18C-099 (5) 19 GLEASON RD COMMONWEALTH OF MASSACHUSETTS BP-2021-1835
Map:Block:Lot: 18C-099-
001 CITY OF NORTHAMPTON
Permit:Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND(MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-1835 PERMISSION IS HEREBY GRANTED TO:
Project# 2021 roof Contractor: License:
VALLEY HOME IMPROVEMENT
Est.Cost: 2000 INC 077279
Const.Class: Exp.Date: 06/21/2022
Use Group: Owner: FINN MARY MARGARET&MARIBETH A ERB
Lot Size(sq.ft.)
Zoning: URB Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P 0 BOX 60627 (413)584-7522 0055030215
FLORENCE,MA 01062
ISSUED ON: 09/08/2021
TO PERFORM THE FOLLOWING WORK:
roof low slope section of house
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:
• a' • .>,! 1 CS-411 •
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
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p 1 iie The Commonwealth of-Massachusetts
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Board of Building Regulations and Standards FOR
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c zr Massachusetts State Building Code; 780 CMR
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Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Permit Number-76e.4-/ir ...5".- 1 Date Applied: _
7
6010-.14,5
CI-7 2102.1
Building Official(Print Name) Signature .
SECTION 1:SITE INFORMATION
1.1 P iperty Address: t.2,44s7vjma,&Parcel Numbers cfiq
,1 a Is this all accepted street?yes no Map Number Parcel Number
.... .
I.3 Zoning Information: 1.4 Property Dimensions:
• Zoning Distri et PrtIpOatti USe Lot Area tut 81 Frontage(if)
13 Building Setbacks(ft)
Front Yard Sidc Yards Ri..--.1r Yard
I
Required 1 Provided Required 1 Provided Required Provided
__I
1.6 Water Supply: (Ni.G1,_e.40,*54) 1.7 Flood Zone Inlormation: 1.8 Sewate Disposal System:
Zone: Outside Florid Zone?
Public CI Private 0 — Ivicuntical 0 On site disposal system 0
Check it yes°
SECTION 2: PROPERTY OWNERSHIP'
2./ Owner 1 of Record:
PACtivA-4 — cfl CU.s7C)
Name(Print) N City,State,ZIP
r.A.9-461C-C.4.. C1------
Ica.and Street Telephone Entail Address
SECTION 3;DESCRIPTION OF PROPOSED WORK'(the&all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 RepaL•s(s) 0 Alteration(s) 0 Addition 0
Demolition M• I Accc&r,ory Bldg.M Number of Units Other 0 Speedy
Brief Deseriplion of Proposed Work2: 'I t4 51rm,t_ Fp 0 r+A icub v Cr,"G roJ Lot,.) SI_OPpi
i Cuts) CP„. P.,.1a6P-- (-) tiOl.),M.
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SECTION 4:ESTLMATED CONSTRUCTION COSTS
r .tuuated Costs:
Item i U
(Label.and Matcrial0 Official se Only
1.Building S I. Building Permit?cm$ Indicate how fee is determined: 1
,,,, ..........-... , " CI Standard City/Town Application fee
2.Electrical S
0 Total Project Coal(Item 6)x rouhiplicr x
3.Plumbing S 2. Other Fees: S
4.Mechanical (HVAC) S List:
_
5.Mechanical (Fire
StTprmsion.) $ Total All Fees:Ar,
heck No.40106/Check.Amount: 4-fe
6.TOTLI Project Co Paid ill,Full 0 Outstanding Balance Dud.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 011--
.�-,,u License Number' � L-+cp�i z i_� -'
��r-� -anon Darr
Naame of CSL Holder _
._ c0 z: CSL Type(ace owa
Vo.and Strut Type Description
T.__ 0(042 Ll
L nr lard(Building";upto 35,01.1 l rut.1'0.1
R Restricted I8e2 Family Dwelling
City/Town.S 1," II' —M Mastiai f
r
1.l 7 roc RnriringCovering
r - r t WS Winnow and Siding
• SF Solid Fuel Burning Appliances
Telephone
Email address
5.2 egistered Rome Improvement Contractor(RIC)
4.
Iti itsMarn +rr RIC Fro►e sstra
r?c' { bnt
t� and Street et s L I Insulati
on
o.
D � elotlo n
3�
HIC Registration Nunn her —ExpirationDate
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City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 2SC(6))
Workers Compensation Insurance affidavit roma be completed and submitted with this application, Failure to provide
this affidavit wi I l tesutt in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... ' No...........O
SECTION 7s:OWNER AUTPIORIZATTON TO BE COMPLETED WliEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of tic subject property,hereby authorize q N-T . "t 'r^t &1 V '{_. , i.__
to act on my behalf,in all matters relative to work authorized by this building permit application.
`'l : v',--' ailL,? .t �g1 da.,
Print Ou s:tiame(Electronic Signature) Late
SECTION 7b:OWNER'OR AUTJIORI"LEI)AGENT DECLARATION
By entering my name below,I hereby arrest under the pa' s and penalties of perjury that all of the information
contained ' ' applicati is lie and accurate to the f ray kn wled d understanding.
4e\Cti 1 ki eAr 04 411/4)
Print 's or Authorized Agent's Name(Electronic • e) Date
NOTES:
1. An Owner who obtains a building permit to do liisfher own work,or an owner who lures an unregistered contractor
(not registered in the Home Improvement Contractor(IfIC)Program).will shave access to the arbitration
program or guaranty#arid under M.G.L.c. 142A.Other important information on the HIC Program can be hound at
v,,v w r i ....,v, tiara Infuriation on the Con.struction Supervisor License can be found at.,,, ci. ,_;,ti ti.s,
2. When substantial work is planned,provide the information below:
Total floor area(sq. R.) ti _(including grage,finished basementl Ica,dec s or parch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of lialfbaths
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'
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Cons ic`-t*At5pprvisor
CS-077279 � - --1' 6cplres 06/21/2022
STEVEN A SPERMAN4.
PO BOX 6062y, —4,�', 1 n .Z.• ..,
FLORENCE M9 01062 tjh
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'O?SS'I�C
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Commissioner P. A. bfmdla
•
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Roston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
VALLEY HOME IMPROVEMENT INC Registration: 105543
iration: 08/20/2022
P.O.BOX 60627
FLORENCE, MA 01062 -
Update Address and Return Card.
SCA 1 ' 20M-05,17
It6iirn,e.//e7Wc`7 e/._l V-.,.«c%a:eVe6
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
STEVEA. ILVEAMAN %1 .'Cv I�o/� /
N
S � J / ���(✓
340 RIVERSIDE DRIVE 0-4•
FLORENCE,MA 01062 Undersecretary Not valid without signature
City of Northampton
�.• ^ Massachusetts
.Ea DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 �t h
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed 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:
The debris will be transported by:
Name of Hauler: ,( V` t, t f Yi ei''Y S 4—"
J !'
i
Signature of Applicant: Date: f
L•„\ The Commonwealth of Massachusetts
Eir- _It
Trzir.r'f 1 \•.,
Department of Industrial Accidents
I
I Congress Stivet,Suite 100
d,ill
Afr Boston, MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leziblv
Name(Business/Organizationiludividualy \JO..1 tti \-k-C>ori C. -I-rn ev--0-4-e fYlt-r)-1
Address: --k(D 4i2,k .vc.,.Ec6\At. --)r-i•-s-c- rp, 0- ?,,,,,K 4.c(..)(02-1
City/State/Zip:Ttor-er-2(.4, k et CA 002- Phone#: 4 t 3-SS(-1-1 22-
Are you an employer?Check the appropriate box: Type of project(required):
ill I am a employer with te employees(full and/or part-time)• 7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working for use at 8. ZI Remodeling
any capacity.Na workers'comp.insurance required-1
El
3.0 I am a homeowner doing all work myself.No workers'comp. 9. n
p.insurance required]I
10 El Building addition
4.0 t am a homeowner and will be hiring contractors to conduit all work an my property. t will
ensure that all contractors either have workers compensation insurance or are sole 11.El Electneal repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5r]1 am a general contractor and T have hired the sub-contractors listed on the attached sheet.
13.0Roof repairs
Theit sub-contractors have employees and have workers'comp,insoranoe:
14.E:10ther
6.0 We are a cmporation and its officers have exercised their right of exemption per MGL c.
152.41(4),and we have no employees.(No workers'comp.insurance required,'
*Any applicant that checks box gl must also fill out the section below showing their workers'compensation policy informal:ion.
1 Homeowners who submit this aiMdavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
iContractors that cheek this box must attached an additional sheet showing the name of the sub-contractors:tad state whether UI not those entities have
employees. If the sub-contractors have employees,they must provide Iheir 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: -Ay'be\ka... ---Srl .k...)f-Cay-)(..t_ (1,1 r-1,.)k p
k .
Policy#or Self-ins.Lie.#: 00 "- C- C).. ' 0 2- \c:3 Expiration Date: o?if je 01 Oc9a...
IP ‘
Job Site Address: k°A. ..\\"e(&)(Nr. ' %If City/State/Zip:,w..tetiNaLn elialikAi4.--oca0
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expir don date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500,00
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 un .r the pains and p je 0 hies of p r hat the information provided above is true and correct.
Signature: , /13 ,,4 1/-.)
e, Date: b t lov,c1.
Phone 4::
Official 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 of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Plume In
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