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17C-041 (11)
63 SHEFFIELD LN BP-2017-1259 GIS#: COMMONWEALTH OF MASSACHUSETTS MalBlock: 17C-041 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:REPLACEMENT WINDOWS/DOORS BUILDING PERMIT Permit# BP-2017-1259 Project# JS-2017-002104 Est.Cost: $14000.00 Fee:$91.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sq.ft.): 15725.16 Owner: CHODOS LEIGH Zoning: URB(100)/URA(0)/ Applicant: VALLEY HOME IMPROVEMENT INC AT: 63 SHEFFIELD LN Applicant Address: Phone: Insurance: P O BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:5/3/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE 3 WINDOWS/DOORS ON BACK OF HOUSE, ENLARGE ONE OPENING 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 5/3/2017 0:00:00 $91.00 212 Main Sheet, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner s rt ,\ Department use only City of Northampton Status of Permit: uliding Department curb Cut/Drro way Permit \\\ '\ 12 Main Street Sewer/Septic Availability t.9' V Room 100 Water/Welt Availability _ Ca W" t5orthampton, MA 01060 Two Sets of structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans \, cc'' Other Specify AP LICATION TO CONSTRUCT,ALTER.REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FPJtiBLY SWELLING SECTION 1 •SITE INFORMATION 6P-17-/,,,a1 .. _. _. This section to be completed byoffic . _. 4A Pr�oneth'Address (' �+ �/ 603 S`1 e-4re: L� 1-ant pap / 7G Lot a 7Lunit 1 w(eo(e-..- Zane Overlay District_ t _ Elm at.bisfist_.. w.Comic:. SECTION 2•PROPERTY OtrdkERSHIP/AUTY.ORETED AGENT 2.4 Cramer of Record: Lei(, b Ch04105 4°3�Sheifirkl Lara FId/roePMfi-orotoz Nam�{✓'r4it Current Mailing Address: c-- P ....^ Telephone .` Signets_ 2.2 Authorised Patent: F-ike AU vma , Cho-60< (006 e7 _ Florcnce (1'l " oior,2 Name(Printf Currant Mailing Address: 1/4-tt3 Sb It-1Saa «,ECTP c tan®TED .. s F'L^CT IR COST' `!em Estimated Cost(Dams)to be Ofiiciai Use Only completed by permit applicant 1. Building I ELK_ / (a)Building Permit Fee i 2. Electrical `� (hi Estimated To`af Cost et i i Gonsimctien from IO) i t ate � `-``:_Frfi@�P^-plYtilf CI i f. t c:ou�,g - _ L4. Mechanical MAC) I _S.Fire Protel=(I +2 {70 S. Tpiei=(i +2+3,.y+E) ��— Check Numhera�/P 7(� � s`f��}/� `,girls Seim For O hoist Use Only jle s dirt_.:a^mesone•Menettsni5eudfngs Este Section 4. ZONiNG All Information Must Be Completed. Permit Cr'ttBe Denied Due To Incomplete Informction Existing Proposed Required by Zoning ibis column tabs fitkd in by Building Depamncm It Lot Size _ .. .Frontage. _ .. . .. Setthaeks Front Side Rear Building Height ... ... . Bldg.Square postage _. .i % I Open Space Footage % _ - (Lotareaminusbldg&paved iwdring) pofParking Spaces I ' Fill: (volume StLocafion) .. __....__ ... ._.. ..:_. A. Has a Special Permit/Variance/Finding�yever been issued for/on the site? NO 0 DON'T KNOW KNOW YES 0 SF YES, date issued: IF YES Was the permit recorded et./.ie Registry of Deeds? _ '-r 4i rl' VES: enter gook / see. :...',l:ir Document ', B. Does the site contain a broold body of water or,wettands? NO 0 DON'T KNOW a YES Q t'F YES, ! s a pal c e n ern: d to -e obrainer from the Conservation Comm ssion? ke e fn be nr,taina,d. -d-.. stn_,{ ( P ficcpE,C+: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and tocation: S. Are ther nu^:.^n v, n_ c t t _to.._ f the ,r: stt, v . .O' LS, &esscrihe size, type'and location: Met t ^paver acre? YES Li -AO t i i 1',En _Nort t. - n Storm Water telenepment Permit tom the no r\r's reouSad. SECTION 5-DESCRPFT@ON OF PROPOSES'PWCRIC(check all sooiicsbiej New House C] Addition ❑ Replacement- Irdows Atteretion(s) ' Roofing f Or Doors ) Accessory Bldg. ❑ Demolition E New Signs (DI Decks (❑ Siding 101 Other[fl Firief Description of Proposed Work: I .r , 3 - ;A/PFsti/AC z aru 444(1( OF 1lotrji. Oft L,c/16F Alteration of existing bedroom Yes No Adding new bedroom Yes No dill oft-iv SAA Attached NarrativeRenovating unfinished basement _Yes No _- Plans Attached Roil _-Sheet ... Ss.Cf=data house and Cr adOhdon to exustines hofcssnrd, Cont Vote the foV6rxvdinot 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? f. Method of heating? _ Fireplaces orrWoedstoves Numbered eadr� g. Energy Conservation Compliance. Masstieck Energy Como/tans form attached? h. Type or construction L Is construction within 100 ft.of wetlands? Yes No. to consnvc5an within 103N floodplain_ ; Yes�No - i. Depth of basement or cellar floor below nn oshed grade AA. Will building conform'to the Building and Zoning ragulaeons? Yes No. I.I fauPtio5anx: Cita Sower . .'.•-to wall_ salty ifiche3iwpfy SECTION 7a-OtftlfER AUTHORED//EON•TO eE CDMPLEe_n :NEER 01kNER5 AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 ti C �} �"L ACi .el by - VtcG\SLCfn -r-k)CVn'at'n to- on my beh f,in ell me ,-dative to work authorized by this building permit a plication Lz7 / 7 Signatur Icer Date i i ACt;CC\ tursklae - rTh ,as Owner/Authorized l Sio d jnd, ice'the stens penalties or penury. aC.t. Y1 cl ef 0,0s-,, �// 1 'A ai /� SECTION 8-CONSTRUCTION SERVICES SA licensed Gonstvection Suoervison Not Applicable ❑ Name pflipense HOW?r: 5kerCarn S1Ah1:°irrvlctin rs(-) ? 0—,1 I License Number Miner e • l:rad _ 7�V cLktlt rE7 1 i<,1C '1E1 _ aka \ I� Address f / r Expiration Date Synaw Teleph ns S.Reoisfered Home lmbrpvement Gontractar: Not Applicable 0 t�A v. f /0 55(13 C4mminnvv KK�amp, Replenished Number ___fes (?o: A>' a' i 7f11 //8 Address _ Expiration Date 4`Jtrednet f1(tQ\b&8r Telephone. 1-1 -:D- SECFION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(111.0?c,152,g 25C(5)) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit ui!i result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes q:. No ❑ 11, o Honie O it r Exethpteel d TM currant -.... FCC r_ ._r .a_, o ec , tcnneUr_ faw(i) ar a(2)families and to aLW such hotherrther to engage ad individual ft_.tre tin Me_..not possess a Ectium,eirmited duet the owner etas as surien er CMR'vE. Sleek Rellaten Sereglith 11;5: .31k. ©etinfitdsn of Homeowner:Person(s)who own a parcel of lend on which he/she resides cr intends es reside,on which there is,or is intended to be,a one or two family dwelling,attacked or detached strictures accessory to such use and/or farm structuressteem who construct rade gees o e iwne n e c-venrmesad s4aR us,be oe,n.dered a Lrthewwmr, Such"homeowner"er shall subb n i to tree&,i,ding Official,on a forth acceptable to the Building Official. that sue/ he shell Ire a^myvd Das PE etch"r vet .e Ate-- e+jY aerinEr. As acting Construct-Eon Sur,end cr your pesence othe job ste will be required from rime to tint,daring andupon completion ofthe work for runieh this permit is issued Also be advised that withreferetce to Chapter 152(Workers Compensation) and Chapter 153(Liability ofEmployers to Employees for injuries not resulting in Death)ofthe Massachusetts General Laws Annotated,you r"-2Fv be'ruble for peson{s) you hire to perform work for you under this permit The undersigned"hcmesocmet'certifies andassames responsibility far compliance with the Stzte.Buii&g Code City of Northampton Ci