31A-244 (4) BP-2023-1345
67 KENSINGTON AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-244-001 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-2023-1345 PERMISSION IS HEREBY GRANTED TO:
Project# REMODEL BATH 2023 Contractor: License:
VALLEY HOME IMPROVEMENT
Est.Cost: 37000 INC 077279
Const.Class: Exp.Date: 06/21/2024
Use Group: Owner: PARASCEVE ATKIN MICHAEL P&
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:10/02/2023
TO PERFORM THE FOLLOWING WORK:
BATH RENO
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:
(s;jwaii7tv&,
1. ,Tf. „
Fees Paid: $240.50
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
_ V p
The Commonwealth of Massach- -tts
(Dr Board of Building Regulations and S : •dare FO. Massachusetts State Building Code, :0 C r a EP 2 5 ?0 C 'ALIT Y
vk> L•E.
Building Perinit Application To Construct,Repair, eno° b,i i r'.,.:• ' h a•' R.vised I. ar t"011
One- or Two-Family Dwelling ORTHA l �NSPEc .,
This Section For Official Use Only '0
Building Permit Number: P- - D to Apphi :
IA.., . I' .io d .
Building Official(Prirrt Name) Signature --- e .
SECTION 1: STTE INFORMATION
1.1 Property 4ddress: 40r, 1.2 Assessors Map &Parcel Numbers
(0? Pr�SI� iciuc. _
1.1 a Ts 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 I 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 ElPrrrate 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check i.i yes❑ i
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
t'\l CLCA. PA\Ktn V0e.44 Lect-I ft-- OtC(oO
Name(Print) City,State,ZIP
(Dr) \<iftngt tL.5ktor‘ - (o akaA131
No.and Street Telephone Email Address
SECTION 3:DESSCREPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 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 Work2: Rt-O 2L a 10,-4t4rO a".
SL•,f+- #."4- l cbc.c h)c". a e•-(.7 -,4c-4.,# r—,., .
SECTION 4:ESTIMATE[) CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only .
(Labor and Materials)
1.Building $ r 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ lZ ❑Total Project'Costs'(Itetn'6)x mttIriplier x .
' 3.Plumbing $ 5 K 2. Other Fees: $
• 4.iv`aec'uailical (IIVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees $ �b,�
Check No.444 A meek Amoui 000���
6.Total Project Cost: $ k .❑Paid.ia Full. . ❑Outstanding Balance Due: . .
- . i
SEC ON 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) q
5"-e. er S(' v ��.,r11- - . License Number E piration Date
Name of CSL HIaider
)•0 c- C:x ) (>U f D>T J •
List CSL Type(see below) .
No.and Street - ' Type Description
•
F- en'-tc.i M.
(p ,:a--- U Unrestricted(Buildings up to 35,000 cu. ft.)
R Restricted I&2 Family Dwelling
' City/Town,S M _ Masonry
i--v. RC Roofing Covering -
WS Window and Siding
•�} f2 , SF Solid Fuel Burning Appliances
f(3S f_1• �S2✓2-- 1 insulation
Telephone Email address D Demolition
5.2 ReQisteredANWIPIA �}Flume Improvement Contractor(MC) 6SSL ��u/2A?�J
�1� �� 1 HTC.Registration Number c�Expiratiion Date i
- RTC Con Name orHIC Re istrant N ame
No.and Street Email address
City/Toum,State,ZIP • Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. i.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 ofthe building permit.
Signed Affidavit Attached? Yes No ..0
SECTION 7a:OWNER AUTFIORIZATION TO BE COMPLETED WREN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property,hereby authorize -Th t 0.e.V1-i1,0.1-0 _ V 1- -2.
to act on my behalf in all matters relative-to work authorized by this building permit application_
a1. hrilif6e- _ 1s)jz3
Print Owner's'Name )•ecaronic ��{ ) Bate
SECTION 7b:OWNER!OR AUTHORIZED AGENT DECLARATION I
By entering my name below,I hereby attest under the pains and p .. ties of perjury that all of the information
contained in this application is true and accurate` /.e best r:1-1.' ff
wiedge and understanding.
S S 1L vl>�:it) i 9--24- 2d2.3
Print Owner's or Authorized Agent's Name(EI omit Signature)' Date
NOTES:
1. An Owner Rho obtains a building permit to do his/her own work,or an owner who lures an unregistered contractor
(not registered in the home Improvement Contractor(AC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c.142A Other important information on the BIC Program can be found at
www.mass.Qov/aca Infbrmation on the Construction Supervisor License can be found-at www.tnass.gov/dps
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 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 ofMassachusetts
•
Department of Industrial Accidents
F.4= , 1 Congress Street,Suite 100
INN •UMW P. Boston, A 02114 2017
-. www.mass.gov/dia •
Workers'Compensation_rnse>t-ance Affidavit:Builders,/Cont1•actors/E►ectriciaes/t Ehlribers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leaibiy
Name (Busiacss/Orgnni7 on/Indiv_dual): vQ l-cu, i sir'-G• .-Ern eez)---'•e .
