23D-007 (9) BP-2022-0876
58 NONOTUCK ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23D-007-001 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-2022-0876 PERMISSION IS HEREBY GRANT;D TO:
Project# SKYLIGHT Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 3000 INC 077279
Const.Class: Exp.Date:06/21/2024
Use Group: Owner: ANNE RIDABOCK HARRY WINTON II&
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:07/25/2022
TO PERFORM THE FOLLO WING WORK:
INSTALL SKYLIGHT
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 VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
V • _ 3-0
1 •
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
' 1�
The Commonwealth of Massachusetts 71;'
ltr�r Board of Building Regulations and Stan•.rds ✓(/� FAR
\ ;/r Massachusetts State Building Code, 780 22 C E .
XTY
�Fp (9 Building Permit Application To Construct, Repair,Reno q9� ish a l�evi� iMw- 011
One- or Two-Family Dwelling aArN4iNr
'o ^C:p
This Section For Official Use Only �'Mq oF�Tio
0ao 41,3
Building Permit Number: fe,P. 79 Date Applied:
✓ � ' /
-]-ZS-ZOZZ
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1CPPropj rty Address` ` 1.2 Assessors Map&Parcel Numbers
I.1 a Ts this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(s4 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❑ Private 0 Zone: Outside Flood Zone?
— Cheek if yes❑ Municipal 0 On site disposal system Ell
SECTION 2: PROPERTY OWNERSHIP°
2.1 Owner'of Record
V IS c-1 \(Yer1C.0- Oe\9— 0\ b(D a
Name(Print) City,State,ZIP
(X‘C UC•�C `5\- q 13 lo9 S' 9Lj
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify: _-
Brief Description of Proposed Work2:
►�5{� C (/t�(v�( -L,ul�- S/C� 1i
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1. Building $ 3 � 1. Building Permit Fee: S Indicate how fee is determined:
❑ Standard City/Town Application Fcc
2.Electrical . $
'❑Total Project'Cost''(Item'6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (IIVAC) S List:
5. Mechanical (Fire $
Suppression) Total Al[Fees:$
Check No. Check Amount:
6.Total Project Cost: $ 3 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) % -1c la /2/ jG l2 y
C License Number 11 Ex pirab on Date
Name of CSL Holder
List CSL Type(sec below)
No.and Street Type Description
` �f C� L�� � tJ Unrestricted(Buildings up to 35,000 cu.ft.)
t"L
1 R Restricted I&2 Family Dwelling
City/Town, ter ZTP 'vf Masonry
RC Rooting Cove,ing
WS Window and Siding
SF Solid Fuel Burning Appliances
13" S1' )S22— T Insulation
Telephone Email address j D Demolition
5.2 Registered Home Improvement Contractor (BIC)
I .cSt-! 'o,2Ci2.G2f
FP('Registration Number Expiration flat
FTT CompaName or�HIC Registrant Name
CAI
No.and Street Email address
Dr 'ntC. cr1 C=t(
City/Town, State,ZTP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT m•I.G.I.,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........... 0
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 SA- "G�lal' I L e,main .
t . on behalf.in all matters rel we to rk authorized by this building permit application.
Ow7r's Name(Electronic Signature) Date
/ 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 b t of my knos ledge derstanding.
Sr S__ilb4,N 7, -a,o ,
Print Owner's or Authorized Agent's Name(Electron a e) 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 Lnprovement 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 HIC Program can be found at
Information on the Construction Supervisor License can be found at "v"', w.m:i s Eo (11'>_
2. When substantial work is planned,provide the information below:
Total floor area (sq.ft.) (including garage,finished basement/atties, decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
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"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
• _ t Department of Industrial Accidents
_ 1#1_= I Congress Street, Suite 100
_''4 Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PFRNIITTLNG AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): \lQ 1 -CLA -I kxri c Tore D"1.e(vi rr)--1
Address: 5- O R\ v- =•\o C �r„rc4J ?. 0. c Cco(c Z-1
City/State/Zip: t- 01 0(02 Phone #: L l3-S`S4--7 S22
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with to employees(full and/or part-time).* 7. 0 New construction
?.❑I am a sole proprietor or partnership and have no employees wonting for me in 8. El Remodeling
any capacity.[No workers'comp.insurance required.]
3.01 am a homeowner doing all work myself.(No workers'comp.insurance required.)t
9. ❑Demolition
Q Building addition
4.01 ant a homeowner and will be hiring contractors to conduct all work on my property. I will
lfl
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.1:1 I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet 13.7Roof repairs
These suh-cootractors have employees and have workers'comp_ini1rrance,1
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Oilier
152,§1(4),and we have no employees. [No workers'comp.insurance regnired.i
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation 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.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those 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: -AyA0C `(� �Yl Svr0.�t L C-I s-c ,o
Policy#or Self-ins.
GLie.#: (D -1 S Expiration Date: 07) F >2
Job Site Address: `,� \ X1O7' _C V City/State/Zip: (y'rZCQ. 01/\..g..- a\.b�2—
Attach a copy of the workers' compensation policy 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$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify un er the pains and pe hies of p r hat the information provided above is true and correct.
Signature: M 0/1 Date: f10 I.20,2.Z
Phone#: -t� J- egq 2 2._
a ,
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3..City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
City of Northampton
Massachusetts ., ••
DEPARTMENT OF BUILDING INSPECTIONS 11 ja
*` y4 212 Main Street • Municipal Building .. �
Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of
in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: 41 fNerH:, j MO; 4+ RJ' r7
The debris will be transported by:
Name of Hauler: 61/L-`- TTV(..
Signature of Applicant: Date: ( - iYv . 010 O
Commonwealth of Massachusetts
�I Division of Occupational Licensure
• Board of Building Re ulaIT'tions and Standards
Con Ion$visor
•t
CS-077279 E:li: ,ke.pires: 06/21/2024
STEVEN A Si VERMA� i= :` .
PO BOX 6065 iy `t 44, ,' '4 p �:
FLORENCE NlA 01062�I ; 'A ;( s ' • `{'t
.1.:4;':::,'t ,S, x
11 Iv d:�3 r
THE COMMONWEALTH OF MASSACHUSETTS
Tom ,
Office of Consumer Affairs and Business Regulation
1000 Washin ` z r : - Suite 710
Boston:,=Massachuse.tt .e2118
Home Imp o e r er fractor,zegistration
- - -
t+" t:i _ Y= t'~�I Type: Corporation
W
'v ... � -----:Fe ist'ation: 105543
VALLEY HOME IMPROVEMENT INC s, �~~ =: ,
a..+. - � E nation: 08/20I2024
P.O. BOX 60627 ,a.
FLORENCE, MA 01062 \ /, bi
'v-"` - i.
�' .I'� Update Address and Return Card.
•
THE COMMONWEALTH OF MASSACHUSETTS
Olfice of Consumer Affai1s,& Business Regulation Registration valid for individual use only before the
HOME IMPROVEIVIENt CONTRACTOR expiration date. If found return to:
TYPE-Cniporatiort Office of Consumer Affairs and Business Regulation
Reuist``'tlOh - iiatio�t 1000 Washington Street -Suite 710
"j • O O4o Boston,MA 02118
VALLEY HOME IMPRQ •EM (T I :"'
I lam- ! -7 j i
STEVEN A,SILVER
1iM ' F ^"r
340 RIVERSIDE DRIVE ,,�, •• --;.�• a.ge-{,,,,<<' A- 1
=LORENCE,MA 01062 v..", '. - .
'-`, _. Undersecretary Not valid without signature