1 )r1 tK i 57,- Address: \Sr:.., ?4 c . 1?)c -4.- (c)(.13 City!State,Zin Qii (C? _ -r C 1C a � Phone#: t4 2 ` -- 1 S2 L.-- Are yen an etziplo}ter?Check the appropriate bar,i Type of project(required): i,ju. m a emp cyer;:"i l2 rr c :(rail an:d.'ai p:tt.unei. 7. ©New cons-tilretion 2.0 I aro a at,le Ir iir,r 'ii 01;i t r1 lu?rid have no employees wort:Log for me is i 8, Remodeling any capacitl. ^So comp.insuiontie _ep':ured..l 3,Fry ; 9. Demolition IT am a hnric,wne,dotha all work myself No ).1i ra'coma.insurance'council; 10(J Building addition 4 El ara a homeowner and will eic Ming contra tors to eh-induct a wrodr on my ptopinty. Z r=ill r e t't t ecc+traitors ei heI-have workers'conpensariran aye at,- 1$. Electrical repairs or additions proprietors with no etnp,oye:s. 12.Q Plumbing repairs or additions 5.0 T an,a 7 ntte-eoritraitior and T have hiteiTe sub-co ttacto s list d ori tin aids'<.tedslrcet. 13.CItvof repairs These,sub-contrescor have tr ap ogees Find have't Villas ee€np, inshran,._. R We area corparaiupn and:e .uncrs nave cycrch ed then right of exemption per h:GL c. 14.❑Other } 152,p1(.1_and;ve nave no employers [v n onl:s'comp.insurance toured.] ltcant the,cheek-is' ix i 1 must also i::J Coat the section.nnclmv ,,c.kcs m?czseUni Homeowners w'hn submit this a;5datil t indicating they are doing all work awl teen hie a,ctside contractors mutt sui riut a r,ew affidavit ladicatica sue r. '" ilri`.ieat'iuis Z7aa'.cheek-this'box most atta•tedau additional abtet showing The P.'n?nt ui tsd;-uon$ai.tuve anti s:ne whether jrt 7_.:.+arty:^_entities trace employees. ache sob-too tr Licht t I,rw.employees,they must provide their u•o;trots'comp.policy tember. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information.Insurance Company Natrte: P f� _( k Policy#ur Self ins.Lit 4: ✓r`?0 ( 12.\ Expiration Date: ) t c 0 cD 1., Job Site Address: (D t, vy‘. 1 ;I.-•ice... City/State/Zip: 1\:\C),4 fijiA pkr-. M" CY.- Attach a copy of the Corkers'compensation olicy declaration page(showing the policy number and eipition 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'rnprisonrcnt,as well as civil penalties in the form of a ST01'WORK ORDER and a fine of up to$250.00 a day against the vi ola:or. A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. f ilTo hereby certi , u de•the pains an peixalti pel;jua +that the information provided above is true and correct. Si'nature: f Date: gt5 , Phone#: 2D' 6 :1' Official use only. Do not write in this area,to be completed by city or tows:official. (''ItS'nr Town; Permit/I.ice'n;ct IIssuing Authority(circle one): I.Board of k'iealih 2.Building Department 3. City/Town Clerk 4.EIectricaa inspector 5.Piurnhinginspe.etor- 6. Other Contract Person: - Phone n: Commonwealth of Massachusetts 2`f Division of Professional Licensure Board of Building Regulations and Standards Cons f it i.Spervisor CS-077279 •• 4- spires 06/21f2022 STEVEN A Si /E M• . 7r47!; -r;E; PO BOX 6062-2 .;_ v tY FLORENCE M9 01052 �> ;} *341 0735140 Q • ,`tip; Commissioner daea 1. [J&niij •-, • • f�P K7/n/no/?iCG�-e ill) • 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. A 1 47 20M-05/17 W'onx lxnncvea&cy`./G'6aAv zc Jeili 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 �Q 340 RIVERSIDE DRIVE .a'a.,r.(/y k' t�U�':v datitK, FLORENCE,MA 01062 Undersecretary Not valid without signature