c n.rcn ,State eard Local Ecting Laws and State of Massachusetts General Laws Annotated. City of Northampton 212 Malin Street, Northampton,MSA 01060 Solid Waste Disposal Aindavit In accordance of the provisions of MGL c 40, 354, I acknowledge That as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shallbe disposed of in a properly licensed solid waste disposal facility, as definedd by MGL c 111, S 150A. Address of the work: (7317 The debris will be transported by � The debris will be received by: Afritd. ew e(.2 Building permit�pumber: (J Name of Permit Applicant \I. At . ', (Mil124kitiYI ajj (74/7 / , Date Signature of Perim;it Appli_r_ant - _ „- ns <i14 t?ostwn,MA 02111 Workers' Cenapensztlen limurametAffidavit: Bu lien/C trwzion/EllectrIciravrhir:be:s Avpt;cnilt Information Please Frdld L egsb'v � rNa- ( - sue,,e - arsz �� -1-10 16Kfitie_ , l � Address: S-i6 't -LiCrsfkCnuj city/state/zip: tD! nCt \1` D`-Phone#: L-k, `522 Are you art employer? Check the appropriate box: Type of pro,peeP,(required): 1. ;am a employer with 1B S. 0 I am a Hensel centi�etor and i 2 6 El New c¢i19dl.ction employees(fo pod/pi-part-nine) t tors u 2.0 S act sole proprietor or Fanners t .�on u.., a sheet .��_;.,� ship and have no employees These sub-contractors have g, 0 Demolition working for me in any capacity. employees and have workers' >. 0 Building addition [No workers' comp).insurance comp. insurance.: required.] 5. 0 We are a corporation and its 10.O Electrical repairs or additions 3.7 I am a homeowner doing zH work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per RR OL 12.0 Roof repairs insurance required.] t c. 152, §l(4),and we have no lo _ rkers' 13.0 Other__ emPY"_s CNo wo comp.insurance required.) *Any applicant that checks box al must also nil nut the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. i Ceutractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whether or opt those entities have employees. If the sub-contactors have employees,they must provide their workers'comp.policy member. .e cm2 c,3 'SiVOlger='2t ]'Jn F _ ,rp!'.T. �- - ...- G_ fro ,. .3J n?.. . rho.. gtm 5 vo$^ > Y^filv l Ln_. tCu r.. .tL'_ ty l •.act; ni CJ t4i3L' Policy#ora h ins.L- i , _. ""!' ` Date: l 8 �i3 i 5' ..�v,.. i Expiration a / k lur r x r_ YY� p oó 2 ;rev Site .a"..^ors: (Ck�7 7he� �r'�1L CI v/. R:. ..tzip: ^loci t3Yoozy .:-a4_ ..m_ isaf n 5ti+1'_a i_ . -u. :,"-�tl __(showing t.3 pulley 3tln v`_ r35a ¢c _a_donate). 'k_., r roc rev:Wired under S.._.-., 25A MCii ,. 15can Ind to e imposition t of.s .4.. . _1 .a f ane up _ a s:00.00=,d/or one-year m r.:_ . _ m .,c. P -._civil p, es in the o Si STOP WORK nn c ., -:„, of up to 5250.00 a day agairst the violator. Be advised that a copy of this statement maybe filywr arde w the Office of —' Investigadons oft the DIA for insurance a age .._ ._ y _,, eLgrs}. . ,. , ,. '%� _ , .-.., eaJr,..«.:aar/rrr✓�orivia fitove:s-erect amearre�cR 1,; ft/ZSJ/7 __ Exxirt. Eu3ourg Reg 3nd Standards - ice CS-077279 "=re Super-113:x � Y V STEVEN A SILV RBMAN • 253 FOMER ROAD SOUTHAMPTON MA UTh7. - • • .�:n ,/_ Expir ion: Commissioner 06121/3616 T At/ /.:;^ Office of Consumer Affairs And attriness Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts}'�y,� 02116 Home improvement Ctntr ctor Registration ye 105543 Type: Pn+rste Ccmnr ation 7/17120'.0 :w , VALLEY HOPI=I fAIPROV_Y_tvTN — STE2 iL ERNnfr+ _ EV - FLORElo : o4 Csr9 . .. _..r. ftr .:illi) use Ty Yc: ..RIC a ... I c:.41 p .NII 41712213 c =on I v Eostas.At&02i&a ..._S` _ i.._.. — - / ; Aalu, 1 fi=J,1 —