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23A-227 ,... :,,,t 'c'. e JOB ) VALLEY HOME IMPROVEMENT, i NC. SHEET NO 6, f Oill .. O r. 340 Riverside Drive P.O. Box 60627 NORTHAMPTON, MASSACHUSETTS 01062 CALCULATED BY_ DATE ! 1 ... TEL (413) 584-7522 - �� FAX (413) 585 -0820 CHECKED BY DATE 1 � ' } i 1 Y SCALE �.:, C liZtitAia •f rILwN.uN{It 4 n , W un.n.n.wiwwtwawe,ttw .: A ' ga r f s ? ;,.� .'•. ii i C a,n :...... ...... .. - r...- . . .. ..4,14fnivluurunna“...amvrn i ........ ................F. 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PRODUCT 204- l(Single Sheets) 205- 1(Padded) - - , 1 - . .. • • t O , 0,3 as :, , itoc n ti , :, „ 1, 1 ci \ li. 0 - 4 n t „ lc st p zu : ,..,,, ,L I il : i 1 : : , ,I 1 1:: : , :., : ::I L., i : , l: N .,„ ..., 270 Restricted to. 00 S 2s6 i 08 E u ' r .ii. 11 4;4S ,EIRp S TR i o L VE T: A 0 N 1073 ;..t v-.,„%.;a,.." , •f,' ; A ; 25705 - . - ,..,.......„ ;., ,..... HOME IMPROVE-WENT coNTRAcioR Rst3154 f1 Expiration: iee13:201:',' T# 27,1'a41".' Lioonso or registration i ,or indiaailai nxi,, urty lieforellio expiration date, 11 found return egiration: 1 to: Board of Building Regutation, anti 1' One Ashburton Ilaee Riu 13.1i1 Boxten, Ma.. 02108 . , , . ____ 7 f / -' irui'vieeni , o STEVEN A, Sit:VET:JOAN i 1 /, STEVEN SILVERMAN' ' v i o 2. L i, , 220 5 . `" . .Y - ' , Z pr ,,--- -- --_, -.., , , , ,,_ sou r! ii\i`xliPTON. MA ',:`,T373 11:x:altlf0-1:il " (U ''''l ' '' /' 1';'/ 1 /./t`,. .......,..-...' ', ,.., , • t. / . ,., 'ksitnillit.rat..)r , , . • ____ 3 The Commonwealth of Massachusetts (' Department of Industrial Accidents Office o f I n ve s tig a do n s 600 Washington Street �; . Boston, Mass. 02111 Workers' Compensation Insurance Affidavit 1 11 ::11 1 .m l n.: ?`. r "`•'". i:;, . '''f r r ac .k. ' ' +'�., � X `"�r Y`t .a"' 3' f ' ,. t � � ��������►t3� -tom � " � � �i����' � W...:., ?�` •, name; Jocation: city phone # O 1 am a homeowner performing all work myself. O 1 am a sole proprietor and have no one working in any capacity +9Wzt7P ;;;„ ✓u > , �,k�r,; 7;di,,:,.,•.Jix4.✓ / , -..xir° , ',4r4 , .rara:4;� ?era:; f4 r44., 4. f-f ����; �K4i..'z r�r,""��r�.krd�<tWk, (p I am an employer providing workers' compensation for my employees working on this job. company name: L J/ -L G l - r` a -/3"7 i',t vr 6.-j /7/ f �,: address: 3 v /e4 6,4,6s 1: / c' city: insurance co. /Z$ S .. ' e = policy # ,- : 1 l ff� .'_ �x? r. �' �, r' �' �, „v4% 3Za?t' ±�" .,tfG' , �rn;�!ir'2Fs 4 ` , x�m�,'r3�d�,�. fir% � 7 ? Pb , ��% �4 : ; '. �< ZtlVL.f".;tiWaP:;9h;;;rv�swwa 'p5 , :5. 1 3'y01.: yJ� 1 , :17,ss,'nIc ,.:4-k'd44k y"�'''�r -K . O I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers'. compensation polices: company name: address: city: phone #. insurance co. policy # °�� 4'# ?§' xy. "`49 , i:' vm , ray1dF ' 1 ti,`, � , 1.1t4',s4o 4 'b; z .4.4 rr 41:.( Fs 1- *,0,f ` ,&-„ Jr., =` t k f , } company name: address: city: phone #: insurance co. policy # ,v$ on1f 111 � AIr' e .i r$S* .. , ilk /` ' AIFF 4:41-4,4;4 VI r`” ' 4. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of erjury that the information provided above is true and correct. Signature gel ,...J'" y Date )- d 3-0? � r .70 $ / / / / '"4 / � Phone# 3 /52 Print name /i' , official use only do not write in this arca to be completed by city or town official 1n city or town: permit/license # 0Buitding Department j DLicensing Board 'i O check if immediate response is required DSelectmen's Office OHeatth Department .4 contact person: phone #; pother 1 ' a '' ass tia+a r (rev■xd 3/95 PJA) • 1 ., SECTION 8 - CONSTRUCTION SERVICES _l licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Steven Silverman_ _` 077279 License Number t 1 268 Fomer -oad _Se,- ,, • •n� Oi o7 6/21/10 Address ,` / / 1 Expiration Date / 1 584 - 752'2 • Signature Telephone • 9. Registered Home Improvement Contractor: Not Applicable ❑ 131945_ Steven Silverman_ __. Comp_any Name Registration Number 268 Fomer Road 10/13/0 Address Address Expiration Date Southampton, MA 01073 Telephone 584 7522 SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.1 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 banding permit. Signed Affidavit Attached Yes. >gl No • 0 —� • • - Home. Owner Exempt The current exemption fdr "homeowners" was extended to include Owner- occupied Dwellings or one (1) or two(2) famili =es and to allow such homeowner io engage an individual for hire who does not possess a license, provided that the owner acts as supervisor, CMR 780. Sixth Edition Section 108.3.5.1. Uefinition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor y=our presence on the job site will be required from time to tinge. during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chaptcr,152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may he liable for person(s) you hire to perform work for you under this permit. The undersigned " homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances. State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature 'IxTfpN 5 DESCRIPTION OF PROPOSED WORK (chr,trk Ipl11g) Etco!..o. Addition Li Replacement Windows ' Atter4tion(s) Fr, Rooting 11 Dr Doors : Accessory Bldg. DcmofltioJ New Signs 1 Decks " ) Siding [ ) Otlier?Ct .11 r / loT 3 i (t 1'2,15 No 5 0 rc , "■1',' ..i/tt:#:; pp, ozr,. af i in - So, If New house and or addition to existing housing, complete the following: tt .rtt lc 1 c-f. t1 7v 7 .1tyttiv g" ,7 i.V. 1 .1, , =:1t t r :11.;1-hr:tel tt t •/!:,1; /7„ t I ,".."(;, . ,‘ C.,r, tie 1 0: _ . ■ t. vt 1 f‘: 'o . tc hs-f: r m 1 f,t E t te:..1,116C It' SVic SECTION 7 OWNER AUTI1OP,IZATION TO DE COMPLETED WIIEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT t Steven Silverman, Valley Home Improvement, Inc. Jp. t' , t--1: t t-/A,l A 1 icc rc OR; J;111 ;;;„it.K. r fr,I r 71clicf Steven Si lverma _ _ tt 1 Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be flied in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved ! parking) f # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding eve been issued for /on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and /or Document # B. Does the site contain a br.•k, body of water or wetlands? NO DON'T KNOW YES IF YES, has a per been or need to be obtained from the Conservation Commission? Needs to be obta' ed Obtained , Date Issued: C. Do any signs ex' t on the property? YES _ NO IF YES, des ribe size, type and location: D. Are ere any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: Department use'only : -� amity of Northampton Status of Peirriit: `' Building Department Curb�Cut /Criv cr > 212 Main Street Sewer /Septic Availaiiiity -' Room 100 Water /Well Availability 3° 2 '1°.\ - 0 Northampton, MA 01060 TwaSets of.Structurai Plans ' phone4.1 - 587 \1240 Fax 413- 587 -1272 Plot /Site Plat Other SpecifY :AP APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office /// /1/ 7 . -j Map Lot Unit _ -- �� ( /)(; Zone Overlay District Elm St. District_,__ _ CB District ,� SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: „,,, / /�/ ' 0 T� t « S j Name (Print) • f c — / Current Mailing Address: �� rt _ J w Tel ephone �i/ .� Signature w �/ -' C / -- J 2.2 Authorized A: t: Steven Silverman Valle • e Im•rovem-1t P.O. Box 60627, Florence, MA 01062 Nam � e (Print) i I ! Current Mailing Address: /mail .// 584 - 7522 _ Signature ' Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS i Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 4 ” 3() (a) Bui c-"" lding Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) , 4r � ( Check Number 91 6/ $ This Section For Official Use Only Building Permit Number:, Date Issued: ___ — Signature: ____ _.-- Building Commissioner /Inspector of Buildings Date File ij BP- 2010 -0685 APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC' ADDRESS/PHONE P 0 Box 60627 FLORENCE (413) 584 -7522 PROPERTY LOCATION 111 NONOTUCK ST MAP 23A PARCEL 227 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �d��� tC Fee Paid Typeof Construction: CONSTRUCT 3 BUILT IN CABINETS New Construction Non Structural interior renovations Addition to Existing_ Accessory Structure Building Plans Included: Owner/ Statement or License 077279 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: Approved 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 _,■:‹7477 i 440 Signature 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. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. BP- 2010 -0685 GIS #: COMMONWEALTH OF MASSACHUSETTS - - CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Pernut: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0685 Protect # JS- 2010 - 001006 Est. Cost: $4990.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 L ot Size(sq. ft.): 11891.88 Owner: PAGE SARA R ROSE & MATTHEW E Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC AT: 111 NONOTUCK ST Applicant Address: Phone: Insurance: P O Box 60627 (413) 584 -7522 Workers Compensation FLORENCEMA01062 ISSUED ON:1/28/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 3 BUILT IN CABINETS 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeT }pe: Date Paid: Amount: Building 1/28/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo