30A-030 BP-2022-1 017
337 RIVERSIDE DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30A-030-001 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-2022-1017 PERMISSION IS HEREBY GRANTED TO:
Project# kitch reno Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 64900 INC 077279
Const.Class: Exp.Date:06/21/2024
Use Group: Owner: WILLIAM GAIDA IAN
Lot Size (sq.ft.)
Zoning: URB Applicant: WILLIAM GAIDA IAN
Applicant Address Phone: Insurance:
337 RIVERSIDE DR
FLORENCE, MA 01062
ISSUED ON:08/18/2022
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:
CArn,' �� Y, -
Fees Paid: $422.50
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Buildinc Commissioner
The Commonwealth of Massachu•etts J 8
Board of Building Regulations and S an - 202� F
i� Massachusetts State Building Code, pTNq ko C `4I'IIY
_ i MPTpG NSPSCI^
Building Permit Application To Construct,Repair,Renovate Or • a,os°Revise Mar 2011
One-or Two-Family Dwelling.
This Section For Official Use Only --1
Building/Eiii•—)/20v5
Permit Number: ( P—al?"'1 V 17_ Date Applied:
,IZ 8-1$-Zozz
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Pro erty A ess: 1.2 Assessors Map&Parcel Numbers
iu '5ld�tfia.l
i.1 a Is-ri s an accepted sia•eet?yes n o M.ap Number Parcel Nutnber
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 Yids near Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.O.L c. 40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private El Municipal T Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Re;ord: •
ZO-ri GEC La S , CAre_r 9— 01.0{02—
• Name
City, State,ZIP -
53-1 K L`C-4/SN✓ p +•1<— y t 3-3 " 3S-1-5--
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2 (cheek all that apply)
New Construction Cl Existing Building❑ Owner-Occupied ❑ Repairs(s).❑ Alteration(s) 0 Addition
Demolition D Accessory Bldg. 0 • Number ofUnits ' . OM ❑ Specity:
. Brief Description of Proposed Work: `< tc 1P A% ) — .nevi ,r
kAhki�DU�• 5 ,,1,1Ns fa., he
en 517.1at)
. SECTION 4:ESTIMATED CONSTRUCTION COSTS
item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 5 cif D U D 1. Building Permit Fee:$ Indicate how fee is determined:
fl Standard City/Town Application Fee
2.Electrical $
3 1 (2)0() ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ a 1 1 0 0 2. Other Fees: $
4.Mechanical (HVAC) $ List: .
5.Mechanical (Fire •
Suppression) $ Co 9 co Total All Fees:.$ Q
Check Nof130S I Check Amount: 1€�,'asli Amount:
6. Total Project Cost: • $ . CI Paid in Full ID outstaring Balance Due: ,
SECTION S: CONSTRUCTION SERVICES
•
5.1 Construction Supervisor License(CSL) . O-11 2,1 9 (01zl I zC'Ztt
S\--eArf% i\ X tr-1 - License Number Expiration Date
Name of CSL Holder (,,
P �) i.IL+X I �LX2� List CSL Type(see�CIUW1 ..�.,
No.and Street Type Description
U yr Unto ad(BurldirOWto 35 4 ft.)
CQ(P. « . L. 0 Cot. R Restricted I&2 Famil i Dwellin
Cityfrown,StaliAd MasonrcUtaiin..= CUv�rin
Winslow and Sidin
SF Solid Fuel'Burning Appliances
14kb- k-t-1SZ2— t insulation
Telephone Email address D Demolition
5.2 Re stered Rome Improvement Contractor(HIC)
t(L)��vy3 S 2.(
v'� ' HIC;Registration Number Expiration Da
c�trrC Comp Name or HIC Registr (Name
Y.t� nC CO-
No. and Street E'nail sddrziss 1
City/Town,Stated 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 liti 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 'mi
r_
to act on my behalf,in all matters relative� � to work authorized by this building permit application.
,�G h L) 4 rr c t1.watU" 6 ",a "4 - ,)...
Prim Chtuier's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereb nest wider the pains and penalties of perjury that all of the information
contained in ' applicatio is tt accurate to the best of my�! knowledge and understanding, {1 �`
A Sr- 4. & �.. it tr '� 0 ✓ — )GL
Print Owner's or Agent's Name(Electronic Signature) 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 fund under M.G.L. c. 142A.Other important information on the HIC Program can be found at
w„w.mass.sovioca Information on the Construction Supervisor License can be found at www.mass sov,dos
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 hal£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"
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
g Boston, MA 02114-2017
t._ WWW.Illass.gov/dia
lVssrkers' Compensation Insurance Affidavit Builder•s/Cot:tractors/E1r'rh-ieians/Plumbers.
TO BE Hii,i?i�vvi T i-i THE,rr,RiviiTTiNG= AUTHOR M.'
Applicant Information -�-t�- Please Print Legibly
Name (Rii,,i ne ir�i1111/ahim/Inciiv,riiotl I \j f le±), � T lA/i p✓'ram.Jf�{1' �� r,c
Address: ?- ) �� ��� � )(1 vY .YY - 0, ��C` CV (s,•0 CYo 22-
� '
City/State/Zip \c r y7( Q ,40-c,ThDL Phone#: S 2 2_
Are you an employer?Check the appropriate box:
Type of project(required):
1.F2. I am a employer with .k P employees(full and/or part-time).` 7. ❑New construction
2.0 I am a sole proprietor or partnership and have no employees working forme in 8, ® Remodeling
any capacity.[No workers'sump.insurance required.]
9. ❑Demolition
3.71 I am a homeowner.doing all work myself.(No workers'comp.insurance requi-ed.l
10❑ Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
enure that all-enr-imctors either-have work-CPS'compensation insurance-or are sole - - I1.0 Electrical repairs.or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 Tam 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. p—�
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Otl]CT
152,i 1(4),and we have no employees. [No workers'comp.insurance required.]
*Any applicant that checks box WI must also fill out the section below showing thch..workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
I•Cunrraetovs that c'he kthis box mast ttachedxn additional sheet showing the name of the sorb-cuattac4urs and state-whether ur•nut 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: A t'V-)e.l, SUS'`u Yc c A r6c t
Policy#or Seri ins.Lie.#: Ob S-C ) ?j(D`_1 Expiration Date: c9I I
Job Site Address: fl Alfie GlQLSL O V J - --- _ City/State/Zip: �(),4- .('(/u jo�(,I'Z M' p10a
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expirktion 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 ••ins and penalti of per' e information provided above is true and correct •
/ �1Z02-z
Signature: Date: (Z1
Phone#: . \7 - k-t" S-22—
Official use only. Do not write in this area, to be completed by city or town official.
City or Town 7 Perin itli,irense
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#:
}}--��yy.. City of Northampton
r L . Massachusetts 4••: , ,f�.
4_ , F> T. DEPARTMENT OF BUILDING INSPECTIONS ,\ 1!1
•212 Main Street • Municipal Building 4. 4
rrw ;Y
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROTECTS)
In accordance of the provisions of MGL c 40, 554, 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 Ma c 111, S 150A.
•
The debris will be disposed of in:
Location of Facility: \In U. oc ci Q , Rke 10 , Qr�
The debris will be transported by:
Name of Hauler: lalk {yam_-Tkik,ie,. i — •
Signature of Applicant: ) Date: D N_ 03` &Vol
Commonwealth o1 Massachusetts .
Division of Occupational Licensure
Board of Building Re ulations and Standards
1r
Cons Ion Srvisor
CS-077279 x i tpires:06/21/2024
y ` r
STEVEN A Sl VERMA ` ii' •
PO BOX 606 .y� r�!'._ •
FLORENCE Iit1'A 01062(1; i I
.dr 1
/�M�fr.1d.>V >'
Commissic:cr •'C nr. r vy .6 •
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affair and Business Regulation
1000 Washing .. rct - Suite 710
Bosto rt;�Ma ssachusetts_02118
Home Imyt_.
�,ro 'e en ractor .•egistration
wi t,7) .
ii Fr..
,.:. _ r t ;;;Type: Corporation
1 � F eisttation: 105543
VALLEY HOME IMPROVEMENT INC "i �:W:
,t t: T •' .*, . E pitation: 08J20J2024
P.O. BOX 60627
FLORENCE,MA 01062 '�R"�=�'
�\`+F�' � : 7 (-� ''�
.,,i.,
\4��. .-
rt./
`�`.- fir; /
` ..__1 Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs,$Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE: `ti1701.7idtiorl Office of Consumer Affairs and Business Regulation
Registration` E3tbifation 1000 Washington Street -Suite 710
1Q5543 �/-0a/2-0J2Q24 Boston,MA 02118
(ALLEYHOME IMPR� tEMTT its
. ,
1w' T..1. : F_
;TEVEN A.SILVERMA� {� ^.E�_.._.� •. ��
140 RIVERSIDE DRIVE';:,•. , ,��„w....ra 1G/ i
LORENCE,MA 01062 ;;,;;., ',t.' Undersecretary Not valid without signature