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23D-005 , ; ' t .. 1Sa•thuP I(t(il Ol Plfl)lfc � .11Ctl 1. Bnu c of Building RC�gufations :in(I 5tafi(i.li• s l Corlstirucfion scttti - DC SuperviLtlt sor License t License: CS 77279 1 Restricted to: 00 STEVEN A SILVERMA ri 1 268 FOMER l ,. SOUTHAMPTON MA 01073 f geXacRa Expiration: 6/21/2 1 1 - -G-- — T r": 25795 ( unnni4s B °flEddgi°cs aFedmicse* Licens or registration valid for individul use only HOME Registration: IMPROVEMENT 131945 CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards . Expfra €fbn 10/13/2010 Tr# 275412 O A shburton Place Rm 1301 — Boston, Ma. 02108 Typ Individual / STEVEN A SILVERMAN 268 FOMER RD. F2(ViAIJ �.,1 / .-6/ frr' ( F l/L �� r f __ SOUTHAMPTON, MA 01073 Administrator '+lot valid without signature . l 4 ' • } tA 0 „ le A a t F $ (iix� xtf Nuu# &ntptn 1 _ *_ � �(� * assaclinsetts = °S'_ • 'W DEPARTMENT OF BUILDING INSPECTIONS , - €` 212 Main Street • Municipal Building � = s �� � ' , Northampton, Mass. 01060 ON WORKER'S COMPENSATION INSURANCE AFFIDAVIT L 4 ts o.ic 'ii i-- = ,7i 1 V,, ..-L 7 //0 e_ ./%��/� ‘/- fit -s 7 r, .%;'1 L Oicenseelpermittee) with a principal place of business/residence at: • 3 'to f )x' 25 I.6 l f /i/D, 2t , i -0 /1 gM (phone #) 5 8 4 , - 7 (str eticity /s'ahip) Cd/!J CI do hereby certify, under the pains and penalties of perjury, that: I am an employer providing the following worker's compensation coverage for my employees working on this job: /S2444 'S �/ GC) . 4/0e (76 55 / Z///119 (Insurance Company) - (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) . (Expiration Date) (Name of Contractor) ( Insurance Company/Policy Number) (Expiration Date) (attach additional shed if necessary to include information pertaining to ell comractors) ( ) I am a sole proprietor and have no one working for me. ( ) 1 am a home owner performing all the work myself. NOTE: please be aware that v+lilo homeowners who employ persons to do maintenance, construction or repair work on a dwelling of not more than throe units in which the homeowner r esid or on the grounds appurtenant thereto are not generally considered to be employees under the worker's compensation Act (GL152,ss 1(5)), application by a homeowner for a lice cc permit may evider the legal statue of an employer underthe Wore Compensation Act I uaderstrnd that a copy of this sr.t.m.r may bs fomardad to the Departnaced of Industrial Accidents' Office of Insurance for the coverage verification and that failure to seatre coverage under section 25A of MOL 152 can lead to the imposition of c: imivs1 penalties of a fine of up to S1,501100 andica'imprisonment of up to oo year and civil penalties in the form of a Stop Work Order and a fine of 5100.00 a day against me. Signed this / 3 day of / 2 ii_, j For departmental uso ply 4 f Permit Number r Si�.,auue of i; Permittee SECTION 8- CONSTRUCTION SERVICES .1 Licensed sed Construction Supervisor: Not Applicable ❑ Name of License Holder : Steven Silverman____ 077279 License Number 268 Fog - Ro - , • ... `• . -,, n.,..._.2A 01073 _ .._..__ 6/21/12 Address •` I Expiration Date 1 1 / 1 584 - 7522 S gna, i ( / Telephone ' 9. ReEistered,Npme improverjent Contractor: i Not Applicable ❑ Steven Silverxaan___ 131945 Company Name Registration Number 268 FoFner_Road 10 /13 //O Address Expiration Date Southampton, MA 01 Telephone 584 - . 7522 SECTION 10 WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.!. 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 building permit. r Signed Affidavit Attached Yes 1gl No 0 I1.. - Hams Owner ExornOtion The current exemption for "homeowner," was extended to include Owner- occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. C':11R 780. Sixth Edition Section 108.3.5.1. Definition 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 form structures. A person who constructs more than one home in a two- vear neriod 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 your presence on the job site will be required from time to time. during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laww -s Annotated, von 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'\4assachusetts General Laws Annotated. Homeowner Signature DEscRirrioN or PROPOSED 1/4 Ptrlific0. Now tic dt.A.! Addition J Replacement Vt'kdawf. A,ter..ttitni(::p< Rootint Or Doors Accessory B!dg. Domolitior New Signs Decks 1 Siding J Other 111 /NV .614 4-ie? 412e44 COI ) 4 _le,fZectI)Y2;,A s 4r/ rp }8-^, * NL ../e" rke/1 / 11' tdc rrp " If New house and or addition to exis_tin housing,sontolete the following: t'th v ^t t ■`t. t St•:"; tr; t ,j1 t':It'd VJ1 7ctl'Uy'7" ■2`. :CC yi r-t"w•Itt t 'r htt "„ f: ttnt,: Ftt rt 'rti ? •4, y SECTION 70 - OWNER AUTHORIZATION - TO DE COMPLETED Yt'llEt4 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT JL Steven Silverman, Valley Home Improvement, Inc . 