23D-130 20 WINSLOW AVE BP-2017-0987
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D- 130 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-0987
Project# JS-2017-001698
Est. Cost: $4000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 108772
Lot Size(sq. ft.): 11586.96 Owner: POWERS GLADYS&M GULLEY D POWERS ET AL
zoning: URB(1001/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 20 WINSLOW AVE
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:3/1/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:AIR SEAL ATTIC/BASEMENT, INSTALL PROPER
VENTS, INSTALL RIDGE VENT, INSULATE SILL, INSULATE ATTIC
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 ft 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 3/1/2017 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File ft BP-2017-0987
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 20 W INSLO W AVE
MAP 23D PARCEL 130 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
�1/'
Fee Paid +t\ �j
Building Permit Filled out
Fee Paid
IypcfConstruction: AIR SEAL ATTIC/BASEMENT INSTALL PROP_ VENTS STALL R DGE VENT
INSULATE SILL, INSULATE ATTIC
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 108772
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
Approved_ Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:*
Intermediate Project: Site Plan ANDIOR Special Permit With Site Plan
Major Project: She Plan AND/OR Special Permit With She 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
3_ [_ 17
„ow-
alio"
Signature of Buildi (O mial 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.
'Dearfinent time only
City of Northampton Stetaird Permit
•
Building Department Cur&CLIVDriveway pet:macroP -
212 Main Street Sewer SepncAVadal2llity
boa
Room 140 Se er,M7eIl AFatlati �}+-_ i r
w^c"s Northampton, MA 01060 Two Sets of Structural Pb_
r� ,no}rso ne 413-587-1240 Fax 413-587-1272 PIoU$,fe,Plane a t Ei ,2 2 t "'
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Properly
Address: ((}} TMs section to be completed by office
a() WIFIS)b1AJ /tom. Map Lot ........._Unit`.
r-/orerxe, NA o o a Zone Overlay District_
Elm St.District GB District
SECTION 2'-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
G� S RhdtdersilD 0 LUrrkssfou) Ave. Florence ,MA owt.
Name(Print$. Toleplmne� i Current Mailing Addle r ' 7/ 0
177 gGJ/ one 3 G �
Signature
2.2 Authorized Agent
.„john Det-w(5k-Y `a/ m- 1 mt 4etner5' Po BO( 06)7 St River--50e LY Flo • ice Ai -
Nam. (Print) Current Mailing Address:
Al 2.24 ,L4:- Lti3 -564 -75aa- i etDw�
Sign IL Tetephone
$FCTION 3-8S11MATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
$ 71X " . �v
2. Electrical (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) F' -dio( '' , v0 check Number 3(„Jr{/%
This Section For Official Usa Only
Building Permit Numberat Date
Signature:
Building Commissioner/inspector el Buildings Date
-oV-:, Cgit -_ of Nurtfiumptutt
„-,0,
:Bassa rErusetta {{(gq�s1.
tpr ., � 1 fUV
l � DEPARTMENT OF BUILDING INSPECTIONS o
.`\ 9 -" 212 Main Street • Municipal Building r`Fi"rh`:'
Northampton, MA 01060
LOUIS HASBROUCK BUILDING PERMIT FEES Phone: (413)587-1240
BUILDING COMMISSIONER Effective July 21, 2008 Fax (413)5a1-1212
DEMOLITION $ 20.00 ACCESSORY STRUCTURE
$ 35.00 PRINCIPAL BUILDING—Residential
$200.00 PRINCIPAL BUILDING-Commercial
'NEW CONSTRUCTION $ .50 per square foot for 1st floor
.30 " " " 2"d floor
.20 " " " " Y floors,attic,basement,garage
STRUCTURAL ALTERATIONS IN ALL USE GROUPS
$6.00 per thousand dollars of estimated cost or fraction thereof,
with a minimum fee of$55.00
$25.00 WOODBURNING STOVE
'NEW ACCESSORY STRUCTURES one hundred twenty(120)square feet and over
$ .20 per square foot with a minimum fee of$25.00
'NEW ACCESSORY STRUCTURES under one hundred twenty(120)square feet
$25.00 per inspection
*SWIMMING POOLS $30.00 for above ground '
$60.00 for in-ground
'SIGNS 8 AWNINGS $30.00
`DECKS $50.00
REPLACEMENT WINDOWS $35.00
SIDING 8 ROOFING
Residential $35.00 per structure
Commercial $55.00 min.per structure OR$$fK of estimated cost
TENTS $25.00
'ZONING REQUEST FORMS $15.00 (Includes home occupation registration)
REISSUE OF LOST PERMIT $25.00
CERTIFICATE OF ANNUAL INSP. $100.00 (minimum)
Temporary Certificate of Occupancy $25.00
PERMITS REQUIRING ONLY 1(1)INSPECTION WILL BE A MINIMUM OF$25.00;ALL OTHERS WILL
HAVE A$50.00 MINIMUM. PERMIT FEES SHALL BE PAID TO THE ORDER OF THE City of Northampton
AND SUBMITTED,WITH THE COMPLETED PERMIT APPLICATION,TO THE OFFICE OF THE BUILDING
INSPECTOR. WORK STARTED WITHOUT PERMIT IS SUBJECT TO DOUBLE NORMAL FEE.
!! NO CASH-CHECKS OR MONEY ORDERS ONLY!!
•Filing deadline is 12:00 pm(noon)on Wednesday.
Section 4. ZONING Au imomatlon Kent Be Canrpteted Permit Can Be Deniee Due to Pronpiete mar-mason
Psixinc I'mporrJ . loioring
Dar. m 10 Is
Fu
Baadee Iskrvanrnnr
I Li! Size
l4ontace
ScrhocA. I
Side
K. L: R.._...._...
F?cir
liulldlnu IIeieht
Bldg.Square loutage
Oise Spare-I.0 eerc '
n m mcg 44o iddan1-1..4t
_
rut,n
of l'erk Ina Spa.a'
fill.
, , o,a.u&G+. __
A. Has a Special Permit/Variance/Finding -ver been issued for/on the site?
NO O DONT KNOW e YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES 0
IF YES enter Book Page anc/or Document u
B. Does me site contain a brook, buoy of water of wetlands? NO 15Z. DCN;KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O Date Issued:
C. an any sans exist on the property? YES Q NO V
iF YES. describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES fl NO
!F YES. describe size, type and location.
E 'Wil:the con5Ir.44.441 amity ty disturb Yrnearsa gradinz ee.«.anon or Oil yi over 1 acre or a rt part of a common plan
tea'mile:sternover acre% YES NO 41f
IL S hen a Nonoa vto _.arm Vvarer tfa n.agemer l Dent Ron.rhe DPVD Is rec.rx...
•
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House r ( Addition n Replacement Windows I Aiteration(s) n Roofing U
Or Doors
Accessory Bldg ❑ Demolition n New Signs ¶01 Decks (C Siam.. pi^ Cr; (
I __ . II Oa.. ._
Brie+Destnpepn of Proposed AU--St`-` aFtc(lxA, me(14, tnSitUL\ roper-Nue) Ir15�CXA rIc e v' f
work tn5utate SIL) lnsolettes 43rCeilQlO R44A iAercfherr ze_
Attaof existing bedroom__Yes No Adding newn bedroom Yes No
Attachedlans Narrattve
Renovating unfinished basement Yes Na
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following
a Use of building One Family_ Two Family Other
b. Number of rooms in each family unit Number of Bathrooms_____—
c Is there a garage attached?
d Proposed Square footage of new construction _ Dimensions
e Number of stories?
I Method of heating? Frreolaces or Woodstoves Number of each ._
g Energy Conservation Compliance Massetetk Energy Compliance form attached?
h. Type of construction_
L Is construction within 100 ft of wetlands? Yes No. Is construction within 1001r. floodplain Yes No
I Depth of basement or cellar floor below finished grade
k. Wilt building conform to the Building and Zoning regulations? Yes No
Septic Tank Goy Sewer Private well City water Supply _
SECTION 73-OWNER AUTHORIZATION-TO BE COMPLE ItO WHEN
OWNERS AGENT, �_`:OR CONTRACTOR�IAPPLIES FOR SOUSING PERMIT
CAC C'-CAA/, -Pcx*:f5 _.as Owner of me subject
property J
hereby gm >e
. _ )Cl.LL _ __n ti's i!1 hr beim-cat'
eim- -I
n
to act oe my ben'eii. in all ers relative to weer. $gazed by this bth Eng permit aura: aeon.
a �rt5h+ Ke9elease_ 0217Ji7
signature of Reiner Date J
I. VQ1124 ki as OwnerrAuthorrzed
Agent her declare that the ;elements and (Jonathon on the foregong apptirzhon are true sad amurate to the best ar my knowledge
and belief
Sq”ec u de:the pa anc per aloes Of pe_ ✓y
J_Chn_Th era,kL
SIVA"
� ��� a/a f17
SECT:ON 3-CONS.R UCT:ON SERVICE_
8.1 Licensed Construction Supervisor: Not Applicable ❑/�`Qn ^�
Name of License Holder _jZ.}ZLai>ine-. L_.__ __cS /`�V / '7 ` ,
!mane Number
(70 Dun phi �-i�� rlo. 1ente MeC oi06 z 912111 g
Addre•, J Expiration Date
Al •
•
. . amu' air, L1/3-5;? 754;
Sig.at e Teiephcne
9.Registered Home Improvement Contractor. Not Applicable 0
• s _ - nC_ ios543
Com•an- • e Registration Number
P,D (00(0)- He r- , • G 0. 0)()&2_ 7L1711b-
Addro.s � ��jj i < Expiration to
A
J. Telephonet(-.Jvt -7522
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.E.C.13$¢25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
I in the denial of the issuance of the building permit
Signed Affidavit Attached Yes 12. No 0
11. - Home Owner Exemption
The current exemption for"homeowner{'was extended to include Owner-occupied Owelling5 of one I I) or Rsot21 families
and to allow such homeowner to.image an individual for hire who does out possess a license.provided that the owner arts
as supervisor.C MR 7SO. Sitth Editing Section 108.35.E
Definition of Homenn nerI ,..-sc.t ist'Alio own a parcel ol Inj on s:Lica he he rcsldc, 4tr intends u. reside,ot which there
it.or is intended to be. a one or two l..r vi;i1“4.JII:tCheli dzi..wh v 5.truchire' ac c c Kid,^v'and face:
-:1 person who constructs more than one home in a two-year period shall not he considered a homeowner.
r.,
+ s ar R , t. .r:. ! .^1.2. o Inc LiJoilirzt>fficitti that heiMe shall he
responsible for all such work performed under the buildint,permit.
