32C-260-004 BP-2023-0138
90 POMEROY TERR COMMONWEALTH OF MASSACHUSETTS
UNIT
Map:Block:Lot: CITY OF NORTHAMPTON
32C-260-004
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-0138 PERMISSION IS HEREBY GRAN D TO:
Project# deck 2023 Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 8000 INC 077279
Const.Class: Exp.Date: 06/21/2024
Use Group: Owner: WROBLICKA WILLIAM T
Lot Size(sq.ft.)
Zoning: URC Applicant: VALLEY HOME IMPROVEMENT IN•
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON: 02/09/2023
TO PERFORM THE FOLLOWING WORK:
REPLACE DECK BOARDS ON DECK
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
T11
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
DourSign Envelope ID;8C921 BFF-B590-4084-A8D1-eD55D04529D1
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The Conunonwealth of Massachusetts F e8
,..p. i Board of Building Regulations and Standards .J FOR
Massachusetts State Building Code, 780 Ch+..k. �0 MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or rleipOsh a Revised Mar 2011
One- or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number:6 p-a 3-/3 7 Date Applied:
J vlN, Z., z-a-W-z 2
3
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
4 90 Pomeroy Terrace unit 4
1.1a Is this an accepted street?yes no Map Number Parcel Number
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 I Side Yards Rear Yard
Iequired 1 Provided I Required l Provided Required l 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 0 Private 0 Cheek if yes CIMunicipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
William Wroblicka Northampton MA
Name(Print) City,State,ZIP
90 Pomeroy Terrace Unit 4 (413)727-3581 wwroblic@verizon.net
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) el Alteration(s) 0 Addition ❑
Demolition 0 L.AcceSSory Bldg. CINumber of Units IIOther 0 Specify:I Brief Description of Proposed W.,.,,.k2:Replan a xisna c.kh-nards with nnw re ;nn nhhngn to framino nr rnilince
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I I.Building I $8K I. Building Permit Fee: $ Indicate how fee is determined:
C3 Standard City/Town Application Fee
2.Electrical $
, 0 Total Project Cost' (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: S
4. Mechanical (ITVAC) $ List:
5.Mechanical (Fire $Suppression) Total All Foos:
CheckNo1l?J Pheck Amount: LA Cash Amount:
6. Total Project Cost: $AK ❑Paid in Full ElOntstanding P.ilanre Thtr
t ,
DocuSign Envelope ID'8C921BFF-B590-4084-A8D1-BD55D04529D1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 077279 6/21l2024
Steven Silverman License Number Expiration Date
Name of CSL Holder
PO Box 60627 List CSL'Ewe(see below) U
No.and Street —* Type Description
Florence MA 01062 tJ Unrestricted(Buildings up to 35,000 cu. It)
R Restricted l&2 Family Dwelling
City/Town,State,Z w Masonry
R(' Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-584-7522 info i2valleyhor,eimprovment.com I Insulation
Telephone Email address 17 Demolition
5.2 Registered Home Improvement Contractor(HIC)
10SS43 8/2tI/24
Valley Home Improvement iIIC Registration Number Expiration Date
HIC Comany Name or HIC Registrant Name
Po eat 60627 Info@valleybomeimprovement.com
No.and Street Email address
Florence MA 01062 413-584-7522
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes 12 No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property,hereby authorize Steven Silverman VHI
dog qneg ey ly behalf,in all matters relative to work authorized by this building permit application.
y,attvivt ,0 1/30/2023
'—'Paf7tl$ il.9F' Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest un the pains and p 'es of perjury that all of the information
contained in this application is true and occur the hes f m edge and understanding.
/- 3/-04 -3
Print Owner's or Authorized Agent's Name(Electronic.i n c) 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 I Ionic Improvement Contractor(HIC)Program), will not have access to the arbitration
program or guaranty hand under M.G.L. c. 142A_ Other important information on the HIC Program can be tbund at
wtM_rnirss,t;oti oCit Information on the Construction Supervisor License can be found at wwti'.r iip
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. IL) llabi table room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halfbaths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Opeen._.
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
DocuSign Envelope ID:8C921 BFF-B590-4084-A8D1-BD55D04529D1
City of Northampton
a�rn.rn to 5 �. J
? f•',, t ; Massachusetts 40, - `c
lP� JH
6,14 DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building S, Cb
Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the nrrniicinnc r-f AA(,I r A(1 ( A a condition of RIIildinr Permit
111 accordance Ir Y 1 LA LII I L.L YI the I_ './I Y Y I.I I V I I.J VI I�IVL. -TY, J_/-�, LI condition LI VII VI IJ b11 11..411161 L.I IIIIt
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: Valley Recycling, Northamptcn
The debris will be transported by:
Name of Hauler: Valley Home Improvement
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Signature of Applicant: /�� - Date: ' �
_ The Commonwealth of Massachusetts
Department of Industrial Accidents
C. spiv1 Congress Street, Suite 100
701
—' , Boston,MA 02114-2017
up www.mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Busincss/Orgaeization/ludividual): V Q 1 -.U� +i�` —Ern OcY1 c e�?-12 m —1 Cr- , t ri C-
Address: 5-IO Rl a-C�S\GIZ, Dr- .`J\rr ?• O. Xrtc 1.00(9Z-7
City/State/Zip:1-10(-ence. t4 r* 01 0(o2- Phone#: 413-S` LI—Z S2-2-
Are you an employer?Check theappropriate box: Type of project(required):
1.231 am a employer with I 0 employees(full and/or part-time).* 7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. jg Remodeling
any capacity.[No workers'corp.insurance required.]
9. ['Demolition
3.0I am a homeowner doing ali work myself.[No workers'comp. insurance required.]'
10 0 Building addition
4.1:I 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 additions
proprietors with no employees.
12.0 Plumbing repairs or additions
50 I am a general contractor and T have hired the sub-contractors listed on the attached sheet. 13.❑RoOf repairs
These sub-cuutractnrs have emhloycea and have workers'coop.insurance.:
6.0 We are a corporation and its officers have exercised their right of exemption per MCiL c. 14.❑Otllet'
152.§1(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 muse 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. Tf 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: -Pty i,\.01/4.. 7X1SLIrray-2(...L._ GI rC,at e
Policy#or Self-ins.Lic.#: C3bc Ci 3 (3 2 \S Expiration Date: c2) 1 ) r,J 0c3a
Job Site Address: d 0 ? --etr,ra_t� U(NAX-t4 City/State/Zip: (sop,-O C) Q
Attach a copy of the workers' comp 'on policy declaration page(showing the policy number and expir tion date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to $1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify0A
un r the pains and pe allies of p r hat the information provided above is true and correct.
Signature: -/Y� Date: k' t11 25
Phone#: L -J- S2LA-1 S2 Z
,t
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License# ,
. Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
Commonwealth of Massachusetts
®) Division of Occupational Licensure
Board of Building Re ulations and Standards
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Cons ionf$ visor
•,. .y
CS-077279 mac' } • I spires: 0612112024
STEVEN A SlA•VERMA ' I,
PO BOX 6062 l' i J '::� �-
FLORENCE WA 01062i, / •
?F. t
Commissioner ,',. "s,,;-n•.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation •
1000 WashingtTr :t - Suite 710
Bosto rt.-Massachusetts _Oa 118
Home Irnprovri enf nfractorRegistration
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I 1V.......
f41,•t-4 tc _- , Type: Corporation
VALLEY HOME IMPROVEMENT INC �' '- .=" .-i -_'~.-:Re station: 105543
P.O. BOX 60627 l \\L 1 - _ E .....iation: 08/20/2024
FLORENCE, MA 01062 -..- + - r--;??
•,,! „,: + f,,x i
,r. j. 7y s,,;;.
st of `S
,,. ,._7 Update Address and Return Card.
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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:.rarporation Office of Consumer Affairs and Business Regulation
Registration-•# ._EXplfation 1000 Washington Street -Suite 710
1, 43 t,1:oB,20r2o24 Boston,MA 02118
/ALLEY HOME IMPRO EM T III�IQ
c: r:1 :.3
STEVEN A.SILVERMAg `-"' _t - �. •tiY�. ' A- 1 iii/vie ,-
3403 'c_1s. .... ',,RIVERSIDE DRIVE';,;, • - _ ,, 4.1
=LORENCE,MA 01062 `;:;• .., ,: Undersecretary Not valid without signature