35-243 (10) 35 LADYSLIPPER LN BP-2020-0576
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35-243 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BASEMENT RENOVATION BUILDING PERMIT
Permit# BP-2020-0576
Project# JS-2020-000988
Est.Cost: $35800.00
Fee: $232.70 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 42558.12 Owner: BLOOM PETER A&CATHERINE M
ZoningL Applicant: VALLEY HOME IMPROVEMENT INC
AT. 35 LADYSLIPPER LN
Applicant Address: Phone: Insurance:
P O BOX 60627 (413)584-7522 _ Workers Compensation
FLORENCEMA01062 ISSUED ON:11/5/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-BASEMENT IMPROVEMENTS
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:
FeeTyue: Date Paid: Amount:
Building 11/5/2019 0:00:00 $232.70
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northampton Status of Perrrrtt
r" Building Department Curb cutiDndeway Permit t
/5� I 212 Main Street Sewer/SephcAvailabt{tty
l ' = Room 100 Water. e AVailabilrty
J
Northampton, MA 01060 Two Sets of Structura4 Plans
phone 413-587-1240 Fax 413-587-1272 PIot/Site Plan`s
OtherSpeGfy
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1:-SITE INFORMATION
1.1 Property Address:
(� CC�
This section to be completed by office
� J LJ�[P K. Map = Lot _Unit
RO/_0-2CC Zone = Ove layDrstiict
Elm Sf<District' CB'District =
SECTION 2:-PROPERTY OWNERSHIP/AUTHORIZED AGENT.
2.1 Owner of Record:
i
Current Mailin ddresf:7
Telephone
ignatur
2.2 Authorized Agent:
2*
( St I��r C� P-O•�6X �o�a1, lo�e��cL NI(k o►C�(�2
Name(Print) Current Mailing Address:
At Z_ Y_b_541-`K_:)Z2
Signature Telephone
SECTION ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official.Use.Only
completed by permit applicant
1. Building (a)Building Permit Fee
321 000
2. Electrical (b) Estimated Total Cost of
i c) Construction from (6):,
3. Plumbing Building Permit Fee .
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+ 3 +4+5) U ' Check Number _
This Section For Official:Use:Only
Date
Building Permit Number: Issued:
Signature: ITM 1 5 -1
Building Commissionerlfnspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Requiredyartment
oning
This columfilled in by
Building D
Lot Size i
Frontage
Setbacks Front
Side L:= R:= L:= R:=
Rear f=�
Building Height —�
Bldg. Square Footage % p
Open Space Footage � % �{
(Lot area minus bldg&paved
arldn )
#of Parking Spaces
(volume&Location)
A. Has a Special Permit/Variance/ g ever been issued for/on the site?
NO 0 DON'T KNOW YES 'o
IF YES, date issued:
IF YES: Was the permit recorde at the Registry of Deeds?
NO 0 DONT KNOW Q YES 0
IF YES: enter Book Page and/or Document#j
B. Does the site contain a br ok, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0
IF YES, has a permit een or need to be obtained from the Conservation Commission?
Needs to be obtai ed 0 Obtained 0 , Date Issued:
C. Do any signs exis on the property? YES 0 NO 0
IF YES, desc be size, type and location: j
D. Are there a proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location:
E. Will th construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan
that II disturb over 1 acre? YES 0 NO 0
IF ES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF.PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) � Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [0 Siding [t]] Other(Q]
Brief Description of Proposed
Work: tZP�A'CE rL(,T)>?-1�'C� �-�CSI-r(�w C(s & '! NT��2](1�I T� )�`_ �b �1Sr�N
Alteration of existing be'dcQorR, Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement _ Yes No
Plans Attached Roll =Sheet
6a.If New_house`and or:addition to existing iLfslnq complete the'fol[ovving:
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
1 as Owner of the subject
property
hereb uthoriz X71 erm
to ac n b h , in all matters relative to work authorized by this building permit application.
Signature of O Date
I, 2'et xl Sl I kiermaa, 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
0 -L ZJ of O / t Date
i '
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Constructions Supervisor: SINot Applicable ❑
Name of License Holder: o1-70
-1Q
License Number
P� boy AYV�- C (_2. tolai Iao
Address Expiration Date
13--58�►-�5aa
Sig at Telephone
n,—}++c' T ai.Cf '7 x t d } ia `�-s7
9 ftea�steEedorrie.improvemen€Contractot ._ . _ �_._._._:, ._._...._ Not Applicable ❑
P.� Lone-, 55N3
Company NaFhe Registration Number
(QUOD-2 v M4 v 1 D 402 `I � I--I 120
Address p/ Expiration Date
44- A% z Telephone
SECTION'10=WORKERS'COMPENSATION.INSURANCE.AFFIDAVIT(M.G..L c.M,§.25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... No...... ❑
i
i
. I
City of Northampton
Massachusetts
rk 'y DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton,.MA 01060'"^ j��
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 Est.Cost:
Address of Work A1Lane, F
Date of Permit Application:
-
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:
V&,Tm�yr Inc �055Ll
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 Nor_thamptor
Massachusetts
'• '' DEPARTMENT OF BUILDING INSPECTIONS p:
212 Main Street • Municipal Building
k 'yam Northampton, MA 01060
Massachusetts Residential Building Code
Section 110.R5.1.2
Homeowner: Person(s)who own a parcel 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 constructs more than one
home in a two-year period shall not be considered a homeowner.
Section 110.R5.1:3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5,provided that if a homeowner engages a person(s)
for hire to do such work,then such homeowner shall act as supervisor.
Such homeowner shall submit to the Building Official, on a form acceptable to the Building
Official, that he/she shall be responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to
time, during and upon completion of the work for which this permit 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 person(s) you hire to perform work for you
under this permit.
City of Northampton,. Massachusetts
!G
F•_
DEPARTMENT OF BUILDING INSPECTIONSY .
�t
212 Main Street •Municipal Building
Nc' rr Northampton, MA 01060 �f Yj�ti~C
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 hou numbeInd street name)
Is to be disposed of at:
�O-WftA P-�CQC-" -
(Ple ` e print nAe and loca4fon of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
//A
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.
The Commonwealth of Massachusetts
Department oflndustrialAccidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITMG AUTHORITY.
Applicant Information Please Print Le¢ibly
Name(Business/Organization/Individual): \11 lleu ,p a\yeffl e lc4 t-Th C.
Address: P.O ZC�(, 100(01
City/Stateizip: -%(e Le. V4Vr 0�bb2 Phone#:
Are you an employer?Check the appropriate box:
Type of project(required):
1.9I am a employer with 1B-employees(full and/or part-time).* 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working for mein 8. 2g Remodeling
any'capacity.(No workers'comp.insurance required.)
9. El Demolition
3.F_1 I am a homeowner doing all work myself.[No workers'comp.insurance required]t
10 E]Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
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.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance t
6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑OtheI
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. 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 �
Insurance Company Name_ '�Ybe1�(� 7DISUra= 6-(F
Policy#or Self-ins.Lic.#: 0OCC& S Expiration Date: a� I
Job Site Address: 1 kAzaam 4a/n4 City/State/Zip: R(J,/!0s Cz
Attach a copy of the workers'c ensation licy 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 under thepains andpenalties of er'ury that the information provided/above is true and correct
Signature: Date:
Phone#:
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone 4:
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Const` ctlS�ttp,rvisor
>J-
CS-077279
fCS-077279 ,> 4 �I Easpires:r
STEVEN A SIJL-�VERMAfI.'.:;' 7
268 FOMER R0�4D_ ' `J ,`
SOUTHAMPTON, A% ! >C
�101,SS3jO�s
T ,
Commissioner
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement,-Contractor Registration
a- Type: Corporation
VALLEYHOME IMPROVEMENT INC " Registration: 105543
P.O.BOX 60627 si T
Expiration: 07/16/2020
FLORENCE,MA 01062 1 j
Update Address and Return Card.
I G 200M�M--0511117
✓/26 UMl/IZLS2[G'B6Cl/L L��(1a.116U1CCr1E`ld
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE,Corporation before the expiration date. If found return to:
Reolstrat1A Expiration
Office of Consumer Affairs and Business Regulation
Q-5543 07/16/2020 One Ashburton Place-Suite 1301
VALLEY H0ME(P E•.ERVE'EN::II C Boston,MA 02108
STEVEN A.SILVERMAN ni ::�
340 RIVERS[ ED �.�. �^
VORTHAMPTON,MA 01062 Undersecreta Not valid without signature
Undersecretary
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PROJECT NOTES: a-' 2 N E
PROJECT PLAN Q) .2Ln
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E THIS PLAN SET,COMBINED WITH THE BUILDING CONTRACT,PROVIDES BUILDING DETAILS FOR THE RENOVATION OWNER: PETER AND CATHERINE BLOOM �•r m m
° PROJECT. THE LEAD CARPENTER SHALL VERIFY THAT SITE CONDITIONS,AND DIMEN51ONS ARE CONSISTENT W (U
WITH TITLE INDEX OF DRAWINGS SHEET rE
° THESE PLANS BEFORE STARTING WW
ORK. ORK NOT SPECIFICALLY DETAILED SHALL BE CONSTRUCTED TO THE SAME PROJECT 35 LADY SLIPPER LANE PROJECT SUMMARY 1 Z N
EXISTING CONDTIONS 7 0 LL
$ QUALITY AS 51MILAR WORK THAT IS DETAILED.ALL WORK SHALL BE DONE IN ACCORDANCE WITH INTERNATIONAL ADDRE55: FLORENCE,MA PROPOSED NUDIMESIONS 3 N N
BUILDING AND LOCAL CODES. PROP05ED W/ANNOTATION5 4 mo >
o ELECTRICAL PLAN 5 n
BLDG PERMIT: co
L2- ELEVATIONS 6 m WRITTEN DIMEN51ON5 AND SPECIFIC NOTES SHALL TAKE PRECEDENCE OVER SCALED DIMENSIONS AND GENERAL EXTERIOR ELEVATIONS I r.y D
��" `� `� "` NOTES.THE SALE PER50NIDE5IGNER SHALL BE CONSULTED FOR CLARIFICATION IF SITE CONDITIONS ARE DE51ONER: INTERIOR ELEVATIONS 8 iry
�a `, ENCOUNTERED THAT ARE DIFFERENT THAN 5HOWN,IF DISCREPANCIES ARE FOUND IN THE PLANS OR NOTES,OR IF A DOOR&WINDOW SCHEDULE 9 d qY
°= QUESTION ARISES OVER THE INTENT OF THE PLANS OR NOTES.CARPENTER OR SUB-CONTRACTOR SHALL VERIFY AND m 4
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15 RESPONSIBLE FOR ALL DIMENSIONS(INCLUDING ROUGH OPENINGS). C o m
`LI`7 1 1 ` t� ALL TRADES SHALL MAINTAIN A CLEAN WORK SITE AT THE END OF EACH WORK DAY. x d m
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This plan is the proprietary work product of Valley Home Improvement,Inc.(VHI).It is delivered for the limited and exclusive purpose of supporting the contract bid of VHI,and customer agrees that the elements of this plan shall not be republished or presented in any
form for the purpose of enabling or supporting the work of competing project contractors without the permission of,and compensation paid to,VHI.
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Valley p Home Improvement, Inc. 35 LADY SLIPPER LANE SCALE SEEVIEW SHEETNUMBER 340 Riverside Drive,PO Box 60627,Northampton,MA 01062 FLORENCENA 01062 EXISTING CONDTIONS DATE:10/30/2019
Office Phone 413.584.7522 Fax 413.585.0820 PETER AND CATHERINE
Find us on the web at: www.ValleyHomelmprovement.com BLOOM DRAWN BY'.
This plan is the proprietary work product of Valley Home Improvement,Inc.(VHI).It is delivered for the limited and exclusive purpose of supporting the contract bid of VHi,and customer agrees that the elements of this plan shall not be republished or presented in any
form for the purpose of enabling or supporting the work of competing project contractors without the permission of,and compensation paid to,VHI.
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Valley p �Home Improvement, Inc. 35 LADY SLIPPER LANE SCALE:SEE VIEW SHEET NUMBER 340 Riverside Drive,PO Box 60627,Northampton, MA 01062 FLORENCE,MA 01062 PROPOSED W/DIMESIONS DATE:10/30/2019
Office Phone 413.584.7522 Fax 413.585.0820 PETER AND CATHERINE
Find us on the web at: www.ValleyHomeimprovement.com BLOOM DRAWN BY:
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This plan is the proprietary work product of Valley Home Improvement,Inc.(VHI).It is delivered for the limited and exclusive purpose of supporting the contract bid of VHI,and customer agrees that the elements of this plan shall not be republished or presented in any
form for the purpose of enabling or supporting the work of competing project contractors without the permission of,and compensation paid to,VHI.
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Valley p Home Improvement, Inc. 35 LADY SLIPPER LANE SCALE:SEE VIEW SHEET NUMBER 340 Riverside Drive, PO Box 60627,Northampton,MA 01062 FLORENCE,MA 01062 ELECTRICAL PLAN DATE:10/30/2019
Office Phone 413.584.7522 Fax 413.585.0820 PETER AND CATHERINE
Find us on the web at: www.ValleyHomeimprovement.com BLOOM DRAWN BY:
This plan is the proprietary work product of Valley Home Improvement,Inc.(VHI).It is delivered for the limited and exclusive purpose of supporting the contract bid of VHI,and customer agrees that the elements of this plan shall not be republished or presented in any
form for the purpose of enabling or supporting the work of competing project contractors without the permission of,and compensation paid to,VHI.
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Valley Home Improvement, Inc. 35 LADY SLIPPER LANE SCALE:SEE VIEW SHEET NUMBER
340 Riverside Drive,PO Box 60627,Northampton,MA 01062 FLORENCENA 01062 ELEVATIONS DATE:10/30/2019
Office Phone 413.584.7522 Fax 413.585.0820 PETER AND CATHERINE
Find us on the web at: www.ValleyHomelmprovement.com BLOOM DRAWN BY: 6