31B-054 (3) 31 LANGWORTHY RD BP-2019-0444
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map-Block:3 1 B-054 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:window replaced BUILDING PERMIT
Permit# BP-2019-0444
Proiect# JS-2019-000719
Est.Cost: $3500.00
Fee: $50.00 T� PERMISSION IS HEREB Y GRANTED TO:
Const.Class: Contractor: License:
Use Group: STEVEN SILVERMAN 77279
Lot Size(sq.ft.): 6708.24 Owner: ROBERTSON CHARLES L&DENISE ROCHAT
Zoning_URA(95)/URC(5)/ Applicant: STEVEN SILVERMAN
AT. 31 LANGWORTHY RD
Applicant Address: Phone: Insurance:
PO BOX 60627 (413) 584-7522 0 WC
FLORENCE ,MA01062 ISSUED ON.1011212018 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE 2 SKYLIGHTS
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:
FeeTvpe: Date Paid: Amount:
Building 10/12/2018 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northampton Status of Permit:
RECEIVELFII In Department Curb Cut/Driveway Permit
12 ain Street Sewer/Septic Availability
R orn 100 Water/Well Availability
OCT 1 1 201Vo am ton, MA 01060 Two Sets of Structural Plans
phone 413= 87-1 40 Fax 413-587-1272 Plot/Site Plans
ther Specify.
R a LTER,REFAJR,RENOVATE OR DEMOLISH A ONE OR TV40 FAM LY DUt(ELLING
SECTION 1 -SITE INFORMATION
6P / q�I/
1.1 ProperAddress: This section to be completed by office
1ty
3 '50_)d r*t7 y Imo= 10ap I Lot �7 Unit
cl Zone Overlay District
Elm St.District CC District
SECTIO!2-PROPERTY 0114HERS€IIPIAUTHORIZED AGENT
2.1 Owner oe Record:
5°910 &6'Z4 Cc rlrs 1266ed37 l-an$r,�v�fh�r
Name(Print) Current Marlin Address:
413- S 8 11-- 900 3
Telephone
ture
2.2 Authorized Agent:
i lve� P•o'60K'CQo(Da_^'lorerxc �4P opo(22
Name(Print) Current Mailing Address:
_Lf t-6— SS f—`750-D-
Signature I! Telephone
SECTlONI 3-EST.H AJED CCOMIS T R'UC T tG-V_COSTS I
Item I Estimated Cost(Dollars)to be I Official Use Only
completed by permit applicant
1. Building �\ (a)Building Permit Fee
2. Electrical v (b)Estimated Total Cost of
Construction from (6
3. Plumbing Building Permit Fee
4. fviechanical (HvAC) �
S.Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Ofriclal Use Only
Building Permit Number: DRtP_.
I issued:
-Signature:' I
i
Building Commissionedinspector of Buildings Date
Section 4. ZONING All Information!Just Be Completed.Permit Can Be Denied Due To Incomplete 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 ever been issued r/on the site?
NO DONT KNOW 0 YES
IF YES, date issued:
IF YES: Was the pewit recorded at the Registry of eels?
K,C, M-OIII l-1X.11 tom* 'r ES
IF YES: enter Boot; Pate and/or Document#
B. Does the site contain a brook, body of ter or-wetlands? NO 0 DON'T KNOW 0 YES 0
OF YES, has a permit been or nee- o be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Gate Issued:
C. Do any signs exist on the p perty? YES 0 NO
IF YES, describe size ype and location:
D. Are there any prop sed changes to or additions of signs intended for the property? YES ) NO
iF YES, descr e Si%e, type and Location:
11-1- a'-LI IIV u.vw��`i.:c.:.:u�y, y:��u. - icr�.G_�: , vi uu.i i.t;;-✓r-i
that will sturb over 1 acre? YES 0 NO 0
IF S,then a Northampton Storm Water Management Permit from the DPW is required.
SECT 10KI 5-DESCRIP'TiON OF PROPOSED t(IfORK(check ail apglicahle>
New House' ❑ Addition ❑ Replacementw, laws Alterations) ❑ Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[C11
Brief Description of Proposed
Work: 4 CQ.
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ga.If New house and or addition to existing housing. complete the foilowOna:
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. Dime ons
e. Number of stories?
f. Method of heating? Firepla s or Woodstoves Number of each
g. Energy Conservation Compliance. sscheck Energy Compliance form attached?
h. Type of construction /
I. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
1. F,d . ry Ss r ter. te sail City ureter--upply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR-BUILDING PERMIT
1, :\�f_n i`c� q_(x fA;1- 4 � as Owner of the subject
property c
hereby authorize VTC`�, 5'7 c Nky('yff-p^
to act on my behalf, in all matters ive to work authorized by this building permit application.
gnature of Owner Date
aent herebv declare that the steterrcents and infornnatian on tree forecoina &oolication arc true and accurate.to the bast of my lmcwledac
Signed under the pains and penalties of perjury.
Prnt Name
I G�
`lgnarure of CIwneri.Agent V Cate
SECTION g-C€ HISTRUCTICid SERVICES
o.'I Licensed Construction Supervisor: [lot Applicable ❑
Name of License Holder:
l License Number
[
AddressExpiration Date
�\\J ��� �� 1��DD
Sign r V Telephone
9. Reeailsstered Borrie Irnaroverrient Contractor: Not Applicable ❑
Company Marne Registration/Number
Lgo
Address Expiration Date
Telephone!'EL, 1 ��
SECTION 10-WORKERS' COFinP'ENSATICI4 RNSURAHCE AFFIDAVIT(M.G.L.e.152, 25C(G))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavitwill result
in the denial of the issuance of the building permit. -
Signed Affidavit Attached Yes....... No...... ❑
11. a Home Owner ExeMdon
Thi-Current=:itenulp' ?i r'r"';Q_:c i'i1crS"`fid c=;tciidcd to inclu:-c L�'GEeE eEC C"r_4Ef11?'wetZ'Ko�-E of zle t:j bvvo(?)f�-dies
and to aloes such Homeowner to en-gage a2 individual for Hire who does not possess a Lcense, nEre_t, rue` �Es
as supervisor.Cly 780, Smith Ed:tion Seciien 109.3.5.1. - — -
Definition of Homeowner:Person(s)who own aparcel 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 eenstrnucts mare than one home in a two-year meriod snail not be ce-n-06a Faomeowr*er.
such"horL,00—vvncr"sli�;11 sial-i nit to the Buil dir,-0'Wcia1, on a forth acceptable to the B-ail d zg Official, t1'wat he/she s h OF bee
restlGnAble fur all SUch wGric Performed ander the baftg permit
As acting Construction Supervisor'your presence on the job site will be required from time to time,cluing and upon
completion of the work for which tltis pen it 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 persou(s)
you hire to perform work for you under this pennit
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Pdorthampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
1:
l..CUL[Gll Ftl LLLr 4:1SLLziC_t 4
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal A.fnda�vit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: nau�0 ,w
The debris will be transported by: mf.
The debris will be received by: tl
Building permit number:
Marne of Permit Applicant
Date Signature of Permit Applicant
The Cd]aninow—peal¢c�t! ofMassachv sits
�., D9 partment oJ Iri!d�cs i�l��cade is
OJ Ice of I ai Jes gation'
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Nae (Business/Organization/Individual): ,� lf,Al ,�Y l'�
Address: a__\0 oy`CV`�:I'dc `j(�Q,-e.: 1
City/State/Zip: ,0t-P_� Ce, r `(J� `�he#:
Are you an employer? Check the appropriate bog:
Type of project(required):
1.[ ] I am a employer with �� - 4. ❑ I am a general contractor and I
employees(full and/orpart-time).* have hired the sub-contractors 6. F1 New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. F] Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in.any capacity. employees and have workers'
t 9. ❑Building addition
[No workers' comp.insurance comp.insurance.-
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
officers have exercised their 11. Plumbing 3.E3 I am a homeowner doing all work f ❑ g repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill 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 ant an employer that is providing workers'compensation insurance for nzy employees Below is the policy and job site
information.
Insurance Company Name: be,� G`_ o
a 7; _4-1 r:, u_ E te- � �.
aucy R V. _QC!f 1 S.LiC.7T. �v_t/v�41.C�.l.,��.__t -------s.
Ex at- l�ao.. l e
Job Site Address: �� L,lt llLi000/{ ca lC� City/State/Zip;��/ ►� 016690
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:J 52 can-ead-to the imposition of crirninal penalties of a
fine up to $1,500.00 and/or one-year imprisonment,as well as civil_penalties in the farm of a STOP WORK ORD] R 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 verification.
I do hereby certify .i the paints a old penalti. perjury that the information provided above is true and correct
�i
Signature: Date: 1
Phone#: -M 3-- ?�jy--� �
Official use only. Do not write in this area, to be completed by city or town off cial
City or Town-: ! Permit/T,icense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.0 er
Contact Person: Phalle#:
Commonwealth of Massachusetts
®� Division of Professional Licensure
Board of Building Regulations and Standards
Const\vcti6-�'§6pervisor
�I
CS-077279 �� I Wires: 06/21/2020
p/,
STEVEN A SILVERMAN y
268 FOMER 140�4D r`
SOUTHAMPTON'PV.A 01073 - aC
Commissioner CIL A&I
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improve me nt-Contractor Registration
�--= Type: Corporation
Registration: 105543
VALLEY HOME IMPROVEMENT INCA Expiration: 07/16/2020
P.O.BOX 60627
FLORENCE,MA 01062
Update Address and Return Card.
SCA 1 0 20M--05/11177
✓/LG c�a/77�rrc/lcUe¢CC/L Office of of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE-.Corporation before the expiration date. If found return to:
Registr`ation\ Expiration Office of Consumer Affairs and Business Regulation
05543^= 07/16/2020 One Ashburton Place-Suite 1301
VEM
VALLEY HOMEi`MP-ROVEMENTINC Boston,MA 02108
r)
STEVEN A.SILVERMAN== A-, �,i2 CGQ� w
�_
340 RIVERSIDEDR:V. Not valid without Signature
NORTHAMPTON,MA'01o62 Undersecretary g