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
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• '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
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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