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31B-054 (5)
BP-2022-0604 31 LANGWORTHY RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31 B-054-001 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-2022-0604 PERMISSIONISHEREBYGRANTED TO: Project# KITCHEN/BATH UPDATES . Contractor: License: VALLEY HOME IMPROVEMENT Est. Cost: 21000 INC 077279 Const.Class: Exp.Date:06/21/2022 Use Group: Owner: DENISE ROCHAT, Lot Size (sq.ft.) Zoning: URA/URC Applicant: VALLEY HOME IMPROVEMENT INC Applicant Address Phone: Insurance: P O BOX 60627 (413)584-7522 0055030215 FLORENCE, MA 01062 ISSUED ON:05/31/2022 TO PERFORM THE FOLLOWING WORK: KITCHEN/BATH UPDATES 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: IP • ir • )2 . OIT Fees Paid: $136.50 . 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner • The Commonwealth of Massachusetj� Board of Building Regulations and Stanciar�isAr • • �.�, Massachusetts State Building Cade, 780 Cti •.°9ry 4„, SE. Building Permit Application To Construct;Repair,Renovate Or De, 004- Revi dMar 2011 •One- or Two-Family Dwelling. �'1oFei> This Section For Official Use Only \ros Building Permit Number;— .a�^"(ioy Date Applied: _ VELAO s ,Z 5- 2/-202z Building Official(Print Name) Signature Date SECTION 1: SITE.INFORMATION 1.1 rp erty Address: 1.2 Assessore.p.t..i. re.Parcel Niimhe, • ih . hd:p ar.>�er Parcel Number l.l a is s an accepted otreet'�yes -r�o _ '1.3 Zoning Information: 1.4 Property Dimensions: j Zoning District Proposed Use Lot Area(sq ft) Frontage(fi) I 1.5 Building Setbacks(1't) 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❑ Private 0 Zonc• _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' - � Owner'of P cord: 151 _ ICPj c _.a Cy-4 ri, (aFr-v-k (\9- Oi.OCR c' Nam-(Print) City,State,ZIP • No. and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2 (check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition. 0 Demolition 17 Accessory Bldg. [7 Number of Units Other ri Speci . Brief Description of Proposed Work': C.a rn•3t-r},p S:.. , to.14-. Vspe1. i-E5 . 415 C?t,z- A 9- .ptp.,b cko s I t_ b'. N,. ►o- reD �- l,�•lcr L. 9,..(4r'4 514,-,e,` v AA-C.-- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use.Only (Labor and Materials) 1 Building $ 12 & 1. Building Permit Fee:$ Indicate how fee is determined: CI Standard City/Town Application Fee 2.Electrical $ � 0 Total Project Cost] (Item 6)x multiplier x 3.Plumbing $ 3/' 2. Other Fees: $ 4.Mechanical (1:IVAC) $ List: • ' 5.Mechanical (Fire $ . Suppression) Total All Fee`s�'$ Check Nd 1.l6(0 Check Amount: ✓u i Cash Amount 6.Total Project Cost: $ G j • ❑Paid in Full ID Outstanding.Balance Due: - SECTION S: CO S RECTION SERVICES 5.1 Cnrtstr Lied 0n Sup crvi.scrLicense(CSL) ��1 '?, ��/t. �t�22 cx1C..o Cy�ti�oX n� - -_ _ . ; License Number Expiration Date . Name of CSL Holdr:r List CSL Type(see below) P.o 'LAN coo,(021 1'}pc 1 Description No. and Street • �n Unresirieted(Buildings up to 35,O)t}cu.ft.) . Ore, /C.0 1�► Qk0(.02 Restricted I&2 Family Dwelling City/Town, ' ZTP / Mason y ///� RC, Riioiinkr Covgrin= _. — _ J i WS WindowandSiding ' SF "Solid'Fuel Burning Appliances `1l.}':3� -1 7622— _ 1 insulation Telephone Email address D Demolition 5.2 Reoistered!Tome Improvement Contr^acctor�(FTIC) • �S5y3 g� Z�ZZ \, e { Q� 1(T7ti�f'] i �F' _ T-IIC Registration Number Expiration Date C Comp 'Name or I-IIC Registr�ntName \i x,.Cc.) ki-)o(o2- lorence,C 01 u _. No. and Street F-r ail adtl:ess City/Town; State,ZIP Telephone - SECTION•6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.1152.g 25C(6)) Workers Compensation Insurance affidavitmust 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..........Ili No SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETE©WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize lea-rr�1 to act o a my behalf,in all matters relative to work authorized by this building permit application. i Print Owner's Name(Electronic Signature). ate SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of p that all of the information contA in ed in this application is true and accurate to th my kn .led understanding. • S L-147'v i71 j/i/410t) .. —C f Z1.--,- Paint Owner's or Authorized Agent's Name(ElectrA,, pa 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(IBC)Program),will not have access to the arbitration program or guaranty fund under M.G.L_c. 142A.Other important information on the BIC Program can be found at w\ w.mass.szovIona Information on the.Construction Supervisor License can be found at www.mass.sovid+as . 2. When substantial work is planned,provide the information below: Total floor area(sq ft.) (including garage,.finished basement/attics, decks or porch) 1. Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of baif radis 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 Uorthamptoft 14.r" Massachusetts :1-447 -.1 ..)1';-• 1 '11.1rie,A-V: -o DEPARTI,SNT OF BUTLDING INSPECTIONS ?A .4 i:';'- .i7s" 1g210t1 212'-, N Main Street o.Municipal Building ‘!;•-, '- -.(,,/''..-,!-f2t7a.c-A-,--. '-.--'-'"-r C!'_--;%•":- • 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 theA all debris resulting from this work shall be disposed of in a properly licensed waste-disposal facility, as defined by l'A-GL c 111, S 15,3A. The debris will be disposed of in: Location of Facility: Vi Uj OCLViL \e 1 (4- ' --.1 The debris will be transported by: . . Name of Hauler: \\CILA./ ..\.Ocno akievh4f...0-V.P,------ • • 0 Signature of Applicant: Date: • • The Commonwealth of Massachusetts ' I't= A '- Depaitrrrert of Industrial Accidents de nts 1 Congress Sire et, Suite 100� ' ; =, \r ' Boston,MA 02114-2017 J L ; • A 1411919.mass.gov/dia • 1Zarl;crs'Co,t,necksatina insurance Affidavit:8uildc-Fs/Cannac ors/F.lectrirk-usfPlurtess. TO RP.FII.F.I)WITH Cl T li P.1"KRTVIl 1 TItil:AUTHORITY. Applicant Information Please Print L et;ibiy Name .�( L(f� Pe' (0\lf.►n ,r- ,not— r (nusinctia'i+r�anzaiinn%inriivirivaij: Address: , ) iv-e':(5\il-r_.-- ---- +.1 ..SC . ?- 0 . ( c Cc,OCoZr-• City/State/Zip k.Q,rc C_e \4 -C >(n2- Phone#: 4,‘2>-SE2,9-152?— Are you an employer?Check the( appropriate box: Type of project(required): 1.� s I a a employer with I('� employees(fc:l and/or part-time).* 7. DNew construction 2.0 I am a sole proprietor or partnership and Lave no employees work ng forme in 8. ®Remodeling any capacity.[No workers'comp.insurance required.) 9. ❑Demolition 3.n I am a homeowner doing all work myself.[No workers'camp.insurance requ.ired.1' i 0❑Building audition ` 4.0I am a homeowner and will be hiring contactors to conduct all work on my property. I will ensure beat ail tontraotois eitiet+lave won rid'compensation insiwal+cc or are 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or add_tions 5.0 T am a general contractor and I have hired the sub-contractors listed on the atachedshCT. i3.❑Roof repairs These sub-contractors have employees aid have tvorkeia'comp.insurance.: 6.❑We are a corporation and its officers have exerciied their right of exemption per N.GL c. 14. Other.. 152,§1(4),and we have no employees.[No workers'comp.insurance requited.) `Any applicant that checks box 0:1 must also fill our the section below.showing their workers'comper.sa.ion policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mast submit a new affidavit indicating a'rich. i +Ctmtrav-tors Mat rnecit•this box mast•att ned-an-additional sbetit showing thenameofthesub-corrtrattursandstate-wheatsornutd:osecatxtitsnave employees. Lf the nib-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 Co:xtpauy Name: A at r r{ ��rC -f> — Policy#or Self-ins.Lie.#:_ OO',9,C) b2_\' ,3 Expiration 1 I ' (90A. 2 y ,_•� iration Bate: Job Site Address: 1 t-CU J . .JU/ City/State/Zip: o,4F i eel M•*01 CcC Attach a copy of the workers'compensatldn policy declAation page(showing the policy number and cspir.ktion date). II Failure to secure coverage as required under MGL c. 152,§25A is a crirni.nP1 violation punishable by a one 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 a ins and penalti of per' e information provided above is true and correct. • Signature: l q� Date: `t 2 S\202Z-.— Phone#: I ' V5 &4- S 72-- Official use only. Do not write in this area, to be completed by city or town official City or Town; Pe.rmitli,icence rr Issuing Authority(circle one): 1.Board of/eattft 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector - 6.Other Contact Person: • Phone ii: • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards • ConsO# 'pry i s or CS-077279 • yy,, spires: 0612112022 • STEVEN A S \/ERMAN : PO BOX 60623 . ,., ;) 5 FLORENCE MI) 01662 tP'• r 1 , t Commissioner OIa K. CJ C�.rR. CCCJJI • • • CEOi72.r720/MeieCGll.0), • Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 • Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation • VALLEY HOME IMPROVEMENT INC Registration: 105543 P.O.BOX 60627 Expiration: 08/20/2022 FLORENCE,MA 01062 Update Address and Return Card. A 1 0 20M-05/17 asniigevneere e ✓0540 d¢ welly 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 xpiratiort Office of Consumer Affairs and Business Regulation 105543 - 08/20/2022 1000 Washington Street -Suite 710 VALLEY HOME IMPROVEMENT INC Boston,MA 0211 B • • . . .. ._. STEVEN A.SILVERMAN 4A1 0,, 340 RIVERSIDE DRIVE-. 46011(14./ FLORENCE,MA 01062• Undersecretary Not valid without signature