10 V., Ere: ..;,q","C.; StIti(- . Steven Si1Mean, Ya1IyHon, IitprQyenLentIflc. rir1"•tr ;;N: rrt7 Steven Silverman 5/7.f • • 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 filled 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) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever b -en issued for /on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Re:' try of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, ►ody of water or wetlands? NO DON'T KNOW YES IF YES, has a permit be or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on e property? YES NO IF YES, describe s' 'e, type and location: D. Are there an proposed changes to or additions of signs intended for the property ?YES No IF YES, descr be size, type and location: Department use only I City of Northampton Status of Permit: Building Department Curb Cut /Driveway Permit 212 Main Street Sewer /Septic Availability Room 100 Water /Well Availability '( 2 3 ' )Qd Ma Northampton, MA 01060 Two Sets of Structural Plans phone 413 - 587.1240 Fax 413 Plot /Site Plans ' _ .S I Other Specify' APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1- SITE INFORMATION This section to be completed by office 1.1 Property Address: 6,f / i)r4z7 `C (/ , :`-- Map Lot ` _Unit ____ L s Zone _ Overlay District Elm St. District__ * CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 of ecord: (l% y /t- )(/L)6 7j ''/e-. S7 - Name (Print)- /� Current Mailing Address: 4 / , �' AL Telephone 6 3 Signature �� _ 2.2 Authorized Agent: Steven Silverman Valley Home Improvement, c, P.O. Sox 60627, Florence,_ MA 01062 Name (Print) � Current Mailing Address: / 584-7522_ __ _ Signature Telephone _ SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only I completed by permit applicant 1, Building 5" (pop (a) Building Permit Fee 2. Electrical ILO (b) Estimated Total Cost of ll// Construction from (6) 3, Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection � 6. Total = (1 + 2 + 3 + 4 5) () £ Check Number d‘ 944/5 45,r' J I This Section For Official Use Only Building Permit Number: Date Issued: Signature: j Building Commissioner /Inspector of Buildings Date File # BP- 2010 -1080 APPLICANT /CONTACT PERSON VALLEY HOME IMPROVEMENT INC ADDRESS/PHONE P 0 Box 60627 FLORENCE (413) 584 -7522 PROPERTY LOCATION 68 NONOTUCK ST MAP 23D PARCEL 005 001 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 ����� �� Fee Paid Typeof Construction: CONVERT 2 BEDROOM TO ONE & ADD LARGER WINDOW New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: R c i oACe Owner/ Statement or License 077279 / N6J 3 sets of Plans / Plot Plan 5 IA 0 AL b co A6 fF C,Tq 23 tvlasT bf. iN S T ! i4-fa P E CAAP12 r.i T H of.. /e THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION 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 SIZ Pi/ o 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. 68 NONOTUCK ST BP- 2010 -1080 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D - 005 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -1080 Project # JS- 2010- 001584 Est. Cost: $6000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sQ. ft.): 14069.88 Owner: STARLING TARA & SUZANNE Zopir_g: TAW 00)/ Applicant: VALLEY HOME IMPROVEMENT INC A _: .38 I,1ONC.) f J^K _ Applicant Address: Phone: Insurance: P O Box 60627 (413) 584 -7522 Workers Compensation FLORENCEMA01062 ISSUED ON :6/1 /2010 0:00:00 TO PERFORM THE FOLLOWING WORK :CONVERT 2 BEDROOM TO ONE & ADD LARGER WINDOWSMOKE &CO DET MUST BE INSTALLED IN RENO SPACE PER CODE 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: 1 7 -4 "K 6 1 Z4Z44 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. 4 ,7°4.4 x.1...4. Certificate of Occupancy 6 f ZY/iocl —t„ Signature: FeeType: Date Paid: Amount: Building 6/1/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo