23D-122 (4) BP-2021-2123
186 FEDERAL ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23D-122-001 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-2021-2123 PERMISSIONIS HEREBY GRANTED TO:
Project# landing Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 16000 INC 077279
Const.Class: Exp.Date:06/21/2022
Use Group: Owner: COMERFORD JOANNE M&ANN M HENNESSEY
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:11/01/2021
TO PERFORM THE FOLLOWING WORK:
BUILD NEW LANDING AND 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:
• • r . ' t
Fees Paid: S104.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECEIVED z -Olt
NOV - 12021
The ornmanwealth of Massachusetts
FOR
Board of uilpS�tatcei Ord MUNICIPALITY
6;�tMassachu etts ? • °
VU' ,; a • C� USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling.
This Section For Official Use Only
Building Permit Number: fi' I'0/1.13 " Date Applied:
_ ,rii � -CIFI at IVI ai
Building Official(Print Name) +ignature ri
SECTION 1: SITE INFORMATION
1.1 Pr''}}n--�j.rty Address: 1.2 Assessors Mar R,Parcel Numbers
(6(.,, F-cc(Lre,( S 230 lZi
i.1 a Is this an accepted street?yes -no Map Nunibes Parcel Number
'1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided • Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private El _Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owned of cord:
'Name COWL kd t ( flA,Nttincs O(en Le t'l.a- 01.0(0 �--
a
Name(hint) City,mate,ZIP
\`8lv Fe.ifiblAart 'fly-5S9-/((-I'
No. and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2 (check all that apply)
'New Construction 0 Existing Building 0 Owner-Occupied Cl Repairs(s).❑ Alteration(s) 0 Addition 0
Demolition D Accessory Bldg. Q Number ofUnits Other O specify:
Brief Description of Proposed Work': w S'
SECTION 4:ESTIMATED CONSTRUCTION COSTS
.Item Estimated Costs: Official Use Only
-_—_ __—.__ ,(Labor and/v12.ter als)_ -
1.Building $ (6. 466 1. Building Permit Fee: $ Indicate how fee is determined:
1 i3 Standard City/Town Application Fee
2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees:•$
4.Mechanical (HVAC) $ List: .
5.Mechanical (Fire $ Total All Fees:
Suppression)
Check NoMA Check Amount: (" Cash Amount:
6.Total Project Cost: . $ /�1 JCJ - Cl Paid in Full -El Outstanding Balance Due:
R
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
. 011219 (o�Zt ( 02-
C`Qex Crian License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
P. c6cz)<.. cpc-)(021
No. and Street Type Description
`� tv v 1a�� n l®`Cr TJ Unrestricted(Buildingsupto35nn9 ft.)
R Restricted f&2 Family Dwelling
City/Town,SSO- ,
� M ia4asanr3
RC . iiuuhng.Covring
J �n WS Window and Siding
�J VVV SF Solid Fuel Burning Appliances
ul� �132G� I Insulation
Telephone Email address D Demolition
5.2 Registered Rome improvement Contractor(HIC)
OS� 3 812c� zz
-�,e (iQ.C�([�VYn.4" HiC Registration Number Expiration Date
�B rTC Comp Name or RTC Registr nt Name
(Qo(oZ? Flo c-e CY1Ps (DtU c°7--
No.and Street Email address
tkt3-Sat--1SZ2
ti City/Town,State,ZiP Telephone
• SECTION-6:WORKERS' COIVMPENSATiON INSURANCE AFFI-DAViT(1Vi.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 TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize �A-L $ --�` 1 S l\
to act on m behalf,in all matters relative to ork authorized by this building permit application.
,2429
. Print O ner' a(Electro ' ignature at
SECTION 7b:-OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
SJ tvbu Sl L v�1.mo o W2daiPrint Owner's or Authorized Agent's Name(Electronic Sign tare)
NOTES:
1. An Owner who obtains a building permit to do his/her oven 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 find under M.G.L.c. 142A Other important information on the HIC Program can be found at
wwv'.mass.-rov/oca Information on the Construction7SupervisorLicense=can=bed'ound-at-www:mass.2ov/dos
. 2. When substantial work is planned,provide the information below:
Total t floor area(sq.it.) (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 half'b-aths
Type of heating system Number of deckslporches
•
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
•
• City of Northampton
r a Massachusetts mow, .r<
,
X.
`�' '�' '' }``` DEPARTMENT OF BUILDING INSPECTIONS ft I.1,. . ;;6'j
t
212 Main Street • Municipal Building �.,
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
•
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
N u-m-be r is �nat all debris
ebCi$ resulting from this work
S^?i: be disposeciof
in a
properly licensed waste disposal facility, as defined by Ma c 111, S 15OA.
The debris will be disposed of in:
Location of Facility: Q U AZ0CV c1 t R-VP �`-IC) , GQ -V\
The debris will be transported by:
Name of Hauler: `\lam Arkf✓ti •
Signature of Applicant: J. d
1
4, Date: /./ / ADY
The Commonwealth of Massachusetts
()1 Department ofIndustzrialAccidents
i : P
_� i 1 Congress Street, Suite 100
Boston,MA 02114-201
'�:>, www.rnass.gov/dia
1Vor Ers' Compensation Insurance Affidavit:Builders/[_,ontr-actors/E.lech_Ic ans/Plumbers.
Ti)E lL,C.I)WITH TUE 1'It*TviIT ONG AIJTPII)RIT Y.
77 Applicant Information Please Print Legibly
]Wattle (RiiRiness/Organiviti.icrn/rndivicii rid): \j(ti-e, ,� Y i t/i C 1\/r0\J\ :� \QJ ' ap (
Address: tl� C��v��v�� �r •► - Q- 0 . C ,G Cc.)0 Cc)Z,A--
City/State/Zip V o rrxi.0 e VA 1.Ck)2- Phone#: 4- ss`-(_-1 S2 2__
Areyou an employer?Check the appropriate box: Type of project(required):
rig I am a employer with f} employees(full and/or part-time).* 7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working forme in 8. ® Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.1^1 I am a homeowner doing all work myself iNo workers'comp.insurance required.)+
I U Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
- ensure that all•contractors-either-have woikets'compensation insular et ar ate sole 11.0 Electrical repairs<o.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. 13.0Roof repairs
These sub-contractors have employees and have workers'comp.insurance?
14.0 Other
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c.
152,*1(4),and we have no employees.[No workers'comp.insurance required.)
* that k. #1fillbelow.showingi, policy information.
applicant cheep box must also out the section��l.,Y,!.su,.�.r,.g their warners'compensation
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
*Cvntrattors that dieek This fxrx must nttatdtednnadditiunal sheet showing the name of the sub-tontrar toys anti state-whether unapt abuse 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( ,l,\- -A-I L. 1el r1C c, (V =P —
Policy#or Sell ins.Lie.#: W 5�c--) J(2` Expiration Date: c9 l I I,DO DL '
Job Site Address: li� ��t1l/IJL U (J) - City/State/Zip: 0(), .(��Lh'L I A-L4 Ol O(cc
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expirktion 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 foam 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 pal a penalties of d erjuiy ,% l e jnformation provided above 's true nd correct •
.. - i i,_- Date: _
-.�._.Sit;iiature._.. _- __- ) �� �_
Phone#: titk9a- - S4——I¶22—
Off cial use only. Do not write in this area,to be completed by city or town official
City np Town: Permif/i,ir_.Nnct # r
Issuing Authority(circle one): l
- 1.Board of Health 2.Building Department 3.CitytTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
Commonwealth of Massachusetts
F r Division of Professional Licensure
Board of Building Regulations and Standards
Consr04fASS'pKvisor
CS-077279 -' ; ;•Q ., apires:06/21/2022
• STEVEN A Sf VERMAN :- : '.! ", G-.�;` ;q
PO BOX 606227 ^;,;�1I _) a 7.- .g?y
> w-r:
FLORENCE MPJ�01062 4 '' O 0@ ''
• ? 3
Commissioner d,8Qa >ri'. BFinc&a.
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.
1 0 20M-05/17
Fo,92,9ze wea6rcy,./Z.m�vac44ue74
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
i 105543 - 08/20/2022 1000 Washington Street -Suite 710
VALLEY HOME IMPROVEMENT INC Boston,MA 02118
laSTEdi
VEN '
A.SILVERMAN �� � •
340 RIVERSIDE DRIVE - �,'^"''(4 04- _ ,
FLORENCE,MA 01062 Undersecretary Not valid without signature