17C-041 (18) 63 SHEFFIELD LN BP-2019-0901
GIS#: COMMONWEALTH OF MASSACHUSETTS
M=Block: 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)
Categorv' renovation BUILDING PERMIT
Permit BP-2019-0901
Project# JS-2019-001503
Est Cosh$32500.00
Fee:$211.25 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group' STEVEN SILVERMAN 77279
Lot Size(sp. ft.): 15725.16 Owner. CHODOS LEIGH
Zoning: URB(100)/URA(0)/ Applicant. STEVEN SILVERMAN
AT: 63 SHEFFIELD LN
Applicant Address: Phone: Insurance:
PO BOX 60627 (413) 584-7522 0 WC
FLORENCE ,MA01062 ISSUED ON:2/20/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:RENO BATH & BEDROOM
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:
Drivcway 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 2/20/20190:00:00 $211.25
212 Main Sirect,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0901
APPLICANT/CONTACT PERSON STEVEN SILVERMAN
ADDRESS/PHONE PO BOX 60627 FLORENCE , (413)584-7522 Q
PROPERTY LOCATION 63 SHEFFIELD LN
MAP 17C PARCEL 041 001 ZONE URB(IOOINRA(Ol/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 44
Tvneof Construction, RENO BATH&BEDROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included'
Owned Statement or License 77279
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IRMATION PRESENTED:
Appr
ovedd_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 Sire Plan
ZONING BOARD PERMIT REQUIRED UNDER: §_
Finding Special Permit Variance'
Received&Recorded at Registry of Deeds Proof Enclosed
_Other Permits Required:
Cmb 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
Demolition Delay
Signature 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.
Dpulepartment use use only
City of No am t 1-1
tus a Pemrd: .3
Building De art ant cu b C Dmeway Permit S 'r
a 212 MainLA
EB 1 5 2019 Be '"`r/S cAvat briny
Room War1W Il Avaiiablldy
Northampton, mets fiStructurall Plans
phone 413-587-1240Al ' I^ tans hr
Other Spa ;. ` Y C
APPLICATION TO CONSTRUCT,ALTER REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
'SECTION t-SUE INFORMATION
1.1 Prooerty Address
/+ This section to be completed by office
LO.J CPub�I--YI'C��i —Q-t�� -Map 7l./ Let T Unit
�lClrla'zLG Zone ' Overlay District
Eim Sh Distnct. Camellia
SECTION 2-PROPERTY OW NERSHIPIAUTHORIZEDRGENT
2.1 Owner of Record:
lo3 She44eld Lant F101enLt N40062
NaKe(Pnnp Cummt Mailing ddoda�2� Zs I.--I
elephone N
Signato
2.2 Authorized Agent
Sk
Name(Pilot) Current Mailing Address:
J z 491{�j 413-584- 522
Signature Telephone
SECTION -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bpermit applicant
L Building 26, 000 (a)Building Permit Fee _
2. Electrical l 00 O (b) Estimated Total Cost of
1 Construction from 6
3. Plumbing a Coo Building Permit Fee
/ ✓
4. Mechanical(HVAC) _
5. Fire Protection
6. Total=(1 +2+3+4+5) Z� 5 DO Check Number 7
This Section For Official Use.Only
Building Permit Number: Date
Issued:
Signature:
Building Commissionerllnspeotor of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement. Widows Alteration(s) Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [E] Siding [0] Other[Ej
WorDescription of Proposed ✓M5-10- BAT+4 p F� �p,.,n,A "610M. - Co/S✓t101':� AOL MO
Alteration of existing bedroom X Yes_No Adding new bedroom Yes 6 No U P VffTlJp
Attached Narrative Renovating unfinished basement _Yes Cb No CU22 WT C J�
Plans Attached Roll -Sheet
Be-If New house agd'or addition tri ex]sting housing, comDlete'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 ofstories?
t Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance farm attached?
h. Type of construction
L 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.
I. Septic Tank_ City Sewer_ Private well^ City water Supply_
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,�f'r h Ci-)OLkbS as Owner of the subject
properly
hereby authorize \3 1lTFpI�VL✓MCLr?
o act on my be If�matters relative to work authorized by this building permit application.
��- z- ('�- 2
re of er Date
I �, S7 jo )n Sl I jf!fMan \/)4T as owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
ev Iyer
Print Nm
Signature o
f O Ser/Agent
Date
City of Northampton
Massachusetts-
.
DEPARTMENT OF BUILDING INSPECTIONS
- 212 Main Street � Municip9l Building 53 Cb
Northampton, MA 01060 . `
`i
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation(-'OCABR)regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC).
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work DA'r>-( I�Yn1Yfd G1/ Est Cost 37- .500
Address of Work: toy) r7h2i-i-i P( A_ I-n- y,
Date of Permit Application: 2-' j) - aol7
I hereby certify that:
Registration is not required for the following remon(s):
_Work excluded by law(explain):
Job under$1,000.00
_Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER MG.L Chapter 142A SUCH OWNERS ALSO ASSUME THE RESPONSIBHSTES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
-Z 2-C)17 Mall A, �1wn�Tm�✓arcmm�;Lnc i0�5y3
Date Contrac rName HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Massachusetts
l DEPARTMENT OF BUILDING
nicl INSPECTIONS
\ zlz Main street on, n Taal Building 1
Northampton, MA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, 554, 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.
The debris from construction work being performed at:
(Please print house number and street name)
Is to be disposed of at:
NC'L1C -ylQ - ��e
(PI a print n We and lo8b of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated,the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as".-every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing sagaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer,"
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance ficenc a number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston,MA 02114-2017
Tel. # 617-727-4900 ext 7406 or 1-877-NIASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
®� Commonwealth.[Massachusetts
Division of Professional Licensure
Board of Building Regulations an'Standards -
Canstr�ctilSr{tS`ilpe rvisor
Cs-077279 Z J i E�imffes. 0612112020
STEVEN A SRS/ERMAFI-fr
268 FOMER ROAD yc
SOOTHAMPTON�JIA 01073- a0
�t()/SS3j0�J
Commissioner C "
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improverne(66ntractor Registration
Type: Corporation
Registration: 105543
VALLEY HOME IMPROVEMENT INCf Expiration: 0716/2020
P.O.BOX 60627 Imo' J�' n
FLORENCE,MA 01062 f�) t I
Update Address and Return Card.
%1 } 20M 05117 6L JJ O
r,LvCon cr Affais&Business Regulation Office at MConsumer Affairs8Business CONTRACTOR
HOMEIMPROVEIdENTCONTflACTOR before
Registration tate.It al use only
foundetur
NPE1Comoration before theexpiration date. a dBu return e
Reo'sirat ons Ex�62020 One hConsumere Suite 13 Business Regulation
106543 0]/16/2020 One Ashburton Place Suite 1301
VALLEY HOMEII'M2EMENNC Boston,MA/j/0/2/1078 �JA/ //�
STEVEN A.SILVE� t A,QLGQrFz-- 6Y�Y
340 RMERsl0E0R�� b (� ° Not valid without Signature
NORTHAMPTON,MA�2 Undefsecf¢fary 9