42-021 BP-2023-1277
851 WESTHAMPTON RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
42-021-001 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-2023-1277 PERMISSION IS HEREBY GRANTED TO:
Project# deck 2023 Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 12000 INC 077279
Const.Class: Exp.Date: 06/21/2024
Use Group: Owner: TRUST SZKOTAK MANDANA MARSH
Lot Size (sq.ft.)
Zoning: WSP Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: •
Insurance:
P 0 BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON: 09/18/2023
TO PERFORM THE FOLLOWING WORK:
re-deck and infill section of 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 � �
Fees Paid: $78.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
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P4nsoctitc: Ai14 ,
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The Cemrnonwealth of Massac setts
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4 ll Board of Building Regulations an• tan•. R
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�l; Massachusetts State Building Co:-, 78i ZCc LAI lTY
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Building Permit Application To Construct,Reps , 'er4 e. ; ! ... Revis,d Mar 201I
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One- or Teo-Family Dwelling 9lti,, 119,1%p.
n This Section For Official Use Only N Mq�FOn
Building gF�`,)+?j' i 7 7 1 Date Applied:
06004,8
�Pcrnit Number:
__ 1<L-u, ) Z2e>, // q-1816z5
BuiJdirg Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map & Parcel Numbers
sack
1.1 a Ts this an accepted street?yes I no Map Number Parcel Number
1.3 Zoning information: 1.4 Property Dimensions:
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Zonin e.Di stri ct Proposed Use . Lot Area(sq ft) Frontage(rt)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
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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 D _l Check 11 jeaO I Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIPI
O '2. o Recor s �ix
nwvnu'if 4 �`'lar1 5 k�-FIB rz,.,�
Name(Print) City.State,ZIP
X( W�Sf—k (�{v 1 Eck 0 3-49-i 3 i itti lLr..►l 0288,;t(ovi-t,n.
No. and Street Telephone P.mail Address
SECTION 3:DESCRIPTION OF PROPOSED WORT£' (check all that apply)
New Construction 0 Existing.Building❑ Owner-Occupied ❑ Repairs(s))4 Alteration(s) ❑ Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work1: 12 t- I.e c-...vL eY;5*:"") d cc
bt u ex:S-t- leti,J SL
SECTION 4:£STligA ED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only .
(Labor and Materials)
1. Building $ 12,K I. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ " 0 Standard City/Town Application Pee
'O TdtalProject'Cot°'(Item'6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Metani al (II VAC)A1..) .pp List:
5.Mechanical (Fire $ Total All Fees: S A
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Suppression)
1 y� Check No.4411 Check Amount.
6.Total Project Cost: $ t 0.Paid in Full. . . 0 Outstanding Balance Due: .
SECTION 5: CO.NS U CTION SERVICE S
55.1 Construction Supervisor License(CSL)
. .JLe l\ :vY11,.,- ._s �?i License Number Expiration Date
Name of CSL Holder
List CSL Type(sec below)
Li ,,(i7a Type Description
No.and Street ..
-- � '� �� Unresrricttd(Buildi i es up to 35,000 cu.ft.)
c`"'>r R Restricted I ts'2 Fam.Iy Dwelling
City/Town,State,ZIP M Masonry
RC Rooting,Covering •
WS Window and Siding
SF Solid Fuel Burning Appliances
1 Insulation
Telephone Email address 1) Demolition
5.2 Re4istered Home Improvement Contractor(FHC)
'! 1"61"4 RTC Registration Number Exp n�*n Date
Cornpa4 Name BIC
nt amp
tOV �
No. Street Email address
-1 Drer)CC-
City/Town,State,ZIP Teleahon_
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 oldie Issuance of the.building permit.
Signed Affidavit it Attached? Yes iggNo.,.........❑
SECTION la:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorizea a1 _ V i-d-.-;
to act on my behalf,in all matter`s relative to work authorized by this building permit application.
Print er's I e{ ectronic Signa tire) Date
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SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under and penalties of perjury that all of the information
contained in this ••' '.- " ' is true and of my knowledge and understanding.
/fJfN,�l
Prim run, . •r 4'Fif Agent's N ( cosmic S_ e) Dee c2.0?-3
NOTES:
1. An Owner who obtains a building pm-mit to do histher own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(BIC)Program),will not have access to the arbitration
program or guaranty find under M.G.L.c.142A. Other important information on the HIC Program can be found at
w.rnass aovloca Information on the Construction Supervisor License can be found at www.mass.auvidps
2. When substantial work is planned,provide the information below:
Total floor area(sq. fl.) (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 half/baths
Type of heating 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
:.I Department of Industrial Accidents
I Congress Street, Suite 100
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Boston, _11L4 02114-2017
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1 orkers' Compensation Insurance Affidavit:Builders!Cuntracturs1Electriciaas/Plt?mbers.
TO BE FILED WITH THE RSfIT T Li'N G AUTHORITY.
Applicant Information - _ Please Print Legibly
Name (Business/Organizarion/ludividual): \IQ 1�t� f %tv1G errs��D�2t'Y1 r ri -1
Address: 5L\O \dc ��tv� l� Q. mic.Z1
City/State/Zip: \or cc, k C1 O(o _ Phone#: SELt- 22
Are you an employer?Check the appropriate box:
1 (� Type of project (required):
LEI I am a employer with l U enp!oyees(pill andiorp rt time).+ 7. New constriction
2.0 I am a sole proprietor or partnership and have no employees working for me in S. 23 Remodeling
any capacity.[No workers'comp.insurance reoui:ed.1
9. ❑Demolition
3_[D T am a homeowner doing all work myself.[No workers'corn:.insurance required)
4.01 am a homeowner and will be hiring contractors to conduct all-work on my property. I will
10 Q Building addition
ensure that all contractors either have workers'compensation instrance or are sole 11.E1 Electrical repairs or additions
proprietors with no employees.
12.Q Plumbing repairs or additions
512 1 am a general contractor and T have hired the sub-contractors listed on the attached sheet. 13.�Roof repairs
These sub-contractors have employees and have workers'comp.insurance.=
6.0 We arc a corporation and its officers have exercised their right of exemption per MGL c. 14.['Other
152.§1(4),and we!rave nu employees.[No workers'comp.insurance requited.'
'Any applicant that checks box#1 amst also 5A out the scetionbelow showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such.
+Contractors thatches$this box roust attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. Tf the sub-comb-actors have employees,they must provide their workers'comp.policy trJnber.
I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: -fttA & S(...)-r0.y2 C.:7~1 Yv o
Policy#or Self-ins.Lic.#: Ot>c3 O ( "Z\ Expiration Date: a) r ) • �i
lob Site Address: 'PR City/State/Zip: F`Cpre.xc. (Y\6— 0,0l2
Attach a copy of the workers' compensation polic 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$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day'against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage_verification.
Ida hereby certify ult. er the pains and per allies of p 'r hat the information provided above is true and correct
Si ature: ( /> Date:
Phone#:
Official use only. Do not write in this area,to be completed by city or town official.
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City or Town: "Permit/License#
Issuing Authority(circle one): •
1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:•
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City of Northampton
/? y.• bMassachuse t$ Ct •:{.
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40 `�y��t 1)EP9RTI�N`1' OF BUILDING INSPECTIONS '�'• rr!V.
�j,."' 212 rain Street • Municipal Building
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rtT Northampton, MA 01060 y
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.
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The debris will be disposed of in:
Location of Facility: NO L_.r�� ' c/ I QJ'pkr7
L.) I
The debris will be transported by:
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Name of Hauler: \liCtItaj NXI,U __
Signature of Applicant: Date: (?— ;/7\ ✓ a?° ��
Commonwealth of Massachusetts
9 Division of Occupational Licensure
Board of Building Re ulationsr and Standards
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Co nstkVaidn§Vrvisor
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- CS-077279 'i` i icpires: 06/2112024
STEVEN A SI VER� A V)r fi
.,!:pa'.‘lilt �•'��'�`+,3�
PO BOX 606 i•I 11, r3,: o I t��4y `
FLORENCE IVf'A O1062 t..j, i 4'��j- 0.
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r't-...m ...siora. ;4. a C-fY.-;:Aw„- - '
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THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affai and Business Regulation
1000 Washing ,nx§,trOt- Suite 710 •
Bostoil-FMassac t set e2118
Home Im ro eirr j 7.�r cto� egistration
; � ~a ' ,, •11.. �l Type: Corporation
,a —. -Re ist ation: 105543
VALLEY HOME IMPROVEMENT INC ",ti �p" -7 E 61 alion: 08/20/2024
P.O. BOX 60627 !':1 � -_-vrfr::.' _-•_ .
FLORENCE, MA 01062 `?\ —= -4 0i-ou,
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r. �, Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairss&Business Regulation Registration valid for individual use only before the
HOME IMPROVE F[CONTRACTOR expiration date. If found return to:
1T E .&orAtior1 Office of Consumer Affairs and Business Regulation
. e fat - - EJCtjiration 1000 Washington Street -Suite 710
I� 4i�y.�r':_.:-x.tp D' 24 Boston,MA 021111
g4LEY HOME IMPR11 - i i' - 4
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t EVEN A. IDE DRMPiI1� -,• .E_R If/ Vl0 RIVERSIDE DRIVE,
_ORENCE,MA 01062 ;��;_:, �-,��`-. '
-- ," Undersecretary Not valid without signature