Loading...
36-376 205 EMERSON WAY BP-2021-1213 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-376 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-2021-1213 Project# JS-2021-002025 Est.Cost: $58000.00 Fee: $377.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sq.ft.): 13242.24 Owner: BASCOMB CHRISTOPHER Zoning: Applicant: VALLEY HOME IMPROVEMENT INC AT: 205 EMERSON WAY Applicant Address: Phone: Insurance: P 0 BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:4/23/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:BASEMENT RENO 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. o • 1' >2 . 16D, Certificate of Occupancy Signature I FeeType: Date Paid: Amount: Building 4/23/20210:00:00 $377.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner : 1.-t-C .---ii--, ,.------.....7 The Commonwealth ofi F usetts / FOR Or Board of Building Regulatiri�� �4 MUNICIPALITY Massachusetts State Building Co e;!1g0 cr/ / USE 'oso s . Building Pennit Application To Construct,Repair-,Renovate mouth a Revised Mar2011 One- or Two-Family Dwelling 'This Section For Official Use Only Building Permit Number: iA• j--/a.'3_-_ Date Applied: ,1 m- I . 2 9/L3A) Official(Print Name) Signature 11 Building bat Officd SECTION 1:SITE INFORMATION 1,1 Property Address: 1.2 Assessors Map&Parcel Numbers '20S rle.7 9:n 3C0 - -7 Ce i.1 a Is this au accepted street' yes V. -no - Map Number Parcel Number '1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Si de Yards Rear Yard _ Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage.Disposal System: Public 0 Private El Zone: Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP1 2.1 Ownerr of Record: Vclr t S 4-jt 11 �` CC>r'r: '#-'tQr eC) -- C. t Cam. Name(Print) City,State, 4.90...cErne uY,14 A LI t 3 383-- S1tnt.. No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition ❑ Accessory Bldg. 0 Number of Units Other ❑� Specify: Brief Description of Proposed Work2: Jeri+,a c.-k t j r-c.,n--F" SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ' '.o K 1. Building Permit Fee: $ Indicate how fee is determined: '❑standard City/Town Application Fee • 2.Electrical $ `' i✓k ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ t-{K 2. Other Fees: $ 4.Mechanical (HVAC) $ List: - 5. Mechanical (Fire $ Total Ail Fe�i49 t ,� Suppression) l/ r/ C }} — Check No.� heck Amountasl Amount: 6.Total Project Cost: $ �`�. . 0 Paid in Fuli. 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES (4). (2 i. 12,002- 5.1 Construction Supervisor License(CSL) -12:1 b\-exico A \leZ300.0JrN License Number Expiration Date Name of CSL Knitter List CSL Type(see below) 2.c ?)c (.0,c)(62.1 Type Description No.and Street U Unrestricted(Buildings up to 35,000 en.ft.) 00-(Pn(C._ W\i( 0\0(02. R Restricted I&2 Family Dwelling city/Town,S l A. ,AIILM Mas,onry RC . Roofing C.:ov.ering WS Window and Siding • SF Solid Fuel Burning Appliances insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) MC Registration\- .e,cc\as\Npf-n\rfre_r\-.4— Number SIZO 2C)Z2- ,c\ Expiration Date FTC Compa Name or MC Registthin Name tock52,1 c-1.ofcf--)c-e_C(lPs C) 2 No.and Street Ern2,i1 address 413-Sa4-1S2.2.. City/Town,State,ZIP Telephone SECTION•6:WORKERS' COMPENSATION•INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 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...... SECTION 7a:OWNER AUTHORIZATION TORE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. C kri 5 Name D %0L.c)co I ici 1"7-0 2-\ Print Owner's (Electronic Signature) Date SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest wider, pains and penalties of perjury that all of the information contained in , •' dication is Emile and occur best of my knowledge and understanding. Print Owner's or Au4,arized Agerk.Name(El c on c Sivianue) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty trod under M.G.L. c. 142A. Other important information on the HIC Program can be foun&at w\vw.mass..e.ov/oca Information on the Construction Supervisor License•can be found at wv,rw.mass.zovidos 2. When substantial work is planned,provide the information below: Total floor area(sq.IL) (including garage,,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths • Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton /f. l Yvl .ss .chusetts mow` L.,, ! J (1 TF F F'�� { k' '{' : DEPARTMENT OF BUILDING INSPECTIONS �, i 117 - r t'i . 212 Main Street o Municipal Building J, a CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by M6L c 111, S 150A, The debris will be disposed of in: Location of Facility: \la UckA ".oqly11.i 1 ,\e 'c), The debris will be transported by: Name of Hauler: \\r &' Y\.4 .X �,9i,-( r4�1. -- )7 4fit\ 3 " t 9 Signature of Applicant: /; /L— Date: The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 t-` `. c. WWW.ntass.govIdia J- Warlrea-s' Cnrtap.earsati.tr.ra Insurance Affidavit:Builders/Cs ntr-antors/Eietb cians,Pbi nber€, Ti r Rr'N 1i.r.ir'WITH THE PFRivrIT T rills All T HORITV. Applicant Information Please Print Legibly Nan-ic(Psi rvinestir'irrganiixiitmtintiivitiun.i): \j('�.G���,h ��Q i l'(�\ yj'\( J y�s� a"}( Address: 5 \sr Q- L . Cs,c Cc)0Cc City/State/Zip k,Ore,12C ' `Q,0-C)k,o*2. Phone#: q, SSy---1 S2 2._ Are you an employer?Cheek the appropriate box: Type of project(required): 1.r� I am a employer with employees(full and/or part-time).* 7, ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working forme in 8. FA Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.n I am a homeowner doing all work myself.[No workers'comp.insurance required.]t i 0 U Building addition 4.01 am a homeowner and will be hiring contactors to conduct all work on my property. I will euwaee that all contactors either have wolicea''e'compensation insurance or ar°e sole 11.0 1 lkctrncal repairs or:additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.1=1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1 .❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 6.❑We are a corporation and its officers have exercised their right of exemption per MGL e. 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that chocks box#1 must also fill out tho scction -::low shcwmg thou: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. 'Ctnsirautors'that check skis box mast attached'an additiunai sheet showing the name of the sub-cuntraelors and state whether urnut 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 polity and job vile information. Insurance Company Name: A e \ vra �_-- Policy#or Self-ins.Lict}#: C� j ('� �j b2,\ Expiration Date: C� l IO ' Job Site Address: t�?OS. -- WO- City/State/Zip: 1(� ,�'uu 4-C1--Z i"t ©1 ad- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expir tion date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to S1,500.00 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 DLA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true\ and correct. Signature: Date: .6\�0 - b a Phone#: U,\2 Srg4" S 2-2— — Official use only. .Do not write in this area,to be completed by city or town official. City or Town- Permit/t,icenst# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityfTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: - Phone#: w. ci City of Northampton S r r . /C Massachusetts mow? -4- `-\ i ' DEPARTMENT OF BUILDING INSPECTIONS u�.,t I 5 („.' tr0..-r, 212 Main Street a Municipal Building v, ,,�.\ - w-✓ Northampton, b 01060 �,I airs ,,. HOMEOWNERS'EXEMPTION ELIGIBILITY.AFFIDAVIT I, (insert full legal name), born (insert month, day, year), hereby depose and state the following: . 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 MR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110,R5.1.2: Person(s)who owns 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 faint structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and. except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. , 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of pei nj-on this -ray-of ,2Q_. (Signature) Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constr j> ti)rkWi p isor CS-077279 �3 6.pires 06/21/2022 STEVEN A SfpVERMANgI to r PO BOX 60627� FLORENCE M j 01062 i i c Opt iSS3� A Commissioner cis 0. 1t. �fin1Q�. Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation VALLEY HOME IMPROVEMENT INC Registration: 105543 P.O.BOX 60627 Expiration: 08/20/2022 FLORENCE,MA 01062 Update Address and Return Card. SCA 1 0 20M-05I17 ✓Z Fo✓nnri, e yd e4✓✓0Kz1Jacjicielll 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: Registration Expiration Office of Consumer Affairs and Business Regulation 105543 08/20/2022 1000 Washington Street -Suite 710 VALLEY HOME IMPROVEMENT INC Boston,MA 02118 STEVEN A.SILVERMAN i 0//i2 1 'J ///P e/7340 RIVERSIDE DRIVE "'y� ���'' FLORENCE,MA 01062 Undersecretary Not valid without signature