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17A-051 (2) 123 BRIDGE RD BP-2014-0695 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-051 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-2014-0695 Project# JS-2014-001184 Est.Cost: $3900.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sq. ft.): 10018.80 Owner: MARTIN ANNELISE J Zoning:URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC AT: 123 BRIDGE RD Applicant Address: Phone: Insurance: P 0 BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:12/10/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:RELOCATE LAUNDRY ON 1ST FLOOR - EXHAUST MUST BE TO EXTERIOR 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 12/10/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2014-0695 APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC ADDRESS/PHONE P 0 BOX 60627 FLORENCE (413)584-7522 PROPERTY LOCATION 123 BRIDGE RD MAP 17A PARCEL 051 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT n Fee Paid p 6A- Building Permit Filled out fQ!] Q�'A°-1 Fee Paid 319 ` 5 e Typeof Construction: RELOCATE LAUNDRY ON 1ST FLOOR tif6-C( New Construction Non Structural interior renovations o5(/14c)5. Addition to Existing Accesso ry Structure Building Plans Included: Owner/Statement or License 077279 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION 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 _ Dee:tion Delay Si .ture of Building 0 icial 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. i r=_.^' .' Y Department use only '`, ity of Northampton Status of? rt , J ( DEC _ 3 2013 uilding Department Curb Cut/D Iveway Per n`it " i .,_,,,f 212 Main Street Sewer/Septic AvaiIabriity a� i Electric. F Room 100 INS r/Well Availability ~—�'- ' I- _____2, ,.. :`7,3--'chottl rthampton, MA 01060 TWa Sets o S cturai Plans , phone -587-1240 Fax 413-587-1272 Piot/Site Pt- ' * Other Speci e ' ' 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 ,.a ?)(1a3-C. R.00,C Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: I + 111ne.1l.c- , K(.v1--t m 123 &rtd ve Koced . 4(orerlcc (1a o1o602 Name(Print) Current Mailing Add s: t, `f I3- s'ig- 04 go Telephone Sign.ture 2.2 Authorized Agent: Steven Silverman Valle Houe Im•rov_'me t ,! P.O. Box 60627, Florence, MA 01062 Name(Print) / // Current Mailing Address: /////I 1 1 584-7522 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only 1 completed by permit applicant 1. Building C0 (a) Building Permit Fee 2. Electrical J (b) Estimated Total Cost of 1/01 (b) from (6) 3. Plumbing 3 br Building Permit Fee 1. 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 + 4 + 5) 3) 9(/0 Check Number 3/ 9 7 3 ('5 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date • Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Requir- sy Zoning This col mn to be filled in by Buildi g 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/Fin'Aing ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded .t the Registry of Deeds? NO DON'T ' OW YES IF YES: enter Book Page and/or Document# B. Does the site contain : 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 o i tained Obtained , Date Issued: C. Do any signs -xist on the property? YES NO IF YES, •-scribe size, type and location: D. Ar• there any proposed changes to or additions of signs intended for the property?YES_ No IF YES, describe size, type and location: c1ipN S DESCRIPTION or PROPOSED WORK [ Uchkj New HC;tifitte edition Li Replacement Windewf, kteration(f..). Roofing Ft Of Doors Accessory Bldg. DemolitiorD New Signs I Decks j Siding [ 1 Other kiall.,.CAfe- kNv 1U ' rift C fk-Siwoi i.J'e0t,' ,114.—W,,he,;:j No aa. If New house and or addition to existing housing, complete the following: E am ■;"" t 1,. lit- . .1 w itr )(Kt 1 ..st tit ty.wistr-...tr:t :At tt•t,- eCt..,:r :■c,r. 1~7w1;;It5p, C ;;," Pr SECTION 7a OWNER AUTHORIZATION .TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ka.).4-th ct LJLct Steven Silverman, Valley Home Improvement, Inc. Ott; -: - V t r iv v., I-, 0,1 lu t;' ,1 1,? Steen Sile iari, 3ai1ey Home ImproxemerLta—Inc......._ , 1 •r '! ' ri ir rr n tr, titti for p, : r ; Ito . tit! 1:i `tw iry rc ii bdici • L.' J • ,,Steven Silverman Jr a"C r 7.1.;•1,:! SECTION 8- CONSTRUCTION SERVICES .1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Steve11 Silverman 077279 License Number 268 Fome ioa. _S• � � - It• 6/21/11f•11.,.�MA 01073 �.._._ Expiration Date Address ate ///' 584-7522 __... Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Steven Silverman 131945 Company Name _ Registration Number 268 Fomer Road 10/13//f 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 1X1 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-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 152(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) 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 /„....7...._ ,. , , LY/te -am-inioltatectid 0 tillad/J42,01;-€‘'‘leen. ;,-3-:, 41,,,,,,:::, ,t,,,, 4.0,,,,,i, Office of Consumer Affairs and usiness Regulation ......1;:-- '5,-rt,-,i'j,' 1 t, 10 Pa,-k Plaza - Suite 5170 Boston. Massachusetts 02116 Home Improv,,thent Contractor Registration Registration: 131945 Type: individual Expiration: 10/1312014 Tr# 232370 STEVEN A. SILVERMAN STEVEN SILVERMAN 268 FOMER RD. SOUTHAMPTON, MA 01073 -, Update Address and return card.Mark reason for change. Address Renewal ', Employment " Lost Card uPs-c:At 0 sokioloizis ,ate,nweetria r 19.. iria,..k.wrAoc.WAZ . ..**\ Office of Consumer Affairs& 8u;iness Regulation License or registration valid for indisidul use only 24 HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 1 :, Registration: 131945 Type: Office of Consumer Affairs and Business Regulation Expiration: 10/13/2014 Incilvidual 10 Park Plaza-Suite 5170 Boston,MA 02116 STEVEN A.SILVERMAN STEVEN SILVERMAN , / ./0 268 FOMER RD ' ir/* I it 17,11/l ji SOUTHAMPTON,MA 01073 ' i L Understert Lary Not valiithithout signature . , .... itf P:ah, Pi:ft.'1 0.,;','a,V:,..-. "'A .,a., .„ x, ... - , c C•t!:::q a:: „:' '.1,' Aht4A1,414101., , ,...... .__ 45f pT t?�o , (Z of NartI nt1J4Lnt P 't =:'v_ $��'j�.; ��9 �aaaacllnsetfa _—�_ ci-. s� }- DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, Mass. 01060 up' WORKER'S COMPENSATTON INSURANCE AFFIDAVIT L 57-1 le Al 51 L i//X' 7"A , 1/1-1-1..L,4.2 n(641£ _i`.�in/✓ lsfitz/Z731�dZ G. (license&permittee) with a principal place of business/residence at: 3 0 e/v i c .�,4 r ,, /t--)/t7�77//J'Z/1/,4 (phone#) �6'-7s 2_ (s iet/city/staf>Jzip5 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) (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 persons to do intro■nM,construction or repair work on a dwelling of not more than three units in which the homeowner resides or oa the grounds appurtenant thereto are not generally considered to be employers under the worker's atapensation Act(GL152,ss 1(5)),application by a homeowner for a license cc permit may evidence the legal status of an employer under the Workees Compensation Act. I understand that a copy of this statement may be forwarded to the Department of Industrial Accidenes'Oioe of Insurance for the coverage verification and that failure to secure coverage under section 25A of MC1L 152 can lead to the imposition of criminal penalties comistiag of a fine of up to S1,500.00 and/or imprison of up to one yes:and civil penalties in the form of a Stop Work Order and a fine of S100.00 a day against toe. Signed as' day of `;J4� !4 k\ t L ) For deplutawital use only /Ai , y Permit Number - A' ._./ZJr/n ; 1./ // /.Z Map# Lot# 2gnature of Li•... :- `ermittee '