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25C-228 (2) „ . __,.„,,, 3 °° '° �� �i�yi i d� nth obscure ins , \ , o r Tile� new sheetrock throughout £ o m . c Bow Frontsh® r ��rta o D 1 7 11i n Surface mounted fed Cab Bath fan on timer Pedestal sip � \ , U - =��' �\ ' New ®ii t� ���d front New fauce i �� \ �h a ” I ii IL ii L-1' i�� 'Floor re i i ra diator � i�it door Box in ri lines a. .y i b u s Uzi , � .� /�/ ( . 1_, - �. T r ., s r : . 7 � .E�3 '3' - " R ',. ,,,, ¢`- '' mi ty 'l ts _ w 4 ..�- ..- tea uA� i 'a.' `r , d it ig c aim r } i / / / - / . 3 kin , , t° OcrirwRld o iPulkig„ , • Board of 1di/1 Re and Noattd.Ink Crucflon `Lte.x,r,,se LAcense CS 77279 Restrothid tn:, STEVEN A SILVERMAN 268 FOMER RD SOUTHAMPTON, MA 01073 Etptration: 6/2V2012 Tr.7: 26868 lioop4 of OrrihirrzpRettriktrntq6-tteiti Stfil ettri Itittott or n k1 for intik idol use tolls HOME iMPROVEMENT CONTRACTOR btfort the expiration date, if found rourn to: Registraton, Boit f fltug Itei anti Stantiorth Expiration 10 0 Tr# 27.54 Ont: Att thttrion PI:tett Rol 1.39.1 Boition.14:71. 02108 <41 Type STEVEN A SiLVERMAN STEVEN SILME,RMAN t„," /2 t ‘TE8 FOMER ' ' /1' SOU EHA MP FON MA 0101'3 Admintctrator Vt ithion /1 r e. 041 pTO .i ii fi r'` _:�_ a — , 1,..� I( B ' sssRCEinsctts := _ t_ - ca - DEP�RP�f .TEI�1T° 4F BUILDING INSPECTIONS _ 212 Main Street • Municipal Building Northampton, Mass. 01060 ��M ow s' WORKER'S COMPENSATION INSURANCE AFFIDAVIT ' /i/ � L-5 l iLt 571 / C'%- =� � - Tr - , �/,1i'% -'.- -� ff -' ;� 'i_ L ,.� /''o!-‘>'zr> s -fZ c9-ii", 2;4 (___ (licenserJpermittee) with a principal place of business/residence at: 3 't() ,ji -. / 2 t�/% VZ ,A ?- -77d.%%'�✓'', A'7: (phone #) `, / :-- ?_ (str t/city/s a: Irip) eV h () 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: /; �L4'.5, (C) . G , (-1(1- k('`.0 6 5 5 / zViv, /.//' (Insurance Company) (Policy Nurnber) (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 additicnal sleet if necessary to include information potainingto all contractors) ( ) 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 while homeowners who employ pawns to do rminsenawY, construction or repair work on a dwelling of not more than three units in which the homeowner asides or on the grounds appurtenant thereto are not generally comidacd to be employers under the worker's compensation Act (GL152,ss 1(5)), application by a homeowner for a license or permit may evidence the legal status of an employer under the Worker's Compensation Act. I understand that a copy of this statement may be forwarded to the Department of Industrial Aoido& Oboe of lrreuuano for the coves verificati and that failure to secure coinage under section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to $1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of 5100.00 a day against mix. Signed this > day of 4 ,,26 For departmental use ally Permit Number ;? ' ,/' ( ;°' // M.ap# lit Signature' ofL s •ermittee SECTION 8' CONSTRUCTION SERVICES ---- ---- --- ------- ---------- -------- — '�---- l .1 Licensed Construction Supervisor: 0u1App/cab|c O | No/neui Lice000 Haider .Gteven Silverman __- O77 L � h 6/�I/l�~ 2 <�8 F �� ^ o, 'MQ�_0l073 _- __ _ | [xpira�onoas / 584-7522 9. Registered Home } Improvement Contractor: NotAp7Loalte 1 | bl]verAan �� ----- --� — �--- ���� — - - �--' - � — � — \ Company Name Rqg,istrai/on Nunhi:r _10/13//0 Expiratiun Da�u | Bout , MA 01073 Te�cpL�n� 584_7522 � SECTION lO~ WORKERS' COMPENSATION INSURANCE AFFIDAVIT (KU�G.Lc152,§25C(6) YYorkersCompensation insurance, affidavit must be completed and submitted with ihsmpphuntioo, Failure to provi will result in of issuance of buUdin�pormit F — — -- / Signed /#fidavitAdachad Yes X No 11. - Home Owner E The current usampdou for ^'homonnnun`was extended uo include Owner-occupied D`*el!\nps L`[ one (|) or *v0(2) i�mUim and moUmr such homeowner |ocnfagcon individual for hire who does not p*ssiesvo license, provided nets as supervisor. CV111780, Sixth Edition Section |00.3,5.L Definition of Homeowner: Person (s) who own o parcel v[ land vu which huSsiluu.sidos inuodom reside, o,d`icbthere is, or is intcndcd 10 be. o one ortwo Inn ||y dwelling, attached or detached structures accessory to such Ilse and./ or farm structures.4 person who constructs more than one home ioa two- ear period shall aol ha considered u homeowner. Such "homeowner" shall submit to tile Building, Official, on a[nnn acceptable to 11)0 Bnilding Officio], that hoishcxbuH be responsible for all such work performed under the boQdinu,nenmit,. Aaa:(ing Construction Supervisor your presence oo the job site will h:required fro/udm Lime. during mid won completion of Lhc work for which this permit \sissued. Also bx advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability ofFnp|ny;,` u, Employees for injuries not resulting in Death) of the Massachusetts General Lu\Vr Annotated. lolLmuvho liable |brp000n(x) you hirc to pertorn) work hr you uncler this perniit. The unduraiuod^`horucnmncr` certifies and assumes responsibility for compliance with the State Do|Nioo,Cndc. City of Northampton Ordinances, State and Local Zoning I .ows and State of Massachusetts General Lows Annotated. P7,017()SED NOKc;!; ...11 N.,-...-• :Lz..t. ... 1"..;..d:ti,,,d ..: 1 ;I °A*1: 1.:. A New Si , r Rif •C pcptAce oF is Ftwg 8o FixfuikEs I sp,mt Loc,A ? A tp6 .. , '• ' - .. '' ' ' ' - - -74 WiN6CW I?J' , Now 11 „:111(1 or , t:':i. ° 11 C0 10 1 1 0"...." ° ... : ... , z "," ' ° ;- z ..-,..• :: z.: ',' '‘.. ! ,'. : ..".,.: ..:, .' ',. i',.: ,;,..1 ."" ';'',.. :', ',. SECTION 7,A - OWNER AUTIIOREZAT4ON - TO E3E COMPLETED WHEN OWNERS AGENT OP CONTRACTOR APPLIFS FOR 81119-01NG PERMIT I /71//777/j ..) <5.-agocz_ ven syverinun, Valley Hone Improvement, Inc. Alp ' . ; , ,,: -. -- , 2 : . / 1", ■ , , ' - L.. ' . L , ' , ' ' 400 41111: 4 " . 4 1 ■■,,' Mr' . Eir , 1 1 Steven Silvenvan, Valley T Home Irproventent, Inc. 1 Steven Silverzraa , J ,/ , , ............ ........ .........,.... .......... _ e Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning 7 This column to be filled fi 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 e -r been issued for /on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at th•• Registry of Deeds? NO DON'T KNO YES IF YES: enter Book Page and /or Document # B. Does the site contain a book, body of water or wetlands? NO DON'T KNOW YES IF YES, has a per it been or need to be obtained from the Conservation Commission? Needs to be obt. ned Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: ` ` . ^ A " ^ - __� _ - _ -- " --- (�itv0fN0rtharnptOn �Steb Building Department ' 212 Main Street Room 100 Northampton, MA 01060 Two Se phone 413-587-1240 Fax 413-5874272 Other Spec __- __ __ | ' -- - -���_ / APPLICATION CONSTRUCT, �0TO CONSTRU� ALTER, REPAIR, RENOVATE OR DEK8OUSHA ONE ORTWO FAMILY DWELLING � �� � ���� SECTON 1 .- SITE INFORMATION Thiss�cbnmtn b*�ommp{eted by office | 1.1 Property Address: ~ � . ) JL <� /- Map Lot Unit ;�� et- J ���r -_----- --- - ---- .4 i ir O 4_"_ /41/1 0 /6(0 Zone __ Overlay District [|m St. District CB District ' SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT - 2.IJ Owner ofRecord: � �� � ' �� -/� ��/� ��/�/- 7 ��i ��C) _ � _� � _-_ Name ~hnt-‘) ' ? Current Mailing Address: ' t 4 4 - -.---f `�� . ii/ ay:p»�n / ��v/4� , 'ft AV ~~"_ ���'^^_��� � ~^.. �� �~ / . ~ _ — �2Au orized Agent: Steven Qilve a Valle . e Izu r �r�mzz � I��~ P.O. Box 60627, Florence, MA 0I062 Name (Print) Cu,mnL�aiiinoAud/eo� ����V �� ^ ��� 584-7522 __ ��mmm' __ �� -__ = � � _- __ -__ ___- -- '---- — — Signature / Telephone . SECTION 3 - ESTIMATED CONSTRUCTION COI | Item Estimated Cost (Dollars) tc be Official Use Only completed by permit applicant _' -J l� Building 1 ^l � ��/�) (a) Building Permit Fee � ��`,�, _ 2. Electrical �����l (b) Estimated ��^/�/ Conotruotionhnm�� _ 3. Plumbing �7 � u 'r\y\ Building Permit Fee J� c/ (, {-= , °w�� � � � 4. Msuhanica|(HVAC) 5. Fire Protection - 6. Total = (1 + 2 + 3 + 4 + 5) - \ 5- 5�c-/� Check Number 2-7 4 c i' W This Section For Of iciu| Use Only Building Permit Number: OP Ao _-- Date Issued: __-- _ - _ _ - Signature: d ___ _--- ____ _ ___ __ Building Comm\sinns//|nopwctu/n|Buildings _ _ uaf _ . _ ____ `6 ""m WA LbrOt ST I BP- 2011 -0111 GIS #: COMMONWEALTH OF MASSACHUSETTS a Bl CITY OF NORTHAMPTON t' ock. °2C � 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- 2011 -0111 Project # JS- 2011- 000196 Est. Cost: $15850.00 Fee: $94.80 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sq. ft.): 4399.56 Owner: SUBOCZ MATTHEW K & JILL L PLOGGER - SUBOCZ Zoning: URC(100)/ Applicant: VALLEY HOME IMPROVEMENT INC AT: 45 WALNUT ST Applicant Address: Phone: Insurance: P 0 Box 60627 (413) 584 -7522 FLORENCEMA01062 ISSUED ON: TO PERFORM THE FOLLOWING WORK: Bath Reno 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: FeeType: Date Paid: Amount: Building $94.80 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner