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,DRAV'N BY: VHI Valleij Home Improvement, Inc. ROBISON, STAGY & REVISED:
p 10.23.2013
SCALE: XANTHI
340 Riverside Drive,PO Box b0627,Northampton,MA 01062 4 LINDEN STREET
ONslidr VARIES Office Phone 413.584.1522 Fax 413.585.0820
DATE: 1 1.4.13 — Find us on the web at wuw.ValleyHomelmprovement.com NORTHAMPTON, MA -
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DRAV*4 BY: YHI Valley Home Improvement, Inc. ROBISON, STACY& REVISED:
10.23.2013
, ,,,� SCALE: XANTHI
340 Riverside Drive, PO Box 80621, Northampton,MA 01062 [} LINDEN STREET
VARIES Office Phone 413.584.1522 Fax 413.585.0820
DATE: 1 1.4.13 Find us on the web at: www.ValleyHomelmprovement.com NORTHAMPTON, MA —__
1:511AMP.7.
at l Gil T of Northampton t ) _**_1
$��.•v�yti'"i t 8 =alt-
o:4,:a`_ ((1• BSaaC1Tn5[tfe _ s�t__
�"'�}-'`
DEPARTMENT OP BUILDING INSPECTIONS —'_.-
212 Main Street • Municipal Building '
Northampton, Mass. 01060 �" ..'
WORKER'S COMPENSATION I SURA.NCE AFFIDAVIT
I, S /e/51 L(/rc ''77%x', OfZLZ/2 //OM C 7,/&) fitt/2 i—/.J7/1{__
(licensee/permittee)
with a principal place of business/residence at:
3Y1-) 4/is"Ti '6G... / i` /,/1-2 /7/..7,1"771/%1/73/1,4'r7 (phone#) &-75 _
(street/city/state/zip c
do hereby certify, under the pains and penalties of perjury, 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) (lasurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(arch additional sheet Tote:wary 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 persons to do maintenance,construction or repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thereto are not generally considered to be
enttployers under the worker's avapussation Act(GL152,.s 1(5)),application by a homeowner for a license cc permit may evidutoe the
legal static of an employee under the Worker's Compensation Act.
I understand that a copy of this uateasent may be forwarded to the Department of Industrial Accidents'Office of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1,500.00 andlor imprisonment of up to one year and civil poultice in the form of a Stop Work Order and a
fine of S100.00 a day against tne.
I
Signed eta. day of I' J i/L7/1)'''t�, -2-03 For depanmeotal use only
7 J Permit Number
/ y
I// /��/,� il�4/7:77;/ J Map# Lot#
ignature of Licenseell�ermattee
•
I SECTION 8-CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Steven Silverman 077279
License Number
268 Forcer Road, 6/21/1
'_.• � - t+• •n.F. MA 0107 _. ._1'
Addres• Expiration Date
//
/ / 584-7522__
S^_n;
"7,1•e Telephone
9. Registered Home Improvement Contractors Not Applicable ❑
Steven Silverman._ 131945
Company Name Registration Number
268 Fomer Road 10j13jt't
Address Expiration Date
Southampton, MA 01073 __Telephone 584-7522
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. 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.
Signed Affidavit Attached Yes 1111 No ❑
1 - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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-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 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 1.552(Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated, you may be liable for person(s)
u 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
cT;ON 5. DESCRIPTION OF PROPOSED WORK (ch(tck ;10 ...tp, J.k )Jp.)
I •
New Flr:12...e Petition Replacement WicalOwf, ktetation(01 Rootinr,
Or Doors
Accessory Bldg. J DernolitioD New Signs Decks ; ) Siding f I Other
'„ Pjz14,141,71 ZCirile-, A,A.,?.
!!..t-tr:*r*VYTI t,p
6.3. 1f New house and_or addition to existing housing, complete the following',
47: g
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SECTION 7a OWNER AUTHORIZATION •TO DE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Obl$0/1 /ank'hst ,
teven Silverman, Valley Home Improvement, Inc.
Stja:Jrp. U 0471er J
• .Steyezi ;r7.
nc,°,74.7y the "'Az t: try
at
Steven Silverro:o
i .
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: ljY+
Rear I L�
Building Height
r14-
Bldg. Square Footage % GOt
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever 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 brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there ally proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location:
M Department use only I
City of Northampton Status of Pertiit:
SN01107nSM_.d I U 0 ��
Building Department
L________,
1 212 Main Street Cut/Driveway Perrin
r a Sewer/Septic Availability _
NOV 6 L,:, Room 100 Wa er/Well Availability
Northampton, MA 01060 T 'Sets of tructural Plans
Q3A13031dhone 13.587.1240 Fax 413-587.1272 Plot/Site Pt ;S°, :
�
—
Other Specify'''. v
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING I
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
l Li ,- Si-reed- Map Lot Unit ______
Zone Overlay District
E1m St. District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
S 0 (eb So- + Yan-I-i; SC/m c O Y2 'f 1-/n den c�-)- Nck"-f ezryt P o. Na. 0IO C
Na..- 'n ) Current Mailing Address:
y13 - 581i— 3293
Telephone
Signat• -
2.2 Authorized Agent: Steven Silverman
Valle H•me Im•rovement I� P.O. Box 60627, Florence, MA 01062
Name(Print) Current Mailing Address:
in L2 584-7522
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building /) �y�1+��() (a) Building Permit Fee
2. Electrical L , (b) Estimated Total Cost of
�f�� Construction from (6)
1 3. Plumbing Building Permit Fee
4. Mechanical (HVAC) I
5. Fire Protection
6. Total = (1 + 2 + 3 + 4+ 5) / , 5-(Jr) Check Number 3 ( gi / A Yr
f This Section For Official Use Only
Building Permit Number: Date Issued:
Signature: — _._ _ _ _
Building Commissioner/Inspector of Buildings Date I
File#BP-2014-0602
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 4 LINDEN ST
MAP 25C PARCEL 201 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out [�r� 7 f i y
Fee Paid ` 6 (/
Typeof Construction: RENOVATE 2 CAR DET GARAGE
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 F OWING 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
4r,jela.
Signa Tr of :uilding-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.
4 LINDEN ST BP-2014-0602
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25C-201 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-2014-0602
Project# JS-2014-001010
Est. Cost: $14500.00
Fee: $87.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 9539.64 Owner: ROBISON STACEY E&XANTHI M SCRIMGEOUR
Zoning:URC(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 4 LINDEN ST
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:11/14/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:RENOVATE 2 CAR DET GARAGE
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 11/14/2013 0:00:00 $87.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner