32A-192 (4) BP-2023-0237
42 PHILLIPS PL COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-192-001 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-2023-0237 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 5000 INC 077279
Const.Class: Exp.Date: 06/21/2024
Use Group: Owner: PALOMO M FRANCISCO &JANE L POTTER
Lot Size (sq.ft.)
Zoning: URC Applicant: VALLEY HOME IMPROVEMENT INC.'
Applicant Address Phone: insurance:
P 0 BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON: 02/27/2023
TO PERFORM THE FOLLOWING WORK:
REPLACE SHEETROCK IN KITCHEN CEILING
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:
/
V . TAR
Fees Paid: S5,000.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
F E B 2 7 2023 ' Thd Commonwealth of Massachusetts
tk.,
Bard of Building Regulations and Standards
� / __ Massachusetts State Building Code, 780 CMR FOR
ITY
`'r.ofF3yIiL I r iN e 'G ,,;
Nom-Fl I#I ai�Application To Construct,Repair,Renovate Or Demolish a Revised Md,•2011
One- or Two-Fwnily Dwelling
This Section For Of&cial Use Only
Building ermit Number: et 0- a. 6 •3 3"7 Date Applied:
��„�a s 1/7 2- 27 ZOZ3 .
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Proper Address: 1.2 Assessors Map&Parcel Numbers
ya h At c' o
1.1 a 1s 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 Side Yards Rear Yard
Required Provided Required Provided Required Provided
l
1.6 Water Supply: (M.G.L c. 40,§54) 1,7 Flood Zone Information: 1.8 Sewage Disposal System;
•Public 0 Private 0 • Zone: _ Outside Flood Zone?
heck if js❑ i Municipal 0 On site disposal system 0 .
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
,...a�4t✓�-- Frrra�,riGtscb �C,10 mr, - ,e-t ( \ - 010(o0
Name(Print) City,State,ZIP
k). (Anti _ Pt( ,6— t-11 -N3—` 1t7
No.and Street Telephone Retail Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ i Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 i Number of Units Other 0 Specify:
Brief Description of Proposed Work2: e fit&c t.tG4v-19 ,w k;J.cL_ -, ,, iii-
. s
f
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ ty-' 1. Building Permit Fee: $ Indicate'how fee is deterhrined:
0 Standard City/Town Application Fee
2.Electrical $ . '❑Total Project'Cost''(Item•6)xmultiplier x
3.Plumbing $ 2. Other Fees: $ 1
4.Mec an cal (I vAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:S
G .-- Check No.'73eck Amount: ur
6.Total Project Cost: $ `)L0L 1.❑.11aidinFull . . .0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
J
5.1 Construction Supervisor License (CSL) C 1.i P U 1 Q (a/2! ) o�y
3-.eyk...e1, 1 m),i .-.", censc Number // Expiration Date
Name of CSL Mulder
0 ,a- cA , O(D:� List CSLType(sec below)
No. and Street V1 Type Description
c.t'``Qr ` — c c .O 6i2 U Unrestricted(Buildings up to 35,000 cu.ft.) 1
R Restricted I&2 Family Dwelling
• City/Town, M 'Masonry
/ I 0�1 RC Roofing Covering •
l� WS Window and Siding
G SF Solid Fuel Burning Appliances
-t f3-S4i-fl J22- 1 Insulation •
Telephone Email address D Demolition
5Z Re iistered Home Improvement Contractor (HIC) 16G5L 8'�f�2
^ �- `)"i--- Ul1\��-r HIC Regishation Number OExpiratiion Date.
• - .1 HI Comp Name or't-IC Registrant Name
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 the Issuance of the building permit
H
Signed Affidavit Attached? Yes 'Igfl 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 l r I Ue rt,ou-t a V 1-I-.2
to act on my behalf in all mats •' e to work auth • ed by this building permit application.
i Owit117-
Name(Elect nic ignature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of p- 'ury that all of the information
contained in this application is true and accurate to the ,• if my kn 'led• %. understanding.
s%r2- J S11 L V m4i) % '1 / , 2---/7-- r?-3
Print Owner's or Authorized Agent's Name(Electroni Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner Win 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.aov/oca Infbrmation on the Construction Supervisor license can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementiattics,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 beating 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
►! Department of Industrial Accidents
-g 1= 1 Congress Street,Suite 100 •
.4=1f_ !�' Boston, MA 02114-2017
www.lnass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information ` ` I I _ Please Print Legibly .
Name (Busiucss/Organization/Todividual): V Q. 1�C� `4c r C. 'rrt}�?� W "i'�-4'2 l cryl , C-
Address: 5+-1tO Q k \tit T 5► rr.`J ?• O. 6cac (co(927
City/State/Zip:-.F.\of cc i-t()- al plot Phone#: 4 l3-51S4-1 S2 2=
Are you an employer?Check the-appropriate box:
Type of project(required):
1.0 I am a employer with I employees(full and/or part-time).* 7. 0 New construction
2.01 am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling
any capacity.[No workers'comp.insurance required.l
9. ❑Demolition
3.0T am a homeowner doing all work myself.[Ne workers'comp.insurance required]t
10 0 Building addition
&.❑I amt a homeowner and will be hiring rontraactors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
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 Fah-contractors have employees and have workers'crimp. insrrrance.t
6.0 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 requittdi
*Any applicant that checks box fi1 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.
*Contractors that check this box mast attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the soh-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: tr 6,,CL T 111 SUrQI1 C..L. el YUt No
Policy#or Self-ins.Lic.#: O b cD 5 O 3 b 2\S Expiration Date: o?) i
Job Site Address: 42 11,D� gk(t�1t City/State/Zip: fl {f Gt 0
Attach a copy of the workers'compens tion policy declaration page(showing the policy number and expiry on 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 r the pains and pe fries of p hat the information provided above is true and correct
Signature: /, //! Date: c)\1(0 12- 5 .
Phone#: • `k13-SS-l--52Z
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.CitylTown Clerk 4. Electrical Inspector 5.Plumbing inspector
6.Other
Contact Person: Phone#:
1
City of Northampton _
,',_ •'"e - i Massachusetts wSs s. irc�i
c DEPARTMENT OF BUILDING INSPECTIONS ai —
212 Main Street • Municipal Building J�:, ,e�
ter' Northampton, MA 01060 s .45\''
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 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: 11 1), ` ,('' , } iov-J-hayr-pk'-]
The debris will be transported by:
Name of Hauler: 'ti ( _ .
vovcry-u„..o---
• _
Signature of Applicant: l Date: —l'�'_ jG��3
f
Commonwealth of Massachusetts
IPDivision of Occupational Licensure
Board of Building Re ulations and Standards
ConstcaltdnLs visor
CS-077279' a _1;�.., .'..;::. spires:0612112024
STEVEN A S) VEri A is it 74' ""' .",.
r
PO BOX 606� `..11: :�
FLORENCE 11r1'�A 01062 ;�', ; a' ,.'e „t+
f ';: 'I✓.• '' ` vhill; '11�.n
()LhVd=):S3 r.I4-6,`.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Aff 141''h(Business Regulation
1000 Washing� trk- Suite 710
Bosto .FMas"sachsisc, . 118
Home Im ro . • I n :G' f' 6:- a istration
�„ _ _: r
"" ,-' .„ Tirpe. Corporation
p�u eJis�t anon: 105543
VALLEY HOME IMPROVEMENT INC t t E><�Si at on. 06/20/2024
P.O. BOX 60627 'r
FLORENCE,MA 01062 ') _ - E.
_ -,, E•
`'� ,ri
-}'F- -T.- --"M T.r
�`-'�� Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of ConsumerAffaii's,&Business Regulation Registration valid for individual use only before the
HOME IMPROVE EIfCONTRACTOR explration date. If found return to;
� r or�tior� Office of ConsurnerAffairs and Business Regulation
- •.4.j;j(r -o i 1000 Washington Street -Suite 710
4 4 '�5..:: ..,: .� Boston,MA 02113
ALLEY HOME IMPiRO f i'1 - a i." ,
TEVEN A.SILVERMAg •n �`�V .'=
10 RIVERSIDE DRIVE Y` .^'' ''" A- 1 libiti/
_ORENCE-,MA 01062�`'''h' f` �� ���L t
.'!ih'- Undersecretary Not valid without signature •