29-103 454 RYAN RD BP-2022-0117
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29- 103 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2022-0117
Project# JS-2022-000207
Est.Cost: $93800.00
Fee: $609.70 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq.ft.): 31450.32 Owner: CUMMINGS CLAY
Zoning: Applicant: VALLEY HOME IMPROVEMENT INC
AT: 454 RYAN RD
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:8/2/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:KITCHEN RENO, ADD WINDOWS, SLIDERS,
CHANGES TO EXTERIOR & STRUCTURAL FRAMING
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
• V • � . C't •
Certificate of Occupancy Signature: I
FeeType: Date Paid: Amount:
Building 8/2/2021 0:00:00 $609.70
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Li---
P(ans in '
cep
The Commonwealth of Mass. hus-, ✓(/ �4
�4 I Board of Building Regulations d Sp(Bards ` 3 0 F�.
�I� �� Massachusetts State Building C.• 1: !+ c24,, r NI SE`j ITY
Building Permit Application To Construct,Repair,Ren.-E:: 9tys:- -nolish aA Revi ed Mar 2011
One-or Two-Family Dwelling. T°'k �Siti
This Section For Official Use Only °eo o'vs
Building ermit Nucor,'oer: P. a?...a t ( 7_ . Date Applied:
etils.—ass
/b-7- _
Buil di ng Official(Print Name) Signature U Date
SECTION 1: SITE INFORMATION
1,1 P.roperty ddress: 1.1 Assessors Map R'Parcel Numbers
1.1 a Is this an accepted street?yes mn o Map Number Pared Number
1.3 Zoning Information: 1.4 Property Dimensions;
I Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
i
1.5 Building Setbacks(ft)
Front Yard i S"de Va•ds I Re-r 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2 Owners of Record:� + oto r Al `5 *-k--a,L.,vT [rl+- GYrfa . Yl[e3 t)
' 10(07-.
Name:, at) p c.T� -?,City,.Stage,
t- - j:k•in a- q 13--17 w-U '7
No.and Sheet Telephone Fin ail Address
SECTION 3:DESCRIPTION OF PROPOSED WORKS (check all that apply)
New Construction 0 1 Exi U.eg Building 0 Owner-Occupied ❑ Repairs(s).0 Alteration(s)I14 Addition 0
Demolition Q I Accessory Bldg. 0 Number of Units I Other Ii Specify:
Brief Description of Proposed World: t -E(,ie IQ Lip d R c i1►'►'to ..p f F {o 1'1'1 )i�1�
Cd`�'J t�t0tct cpug - flc,Alb4 �,v,.,ar;,6 4- Si, l2is_ C idl 4'.—.PS +'b - OXteVlel_
S vvctV1 1 cis-A;mii0, _ kAD i tiff 11Ous II Co I Sit.,plc-6
SECTION 4:ESTIMATED CONSTRUCTION COSTS •
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ C3 c 0 c)o 1. Building Permit Fee:$ Indicate how fee is determined:
CI Standard City/Town.Application Fee •
2.Electrical $ .3%
❑Total •Project Cost'(Item 6)x multiplier x
3.Plumbing $ 21 C> 2. Other Fees: •$
4.Mechanical (HVAC) $ List:
•
S.Mechanical (Fire i
$ Total All Fees:$ U
Suppression) �c Gash Amount:
t Check Noq(a ilieck Amour .
6.TotaI Project Cost: $ 'j tom-, , .p Paid 1n Full CI Outsmnding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
i
Si. Construction Supervisor License(CSL) . D-11 ,219 to 12(. I a°02_
ce.. T-x- Cjt QeAr irla.ir\ License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
R c> (?)c=w ((,,C)(0.2.-1
No.and Street (� J Type Description
L/�C �Z�� iv v l.,Lti.J Y U TTni•estrieted`Suilain .„,to3c nn�t ft.)
City/Town, •e TP R Restricted I&2 Family Dwelling
''/ // / Ri, iittoiing.%Uv. ring
!,(�// �// /eir'� WS Window and Siding
• SF - Sol id Fuel burning Appliances
Lk&SM-1522 I Insulation
Telephone Email address D Demolition
5.2 Registered HomeImprovement Contractor(HIC) g+w t
� � nl < <Q� � - HTC Registration Number Expirattion Date •
YC Comp 'MC or C Registr nt Name
.(3 toC 22—) -iorince...CY\ 0\0c(2
No. and Street 'Pr,ai l ad,li.ess •
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 affi"davitwill result in the denial of the lssuance"ofthe building permit.
Signed Affidavit Attached? Yes 14 No O
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRA.CTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize \\ -T 1 �tLt Cj i i rn- ,
to act on half,in at tters relative to work authorized by this building permit application.
Print x ei e e Date
SECTION :OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate i e best of y know J and understanding.
Print Owner's or Authorized Agent's Name(Electronic Sinaturc) 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
wt'vv.mass.sov/oca Information on the Construction Supervisor License canbe found at www.mass.sfov/dos
. 2. When substantial work is planned,provide the information below: y
Total floor area(s- ft.) (includinggarage,finished basemen`✓attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
• Number of fireplaces Number ofbedrooms
• Number of bathrooms Number of halt'batlis
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 Northamptort
FLa$saachusetts < a C
1 }j '�i ,! F es, t�
I1 6..`i t( � DEPARTMENT OF BUILDING INSPECTIONS ? a ],. ;
212 Main Street v Municipal Building
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 •
i '''�:` is-that all debris resulting frn:�`! this work ��'c?!: be Qt��'•��A•.^.. ����',c'�
properly licensed waste disposal facility, as defined by Mac 111, S a SOA.
The debris will be disposed of in:
Location of Facility: \j0�` CJ.� �� ,4hCliU--1
The debris will be transported by:
Name of Hauler: `\CI.,lk C vNret 4— •
•
Signature of Applicant: Date: / J
1
•
The Commonwealth of lifassachusetts
r! r J Department of Industrial Accidents
MU i .1 Congress Street,Suite ICC
t' ) Boston,MA 02I14-20I
.,��.�-ter. T�rvw.rrtass.ga /dia
W 'aarkea-s' Caimre ssatio.n Tnstwance Affidavit:Builder•s/Conir-grans/Jslertririzrts/PI,-.tinbt Ts.
Ti)AF.Fir,F1)WiTH TRF i t.iciveIT TfNG'A1lEi-IC PITV.
Applicant Information Please Print Legibly
N_ Y \1 rd,t e , 't:Y\ r��lam. n. S3�� C
Ivarrre iRu�ine ve�rniiti.inni�nriiviuuai �--1
Address: `) \\k v-F' - ---Dr 1 C , p- 0 . c (c)0 Co 2A—
City/State/Zip c\--k.C7reX 2.0 e V, 10b2-- Phone#: 4,p2- :g9-1 S 2 2
Are you an employer?Check the appropriate box: Type of project(required):
1.M I am a employer with t ei. employees(full and/or part-time).* 7. 0 New construction
2.17 I am a sole proprietor or partnership and have no employees working forme in 8. ®Remodeling
any capacity.(No workers'comp.insurance required.)
t—� 9. ❑Demolition
3 1 1 I am a homeowner cluing all work myself.!No workers'comp.insurance required.]}
10❑Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that ail contractors either-have workers'compensation insurance or are sale - 11.-E1estric al repairs.or rat hangs
•
proprietors with no employees. 12.❑Plumbing repairs or additions
5.®Tam a general contractor and T have hired the sub-contractors listed on the attached sheet. 13.QRoof repairs
These sub-contractors have employees and have workers'comp.insurance?
6 EllWe axe a corporation and its officers have exercised their right of exemption per MGL c. 1 4.®Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.] .
r ka� rill (clew �.: policy information.
Any applicant that ehe;.a.s box,.�must also...�mu the s:.c:roa„�..,w,showing dui/workers'compensation
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
'Cvmxatitart that checrk th is box=rust attadtedan additional?tied showing the name cif the sub-wi travto s read state-whether or not thine entities have
employees. Lithe 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: A tt ,t,\cA.._ rt 5u,'1 ry Atr-Cil-t-e
Policy#or Sel ins.Lic.#: 00 ,(7 3 C.D2.\ Expiration Date: I 11,:C.)
Job Site Address: L6'4 Cht _D'-((1 City/State/Zip: 1()A-{'}ailkpol ,i'Z kI1 -01 C
Attach a copy of the workers'co ensation policy declaration page(showing the policy number and expirktion date).
Failure to secure coverage as required under MGL c. 352,§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 aggin.t 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 u der the pains and pe hies of 'ury that the information provided above is trueand correct •
� / Date: 7/17tr f Z 0 a .-�
Signature: ...
Phone#: \7- SS4——I¶ —
Official use aniy. Do not write in this area, to be completed by city or town official.
n City or Town: Permit/License##
1I
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing inspector
6. Other
Contact Person: Phone#:
City of Northampton
N. _sus \,
t % t
Massachusetts
r
' L I DEPARTMENT OF BUILDING INSPECTIONS n
< ="F}G 'y' 212 Bain Street o Municipal Building
Northampton, ...A 010£0
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 CMR 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 farm 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 perjury on this day of , 70
(Signature)
Commonwealth of Massachusetts
+ire. Division of Professional Licensure
Board of Building Regulations and Standards
ConsttrOt* SSp'4-visor
CS-077279 06/21/2022
STEVEN A SEVERMAN
PO BOX 606U3 4O '
FLORENCE M/j 0104 j x
3T
Commissioner di t D&ICLa_
� J
•
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
Expiration: 08/20/2022
P.O.BOX 60627
FLORENCE,MA 01062
•
Update Address and Return Card.
iCA 1 is 20M-05/17
rommeviezwa/ac/j. a�acAie45
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 .�
///://64
340 RIVERSIDE DRIVE- ,, �((�.//tiGl�k J0
FLORENCE,MA 01062 Undersecretary Not valid without signature