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30C-083 144 CLEMENT ST BP-2022-0061 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30C-083 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Bath reno BUILDING PERMIT Permit# BP-2022-0061 Project# JS-2022-000112 Est.Cost: $18600.00 Fee: $121.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sq ft.): 32539.32 Owner: DAVIS J MICHAEL&ALINE LABORWIT-DAVIS Zoning: SR(100)/ Applicant: VALLEY HOME IMPROVEMENT INC AT: 144 CLEMENT ST Applicant Address: Phone: Insurance: P 0 BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:7/19/20210:00:00 TO PERFORM THE FOLLOWING WORK:1 ST FLOOR BATH 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 . '1 • Certificate of Occupancy Signatur i4► I 0 FeeType: Date Paid: Amount: Building 7/19/2021 0:00:00 $121.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner 'AC Jol 0 The Commonwealth of' as-4*. setts 1'9. 20 / I Board of Building Regulati. an. •.• .,-. FOR Massachusetts State Building Co.-,�4.: 144' ,by USE ri Building Permit Application To Construct,Repair,RenovateN M. I'fi e%q4fisti a Revised Mai-2011 One-or Two-Family Dwelling This Section For Official Use Only Build Permit Number:,e,P".13.-0 J ' Date App'ed: Cwx..)1, 7- I9 zaz I Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1,1 P►ooe.rty 4.ddress: 1 1.2 Assessors Map&Parcel Numbers HYI1.l a;s dris an accepted street?yes -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 1 Side Yards I R•a 1r Yard I Required 1 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 1 Owner'of Record: -ktkt. .- { ka-f 1�. •3\S �Ut-e.+%iCr. 1H Cat0(02_. . Name(brat) City,State,ZIP \q 4 C 41-- S\-ve t- 413-5Wo-v4 Li 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) ❑ Alteration(s) 0 Addition 0 r,-'emolition 0 1 Accessory Bldg. E Number�ofU its I Other [.l Specify: . Brief Description of Pro osedWork2: �Ntreye., 1 / F-4 A'—.)-1 � L .tti �/) 1y�1n' .�Tt�2rS /A) 1-4 F LAce 1'/11517rL. L.4t .( e,. G41;4/.!?,OLv - C /IA.1G+; 6riliW To 2 pV = A-# . SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item rr abo•and Materials) Official Use Only 1.Building $ j � SU �� 1. Building Permit Fee: $ Indicate how fee is determine& �� D Standard City/Town Application Fee 2.Electrical S 7tf c 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing S j1 WOO 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire j � 6 Suppression) $ / Total All Fees: .ii�� Check No.411s heck Amount. Id/1 Cash Amount: 6. Total Project Cost: $ ❑Paid in Full 1 Outstanding Balance Due: • SECTION 5: CONSTRUCTION SERVICES I 5.1 Construction Supervisor License (CSL) . D 11 '2- 19 Co- 12.1. /1022- �- \eVt .�r � �(nay License Number Expiation(Date Name of CSL Holder List CSL Type(see below) Pc?),t-' '' t5. ()021 Type Description No.and Street R(� �`� r� U Unrestricted(Bur l di rigs up to 35,000 cu.ft.) , IQrPxtC� t" " �C R Restricted 1&2FamilyDwelling City/Town, t te,^iP Tur iadasona,, /r 1,7;ii; Rt; Mason ic?vt ring ��� WS Window and Siding • SF • Solid Fuel Burning Appliances " 4 -c3 —1522— 1 ' insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Qcv`12D g`21)(2-62-7— V(`,L\ e k—e k rn-NY HIC Registration Number Expiration Date YC Compel?.Name or MC Registrant Name .k c7?c (.0c)(02-1 c-lorc..nce CYbt5 b 1 o(o'z-- No.and Street Email address 4t2-Sat-v 22 City/Town.,State,ZIP Telephone . SECTION 6:WORKERS' COMPENSATION INSURANCE AF'FIDAVI'T(M.G.L.-c.452.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit willresult in the denial of the Issuance of the building permit. Sib ed Affidavit Attached? Yes 14 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 \\A-,_ i —i" 1\ rryNcii-1 to act on my behalf,in all matters relative to work authorized by this building permit application. N . Day t-( 7lsa. j21 Printmer's Name ectronic Signature) Date SECTION 7b:OWNERt OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under pains and penalties of perjury that all of the information contained' lication is true d accur t best of my knowledge and understanding. t Owner's or Authorized Agent's Name(Electronic Signature) 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(BIC)Program),will not have access to the arbitration program or guaranty find under M.G.L. c. 142A.Other important information on the HIC Program can be found at www.mass..aov/oca Information on the Construction Supervisor License can be found at www.mass.roviidos . 2. When substantial work is planned,provide the information below: Total / ft) 4 ti.. decks s floor area,,sq. fincluding Farage,finished basement/attics,ueC�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 Iorthampton,a ,. i= _ s�S sfc 'y� �c MMassachusetts �y y= <<' • ± { DEPARTMENT OF BUILDING INSPECTIONS ?, jy ' �S� A'�c 212 Main Street • Municipal Building �J� b ;. :cs e..t �. .ter • CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) . In accordance of the provisions of MGL c 40, 554, 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!, GL c 111, S ?5OA. The debris will be disposed of in: Location of Facility: \Ha U J) '115o c1 \..a 1 ,.\-P yCC, '4 1' -1 , , The debris will be transported by: Name of Hauler: \I \ f6{Yu 'TNT,.rc,( _i- - . Signature of Applicant: Date: 7-12=Z612 The Commonwealth of Massachusetts 11 + jf�.: Department of Industrial 1-1 " ° 1 Congress Street, Suite 100 Boston,MA 02114-2017 • v 4 y WWW.Illass.gov/dia 111 rkers'Compensation IstsatMtr.ce Affidavit:Builders/Contractors/Electricians/Plumbers. TO YYITi'1 Ti-if Pt',M NUTTING AUTHORITY. Applicant Information Please Print Legibly Name Vame(Fik.Klnes)Omani%aiii on ntiivid IJ:I i): \ (iJk '� Pf,("y 1 -(# \ t C��.f>�. 4�S�f" a'( Address: ? -t() \at-_.- ��t(�C . P- t7 . +c7c 1 (c,0(co .+ Ciiy/State/Zip �C7,r�1'2C� �-Q;' -t3nb2.- Phone#: -t. 2)— S` Lt--`1 S2Z.. Are you an employer?Check the appropriate box.: Type of project(required): I am a employer with employees(full and/or part-time).* 7. El New construction 2.1:3 I am a sole proprietor or partnership and have no employees working forme in 8. ®Remodeling any capacity.[No workers'comp.insurance required.] r� 9. ❑Demolition 3.1 1 I am a homeowner doing all work myself.[No workers'comp.insurance required.)} 10 U Building addiiion 4.0i am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all coat+actors either leave woraceie'compensation imyrance or are sole . - Electrical repairs of additions • propietors with no employees. 12.❑Plumbing repairs or additions 5.0 Tarn 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. 6.❑'We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other 152,✓71(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box;II mist also fill out the section below showing their orkC:is'comp don policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mist submit a new affidavit indicating such. --Ctmtraeturs that Bieck this box trust attached-an-additional sheet showing the name of the sub-contractors and srate'whether or'nv t those entities have employees. If the sub-contractors have employees,they must provide their workers'romp.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: lc (�-++����A e t�S� r Policy#or Sell ins.Lie.#: ',nJ�j�(� ?j�Z,�'7 Expiration Date: 1 � l e C) Job Site Address: ttiLl &Vy. 4— City/State/Zip: K\(k 1/c. a u" L t\414©I O 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 cirri.al 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, and penalties perjury th t information provided above is true and correct. Signature: ' ,/( e/f...-- /if fi✓jate: 9I 12024 Phone#: kAk2- S — ?j2.2—_ Official use only. Do not write in this area,to be completed by city or town official City or Town: •Permit/I,icense# rr Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitytThown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 74: Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Con-4i�r til it l�ervisor CS-077279 empires 06/21/2022 STEVEN A SEVERMAN i s � - • PO BOX 60627� 1 nt z FLORENCE M j 01062 , 1 rI O A'0Y3S330-1• � ✓�� ti Commissioner pP. �'. �`&i. 1 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 a 20M-05/17 gm..91-ict.eici2 tV.. a--1 s¢ eiive/lam 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 9�J (?,, � /111141/4/ 340 RIVERSIDE DRIVE �(lG• .G� c ; rt FLORENCE,MA 01062 Undersecretary Not valid without signature