29-593 BP-2022-0930
130 WOODS RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-593-001 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-2022-0930 PERMISSION IS HEREBY GRANTED TO:
Project# KITCH RENO Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 44100 INC 077279
Const.Class: Exp.Date:06/21/2024
Use Group: Owner: D PACHECO SARAH H & NORMAN
Lot Size (sq.ft.)
Zoning: WSP Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON:08/08/2022
TO PERFORM THE FOLLOWING WORK:
KITCHEN RENO
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: I 2
• 3-11 *
Fees Paid: $286.65
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
_ The Commonwealth of Massa6huse s
Board of Building Regulations d St dat4 / / FOR
� I� G \�" jMUNICIPALITY
`&, i� Massachusetts State Building Code,` 0 CMR S \V AEI
USE
Building Permit Application To Construct,Rcpaii`,A 6�r Or Desch a Rev ed Mar 2011
One- or Two-Family Dwelling tiga,�)/tir
0,4b
This Section For Official Use Only �^ s6`r,�
Building Permit Number: eja-' �'2 4130 Date Applied: °sooNs
4,t)iv ' /Wz5 7/72 8'$'2022
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map & Parcel Numb rs
1 t Docck 0-0 '�
1.1 a Is this an accepted street?yes ,_,-" no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
6-mte 41()
Zoning District Propo ed Use Lot Area(so ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water upply: (M.G.L c. 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone? ��
Public Private 0 — C t_ Municipal lE Un site disposal system 0
I „Gc,� ❑„yEs 1
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
irc.h,-0-3or4-‘ Qooc eca . NALDrenr.c. c;ev Ole,Z
Name(Print) City,State,ZIP
No. and Street Telephone Email Address
SECTION 3:DESCRrnTION nF gunPrI - WORK (ci,ec4 all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) GI Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: Ci.r l-t vl ,/r2v7 / (t it,i c-Lx !iSh4.�, ri0i,n„P r roSc� liqou,
� ec:,-0,�� - filt Pico- S
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ J:21 am'_00 I. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2. Electrical $ t0 0 TotalProjedt'Cost''(Item'6)x multiplier x
3. Plumbing $ ?4(0 2. Other Fees: $
4.Mechanical (ITVAC) S T ist:
5. Mechanical (Fire
Suppression) $ �--- Total All Fees: S �! �`
cti
Check No. q eck Amount: 2- .
` 6. Total Project Cost: $ (pi (� 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL)
3'. 1 (l' ' -ti, License Number Expiration Date
Name of CSL Holder
c}- 3 `n (cs0(z,�� •List CSL Type(sec below)
No. and Street Type Description
.�� �r t�0 �C& U Unrestricted(Buildings up 35,000 cu.ft.)
City/Town,� tV Stat R Restricted I&2 Family Dwelling
ll . Masonry
RC Roofing Covering
WS Window and Siding
I.
SF Solid Fuel Burning Appliances
LI. 5S4 )S22- T Insulation
Telephone Email address D Demolition
5.2 Re istered Home Improvement Contractor(HIC) ���� �' u�� ,
\h�- 'Y`i— ,�.� -� HIC Registration Number Expiration Date.
HT Comp ai Name or HIC Registrant ame
V b . 6oc, (oocc31
No.and Street Email address
'Et p<>a> L (YLG 0VD02.-
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 of the building permit.
Signed Affidavit Attached? Yes .Pi No . O
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$ 0-5, . V l•4.L
to act on my behalf,in all matters relative to work authorized by ' g mi cation.
STg\ A SIL L- 1 Ki ISX: Oi`-aria
Date
Pont Owner's Name(Electronic Signature)
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.
/ S y-;;1— Pek,C tn.�.v Z is eth.I Z
Print " is or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. 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 fund under M G_L. c_ I42A. Other important information on the HIC Program can be found at
www.mas:.gcv.oca Information on the Construction Supervisor License can be found at www.i:-iass.so dps
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
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
=s 1 Congress Street, Suite 100
i Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/ElectriciansrPlumbers.
TO BE FILED WITH THE PERJTTIN G AUTHORITY.
Applicant Information I +` Please Print Legibly
Name (Business/Organization/Individual): J a l-c� 1•t-ocr G Li
Address: ' -\o R\tv'S\&t j7. 0. .60zc Cc0(02-1
City/State/Zip: 1 1 O;iy)u. 4D) O(02 Phone #: 4 t3-c 4— 7 S22-
Are you an employer?Check the appropriate box: Type of project(required):
LEI I am a employer with l El employees(full and/or part-time).* 7. El New construction
2.❑J am a sole proprietor or partnership and have no employees working for me in g_ J Remodeling
any capacity.[No workers'comp insurance required.]
3.0 T am a homeowner doing all work myself.No workers'comp.insurance required.]t
9. El Demolition
4.01 am a homcowaa and will be hiring to conduct all work on myl 0 El Buildingaddition
contractors property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.Ej Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 I am a general contractor and T have hired the sub-contractors listed on the attached sheet.
These slob-contractors have employees and have workers'crimp.insurance.: 13. Roof repairs
We are a corporation and its officers have exercised their right of exemption14. Other'
6.
❑ nVg per MGL e.
152,il(4),and we have no employees.(No workers'comp.insurance required.]
*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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: - ( \ka- - S�r•Qy-2 Lk_
Policy#or Self-.ins.LLiic.,#: O65CjO 3 b 2 1 S Expiration Date: 07} €
Job Site Address: ‘ �
JV ;l(`YIJSS City/State/Zi Cyl _ `L CA(>(c 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 sties of p r' hat the information provided above is true and correct.
Signature: J �/? Date: .Lb (2O77
Phone#: I3- S4 ci]2.2_
•
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 S.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
,oatr+ak'�a
i' Massachusetts
' 4 4Ik DEPARTMENT OF BUILDING INSPECTIONSsi
fj m
w t'. 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: U f , jG✓4-4-,Q_-nfv,
The debris will be transported by:
Name of Hauler: \iCtliI9j
Signature of Applicant: Date:
Commonwealth of Massachusetts
L�1 Division of Occupational Licensure
Board of Building Re uIlationsr and Standards
Cons ion Akie,rvisor
CS-077279 'c _ i tplres: 06l2112024
STEVEN A SI VERMAt `i }.. A : > dry ,�#-
PO BOX 606 i:q .. r yi; O . :t:;: ` '
FLORENCE IVI'A 01062` _ r. -t f` t�,., . vs;., ,
c •
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V l.i0w �.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washing�gk „trt- Suite 710
Boston Massachuse-tt-s93118
Home Improvem nt C'� fracto egisttration
L !y7 : 9. 1._ t} r r
1r" _ _+ -�.... '�'i Type: Corporation
1: .~ _ — J egisration: 105543
VALLEY HOME IMPROVEMENT INC �? Ei anon: 08(2012024
P.O. BOX 60627 i _,.., • =;=r
FLORENCE, MA 01062 _ f ---_, r,..;{-,P
fa
'a r- 4., .Y
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer AffatPt,B,Business Regulation • Registration valid for individual use only before the
HOME IMPROVED IENT'CONTRACTOR expiration date. If found return to:
TYPE :i pa'r tior Office of Consumer Affairs and Business Regulation
Re''s_-. 16i_ :5.11177 . 1000 Washington Street -Suite 710
±/Tr24 Boston,MA 02118
VALLEY HOME IMPR4 :i fr I F -_'-� "L
I? t.... VI '•- ,1:'11
STEVEN A.SILVERMANy ttt' 1 ,- �/�e 340 RIVERSIDE DRIVE°; N •"`::` ..x...0.4 /"W
A- 1 Q/>Q /�7
FLORENGE,MA 01062 � �,�'•� :, ,;. �" 'b (�
?:.- Undersecretary Not valid without signature