18-039 (3) BP-2024-0088
27 EMILY LN COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18-039-001 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-2024-0088 PERMISSION IS HEREBY GRANTED TO:
Project# DOOR 2024 Contractor: License:
VALLEY HOME IMPROVEMENT
Est.Cost: 26500 INC 077279
Const.Class: Exp.Date: 06/21/2024
Use Group: Owner: BRENNAN MAURA JO &DENNIS T YASUTOMO
Lot Size (sq.ft.)
Zoning: RI/RR Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON: 01/29/2024
TO PERFORM THE FOLLOWING WORK:
REPLACE BULKHEAD DOOR AND EXT DOOR
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: $172.25
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
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JAN2g2024
g . The Commonwealth of_Massact.;
Board of Building Reg [atio is and S'Tagg INSPECT
r FOR
N\rI
Massachusetts State Building Code, 780 CiviR="'"'^otoso°"Is CIPALITYT;CE• •
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Building Permit Application To Construct,Repair,Renovate Dr Demolish a Revised Mar-2011
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One- or Two-Family Dwelling
• Th O ttion For Official Use Only
Building Permit Number: 15 P A 4 Date Applied;
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Z q.zOZL
BuildingOff'cial(Print Name) Signature Date .
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
e
1.1 a Is this ar accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning.Disa•ict Proposed Use Lot Area(.so d) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Requi-ed Provided Required Provided Required Provided •
1:6Water Supply: (M.G.L G. 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: — Otrtside•Flood Zone? Municipal 0 On site disposal system 0
Check if_es❑
SECTION 2: PROPERTY OWNERSH1P1
�•1- Ojsner=of Record:
M0,04-hand- -vn rha- Ot 0100
Name(Prim) City,State;ZIP
Z� n'tt,h1 LGc.4.1 _ 47g--� 934
No. anu St tV2.t Telephone Fmsil Address
SECTION 3•DESCRIPTION OF PROPO-Sr.nWORK (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 I Repairs(s) 0 Alteration(s) 0 Addition ❑
Demolition ❑ Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work2: do(). .e-,r e..**$
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1.Building $ 1. Building Permit Fee: $ Indicate how fee is detrrrn itled:
0 Standard City/Town Application Fee '
2.Electrical $ : '❑Total Project'Cost''(Item•6)xmultrpI'ier x _
3. Plumbing $ • 2. Other Fees: $ •
4.Mcwaau.ical (II AC) $ T iet:
5. Mechanical (Fire
Suppression) Total All Fees: • j
Check No.1f4 eck Amount: I u i
L6. Total Project Cost: $ ❑.paid in Full. . 0 Outstanding Balance Due:' .
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SEcTIc1N'5: CONS'TRFJCTIONSF.R�'IGES
S.I Construction Sup ery s r Uceri.Se(CSL� U' %o) Gj EJ /G! J c zv
i-%Sl\ )(n-\ .- . License Number ..xpiratiocDatc
Name of CSL Holder .
List CST.Type(see below)
c)-0 ,c- c 00c�a - .
No.and Street . � • Type Description
,� , ( - L� U Unrestricted(Buildings up to 35,000 cu. ft.)
(-Aortit- E rk, R Restricted I&2 Family Dwelling
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City/Town,State,ZT? N4 Masonry
_ RC Roofing Covering
WS Window and Siding i
SF Solid Fuel Burning Appliances
(j (2 G .,- 22 i Insulation
Telephone Email address D Demolition .
S.2 Reaistered Home Improvement Contractor (RTC) 6cS •
1C)l �
IND—ULLA1t` r, }
'Y`'L-- ,�V'?���- �T HIC Registration Number Expiration Date.
• AT Cornpar6 Name or HTC Registrant '\Tame
c) . 40ot0 ' -
No.and Street • Email address
City/Town,State,ZT? 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 oldie building permit
Signed Affidavit Attached? Yes X No...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Opener of the subject property,hereby authorize
e_rI N 1 t,}-e,vft'r\1X1-1 . V I-eL
to act my behalf.in matters relative to work authorized bythis building permit application.
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P is �'n s N e(Electronic Signature). 6///fi7MY
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below, ereby attest under the pains and penalties of perjury that all of the information
contain in this licati i true and accurate to the best of my knowledge and understanding.
r ( 1
Owner's r A onzcd Agent's Name(Electronic Simi.arore)• Dare
NOTES:
1. 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 Home Improvement Contractor(HIC)Program),will not have access to die arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at •
. w '.v.mass.aov/oca Information 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.) (incluriing garage,finished basern.ent/adics,decks or porch)
' Gross living area(sq.ft.) Habitable room count •
Numbet 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"maybe substituted for"Total Project Cost" •
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1 The Commonwealth of Massachusetts
G ( Department ofIndus`rialAccidents
I- _001 "r 1 Congress Street, Suite 100
.. C42. . Boston,MA 0211 4-2 01 7
www.rnass.s ov'dia
Workers'Compensation Insurance A fid.avit:Buhl ers/Contractors./E1ectricians,Pln rbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name `(Business/Orgauizadon/Individual): V a `
1 t-c #Ot n c .Sm er-2 -e rn z^r)-) . -n(—
Address: J'-\O Ro�,-- ,,k ) ►`rc. ?. 0. Pack CcOC21
City/State/Zip: 'r 101-enC1. kPr al plot Plio .e#: L 3-SS4—`1 S22
Are you an employer?Cheek the-appropriate box: • Tie of project(required):
1.Vj I am a employer with l 6 employees(full andior part-time).* 7. pNew conslaction
2.E1 I am a sole proprietor or parMership andhave no employees working for me`.n 8. 2 Remodeling
any capae ry.flgo workers'comp.insurance requi•ec!l
3.E i am a homeowner doing aI work myself.[No workers'comp.insurance reo-airedd.]I
9. ❑Demolition
4.01 am a homeowner and will be hiring contractors to cocdnct all work-on my pe opcT•. .will10 Q Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.E Electrical repairs or additions
proprietors with no employees.
