24C-145 (2) BP-2022-1613
15 ARLINGTON ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24C-145-001 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-2022-1613 PERMISSION IS HEREBY GRANTED TO:
Project# BATH RENO, SLIDER Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 45000 INC 077279
Const.Class: Exp.Date: 06/21/2024
Use Group: Owner: SCHWEITZER WAYNE A
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: 12/13/2022
TO PERFORM THE FOLLOWING WORK:
BATH RENO, SLIDER ON PORCH
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:
e; 9.r411
Ito
Fees Paid: $292.50
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
gip. 1 i .E
•
The Commonwealth of Massachusetts
rr 1,6 Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR 'EC / 3 MYNIC2022 LPE
Building Permit Application To Construct,Repair,Renova •Demolish a RevisediMar 2011
One- or Two-Family Dwelling °` rir rn,, _i
This Section For Official Use Only ?n,prig
Building Permit Number: ]: 10 13 Date Applied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: IIAssessors Map&Parcel Numbers
1S (l 3-01r1. .q v /YS
1.
1.1 a Ts this an accepted Meet'?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
IZoning.District Proposed Use Lot Area(sa 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:
Zone: Outside Flood Zone?
Public ElPrrvate❑ — Cbaea if yes❑ Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of ecord:
(Jock. Zee l\1w 6\tl-• •')oA -*U (ko�. Ctc,lv0
Pancrie-tAiig-- City,State,ZIP
(S crtekl ooykn (i3t-
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) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work:
4 LLtL }pr- `JANkQ.1 4r ?Ford, 5,l, (l1 'Sl -5 5
sg.6?li-e.L. 41 t 4- (r k 3rd (ate 7 L Ada r a ,-I-- t- -I--O.-.,Z9
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only .
(Labor and Materials)
1.Building $ La) j< I. Building Permit Fee: $ Indicate how fee is deteunined:
2.Electrical $ 2i< 0 Standard. City/Town Application Fee
'❑Total Project'Costs'(kem'6)x multiplier x '
3.Plumbing $ 3K 2. Other Fees: $
4.Mechanical (IlVAC) $ T ist: .
5.Mechanical (Fire $
Suppression) Total All Fe ((!! 131.,p
C.j ,60
' Check No.14 (�Gheck Amount: Al d,
6. Total Project Cost: $ (5/(,y 0 paid in Full . ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL) o- 'q ea/2i /20zy
--eL rN CDt License Number 11 Expiration Date
Name ui CSL Holder
(� (n7 List CSL Type(see below)
-�1 `7 10G�cn ---_—.-._ •
Type DescriptionNo.and Street
(r10. a (0� U Unrestricted(Buildings up to 35,000 Cu.ft.)
Restricted I&2 Family Dwellinj
City/Tow M Masonry RC Roofing Covering •
WS Windo and Siding
SF Solid Fuel
w Burning Appliances
i{,l3 {—1 22-- 1 'Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
RTC Registration Numb1er• Expiration Date
R1C Compert4Name or HIC Registrant Name
(/-L)
No.and Street Email address
t,o MG- 01 o OZ.--
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M4.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 No O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WREN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize if Jr �1 106/ Y1.au-, - V l L
to act on my behalf in all matters relative to work authorized by this building permit application.
Wac nt SC�.wQ� +ter I7
Print Owners Name(Electronic Signature) Date
•
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby art der the pains and penalties of perjury that all of the information
contained ' plication is a an e to the best of my knowledge and understanding.
1/4g7tV1iI A. SfL1g 414 / l - -��a
Pri 's or uthorize. : Ft's ame Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do hisrher own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will rtot 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 gov/oca Information on the Construction Supervisor License can be found at www.mass.;tov.dns
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 half7baths
Type of heating system Number of decksl porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
The Commonwealth of Massachusetts
•��£�t' Department of Industrial Accidents
I Congress Street,Suite 100 .
`. Boston,MA 02114-2017
�a
— www.inass.gov/dia
Workers' Compensation Insurance Affidavit:BuilderslContractors/Electricians/Plun2bers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Apilicant Information I Please Print Legibly
Name (Business/Organization/Individual): v(,1_Ct-e� ,t7IOcrIC �rv1prr.)`1€rricr,-4 , II'IC
Address: \dt. ? 0• 6c Co0(021
City/State/Zip: t- IO i rtt ke- O(o2- Phone#: 4 t3-SOU 1 S22
Are you an employer?Checkt>ite•appropriate box; Type of project(required):
l.ix)I am a employer with t e employees(full and/or part-time).* 7. New construction
2.0 I am a sole proprietor or partnership and have no employees working for roe in 8. El Remodeling
any capacity.[No workers'comp.insurance required]
9. ❑Demolition
Tama homeowner doing all wodc myself.No workers'comp.insurance required.]t
10[D Building addition
4❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11 Electrical repairs or adcitions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 Roof repairs
These Ruh-contractors have cmployees and have wnrkers'camp.inanrancc.'
6.1=1 We are a corporation audits officers have exercised their right of ri exemptionp 14.❑Other
erMGLc.
152.61(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.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors 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. Tf the sob-contractors have employees,they must provide their workers'crimp,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: - r \`ok.., ri ra►-)LL ( i rC�t\Q _
Policy#or Self-ins.Lic.#: O.6cD o' b 2\S Expiration Date: o?) t
Job Site Address: IS r Y 4"CJri (31 City/State/Zip: 'iOr'J-1 • • •%: (VW- 01 00C
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration!:te).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,501.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$251.00 a
day against die violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for ins .1.ce
coverage_verification.
I do'hereby certify un r the pains and pe ties of p hat the information provided above is true and correct
Signature: //' • (/? Date: f (e7 I22
Phone Of: 13- e24-1 S22
It
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 Aealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
City of Northampton
,J;/ 4N Massachusetts 0,,,;,\. ...:::-.i.t.c>e,,,_
i f,: c:1. DEPARTINT OF BUILLING INSPECTIONS212 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, 554, a condition of Building Permit
Number is that ail 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: '111'p Ur `�f f ; v4+ a-' kr
The debris will be transported by:
Name of Hauler: \jattOj T-n\-r21,-(_.
Signature of Applicant: Date: / 2 ^D '-02,007,07
•
•
r - t ,
Commonwealth of Massachusetts
`P Division of Occupational Licensure
Board of Building Re ulatinns and Standards
Cons It)nr rvisor
Ns
CS-077279 .. qp i res:06/21/2.0 2 4
STEVEN A SIA.VE12 7 ``t.
PO BOX 606 i I 1 xi' r i ;, r�'`'e?LY;
FLORENCE iVVj. 0106 .•�',y' O -7i ?
f 41
(4.Lvd'ei3 rl t'T
Commissioner {;. i1,;;:a;.,. ,
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affai NJ Business Regulation
1000 Washing t` rc t- Suite 710
Bostot}--NJassachuseJf,s 2118
Home Im ro fr...,,.. ;- Jac r_egistration
• r,t -- -
i oft -'"irk= '�3 �� ,a,Type: Corporation
1-4 z—` =7- t-_---_- a istTation: 105543
VALLEY HOMEIMPROVEMENT INC Irli F7-=;" '' • E anon: 08/20/2024
P.O. BOX 60627 t = _
FLORENCE, MA 01062 ''mot\--N '"'G='-�_
rY— I„J
•
�` ..' Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affaii\&Business Regulation Registration valid for individual use only before the
HOME IMPROVE�tI EIFCONTRACTOR expiration date, If found return to:
1Y .�,YC�it P.PF%Bor1 Office of Consumer Affairs and Business Regulation
- .' . ' li L: 1 • ' I l 1000 Washington Street -Suite 710
iST1 ;, re _d Boston,MA 02118
VALLEY HOME IMPRv F , .4 1 ,
_
STEVEN A.SILVERMPi w,f /
MO RIVERSIDE DRIVE,, ti--- ,-`' ,-•'; ,,,, 23
u; (2„��.c�
FLORENCE,MA 01062 • •�-1M is 1:' .,(A,„,„,,;(
,
F -• Undersecretary Not valid without signature