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
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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
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}- 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 '