12.E Plumbing repairs or additions
517:1 I en,a general contractor and T have hired the sub-cont.-actors listed on the attached sheet 13.nRoof repairs
These.e&-cnntractnrs have employees and have workers'comp.inarranex 1
EC We are a corporation audits officers have exercised their right of exemption per NAGI,c. 14.❑Other
152.§1(4),and we have no employees.INoworims'comp.insura_ncerequired.l
*Amy applicant that checks box 141 must also fill out the secnonbelow showing their workers'compenaetion policy information.
t Homeowners who submit this affidavit indiea+mg they are doing all work and then Tire outside contractors must submit a new affidavit indicating such.
1Contraceots that check this boxm st attached an adrlidona sheet showing the name of the sub-contractors and state whether or cot those entities have
employees, Tf the sub-etmracto s ha-ve employees,they mast provide their workers'comp.polity mambo-.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name; -AYbC \& x'i see/Qy-?s-L (`1'r0L,0 _
Policy#or Self:ins.Lic.#: 0.(7) 5 D 3b 2`S Expiration Date: a?1 t 2
ti
Job Site Address: ?i 63 r t (y City/State/Zip: M.)efitakipfrAeifr1f ° 10 C
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$250.00 a
day against the violator.A copy of this statement may be forwarded to tie Office of Investigations of the DIA for insurance - •
coverage verification.
Ito hereby certij5)un, r the pains and pe ties of p , her the information provided above is true and correct.
. 5ionatllre: �' !/, /r-.? Date; I l !C° 1 24329
Phone#: t J- 524-1522—
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Official use only. Do not write in this area,.to be completed by city or town official
City or Town: Permit/Li cease# •
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Issuing Authority(circle one); • •
1.Board of Health 2.Building Department 3.•City/Towri Clerk 4.Electrical Inspector 5.Plumbing Inspector
S.Other
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•ContactPerson: Phone#:
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I-e _ City of Northampton _
ISassachusetts '�
;i! r ,c
`�� .'�+ , i-X 1' DEP�SRTIalf OF BUILDINGTI INSPECONS • '�y� Vti `
\' � �l 212 Main Street • Municipal Building ../, ,cb
Northampton, MA 01060 ''Pl.ii
CONSTRUCTION DEBRIS AFFIDAVIT
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(FOR ALL DEMOLITION AND RENOVATION PROJECTS) • .
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit .
Number is that all debris resulting from this work shall be disposed of
in a properly licensed waste disposal facility, as defined by MGLc 111, S 150A.
The debris will be disposed of in:
Location of Facility: m\v') ,U CJ✓t `CS/.( ��:. --A_S �'C-Y 1 '7
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The debris will be transported by:
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Name of Hauler: Aj�ttj 0,-orvf--L._ -
�/ Date:_ l Z3/t
Signature of Applicant, '
Commonwealth of Massachusetts •
��� Division of Occupational Licensure
Board of Building Re ulalions and Standards
Const bnr$ iyisor
p
CS-077279" �' ( ltpires:06/21/2024
STEVEN A 5l VER qAi • '-I
PO BOX 606 1-! l;.( 'TA1if.
" is i. . I•�9
FLORENCE Mi O'a06 t,'•+ O r'�i,i '
ti
Yr�11,1401)
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affair0R0 Business Regulation
Ai
1000 Washing t 4gZ,' :l ,4- Suite 710
Bosto r ( ssachlst, 118 .
Home Im ro e-"'-6.. :-. rac or;_ egistration
m — '7 ---:-.— ---,..— f.z.-..3 .
�' �,.- _ F Type: Corporation
VALLEY.HOME IMPROVEMENT INC yy�" tCe•isf�ation: 8/20/2
P.O. BOX 60627 4 ~•^� E 6 ation: 08/20/2024
_
FLORENCE, MA 01002 r-
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' . .r .4�f
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of ConsumerAffaiNs,.$Business Regulation • Registration valid for individual use only before the
• HOME IMPROVE '•CONTRACTOR• expiration date. If found return to;
. 'r �'r • Oo Office of Consumer Affairs and Business Regulation
Re t"• t' 1000 Washington Street -Suite 716
W' qz- - Boston,MA 02116
4l.LEYHOME IMPR dii. iTl :.� 11
TEVEN A.SILVERMAA " �`-j i•,r
l0 RIVERSIDE DFtIVE� - �.�
-ORENCE, MA 01062'�t1:,'yi:V=�:;: "'"'r�G.� Az ®�I/��
,....1.. .r.� ''' n Undersecretary �{/� /
Not valid without signature