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11C-065 82 FLORENCE ST BP-2020-0130 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: I 1 C-065 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Deck BUILDING PERMIT Permit# BP-2020-0130 Proiect# JS-2020-000208 Est.Cost: $5272.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sg.ft.): 24262.92 Owner. LARAREO WILLIAM zoning:URA(100)/ Applicant: VALLEY HOME IMPROVEMENT INC AT: 82 FLORENCE ST Applicant Address: Phone: Insurance: P O BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON.811/2019 0.00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE DECKING - NO CHANGE TO FOOT PRINT 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 Deaartment 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: FeeTyue: Date Paid: Amount: Building 8/1/2019 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2020-0130 APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522 PROPERTY LOCATION 82 FLORENCE ST MAP 11C PARCEL 065 001 ZONE URA000) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinp,Permit Filled out Fee Paid Typeof Construction: REPLACE DECKING-NO CHANGE TO FOOT PRINT 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 INFO MATION PRESENTED: INFO 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 Demolition Delay A- ,rz,7 9- 1- z0/7 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. r Department use only City of Northapto tus ofPermrt J z Building Depa meE! V � !�ut/Dn eway Permit` 212 Main St eet e Septi Availability Room 10 JUL 3 U�(ate ei1 vallabrlrty 1r' 2� wo ets o Structural P[ar�s Northampton, 01 60 phone 413-587-1240 F x 413-587-1272 Plot/ rte Pl ns DEPT OF r UILDINC;INSP „- Spe / MA olo APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENO ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: - Thrs sechon:to be completed by office g2O{ei��L cJ` Map Unit l��tds Zone OverlayDlstrrct Elm Sf District CB District SECTION 2:-PROPERTY OWNERSHIP/AUTHORIZED AGENT. 2.1 Owner of Record: W ,((( 0-r L.CLray-e o '� 2 i1i orencc S� o k o s3 ame fit) Current Mailing Address: `f(3- S`SS l 98/ Telephone Sign ure 2.2 AA`uthorized Agent: cJ'— . 1 I \,)er C� P O•�btiC l�o(�a1 i'lore�-�c� (�� d►C�(�Z Name(P Current Mailing Address: AM /Z) / q13-CCAy--1 5ZZ g t r Telephone SECTION'3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official:Use.Only completed by permit applicant 1. Building -72 (a)Building Permit Fee Z. 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) ' Check Number _ This.Section:F'0 r. . Use:Only Date Building PermrtNumber: Issued. - Signature: / � _ ', Zoig. Building Commissioner/Inspector of Buildings - Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [O] Other[O] Brief Descri ian of Pr osed c'Y�+tA,Y) Work: 1' p ItG� (�L,�M iC C�2Gft-� � ' - 1y1 f5��1�t�CvVViP � U_�1 nYI� ✓ Alteration of existing bedroom Yes No Adding new bedroom Yes _ No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.If New house anchor addEt�on to ex[strnq f`o�sinq, complete ttie fomwln4: 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 or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck 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. 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 Wiliam La`y/&L'co as Owner of the subject property hereby authorize = t ��n �l JVeK0-7CC,1 to act o y half, in ail matters relative to work authorized by this building permit application. Signature of Owner Date C Mum I, l� �1��'1 �I I�►e-rmQ V Wr 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. Print Name �� RO Si a re of 06er/Agent Date City of Northampton Massachusetts- DEPARTMENT assachusetts-DEPARTMENT OF BUILDING INSPECTIONS � 212 Main Street • Municipal BuildingNorthampton, MA 01060 lY1 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("IIIc"). 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: �Q�/�i�,- DO(4I'Py,6 Q Est. Cost: r ZJZ Address of Work �O t146 CcDate of Permit Application: : Zq I hereby certify that: Registration is not required for the following reason(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 M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES 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: y&zc m4-rk 10 C 9 S Date Contract6r Name 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 1 G DEPARTMENT OF BUILDING INSPECTIONS .y 212 Main Street •Municipal Building „r r Northampton, MA 01060 Debris Disposal. Affidavit 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. The debris from construction work being performed at: (Please print house number and street name) Is to be disposed of at: �(Wif�tA No-Aoij� — (kc \o i�1v��hc � n (Ple ` e print nd e and locatfon of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of P rmit 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 engaged in a joint 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-contractor(s)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 license 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 p6rmittl cense 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 bum 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 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia i Commonwealth of Massachusetts ®� Division or Professional licensure Board of Building Regulations and Standards Construe.j �4e,rvisor fJ CS-077279 E�pires: 06/21/2020 STEVEN A S61ERMA 13,:•, ' ^ 268 FOMER RO D SOUTHAMPTOU VIA-01073.:' Commissioner Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 el� a Home Improvement��\ractor Registration Type: Corporation VALLEY HOME IMPROVEMENT INC -'' �. ,`` r_ I;. Registration: 105543 P.O.BOX 60627 ! Expiration: 07/16/2020 :_ FLORENCE,MA 01062 d V k�� f /Y Update Address and Return Card. 2OM-05/17 ✓/� �inrmcit�a�¢Cl�c�,��¢�.1¢�r.lell.i Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYP&Comoration before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 05ONM 07/16/2020 One Ashburton Place-Suite 1301 kLLEYHOMEQ'IeIIQVEMEN>INC Boston,MA 02108 EVEN A.SI LV 7 RIVERSIDEDR����%• IRTHAMPTON,MA 01062 Undersecretary Not valid without signature The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 r www mass.gov/dia Ni'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant information i Please Print e 7ibly Name (Business/Orgattization/Individual): `'_ VQ eu ocnG SI'1r1YJ�0�12YY1Z�1-1 �nCr Address: 5-10 ��yC,rS�d �r-►arc `� (�• ��c (00027 City/State/Zip:Tlot-encc kR Z>1 o(o2 Phone #: 4 J3-SSN-1 S2Z Are you an employer?Check the appropriate boa: Type of project(required): LIM I am a employer with employees(fi ll and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in b. 0 Remodeling any capacity.rNo workers'comp.insurance required.l 3.[:]l am a homeowner doing all work myself.(No workers'comp.insurance required.)t 9. ❑Demolition 4.❑I am a homcowncr and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.711 am a general contractor and T have hired the sub-contractors listed on the attached sheet. 'niece sub-contractors have employees and have workers'comp.insurance.t 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL C. 14.[:]Other 152,$1(4),and we have no employees.(No workers'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. Tf 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 thepolicy and job site information. p Insurance Company Name: -Ay-be kk L 7,n SUr0.h C.L l-1 rOc�p Policy#or Self-ins.Lic.#: Q b GJ Cj D 3y 2\S Expiration Date: o?) I ) a Job Site Address: �2. Florrx e &— City/State/Zip: Iee-JS MO ()/0&3 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify un r the pains and pe hies of p hat the information provided above is true and correct. Signature: Date: Phone#: LA�-5-SgLA—_1 S2 2- Official Official use only. Do not write in this area, to be eotttpleted by city or town official Ci r City o Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone#: