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17A-163 (2) St 0 .' 15 HAM Pi, t o a ... All GNu tI &nt14rt _*_� .,.1. 1 � 04„ JaSSRhnEett5 Elam= ,:t © = — DEPARTMENT OP BUILDING INSPECTIONS =-t j 212 Main Street • Municipal Building =_ Northampton, Mass. 01060 �" ow' WORKER'S COMPENSATION INSURANCE AF1`WAVTT I, SIiV i I 5/1..17/760/17/,, t��Gh'Fv hi-OM i %��1/✓r filZ4 i.1ittC__ (Iicensee/permittee) with a principal place of business/residence at: 3YO /1/ ' LS 1�F..�i4 t-� r, /7.77/7 -n///zw,gj,4 (phone#) :��6/"7�Z'._- (stret/city/s' tP 7ip5 do hereby certify, under the pains and penalties of penury, that: 0 I am an employer providing the following worker's compensation coverage for my employees working on this job: (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 sheet if necessary to include information pertaining to all contractors) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that while homeowners who employ parent to do__i+t/ma construction tion or rtpair work on a dwelling of not more than throe units in which the homeowner resides or on the grounds appurtenant thereto are not generally considered to be employers under the world's compensation Ad(GL152,ss l(5)),application by a homeowner for a license or permit may evidence the legal status of an employer under the Worker's Compensation Ad. I understand that a copy of this statement may be forwarded to the Department of Industrial Melds Oioe of Insurance for the coverage verification and that failure to secure coverage under section 25A of MOIL 152 can lead to the imposition of criminal penalties consisting of a fine of up to S1,500.00 and/or imprison 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 me. Z Signed as 1 jr day of `;J r l4 A. 7�3 For use only Permit Number AV.r ir',r' ; /I( , (,/:4/e/tM . J Mall# Lot il ignature of Licenseef ermittee k m • iUt ? . itord,jacitee<4 0111ce cat"Consumer At darts and usiness Re; uIation 10 Pa.`k Plaza Suite 5170 Boston Massachusetts 07116 Home lxrprov—,invent Contractor Registration Registration: 131945 Type- individual Expiration: 10/13/2014 Tr# 232370 STEVEN A. SILVERMAN STEVEN SILVERMAN 268 FOMER RD. SOUTHAMPTON, MA 01073 f pdate Address and return card,Mark reason for change. Address RenenaI Ernplo r ent Lost Card /Arr f;.o nz rra,rar ifh �, ()fact of Consumer Affairs R or sin:ess t itr egcaur aairta i r n License or registration valid for intiv tul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. '11 found return to: 'Y Registration. 13;945 Type: Office of Consumer Affairs and Business Regulation Expiration: 10t 1�014 in8i+rsduat 10 Park Plaza-Suite 51'0 Boston,MA 02116 STEVEN A.SILVERMAN • STEVEN SILVERNIA$ 't 268 FOMER RD ii":2 /211 SOUTHAMPTON,MA 01073 t`ndereserrrtars Not s alfhi without signature 1V1 A a¢ w L -. SECTION 8 -CONSTRUCTION SERVICES 1 Licensed Construction Supervisor: Not Applicable ❑ Nance of License Holder: Steven. Silverman_ 07727 9 License Number 6/21/1!f 268 Fo�ner Road, a. * - �+• �•n.,_ MA 07 073 �.. _ Address Expiration Date /- 584-7522 Si t� e Telephone 9. Registered Home Improvemen Contractor: Not Applicable ❑ Steven Silverman__ 131945 Company Name Registration Number 268 romerRoad _ 10.13M" Address Expiration Date Southampton, MA 01073 _Telephone 584-7522 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, § 25C(6)) l Workers Compensation Insurance affidavit must be completed and submitted with ths application. Failure to provide this af=fidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes 1231 No ❑ 11 - Home Owner Exemption The current exemption for"homeowners"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. CMR 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 farm structures. A person who constructs more than one home in a two-veer 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 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 Laws 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 Massachusetts General Laws Annotated. Homeowner Signature , . '77,1-tpri .5. DESC.RIPTIDN OF PROPOSED WORK Cchttck ."1tl p42E115-„,b1c) , , 1 Nuw Ficr.n.e. — Atdittion L.1 Replacement Windows A.ter4tion(L)1 4 Roofing r. [ Or Cowl i Accessory Bidg. : Demolitior L''. New Signs ' I' Decks ' ) Siding i j Other I 1 . ....-;'P:' Dr:...'. .-r`.,.". )r ;# "t: r '',- : .`,' ", Ipst411I 6 ' 5-1)APA !VI jilt li So so r y ti,:rlil iv\ five of_3C 14 1:141cloaA) , BACk CP hoLx., ... .„-i-,- ,... -„,, ,,,,„ :,„„, ,,-rn 11 . .747 Nr., ■%1-1 1 ri■ r...:•-•,'. 'Ff-"I'r " '''7, --K. ',ts• 611 If New house and or addition to existing housing. complete the following: '%., .--t k.., ,.; c -r -.-Jirrt .,, 7v,,,:,), :Thrl l'f :-"'.'-".• _ ,, 1 1 4,,;:r.11 °,:„.,,t—:: .1,-," I "Vr°.,°:',i'" 10.1C: L 'o'C*.":-.,..i :,.;`" 'I":„It t 1,t.; ", 't:i: c:•-,::, ,r "."'.°G, ,:i'sts.:.,t, Is. r,Lr- L.:- .; ,....,00:..J1 ! . f.'s-AT! .-'.1L..:1 ,-_,c7' Cl 1 :,,'IS ......_......._ NI , 1:"• (,::011St 4.1:.,t A i 'Oa :,.'I :OC ':,°1 1`... ::111.'t ■, Yi; 7:41 !dr'i.-: ...,;:',.' A'"Ti tC. '.' t' 1-1.!t I. ;!,E ,1 1:i ?„'W.i.: t 4,.„1,ThCr f-C." '1',.;:. 1,1t", i..;A: lt ___ f"...; '„,.s. ',-,,,,-r.,..tr. ____ ___ Pr .4"...7.:,4, v.t ■ _ :-.,t"'sv v,<1..4"..t...,T ..t:..r,',I, y SECTION 7a . OWNER AUTtiORIZATION . TO BE COMPLETED WHEN ,,. OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 _ .........YbC ic)I c ha Iciso(-) 4 Steven Silverman, Valley Home Improvement, Inc. -1 5V; liii■ I I ,,,, .1t _........_1 EMIIIIIIIIIIIIIIIIIIBIIIMIIIIIIIIIIIIIIIIIIIIIM — Stexen S.ilxexraan,_Valley_Jiorae_Inproxemerkt,,, Inc... , is ,%,.., ,is...1, .. l ,:i-,-1 Al.,:f-r. ! , -21',,,' :..1:2C. i.`1,:: '. ::,.. -.: ::::,10,:fly...-C,.... ::F1C 1-il:•17-i.',. :..fi 1 1,:-. the f:joRT.:117 i...: ,•411_'•• ,ific• ,F,-; ,,ue■ •-1•,,,j ;11:,,i•,••Jr-•, 1-,, he •„,t....,', 1," Ivy , t.r:z -....cre. :n7 t.",,,:itc.: I - 1 ' ' Steven Silv nman• / ...___ , .. ..._ I . I 5h/7.I 223 1 : ° ...°.• -..'•): • ••:. r''r' -••V.: 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) / i #of Parking Spaces Fill: (volume&Location) / A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW i (. YES IF YES, date issued: , IF YES: Was the permit recordedythe Registry of Deeds? NO DON'T,KNOW YES i IF YES: enter Book f/ Page and/or Document # B. Does the site cont 'n a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, ha a permit been or need to be obtained from the Conservation Commission? Needs to a obtained Obtained , Date Issued: C. Do any,4igns 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: GG� Department use only nak 3 City of Northampton Status of Peitnit: • �� • :wilding Department Curb Cut/Driveway Permit l04S 212 Main Street Sewer/Septic Availability oF���oN`n°t o613 Room 100 W ler/Well Availability ovc, � Northampton, MA 01060 Twv Sets of Structural Plans phone 413-587.1240 Fax 413-587-1272 Plot/Site Pi . Other Specifyt' 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 �\ FOX Toy-- Road Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: 6,63— Lit-10 - 5- 'y3 Telephone Signature 2.2 Authorized Agent: Steven Silverman Valley Home Improve t, Inc. P.O. Box 60627, Florence, MA 01062 Name(Pr' Current Mailing Address: / - 1/1'L' 584-7522 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars)to be Official Use Only completed by permit applicant 1. Building 7 3 (a) Building Permit Fee 2. Electrical a° (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) p p QO Check Number //6/ This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2013-1077 APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413)584-7522 PROPERTY LOCATION 11 FOX FARMS RD MAP 17A PARCEL 163 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE fi (/ ZONING FORM FILLED OUT �'— /r Fee Paid Buildin l Permit Filled out • Fee Paid Myr A��f Typeof Construction: REPLACE WINDOW W/SLIDER New Construction / ; v Non Structural interior renovations Addition to Existin l I _ �Nerrrl Accessory Structure Building Plans Included: Owner/Statement or License 077279 0 v 3 sets of Plans/Plot Pla• THE FO i ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I I '4 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 emo ' ioj'ela. 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. 11 FOX FARMS RD BP-2013-1077 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A- 163 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2013-1077 Project# JS-2013-001773 Est. Cost: $8800.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sq. ft.): 9975.24 Owner: RICHARDSON JULIE Zoning:URA(100)/ Applicant: VALLEY HOME IMPROVEMENT INC AT: 11 FOX FARMS RD Applicant Address: Phone: Insurance: P 0 BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:5/14/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE WINDOW W/SLIDER - header must be appropriately sized 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 5/14/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner