23D-104 BP-2022-0436
17 NUTTING AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23D-104-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-0436 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 18600 INC 077279
Const.Class: Exp.Date:06/21/2022
CALDANARO ANTHONY J JR&BOSILJKA
Use Group: Owner: GLUMAC
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:04/26/2022
TO PERFORM THE FOLLOWING WORK:
REPLACE 5 WINDOWS
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: ( ; 1 )9 cg', •
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
h The Commonwealth of M.assa use APR 2 6 OR
�c:, 1' Board of Building Regulations and Stan •ds2022
�( Massachusetts State Building Cod 780 CIPALITY
bEaT of u" USE
Building Pennit Application To Construct,Repai ;R-euo t_el A r �,d aTlotiizevistdMar2011
One- or Two-Fancily Dwelling. '"` ^01060
,,,, This Section For Official.Use Only
Building Permit Number: SSP' _a'_43 ce - Date Applied:
, 1/6-v 1 N k 1Cos5 / '1 21,-ZOZ Z
Building Official(Print Name) Signature Dare
SECTION 1: STTF INFORMATION
1.1 Property erty Address' 1.2 Assessors Map &Parcel Numbers
Ai � r - t<_ fl 0
'�'i �- . lull Number Parcel Nu�a�
l.1 a is his an accepted street?yes mo • P
_ 1
'1.3 Zoning information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard i Side Yards. Rea;Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c. 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone? Municipal D On site disposal system 0
Public 0 Private 0 Check if yes° P y
SECTION 2: PROPERTY OWNERSHIP'
31 Owner'of ecor d::
1-6 1 iGU f—v-0 41 vx -c , Mg— O'\0(00
. Name(Plitt.). Ck+,.fate,7
No.and Street Telephone Rmail Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2 (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s).° Alteration(s) 0 Addition °
Demolition 0 Accessory Bldg. 0 Number ofUnits . Other b Speed":
. Brief Description of Proposed Work2: g_e t 5 l :rZlioL0 vel . 1 ci . `_nIN*
. SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use,Only
(Labor an d Materials)
1 Buildingc�i CoO O 1. Building Permit Fee:$ Indicate how fee is determined:
_ $ I t7/_- - '°Standard City/Town Application Fee
2.Electrical $ 0 Total Project Costa(Item 6)xmultiplies x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (EVAC) $ List: .
•
5.Mechanical. (Fire $ �j
Suppression) Total All Fees: (I4
Check No4? I Wtheck Amount: Cash Amount:_
. 6.Total Project Cost: , $ ) �/ 6,6 0 . .D paid is Full, Cl Outstanding Balance Due:
•
SECTION S: CONSTRUCTIONSERVICES
i
5.1 Construction Supervisor License(CSL) 0 11 Z (Zi l 4°Z�
b\--e-v-r..ss-1 76\eg(l'l,0 r\ License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
P"e) gC, , ( .)(r)21
No. and Street Type Description
�(\,/� TiUn:-.0tri to (Buildings u to 3ir`.,v0�n cu.It
'HOrPS�.( � '" "`� C� _ R Restricted I eta Family Dwelling
City/Town, t M Masonry ._..
Ri, , Rqutiny,CA)vCring
WS Window and Siding
SF Solid Fuel Burning Appliances
•- 4-522_ i insulation
Telephone Email address D _ Demolition
5.2 Registered Home Improvement Contractor(ITIC)
1a3 Blza{2�zz
.MCP T Q-c {irf "'- HiC Registration Number Expiration Date
NC Compart,Name or RTC Registrant Name
.L�.Ej3la lDO(pZ� c-lor nc.t',CY1�Ps b 10< -2-
No. and Street Email , iy,•.
413-S 311-1 Z2- •
�. �s
. City/Town,State,ZTP Telephone .
• SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c.152. § 25C(6))
Workers Compensation insurance afftdavitmust be completed and submitted with this application. Failure to provide
this affidavit will result in the denial"of the Issuance-of the bui lding permit.
Signed Affidavit Attached? Yes No...........❑
SECTION 7a: OWNER AUTHORIZATIONTOBE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR ATPI.iFS FOR BUILDING PERMIT
I, as Owner of the subject property,hereby authorize CA_j
to act on my behalf,in all matters relative to w authorized by this building permit application.
Print Owner's Name(Electronic SiLnature). Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains d penaltie f p • at all of the information
contained in this application is true and accurate.tztthe kno ge rstanding,
S r S1 /r t0 y- 7-026a a ...
Print Owner's or Authorized Agent's Name(Electronic Si_ . •c) 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 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 MC Program can be found at
www.mass_nov/oca Information on the Construction Supervisor License can be found at www"mass.Qov/dns
2. When substantial work is planned,provide the information below:
Total floor area'(s i.IL) (including..aar
InZ1LLJri ,a.L e,finish—ed. basement/attics,deck,Or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces
es Number ofbedronme
Number of bathrooms Number of half/baths
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" •
•
Ca_ty o Noi 'champ ta1
/r `k biassachusctts•
4 •;i.�� DEPARTMENT OR BUILDING INSPECTIONS t, 2 r
.'``�,_, � '�`• 212 Main Street P Municipal al Buildingtv'
�\y l;cr ampta.., �f s f
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 M€L c 11?, S 1.50A.
The debris will be disposed of in:
Location of Facility: \Q U, 10C iC) , ,4h -�
The debris will be transported by:
\l
Name of Hauler: `\ t1 {ri4 lct triVi
//1 ,
Signature of Applicant: 4Date: V 7
The Comrrronwealth. of Massachusetts
11i Department of Industrial Accidents
I Congress gtreet,Suite.I QO
_Roston,MA4 02114-2017
ma y' www.mass.gov/dia
Workers'Comp insaitiotr instil aace Affidavits$reindeers/Contz"arl_or'slal 'rotors/Plumbers.
PP F r R.fTTi T YrTTiAT(TY
i O nr.• u.r.�a w��n �i-f r,i�M.Kivti i I II�Ti.fi 11!t761K1 1 Y.
Applicant Information Please Priest Lecibly
Name ir'fur irteKsiOrgxnicai.tnnrindivicivail: ,,(�� Ir�^�Q •
Address: ?")4(`) i\5C_ . Q- . C (c)0(6:.-
City/State/Zip G-01062_. Phone#:
Are you an employer?Check the appropriate box.: Type of project(required):
i.i I am a employer with t g employees(hill and/or part.time).* 7. I]New construction
2.0 I am a sole proprietor or partnership and lave no employees working for me in 8. ®Remodeling
any capacity.(No workers'comp.insurance required.]
3.0I am a homeowner doing all work myself.(No workers'comp.insurance required.]* 9 El Demolition
10 U wilding addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that a71 contractors eitheriiave workelo'compensation a.crnaa,ee sr are soft • • I LC Electrical repairs,or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 Tam a general contractor and T have hired the sub-contractors listed on the attached sheet. 13.❑ROof repairs
These sub-contractors have employees and have workers'comp.insurance?
6.awe are a corporation and its officers have exercised their right of exemption14•El Other
rip perMGL r.
152,p 1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that:hcGsivui#1 must also fill out the section t.,ow snowing their workers'corr.p,;rsst.ar,policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Con'G'aetors that tdrerk'this box must ottached2aaddiuvnai sheet shuwinaltle name attic sub-contra:tors state-whether ur nut tbuse entities have
employees. If the sub-contractors have employees,they must provide their woricets'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‘f Zia YlC r (-err fl
Policy u.or Sell-ins.Lic.t#: v,f O t�, ,c b21� Expiration.Date: t9 ao() ) ) �
t �
Job Site Address: t� a kk'1(\ City/State/Zip: K1(),4 1u,p h, Oi of :
Attach a copy of the workers' compensatiWpolicy declaration page (showing the policy number and expiration 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 e 'this and penalti of per e information provided above is true and correct.
IIi `
I
Siexrature: /- Date:
Phone#: q‘ 2—
Official use only. Do not write in this area,to be completed by city or town official.
City nr Town; Permit/Lie.ense#
Issuing Authority(circle one):
1.Board oTHealth 2.Building Department 3.CityiTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: • Phone#: