17A-260 BP-2022-1134
89 OAK ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17A-260-001 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-2022-1 134 PERMISSION IS HEREBY GRANTEI) TO:
Project# DORMER ADDITION Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 50002 INC 077279 '
Const.Class: Exp.Date:06/21/2024
Use Group: Owner: HILL LE1BL,HANNA &PAIGE
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:09/14/2022
TO PERFORM THE FOLLOWING WORK:
DORMER ADDITION
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:
>2 . C:g I •
Fees Paid: $325.00
212 Ma in Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Buildine Commissioner
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The Commonwealth of Mach tts
Massachusetts State Building Code,.7 �� � <-0,9� U�`�`LITY
Building Permit Application To Construct, Repair, Reni3yvet '3s dish Revised Mar 2011
One- or 7bvo FarrTily Dwelling. h' �9 pFCT�
. 070 _kyJ
This Section For Official Use Only 6
Building Permit Number: S P" ? } 11 - Date Applied:
. 9 Pi 2
Building Official(Print Name) Signature D. e
SECTION 1: SITE INFORMATION
1.1 r Aperty Add t;. s; 1.2 Assessors Map &Parcel Numbers
- �Lklrve #- j�f ?iflO
• 1.1 a fs this an accepted street'?yes__ -no • Map Number P.arrel Number
'1.3 Zoning Information• 1.4 Property Dimensions:
5. „-'1 / e r
Zoning District Propo Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard F S•deYaids 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 lV Private❑ Zone•: — Outside Flood Zane?Check if yes❑ Municipal c2115n site disposal system 0
SECTION 2: PROPERTY OWNERSHIP1
21 owner1 3f record:
M_ nt1 L1rhA, -1- () .._gst_ '41,0 Ur-en .- r - (` . 7
- Name.(Punt) City, State,ZIP .
'Q -Cc (On-4.(o>-LO`b 2__
No. andStreet Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) ❑ Addition ❑
Demolition Et Accessory Bldg. Q Number of Units . Other O Specify:
:
. Brief Description of Proposed Work2: /(1Y NL[✓ ;41 Y 4te
V4Cl,...J
_tie. P��t v O "e 5d�c'. S,t4�� U S 1
( 4rdi-kw,e ( (V itS Scbe: -
SECTION ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ eI(,sv 1. Building Permit Fee: $ Indidate how fee is determined.: .
4..___ f 0 gtandard City/Town Application Fee
2,Electrical •$
i S ❑Total Project Cosh (Item 6)x multiplier x
3_Plumbing $ �—"— 2. Other Fees: $
4.Mechanical (HVAC) $ f- List: • •
5.Mechanical (Fire $
Suppression) Total All Fees: $ 6
Check No.1f.�13 Check Amount Z Cash Amount
6. Total Project Cost: . $ 51low . .0 Paidin Fug 0 OutstawdirigSalaflce Due:
•
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 01121; Utz', (zoZ2
t�U J fx ry-lOx license Number Expiration !Date
Name of CSL Holder •
List CSL Type(sec below)
P c� cl coN 02,--1 •
No.and Street Type Description
'
n �1�`, U Unre.tricted(Buildings upto3S,0�09 cu.f.)
-1ocenC(. 1v v W2r R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Igasronry
RC Rrioting:C&vexing
WS Window and Siding
SF Solid Fuel Burning Appliances
&St..0 1S22— _ s Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor„(FRTC) 812o t�ZZ
\�es4� ¢� 1 HIC Registration Number Expiration Date
2TCC Co�npa,4Y Name or HTC ltegistr nt Name
t
2! lorrn ce_CY1X; b\v bZ
No. and Street Email address
. 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 th a lssuan ce of th a building permit
Signed Affidavit Attached? Yes No...........❑
SECTION 7a:OWNER AUTHORIZATION TORE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize -L i ce` S i QPy-rr-cc -1
to act on my b all ers relative to work authorized by this building permit application.
/111
utters a metallic Signature). Date
SECTION 7b:-OWNERr OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
stained in this application is true and accurate to the best of my knowledge and understanding.
51u1zz
PrintOwner's or Authorized • _' 's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her ownwork,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
www.mass.szov/oca Information on the Construction Supervisor License-can be found at www.mass.g.ov/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 haifbaths
Tye of heating system 411 ry1 i /-1'5 - (cQ.ne,! Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
City of Northampton
Massachusetts tiY ` a_ P. "
DEPARTIENT OF BUILDING INSPECTIONS j rM
\.' 212 Main Street • Municipal Building ^v.% _ate
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 that all debris resulting from this work shalt be disposed of in a
properly licensed waste disposal facility, as defined by WG•L c 111, S 3.50,E,
•
The debris will be disposed of in:
Location of Facility: NiCE
The debris will be transported by:
Name of Hauler: \ltk . •
Signature of Applicant: Date: l r 7I22-
•
il-i,
T� ' (
� The Comrnoswer lth of Ilassaehrset s
Depar r rial Accidents
_ . 1 Congress Street, Suite 100
l . J •
/I Boston, 02114-2017 .
/�/ www.rrr ass.gov/die
Workers' Compensation Trrscrr'ance Affidavit:Ruilder•s/Con-ftartor•s/Elect ans/Plrllnber•s.
TO lit:Plii.,Fri WITH THE YIeTaiiTT NG AlJliiiirRi Y'.
Applicant Information Please Print Legibly
Name (nutiineuviirganiittLitnt/in(iividtiai): \1 e'•L4-e j ,,,f1 .r1 se,Ya� � � prO\J r'cu r C
t�
Address: i \`- r i ., P` 0 . C�` (c.)06-D 2.2-
City/State/Zip c0.0,- e \'-Q Cjk,0 2.... Phone#: 4,12j- s2,9 -1 S 2 Z.
Are you an employer?Check the appropriate box: Type of project(required):
1.,Eg I am a employer with .) employees(full and/or part-time)."
7. 0 New construction
2.EI I am a sole proprietor or partnership and have no employees working for me in 8. ® Remodeling
any capacity,(No workers'comp.insurance required_]
^ 9. ❑Demolition
1 3. 1I I am a homeowner doin it all work myself.INo workers'comp.insurance required.)
10 G'Building aduiisuu r
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I Will
.ensene that all c13l t4 asters either have workers'camper'sat+an ssca ra ce 31.al esae . . 11.0 Electrical repairs or additions ,
proprietors with no employees. 12.0 Plumbing repairs or additions
5.0 Tam a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E Rllof repairs
These sub-contractors have employees and have workers'comp. insurance?
6❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other
152,§1(4),and we have no employees. [No workers'comp.insurance required]
*Any applicant that checks box#1 must also fitl out the section bc!cu shiovriug their:oikers'compensation policy inferainn.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
'Cvntrancterrs'thatchatrk this 1ux must anaciatd'an-d±tilma sheet showing the az=uf the sub-euntraLinis-and state whether or not those entities have
employees. lithe sub-contractors have employees,they must provide their wodcers'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(1` A\cL "(t Lj,• Y y. (3tri-14_e
Policy#or Self-iris. Lic.#: OO 5¶(') -2j(D2_\ Expiration Date: c9 l 1 I egg
Job Site Address: &R Cin_L_ s\_.
• City/State/Zip: 3(), '1A,ilorkel t— -01 OC
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiron 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 agrinst 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 ofper• e information provided above is true and correct.
Signature: p Date:
511 \
Phone#: t4\I5- • j4—-1 ,�—
Official use only. Do not write in this area, to be completed by city or town official
City nr Town; Permit/License.
1
Issuing Authority(circle one):
' 1. Board of Health 2.Building Department 3. CitytTown Clerk 4.Electrical Inspector 5.Plumbing Inspector -
6. Other
•
Contact Person: Phone#:
I
Commonwealth of Massachusetts
k-11) Division of Occupational Licensure
Board of Building Re ulations and Standards
Cons tonTS rvusor
.f
CS-077279 r i li E:Xplres:06/21/2024
STEVEN A SIA.VERMAw4�E � i ..
PO BOX(i06 ' 1] >' *1
FLORENCE my. 01062 ;:i, '
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Corn miscic nc. ' ,• (2. x' S1%._:,A "
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affair and Business Regulation
1000 Washingt , rt- Suite 710
BostonMassachusetts44 118
Home Improyement5racteregistration
;r` 1:r -- ',"-;' Type: Corporation
¢',t 1~.: :�-� .[ egistation: 105543
VALLEY HOME IMPROVEMENT INC {*"" E>E�l!,i -_ « . p'.ation' 08/20/2024
P.O. BOX 60627 ,�• �=i
FLORENCE, MA 01062 -,;;:;� , '�', "f le
;: t
�..,,.-l""` Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affai'Ps B Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT-CONTRACTOR expiration date. If found return to:
TYPE:r-oryoration Office of Consumer Affairs and Business Regulation
Registratiob•`: EXpitition 1000 Washington Street -Suite 710
fQ '}} .l OEI)/'�024 Boston,MA 02118
GALLEY HOME ItG
1 .L �; ;
iTEVEN A.SILVERMAN. ''''''''
40 RIVERSIDE DRIVEi;:. ,:-:. ;_ ���,,,.ya.7
LORENCE, MA 01062 -:-;;;.:
" ' Undersecretary Not valid without signature