As acting Construction Supervisor your presence on the job site will he required tnmt time to time,auring and alum
inch of he o,,,C c hilt this permit s ex¢ti.
Alsop 'me('...:a sit icrc..ec toe tit urkitts C(-npu;eattsron and(lar.... 5 o 1 CL 1:111,H`:to
_ . _+'Alone In U t -.the.t.I.Iss.mflusetts tetencrai I n„ 4:,o:c 1.you muv he liable for :mc.
ccrtorm wont for you under this permit.
und tined homer n cera es and 4st,untes resp t t-Cr)mp„m tie vcS the State Building C>dc,City of
.':riot t inaao s _ad I ecel 7. t ntt 1_an e of Massachusetts c f'eneral Laws Annotated.
•
H omet n r Signature
ac e,u. .^.L.:7Vggc.cr Cif/,zi_M✓..t:,d'Se'ats
Department of Industrial Accidents
- JJ:ce ft.ae; guti0::s
600 Washington Street
Boston, MA 02111
:tinier.mass.gov/d€a
,. ..i E er .r ,.,,v,..-_u La..„na.mAfccdavkt sriwEtVca/Cmtrzete:5! e :ileum tiraben
Annlicant Information Please Print Letaibly
Name (Business/Organization/Individual): 'ILIUi u. \-0[1a-t. .3.Arn O'Ic,<,,,'k'v)tn-4- Lofl1_
Address: :5'-kb �IVCVo � yJ IVB(
City/State/Zip: A' \Drente al hone#: LU s s'%I- --1S2Z
Are you an employer? Check the appropriate box: Type of project(required):
1.13 I am a employer with 1B 4. ❑ I am a general contractor and I
employees(full and/or part-time).*
have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers'
9 ❑ Building addition
[No workers' comp. insurance - comp. insurance,:
required.] 5. Fl We are a corporation and its 1 se.❑ E-zca.ca.repairs or euest ens
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.]t c. 152, §I(4), and we have no
employees. [No workers' 13A0ther�r IS O.,On
comp.insurance required.]
"Any applicant that checks box 41 must also tilt out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. i�
Insurance Company Name: fryib{'A\G CJn5(.}17iLl\Ce l ) rO'jp
Policy#or Self-ins.Lie.#: O'Z 1 Expiration Date: 13 i k 1 IS
Job Site Address: dO [t1r1Sla t) Ave. City/State/Zip: r rictrente MA- 0/0(0.2Z
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage vierification.
I do hereby certify ' the pains and penaltiQ of perjury that the information provided above is true and correct
pt )n A /p��rp�PAf o� 41
Signature: jt,j:!e p U /t,9 r✓e/ Date:
Phone#: .k1S1 S `.yq --FOB--Th
Official use only. Do not write in this area, to be completed by city or town official
C y or awa, Per_Et/L hoar#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3. City/Town Check 4. Electrical Inspector 5.Plumbing Inspector
6. Other
Contam Person Phone#:
Massachusetts Department or Public Safety
Board of Building Regulations and Standards
License: CS-108772 -
Construction Supervisor slii
JOHN DEMERSKI _
72 DUNPHY DRIVE
FLORENCE MA 01082 i
r s CA__-. Expiration:
Commiomnissioner 07/21/2019 ;
C Cie painrn(auoeatv�i od f c�u�et&
c
Office of Consumer Affairs and Business Regulation
a_i10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 105543
Type: Private Corporation
Expiration: 7/17/2078 yrs 419291
•
VALLEY NOME IMPROVEMENT INC.
STEVEN SILVERMAN
P.O. Box 60627
FLORENCE, MA 01062 -
- Update Address and return card.Mark reason for change.
SCA 1 a zoxsos: In Address fl Renewal fl Employment n Lost Card
7h/ snob 17 C / /.,;4/
Office of Consumer Affairs&Business Regulation License or registration valid for individual use only
tbefoY HOME IMPROVEMENT CONTRACTOR
re the expiration date. If found return to:
_ Registration:. 105543 Type: Office of Consumer Affairs and Business Regulation
k,„; Expiration:. 7/1 712 01 8 Private Corporation 10 Park Plaza-Suite 5170
Boston,MA 02116
VALLEY HOME IMPROVEMENT INC. /
•STEVEN SILVERMAN
/f,//
340 Pm _ +ti liP" / /IliJ/Iia
Northampton,MA 01060 Undersecretary Piot valid without signature