31B-130 134 STATE ST BP-2021-1454
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B- 130 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Budding DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: KITCHEN RENO BUILDING PERMIT
Permit# BP-2021-1454
Project# J S-2021-002415
Est.Cost:$59500.00
Fee: $386.75 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq.ft.): 4007.52 Owner: PARRISH CHRISTINE M&SUZANNE SMI f I I
Zoning: URC(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 134 STATE ST
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:6/8/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:KITCHEN 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. I , 2 TO
• •
Certificate of Occupancy Signatursl I 0
FeeType: Date Paid: Amount:
Building 6/8/2021 0:00:00 $386.75
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
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The Commonwealth of Massachusetts 4,To,
19 Board of Building Regulations and Standarr 1yq&/e0, ��?/ , C�PXLI I Y
Yrr7 Massachusetts State Building Code, 780 CMR M°),"//�s U
A
st
Building Permit Application To Construct,Repair,Renovate Or Dem goa*io 'evis 1/Mar2011
One-or Two-Family Dwelling 6� is /
This Section For Official Use Only
Building Permit Number: dixAl '//6-y Date Applied:
4vii--$ /Z3 ,7/ G6' x21
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address; 11.2 Assessors Map Z Parcel Numbers
Icy _ , - (1 3 130
1.l a is this an accepted street?yes --no Map Number Parcel Number
'1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(so ft) Frontage(ft)
1.5 Building Setbacks(ft) .
Front Ya:•d Side Yards I Rear Yard
Required Provided Required Provided i 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 0 Zone• _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yesD
SECTION 2: PROPERTY OWNERSHIP1
f'fi1 Ow eriof n�ord. (� �� J {I
l iNt- -1.m t_+t�P i'rf.6.11 t--302an 1f_c.Yrl 4 h � k`� ..1'A 7 C31 toi)
Name(Print) City, State,ZIP 1
i S
1, ed4---- ke 15-320-- i 5(02-
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK''(check all that apply)
New Construction 0 1 Existing Building❑ Owner-Occupied 0 Repairs(s).0 Alteration(s) 0 Addition 0
Demolition 0 j Accessory Bldg. 0 ` i
Number` r`c-�ofUnJtj s, f Other C7 Spec*:
. Brief Description of Pro osed Work2: " r TC�wiv, 4 * f — NO `�'idiev -to e A'rre-;(fs—
h tit 'N D f rM_
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ sei1 000 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ 1
5 ❑Total Project Cost' (Item 6)x multiplier x
3.Plumbing $ I) 0 DO 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees,�Q rr� 7
Check No!'I 1/GCheck Amount:'7 ,Cash Amount:
6.Total Project Cost: $ 59) 5 CC) . -0 Paid in Full -0 Ot tstaimling Balance Due: -
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) . D-1122- .9 Co12 L I z02 -
b\-cxyco Cjk.'J fX(rta r1 License Number Expiration Date
Name of CSL Holder
p (�( , ? List CSL Type(see below) .
'Q g&a� ")(021 Type Description •
No.and Street
n n t_�2 U Unrestricted(Buildings up to 35,000 cu.ft.)
'00ren(� 1v 0` (s1 _ R Restricted I&2 Family Dwelling
City/To te,ZTP TA Masonry
7/ ,--- RC Winding.C, dS
WS ; Window and Siding
"SF ' Solid Fuel Burning Appliances
`l&-S3` l. 1522— 1 Tnsuiation
Telephone Email address D Demolition
5.2 Re istered Home Improvement Contractor(FTIC) k.OSSUt3 3I2Z(W2-2— .
eRQU y-mrir ThQJ1 — HIC Registration Number Expiration Date
YC CompatiSr Name or TITC Registrhnt Name
�_6 G,c k o(D2J c-�O.rcr2G-P A; b\0(92
No.and Street Email address
4l2,-Sa-t`IS22
City/Town.State,ZTP 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 Issuan ce"of the building permit.
Signed Affidavit Attached? Yes Igi No . 0
SECTION 7a:OWNER AUTHORiZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize ' -Z A-i?L S i\ y-r-y)CIA-,
to/acct on my behalf,in all matters relative to work authorized by this building permit application.
C.. .Srl c:'" iii .. P us :%✓ eeA1/421/
\Print Owamer's Name(Electronic Signature)" Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By enterin my name below,I hereby ttest under the pains and penalties of perjury that all of the information
contained 's applicati.,. is tru ccurate to}tthe best of my knowledge and understanding. s
ei
Print' s s/Au . . .Ag t' e(Electronic Si nature) 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 fund under M.G.L. c. 142A.Other important information on the HIC Program can be found at
\vw w.mass.aov/oca Information on the Construction Supervisor License can be found at www.mass"rov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (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 haIf/ba'uis
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
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+, -ItA DEPART1 13T Or BUILDING INSPECTIONS ?t. , r;;-
Cy " -T' ` 212 Main Street • Itunicipal Building 3� ��
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CONSTRUCTION DEBRIS A F]JJAVIT
(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 shalt be disposed of in a
properly licensed waste disposal facility, as defined by{AGL c 111, S 15OA. ,
The debris will be disposed of in:
Location of Facility: \la . -) -o ct).•.��_ I .\-Q \ 1 (-- `'C, ,--�
The debris will be transported by:
Name of Hauler: VOW ' ` . T
. / 1 /1/ i . n .
Signature of Applicant: ,../r Date:
The Commonwealth of Massachusetts
Vet- 1;%-7 Department of Industrial Accidents
.:1• I Congress Street, Suite 100
Boston,MA 02114-2017
•
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1wvww.rrtass.gov/dia
1Zoricer-s'Compensation Insurance Affidavit:Builders/Conh-artors/Electri ians/P]wrabers.
TO I1 .FILM)WITH THE PERMITTING AUTHOR ETV.
�� Applicant Information } --{{1,..,^ Please Print Legibly
Name ame CR11sinems/ /rgirnizglitinilndi WitIl1N.1).: � -� -4..FF *��j j�r`+�` �+�,tf\i"1/J r _� (
Address: 3« �� �v �.-vv�lll YYYL�l . - 0 - 'C ,c 4 £oY0 I(c) T
City/State/Zip -VOr j- c vnb2.- Phone#?: `-t, ---1 S2 2
• Are you an employer?Check the appropriate box: Type of project(required):
1x!I am a employer with 1 P> employees(full and/or part-time).* 7. El New construction
2.0I am a sole proprietor or partnership and have no employees working forme iu 8. ®Remodeling
any capacity.[No workers'comp.insurance required.]
3111 am a homeowner doing all work myself.(No workers'comp.insurance required.]'
9. [2]Demolition
10 U Building addition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure That all nontrectorseitl+ei lave workers'compensaitse insurance or are sole • - 11.E Electrical repairs ar additions
proprietors with no employees.
12.C Plumbing repairs or additions
5171 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.0 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.]
*Aoy applicant that checks box 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.
^Cnmtlaetors Mat check this box most nttat-hed'a:n uddlitiunal sheet showing the name of the sub-contra turn and state`whtther ur'nut those entities have
employees. If the nib-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: A'eh, , .. {t'x,St a.'t`1 3'ZC< , Alas
Policy#or Self-ins.Lie.#: C� C�rt) t�j,�=,(C")� (D21 Expiration Date: a} I c�C�D),
Job Site Address: J�C k'C Z lc-R - City/State/Zip: <C),A1-1- I'ijuto 4 0l O1 _
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiation 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.
I do hereby certify under the p n and penalties perjury t1 tt • information provided above is true and correct
Signature: 4 / ✓��G (/ n/fl` Date: B{22b 12-621
Phone#: ill - SSLt•-`1 S 22—
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/I,ic nse#
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
1.1 1 Division of Professional Licensure
Board of Building Regulations and Standards
Cons`i�r ti'o ItSperrvisor
J•
CS-077279 � Spires:06/21/2022
• STEVEN A SVERMAN , k i �.
PO BOX 60627
FLORENCE IVIA 01062 1 a ! > i
OISS3 dO
Commissioner d. g•
K/22/22Gz/?i 0eGae,e o/����'ar)c)-C?iG2a,ezZ1-
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.SOX 60627 Expiration: 08/20/2022
FLORENCE,MA 01062
Update Address and Return Card.
sca I Cr 20M•O5/17
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
11/
STEVEN A.SILVERMAN ;l,- 1 j
340 RIVERSIDE DRIVE �.� 4� �
FLORENCE,MA 01062 Undersecretary Not valid without signature