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
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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 /
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STEVEN A, Sit:VET:JOAN i 1 /,
STEVEN SILVERMAN' ' v i o 2. L i, ,
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____ 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
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(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)
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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:
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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
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Steven Si lverma _ _
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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