31B-055 BP-2023-0418
27 LANGWORTHY RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31B-055-00I 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-2023-0418 PERMISSION IS HEREBY GRANTED TO:
Project# RENO 2023 Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 125000 INC 077279
Const.Class: Exp.Date: 06/21/2024
Use Group: Owner: A MACISACC RICHARD A&CHRISTINE
Lot Size (sq.ft.)
Zoning: URA/URC Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON: 04/13/2023
TO PERFORM THE FOLLOWING WORK:
ADD BATH, 3 SEASON PORCH, KITCHEN BUMP OUT
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:
Fees Paid: $812.50
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
z- ak
File #BP-2023-0418
APPLICANT/CONTACT PERSON:VALLEY HOME IMPROVEMENT IN1
P O BOX 60627 FLORENCE, MA 01062(413)584-7522
PROPERTY LOCATION 27 LANGWORTHY RD
MAP:LOT 31B-055-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $812.50
Type of Construction: ADD BATH, 3 SEASON PORCH, KITCHEN BUMP OUT
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
XApproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
1/ 63 d3
Sii ture of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
I I,
*Variances are granted only to those applicants who meet the strict standa s of MGL 40A.Contact Office of
Planning&Development for more information.
II -
•
efrviat./ c6L,
.14 The Commonwealth of Massachusetts �
Board of Building Regulations and Standards 4135) ' FOR
kijMassachusetts State Building Code, 7$0 CIChR� MUNICIPALITY
USE
Building Permit Application To Construct, Repair, Renovate'Onr olish kile7 Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only syn c
Building Permit Number: BQ" - Date Applied:
L03al
Building Official(Print Name) f Signature I / Date
SECTION 1:SITE INFORMATION
1.1 Prot Property Address: 1.2 Assess s Map& Parcel Numbers
c�1 t�t0Fi'1� a a'-i'�
1.1 a 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(II)
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:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Rich Macisaac Northapton,MA 01062
Name(Print) City,State.ZIP V
27 Langworthy Road 1(00- p -Th O2 t'tG1n 6ACt4, t Sant' 0 -c- "
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2 (check all that apply)
New Construction 0 Existing Building la Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:
Add bathroom to existing upstarts bedrom
3 season Porch
Kitchen bumb out
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ IOn r 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical S 0 Standard City/Town Application Fee
�.00XT 0 Total Project Cost' (Item 6)x multiplier x
3. Plumbing S l0f— 2. Other Fees: $
4.Mechanical (HVAC) S List:
5. Mechanical (Fire Total Al(Fees: $
Suppression)
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 1r � COX} 0 Paid in Full ❑Outstanding Balance Due:
—". •••••••• -nu t-rvtauf'SJW.P11.1"flo I to:J.1W
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
077279 6/21/2024
Steven Silverman License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
PO Box 60627
No.and Street Type Description
U
Florence MA 01062 ii
RC
WS Restricted '&2 Family Dwelling
Masonry
Rooting Covering
Window and Siding
mit Unrestricted(Buildings up to 35,000 tat.it.)
City/Town ZIP
SF Solid Fuel Burning Appliances
413-584-7522 info@valleyhomeimprovment com I Insulation
Telephone Email address Demolition
5.2 Registered Home Improvement Contractor(RIC)
105543 8/20/24
Valley Home Improvement MC Registration Number Expiration Date
Mt Company Name or HIC Registrant Name
PO Box 50627, Info@valleyhomeimproverrent.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 thc denial or the Issuance attic building permit.
Signed Affidavit Attached? Yes . No ..... C.3
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize Steven Silverman VHI
deocutagitymy behalf,in all matters relative to work authorized by this building permit application.
IttAti saw, 4/1/2023
-sPrr4cit/GrAidl3s Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penal of perjury that all of the information
contained in this application is true and accur best of y k e and understanding.
/ t)444/44)
Print Owner's.or Authorized Agent's Name t ectronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(riot registered in the flume Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty timd under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www,mas,s,ttovioca Information on the Construction Supervisor License can be found at www,inas.c,gor
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished baseinem/atties,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'healing system Number or deckst porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
ui S1S' M. Sr0
Massachusetts �� se
w. G
I. a DEPARTMENT OF BUILDING INSPECTIONS
>+ " 212 Main Street • Municipal Building fis`
Northampton, MA 01060 �fj .vp'�
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, SS4, 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: Valley Recycling, Northampton
The debris will be transported by:
Name of Hauler: Valley Home Improvement
Signature of Applicant: Date: v3
The Commonwealth of Massachusetts
Ps,. f} - Department oflndustrialAccidents
�q=�= (. s I Congress Street, Suite 100
's» r is
Boston,MA 02114-2017
Aa,,`, www.mass.gow/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information I Please Print Legibly
• Name(Business/Organiaation/Individ ,ual): vI ta 1 Q L t•e 1-Ciay,G 1 n-\+o,� r-ve YY1 c ri , -Tr)C.
Address: .AO R .. cx- c*t )r-,� -ecJ ? 0• gc2c co0(PZ1
• City/State/Zip:-Floc'-elrx,e IR t71 O02 Phone #: 4 t3-523t-1-- 22-
Are you an employer?Check the appropriate boa; Type of project(required):
LEI I am a employer with 1 9 employees(full and/or part-time).* 7. D New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in . 8. E Remodeling
any capacity.No workers'comp.insurance required.] .
3.01 am a homeowner doingall work myself. 9. ❑Demolition
y No workers'comp. insurance required.]t
10❑Building addition
>Di 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.ri Plumbing repairs or additions
5.71 I am a general contractor and I have hired the sub-contractors listed on the attached sheet.
These soh-contractors have employees and have workers'comp. inmirance.t I 1-]Roof repairs
6 We are a corporation and its officers have exercised their right of 14.❑Other
❑ mPexemption per MGL c.
152,41(4),and we have no employees.[Igo 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.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and stare whether or not 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 fur my employees. Below is the policy and job site
information_
Insurance Company Name: -Pe 1/4A.C... 'i SL)ra, -1(...t._ l�—1,-c \p
Policy#or Self-ins.Lic.#: DbSSO 3 v 2 \S Expiration Date: 071 I C},
Job Site Address: D-1 1"0"' ` L. t k-v....t City/State/Zip: O-CI Dio(5
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration 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 ties of p r' hat the information provided above is true and correct.
Signature:
,�� "mil �r'//Y///) Date: 4 rb l O.3
Phone#: Li 1.5'Sg* 1 S2 2_
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.BuiIding Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
•
Contact Person: Phone#: