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DRAWN BY: YHI_ Valley Home Improvement, Inc. DAN 51R015 I Home improvement,Inc.(VHI),Itis
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delivered for the limited and exclusive purp<se r'
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' REY15 ED: customer agrees that the elements of this plan shsd
Office Phone 413.584.1522 Fax 413.585.0820 & HIGH MEADOW 5T not be republished or presented in any form
DATE: 5/� /ZOOt} Find us on the web at: u�uu.ValleyHomelmprovement.com I FLORENCE MAC =ting Project ccobactors without t
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This plan is the proprietary work product of 11111r
D RA(W N BY: YH! Valley Home Improvement, Inc. �DAtN 51 RO15 I Home improvement Inc.(Vkl).It is
i I I delivered for the limited and exclusive pure..,_n
340 Riverside Drive, PO Box 60621, Northampton, MA 01062 JA(RAt MA(LKI N not the contract bid of VHI,and
III, REVIB ED: customer agrees that the elements of this plan sh.
I Office Phone 413.584.1522 Fax 413.585.0820 I 8 HIGH MEA(DOY�I 5T not be republished or presented in any form
5/15/14 Find us on the wet)at: w wMalleyHomelmprovement.com for the purpose of enabling or supporting th
- - - --- - contractors without the
1 FLORENCE MA compehngproject
DATE: 5/15/20-14 GO NTCT PRINT 5/15/2014 ! ' I Pemrrssion of,and compensation paid to,\h fl
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DEPARTMENT OF BUILDING I.NSPECTIONS
212 Main Street ' Municipal Building y j
o.
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(IicenserJpermittee)
with a principal place of business/residence at:
(phone )
do hereby certify, under the pains and penalties of petury, that:
I am an employer providing the following workers compensation coverage for my
employees working on this job:
(asurance 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 Comps ay/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) - (Expiration Date)
(attach additional sheer ifnec=sary to ine}ude kdbrmtion p r aimng to an ooatractors)
( ) I am a sole proprietor and have no one working for me.
{ } I am a home owner performing all the work myself.
NOTE.piease be aware drat while homeowners who employ p==to do raklena,,, consmiction•or rsgairwork on a dwelling of
not mare than LEL�Wsts in which t�--hem-awac z sides or cc the g=ads appur Laornc tha do are not se msay cowid=to be
�10;�.:t��t`�;?vo<�� ;�w�a�,,,�.�,-.(vLFS�1(ij,applicatiaa by a nosne�wo:r for a iics�e ar prmii may tite
legal rtatua of an employer under tha Worlwez Compac=tka Act
r u " ^d tbai a copy of this ssstemeot may be forwarded to tllo De;`qr�of lndz,�sl Acdd=te dfo:of lar-ar=-.for the
ccv�uada socdoa 1SA of MGL 152 can lead to ibaL i oa of criminal p=aitim
caasisiffig of a.fic--of up to S1,5W.40=dfor i n of UP to oW y=and civil p=aWes is tt;e fcrm of a Stop Work 06 der and a
fm of MOM a&-yn�i"°Rm<
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Y t �tl:li 1t l,£7T?SLI1T?f�I' < 11airs and 1�i"I�Z1I"etss ilk"�„ul't'of)O
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i n l.# c:aY Plaza _ S.Ld•.: wK a 710
Bclston Massa chusetts 02116
Registrat on 13195
Expiration: 10/13,2014 Tr# 232.370
STEVEN A. SILVERAN
STEVEN SILVERMAN
268 FOMER Ra,
SOUTHAMPTON, MA 0107 __._._ . ___
Update Address and return card.Mark reason for charge.
,Address Itene�kai _ lmplot#rent host Card
QPs-CAI
i*xn Gfa»olbisfs-v!a+:tt'x.siei+ x,.t�a•6cviJtitid+%oe
Office u#Consumer Affairs:��ustnc�s Regulation
License or rcvistYntior valid for cncl Yattu!use�snf�'
N —HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
a
Registration: . 132945 Type:
Office of Consumer Affairs and Business Regulation
�c .Expiration: 1011WO14 individual 10 Park F Win-Suite 5170
Boston.MA 02116
STE N A.SILVERI511�i1
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STEVEN SILVERIAA�i 268 FOMER RIB.
SOUTHAMPTON,MA 01;073" Underseeretart Not rali�ithaut signature
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268 FrYnAz n,,__M-A 01073
Address Expirat::on Date
Tele
whone
9. Reiistered Home ImproveMg
268 Fomer—R-o-ad
Address Expiration Daze
Southampton, MA 01073 --Telephone 584-7529
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, §25C(6,1)
Workers Compensation Insurance affidavit rriust be con-,pleted and submitted with tl�,�is appitcation. Failure to provide this nf
will result in the denial of the issuance oi the building permit.
11,- Home Owner Exemption
Decm��c�m�uol�`h��o*n����o��d�mb��� m�(|) m �o�) ��|i�
and 10 allow such homeowner zn engage un individual for hire who does not possess ulicunso. provided that the owner acts
as surwirviso r. CMR 7 80 Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)Nvho own a parcel of land on which he/she resides or intends to reside,on which there
i.,. or isint"ridcd to be, a one or nv,-, 1,'ami!y dwelling,attached or detachedstructures accessor,."to Such 'Ise Lind!or farm
structures. A person wilo corztructs more than one horne in a two-year neriod sh--Il not be considered it homl�nwne--
Stich"horn.cowner"sliall submit to the Building Official,on a form acceptable to the BUilding Officialt±.at lic/she shall be
responsible for all such work performed under the bujidinaperinit.
As acting Construction Sune your presence on the job site will he required from time to time. during and upon
Completion of permit is issued.
Also advised that Nvith reference to Chapter 152(Worker,;' Co p:ouution) and Chapter |G (Liability ofEmpioyoom
Employe-.s
for injuries not resultini-in Death)of the MassachUsetts General Laws Annotated, N,otl may be liable kvpersond
you hire in perform work for you tinder this permit.
The uodcoigncd^homeo*nor^oeni�cx and assumes nuapnnsihi|ity for comp!iunne`vith the State Build in�Codc`Ckyot
�oohznopto: 0rd�ouoccu` Stxe and Locm! Zooin�|.awsmndS�o��o[��osynchuscosCcnu,o( Lu"/sAnnotated.
`
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a, If New house aild or aiddition, te, eXistlu hopsing. completc thc follCi4,'ng ti
7` s •„,wa ., ,. ;°s ..a,l. .. .' t:=°.., 1...'”:t ...:E _'a't ..� ....._ _ .._._._, .._____
L,:,
�....FT'i'�5l ._�13:.d_ry. .!(".l..d c«qtr.a.k �f.�• .............. .. ..._..
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SECTaCIN as - OWNER SALITMORIZAYt. N .FC EE COMPLETED WHEN
OWNERS AGENT OR CONTRA,CTCR APPLIES FOR BUILDING PERMIT
`r C��l�^.� L]—.\.G,�..�....� V.W`.�L � �",�L�.. -. . _. ,=P'_.'�C '."t£'•L '...6' _it� �� ��t°.�3
dF =- ,•.t t..t S .. ,t } �
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.dam �f:, "s.�'::3f_ ___ � :°ttt#_fte<•'1^;.. _FP'" t` �_►r"'E: .tl A::' LkIC:�C)f;'�vli p. .d�dt. Spiv .;Fx, ! .Yt� .t_,::'�C k'� kr .ltC' �'..,. t`r F;,'y�
mom
Steven Silvezrm .........
t _
Section 4.
ALL LNTORINIATION 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)
#of Parking Spaces
Fill: '
volume&Location)
A. Has a Special Permit/Variance/Finding ver been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at he Registry of Deeds?
NO DON'T K GW 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 rmit been or need to be obtained from the Conservation Commission?
Needs to be btained Obtained , Date Issued:
C. Do any sig s exist on the property? YES NO
IF YE , describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES _
No
D ',City of Northampton Status of Permit:
uilding Department Curb Cut/DrivewayPermit
MAY 2 3 2014 212 Main Street Sewer/Septic Availability
ections Room 100 Watzr>Weff Availability
ectric,PiumbIng 4 Gas F 01060 Insp hampton, MA 01060 Two Sets of Structural Plans--
i
crth2mplc, ti1
phone 413-587.1240 Fax 413-587-1272 Plot/Site P1a6,
Other Specify^
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
b C-c\QI 1 \Afo A 6uj SY Oe Map Lot Unit
Zone Overlay District
Elm St. District.____ ,___. .,_ C8 District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
dame Print) ,� Current M Iiruid�ss_
C <` Telephone
Signature
2.2 Authorized Agent: Steven Silverman
Valley Home Im r®v nt Inc. P.O. Box 60627, Florence, M 01062
Name(Pri Current Mailing Address:
584-7522
Signat re Telephone
SECTION 3 - ESTIMOATED CONSTRUC T i'tu N COSTS
Item Estimated Cast(Dollars)to be Official Use Oniy
completed by ermit applicant
1. Building 3 (a) Building Permit Fee
2. Electrical r, (b)Estimated Total Cost of
u(, 0110 Construction from 6
3. Plumbing ,= Building Permit Fee
4. Mechanical (HVAC)
Fir i'roiection
( I I
6. Total =(I + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Only
Building Permit Number: Date issued:
File#BP-2014-1247
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESSIPHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 8 HIGH MEADOW RD
MAP 30A PARCEL 079 001 ZONE WSP(100)/SR(56)/URA(44)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REMODEL KITCHEN
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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
C/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
emolition Dela
Y
Sign re 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.
8 HIGH MEADOW RD BP-2014-1247
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A-079 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-2014-1247
Project# JS-2014-002100
Est. Cost: $34000.00
Fee: $204.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sg.ft.): 153766.80 Owner: SIROIS DAN&JARA MALKIN
Zoning: WSP(100)/SR,(56)/URA(44) Applicant VALLEY HOME IMPROVEMENT INC
AT: 8 HIGH MEADOW RD
Applicant Address: Phone: Insurance:
P O BOX 60627 (413)584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON.513012014 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL KITCHEN
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:
FeeTvne• Date Paid: Amount:
Building 5/30/2014 0:00:00 $204.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner