38B-239 (13) 26 OLIVE ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1951
Map:Block:Lot:38B-239-
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-2021-1951 PERMISSIONISHEREBYGRANTED TO:
Project# BATH RENO Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 25000 INC 077279
Const.Class: Exp.Date:06/21/2022
Use Group: Owner: HOSKIN RYAN M& KERRY M SCHLICHTING
Lot Size (sq.ft.)
Zoning: URB Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON:09/28/2021
TO PERFORM THE FOLLOWING WORK:
RENO BATH AND CHANGE OUT VANITY IN OTHER BATH
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:
4 I J a 3-11
I �
Fees Paid: $162.50
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
sepe
The Commonwealth of:Massa lu em pr / ;
t-- t Board of BuildingRegulations and 6 .- lxlyde& O?
y s I a :ram Mp 1N�r 'ILN .I P A LiTY
•Massachusetts usetts State Building Code, 780 C roN Mq o trio USE
�- '•o s r r ,.
Building Permit, App:=cation To Construct,Repair, Renovate Or l)emi_Ih,s : Rev'eeciAfar 20__
One, or Two-Fan-illy Dweiiinz.
lii. tec`..ion For Off cultist Only
Building.PernitN:.un er. CIP- ' !Jae Applied:
C=v1r.- // 4 28-Zozi
Building Official(PrintName.) tgu urt Date
1 SECTION 1: SITE INFORMATION
1,1 Property Atltlr cs: 1.2 Assessors Map & Parcel Numbers
1.it is this rn acceptor,it ect?yes MO ladap Nurr.bes RE-rel Ni saber- 1
'1.3 Zoning Information: 1.4 Property Dimensions:
Zoning D c_;-i ct Propos®d.Use ( Lot Area!sci`t) Frontage(tt)
1.5 Building Setbacks(ft)
Prot Yard Sidi Yards ue..•Y::;:?
Required I P;os-ided. Required Provided 'RequiredProv'.doa
'
1.6 Water Supply: ('M.G.L c. 40,§54) ! 1.7 Flood Zone Information: 1 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public 0 Private 0 — Chick if yes 1Municipal 0 On site disposal pystcrn 0
SECTION 2: PROPERTY OWNERSHIP'
1.1 l ,411e-tofRecord:
.,f .. i CG4't�tn�.4. l tlr�1�rn ��nC�r'�t�K�t-, nut.. C�iC�.cP.C)
'Name{ .
7 '_) City,.4 ate,
c CAL. , .. ' gt,.3 4 1c' ??. �~3V c.�C% cz 1.4 c C.k;"1 t ` 'N -`1 .tc'.
No.and Steet Telephone 17.ma l Address
SECTION 3:DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction 0 Existing Building 0 i Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition ❑
Demolition ❑ Accessory Bldg. ❑ i Isiu tber of Units • t)titea d Spec **:
Brief Description of Proposed Work': em eh t s tJJ.!4ra lc.-►40.,-ocr*+ tc+ t1`SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
item Official Use Only
1 Buildinga 1. Building Per Fee: $ Indicate how lee is determined:2.Electrical - . f3 Standard Cit}*r'iou r�l�pficatinn fce
❑Total Project Cosh(Item 6)x mi tipliet
3.Pluming $ F( 2. Ot .er Feess: :S
4.Alechanical (HV A C) $ p List:
5. Mechanical (Fire
Sunit ersir+n) Total All Fees:$ _
r .,,.. . Check Noyd/4./Cheek Annuli 10)/�sh Amount:
6.Total Project cost: $ ., ❑Pa-id n F414 -0 tom ding Balance Due:
SECTION 5: CONST.R:tt_TION SERVICES
5.1 Construction Supervisor License(ESL)
c- `\rAt pin a. License Nt robin t xi:iration Date
Na.ie of Ca.holder
List CSL Type(see below)
P 0 (:) t i_ f 2-1
. ... _..._ hype t)escription.
No, and Street
II l nt ied(Th 1C09tns...it;
` '' Olen(_(.- NV-4 CACl,02 R ._...... Restricted I t2 Pairrly 1)wz;ling......_
City/Town,State,2TP hd' 1sA:a:r,_-a� - •
RC Rilornt4,._:.Covei i rig
WS Window and Siding*
SF Solid Fuel Burning 1',);,liances _
ta' -'ki_152 1 I auianon
Telephone Erna:1 address D j Demolition
5.2 Registered Home Improvement Contractor([TIC)
\' tt53 gist.,( ?—z-
1t ��%t+� FitC Registration Number 1 riiration Date
H1C C , Name or TTTC Registr nt Name
y..:K.A. tnt 21._ c-lon'_r� ..._, 1c)(0Z
No. and Street L^rr4:l addreos
415 i522._
City/Town, State, ZIP 'T'elephone
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. I
Signed Affidavit Attached? Yes Igi No i
SECTION 7a: OWNER AUTHORIZATION TORE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPI.T1'S FOR BUILDING PERMIT
I.,as Owner of the subject property,hereby authorize.\1 T t C) t'‘,,, i\ e -nmca r--
to act on my behalf;in all matters relative to work authorized by this building permit application.
Y‘erh1S1,‘; \i 1 Rs?" k; , ' r"7 -4� )
Print O'x 's Name( 1ecuoai attire) Date
SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION
By entering ray name below,7.hereby attest under the pains and penalties of perjury that all of the information
contain.edin this application is tree and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signaare) Date
NOTE&
1. An Owner who obtains a building permit to do hislher own•work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(IBC)Program),will not have access to tine arbitration
program or guaranty tend under M.G.L.c. .142A.Other important information on the HIC Program can be found at
,,,w .:Hassz o -oc_Information on the Construction Supervisor License-carlie found at urww.mass.rov/des
2. When substantial work is planned,provide the information below:
Total door area(sq.It.) _ (Mein di_re garage,.fi ricl rcu basement/attics,decks or porch))
CGross living area(sq.ft.) Habitable room count
Number of fireplaces Number ofbedruuuis
Number of bathrooms_ Number of hall7baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed _..—Open
3. "Total Project Squat Footage"may be substituted for"Total Project Cost"
City of Nor ampto•.'•.'3.
r .. rassaciusetts n,..,,ti.•
ti ' +� N
,1— is
F717 Na?n SLrceL tiunicipal GuilQing
•
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.th4t all debris resulting from this work shall be disp.osedcf in a
properly licensed waste disposal facility, as defined by MG_c 111, S 15-0A.
The debris will be disposed of n:
Location of Facility: \!( Lk' o ' (1 t is) ' .\ ,A._.
The debris will be transported by:
Name of Hauler: VISA r o _C vn4-Ct'�2.rk
7 --) 1 /,
///::: /.144/C///
Signature of Applicant: / • Date: `J l
The 0171<)eair l'ass.rtellIts'ett's
Departlifent of IndtarYialilecidents
•
- •
C,711.gress Sti-eet, ,Surte 160
I.
Boston, MA 02114-2017
KiTvw.rnass.goviiiia
Insurance 4....fR vkBuitders/Contraci..c..1r.salle.edicia.Dalumbers,
it)F37.F FTWtTfl TtiF PRIZMITTINC. AI:11101-Zil"V.
Applicant Informs flora Ilea se Print Le.giblv
Name, 8in essiCirvin i al vi c nal): \kl r
Address: 34(1‘) .. o .
City/Stale/Zip:c\--\.0,re)--2.c c) 0-CA)62..., Phone 4: t4.12-,_c„..;sLi....21 S2 2_
Are you an employer?Check the appropriate bra: Type of projec.t(required):
a=a.cmployei with t P)._ emplo'yecs(nal andica part-dtrit) 7. p New constniction
2..EI I am a sole piopidetui ci hlo azdhzvt-, cimilnyees working Re ua g Remodeling
any capacity.[No wc_Lces' Ij I suratice requaall
9. E]Demolition
3_I atn a bomeownet doi. . ;J myself. No isfailese:s reatired.1
la 0 Building addition,
4 DI am a homeowner and will b•7.. cortractors to conduct aZ walk on ray property. I will
• eNflire that all'ow-rumen;t•jtsi have worl4e.i,s'cosnpentation inmrrowe or&resole - • I 1. La1cepars radditiOnS
proraietnm with to employees.
Plumbing repairs or'additions
5.0 I am a genti-a:contractor and T have hired the sub-corcsactois Iiied on the attached sheet
13E:Roof repairs
These sub-contractors have employers and have workers'comp. irance.t
14.0 Other
s.E1We are a corporation:melts°thews have exercised Mon riget of exemption pet MGL c.
152 §1.05,and-we have no employees. No workers'comp.insurance Lequitedj
'Any applicant that cliceka box#1 mast also fill out the section below siscreidtg,their workers'ccImpcasatioa policy information.
I Homeowners who sulurtii this affidavit indlcarn!,,they are doing ad wale and thee hire outside contractors ratisr submit a new affidavit indicating soch.
401-....trautors that ubeek•Mis,box must attacted.mvadditional theetchuwin ±t 112.21t tithe suh-turrhautses andstra -mh.ether ru nut those entities have
emplovees. If the sob-tonti-actors have employees,they mast provAt their workers'comp.policy nurnher
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(beAcA.._.
policy ar Self-ins.Lk.4: CDC)5 F"-,("") Expiratior Date: c9 i 1,D 0
Job Site Address: Otc:i L1/4.Y- CityiSta-ie : . MiO10a
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expir thin date).
Failure to secure coverage as required under MGL c. 152,§25A is a crimilia:violation punishable by a fule ta$1,500.00
and/or one-year imprisontoenit., 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 twy be forwarded to the Office of Investigations of the DIA far insurance
coverage verification.
I do hereby certify under the pains and penalties ofpeijuly that the information provided above is true and correct.
Signature: Date: 1g) SI
Phone#: 2D- Seg1/44 S 22—
Official use only,. Do not write in this area, to be completed by city or town official
City Qr Town; Permit/I kense#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person t Phone 4:
Commonwealth of Massachusetts
i<;�,. Division of Professional Licensure
Board of Building Regulations and Standards
C.onstr.,t,`ctl .'tkthi.I'{ cvisor
s•
CS-077279 E; pires_06121/2022
• STEVEN A S VERMAN ;: : '3 s
PO BOX 60627 • x
FLORENCE MPJ 01062 ait G
_ =n
Commissioner UI ><'. tjiIla.
K;f-)'li/.2wll�.lt ' . �Ji D-
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
• Registration: 105543
VALLEY HOME IMPROVEMENT INC Expiration: 08/20/2022
P.O.BOX 60627
FLORENCE,MA 01062
Update Address and Return Card.
A 1 Co 20M-05/17
.e awrzeweverllW c/../vez-ickze .Le .
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
105643. 08,12012022 1000 Washington Street -Suite 710
VAI.I.EY HOME IMPROVEMENT INC Boston,MA 02118
STEVEN A.SILVEFiMAN � -rt."
340 RIVERSIDE DRIVE- CL r, +
rLoRENCE,MA 01062 Undersecretary Not valid without signature