Address: 3A0 ?• 0• etc (co(>2-7
City/State/Zip: for-rgx_ kc4' 01 O(02 Phone#: 27--
Are you an employer?Check the-appropriate box: • Type of project(required):
1.IM I am a employer with 15 employees(full and/or part-time).' 7. Ei New construction
2.0I am a sole proprietor or parmership and have no employees working forme in 8. 17i Remodeling
any capacity.(ti Workers'comp.insurance requiter!.]
3.0 Tan a homeowner doing all wort'myself.[No workers'comp.insurance requi red.)t
9. ❑Demolition
10 D Building addition
4.01 am n homeown=and vrll be hiritg contactors tc conduct all work On my property. I will
ensure that all contractors either have workers'compensationinsu-atce or are sole 11.Q Electrical repairs or additions
proprietors with no employees.
12.Q Plumbing repairs or additions
5 a I am a general contractor and I have hired the sib-contractors listed on the attached sheet. I3.0Roof repairs
These cub-contractnrc have ernrloyeer and have workers'camp.inr,urnX.1
6,0 We are a corporation and its ofrsces have exercised.theirright of exemption per MGL c_ 14.0Other
152,§114),and we have no employees.No workers'romp.insurance required.)
*Any applicant that checks box#1 must also ill oul the seetion below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicat.>rrg 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 stare whether or not those entities have
employees. Tf the sub-contractors have employees,&rey must provide their workers'comp policy number-.
I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: -A-1'be`,`LL 'lS�> + C t_ 6 v-c..),•,o
Policy#or Self-ins.Lic. #: O.b 3 ,o 3 2,1 S Expiration Date: a)-f ) �Cr2'
Tob Site Address: lot) '( XY 't ' `Q.i-� City/State/Zip: N(�/ (r\9. Ch.()ur a
Attach a copy of the workers'compensa on policy declaration page(showing the policy number and expira'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-
Ido hereby certrfy urt. er the pains and pet ties ofp ' hat the information provided above is true and correct
Signature: gy /Yf� Date: ct1A8\Vj
Phone#: GJ22- •
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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#:
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i •
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City of Northampton
Massachusetts `
dassa� 4c
i(;[ l;, c AAI t e
1 } 1;F- i .DEPARTIEN OF SUILAING INSPECTIONS
1��{� '� ;` � fj
212 Nair. Street • Municipal &wilding J'.,,
Northampton; NA 01060
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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, 5 150A.
The debris will be disposed of in:
Location of Facility: 4) 0 F,!^`L�C I R 1'G✓�'L� k�
�J
The debris will be transported by:
•
Name of Hauler:
•
Signature of Applicant:, _ Date:
`
-` Commonwealth of Massachusetts
Division of Occupational Licensure
���
Board of Building Re ulagti'ons and Standards
COn5l (OnTSu rvjSor
+a J
CS-077279 ltpires:06/21/2024
EVEN A SAYER. �r s 1rf, •
PO BOX sos f:!' .', is ti,. .�r',,,4 1414
a 17
FLORENCE ILIA O'106 rl,''= �';;� ! r
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affit. abq Regulation
1000 Washing qnx ,tr-. Suite 710
Bosto ;,;-Massary1 use:t • =0- 118
Home Im nlyc•`-6 7 7fa' £o . egistration
•
hs .
...Y __ Type: Corporation .
_4 At ..,
VALLEY.HOME IMPROVEMENT INC 1rt; ��� '� a 1st,. abort: 8/20/2
t_-A -ter : , �"'- anon: 08/20/2024
P.O. BOX 60627 -A• ��' �I
FLORENCE, MA 01062 ' ==- /+1_V/F ,
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,~ ���. �. Update Address and Return Card.
•
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THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer AffaiFA,B Business Regulation - Registration valid for individual use only before the
HOME IMPROVEMEN'•CONTRACTOR expiration date. If found return to:
"c_CP.w; :. cutior1 Office of Consumer Affairs and Business Regulation .
Jigs] EJD1FatIo 1000 Washington Street -Suite 710
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'�-:' `~ g2� 4 Boston,MA 02118
ALLEY HOME IMP •C r1 -- .
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TF�/EN A.SILVER � !-,
10 RIVERSIDE DRIVE;,f�,' ,4"
-ORENCE,MA 01062 �°�""'��'4`� ` -7i/(-4 �� C�
`� f''"'`•'` undersecretary` ,_.. - Not valid without signature •
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