24C-084 BP-2022-0528
17 MASSASOIT ST COMMONWEALTH OF MASS A CHUSETTS
Map:Block:Lot:
24C-084-001 CITY OF NORTHAMPT 1 N
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERE a CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY F ND (MGL c.142A)
BUILDING PE MIT
Permit # BP-2022-0528 PERMISSIONISH REBYGRANTED TO:
Project# DECK Contractor: License:
VALLEY HOME IMPROVE' ENT
Est. Cost: 45000 INC 077279
Const.Class: Exp.Date:06/21/2022
WOLF ALEX NDER G&JENNIFER A GROVER
Use Group: Owner: CO-TRUSTEE`
Lot Size (sq.ft.)
Zoning: URB Applicant: VALLEY HO E IMPROVEMENT INC
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON:05/18/2022
TO PERFORM THE FOLLOWING WORK:
REPLACE EXISTING DECK
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 NORTHA PTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I
i• i % .6
Fees Paid: $293.00
212 Main Street,Phone(413)587-1240,Fax:(413) '87-1272
Office of the Building Commissioner
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The Commonwealth of Massachusetts MAY 3 �U FOR
tr i Board of Building Regulations and Standards -MUM Y
Massachusetts State Building Code, 780 CirviR E .
r' OFF�JII DING INS EC;1IO
Building Permit Application To Construct,Repair,Renovate O'I4?1FI t1�1 1-a)N. n,6rnae _ar f111
One-or Two-Family Dwelling.
This Section Fdr Official Use Only
Building Permit Number: a 0- 42.1.-6'A 2 . Date Applied:
6Vi,-) )► Y2' 5- Ro-Z02Z
Buil di ng Official(Print Name) Signature Date
L SF.CTION 1:SITE INFORMATION
1.1 Property d��e��0►� S! 1'?.�s_els�Map&Parcel Numbers �.
a /� J
• 1.1 it Is this an accepted street?yes -no Map Nu.rnber Pant)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
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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? Municipaldisposal system 0
Public 0 Private 0 — Check ifyes❑ 0 On site
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owned f.4 Record:
1r7IM949s4 Co(e/- 5C-63c1Y.
No.and Street . Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s).❑ Alteration(s) 0 Addition 0
• Demolition 0 Accessory Bldg. Gr Number ofUnits Other b specify:
. Brief Description of Proposed Worke: il epl ac.fi c'Yi'7 A,-• aceji_,• -
c)P-rivr) r.-'0 AtericHip-rvt Not Ar-1 niukg deck- LA AA, gallAp__
• SECTION 4:ESTIMA.TED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1 Building $ LI D .�-- I. Building Permit Fee: $ Indicate how fee is determined:
�4 O'Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing S ----- 2. Other Fees: $
4.Merh.anical (HVAC) $ List: '
5.Mechanical (Fire •
Suppression) Total All Fees.,$
' Check No.42 as( Check Amount: Cash Amount:
6.Total Project Cost: • $ L{s-a r , 131'.aidinFa .❑oitseanding BalaoaeDue.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
(� Dili V1 Ci (DIZI. (ZoZ2
-e.\• r1 \Je) License Number Expiration Date
Nanic of CSL Holder
List CSL Type(see below)
P.c ec+x, ( . 21
No. and Street Type Description
re CC- O� � U Unrestricted(Buildings up,to 35,000 Cu.tt.)
MPTR Restricted l?c2 Family Dwelling
City/Town / M Masonry
RC .Ruufingr.Cuvering
WS Window and Siding
SF Solid Fuel'Burning Appliances
insulation
Telephone Email address D Demolition
5.2 Registered Rome Improvement Contractor(MC) ���� g`
�b
�` " � -�-�' HIC Registration Number Expiration Date
Y.0 Co pay Name or MC Registrant Name
.%- Gjo (0O(02:1 '�lOre_nC 'CrlPs O 1 U(0 2 -.
No.and Street Email addreeea
. City/Town,State.,ZIP Telephone
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 ofthe•buildingpermit •
Signed Affidavit Attached? Yes...... No .❑
SECTION 7a:OWNER AUTHORIZATIONTOBE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorized
to act on my beh. in all matters relative to work authorized by this building permit application.
' '.. er' Name eaeclronicSignature). Date
SECTION 7b:OWNER/OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under th= •alias and penalties a •erjury that all of the information
contained in this application is true and accurate to ,-`.`;t of my owl:•� and understanding,
r_-sift J 1 4 /M4 i/hhf/
Print Owner's or Authorized Agent's Name(Electron] f.f.tf.e) Date
NOTES:
I. An Owner who obtains a building permit to do his/her ow 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 fund under M.G.L. c. 142A Other important information on the EEC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can•be found at www.mass.Rovldos •
. 2. When substantial work is planned,provide the information below:
Total floor area(sq-ft.) (including.garage,.finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Nuuabcr of freplaues Number ofbed o ms
'Number of bathrooms Number of hali7baflns •
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"
City of t Or ampLOfl
-`ice,, `,5- f�
7,7)- .1,(y..11t assachusetts 4,� •r<<ti � iF ,N, ` Ir.-
DEPARTMENT
� tp
:� ' DEPARTI ENT OF BUILDING INSPECTIONS merit I •k.
_,.k 'r 212 Main Street a Municipal Building C�
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROCTS)
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In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number isthat all debris resulting from this
c K shall be disposed-of in a
properly licensed waste disposal facility, as defined by M€i_c 111, S 150A.
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The debris will be disposed of in:
Location of Facility: \JQ U oc (',� 1 -\-P IC) • oF-4-
The debris will be transported by:
Name of Hauler: `\oJi m4 Mribc r r — . •
4 ,
Signature of Applicant: J / ` Date: ) 0— 0-a
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_� The Commonwealth of Afassachusetts
� a R il ��7? Department of Industrial Accidents
` I Congress Street, Suite 100
;\ Boston,MA 02114-2017
ntiww.inass.gov/dia
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TO ash.FILED W l r n TM'.PERMITTING AUTHORITY,
Applicant Information }`
Please Print Legibly ibly
Name iicxineswrrrgantvinniinrivicitr its C^Ona.. —tn. p) u-r c
Address: ofCZ
City/State/Zip: A 0reX2C P C L Phone #: 52
Are you an employer?Check theappropriate boi: Type of project(required):
1.,`�I am a employer with . , employees(full and/or part-time)." 7. [,New construction
2.Q I am a sole proprietor or paituership and have oo employees working for me io 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.)t
I 10 Di Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will n
enstre�hatall eontractors.either•havewordee1s'compensation 41 urewce sr a+ecole - • I I.L�Electrical repairs.or.aktelitiimns •
proprietors with no employees.
12.E Plumbing repairs or additions
5.0 T am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs
These sub-contractors have employees and have workers'comp. insurance.
6. We are a corporation and its odlcers have exercised their right of exemption14. Otherg per MGL c.
152,§1(4),and we have no employees. [No workers'comp.insurance required.]
"An- applicant that checks box nl must also fill out the ollorr showing the' orkers'ccmpcosation 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.
'Cuatratstors that check this box mist'attachtdanadtlitional.sheet shvwing'the name of the sub-cauhattvrs'and state-whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I an:an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. (�
Insurance Company Name: F��hQ,�\ L�,' Y1(C Arra(-C)
PolicySelf-ins. #: OC) �� V 2�� Expiration Date: ✓'I i 1 �Al
#Or ace-i.iii,r�iC.rr, J c , i.x rrattGn ,are: 11 T
Job Site Address: k I l t t� jC r 1 `1/�(�—�' City/State/Zip: 11(),41'111&pchr}, 14401C•{
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expix4tion 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$25 0.00 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 'ins and penalti afper' a information provided above is true and correct. •
cc 42Z
Signature: � Date: (
Phone#: 'q\23- S 22--
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permitui,icense#
fIssuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Iowa Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Cons Ni,Spr isor
CS-077279 � i- 6cpires: 06/2112022
STEVENAS!t1lERMA. lr : 't �, y- "
PO BOX 60627} •,' T e a
FLORENCE M9 0106 z� +
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Commissioner j, 0. g" �J
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gre KGz/n/2Q/liiOdac,/-
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
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Type: Corporation
VALLEY HOME IMPROVEMENT INC Regis 18
P.O. BOX 60627 Expi ration:ration: 08//20/20/
2022
FLORENCE,MA 01062
Update Address and Return Card.
i 1 C 2DMM-j-05/17
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17 &p ,qp' 4
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 BuSlness Regulation •
105543• - 08/20/2022 1000 Washington Street -Suite 710
VALLEY HOME IMPROVEMENT INC Huston,MA 02118
STEVEN A.SILVERMAN O/, ,�/
340 RIVERSIDE DRIVE-, --
FLORENCE,MA 01062 Undersecretary Not valid without signature
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