23D-071 (9) RNER ST BP-2007-0912
immiGIS it. COMMONWEALTH OF MASSACHUSETTS
71
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2007-0912
Project# JS-2007-001481
Est.Cost: $24400.00
Fee: $112.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Valley Home Improvement, Inc 077279
Lot Size(sq.ft.): 18774.36 Owner: DONALDSON RONALD P&R CHERYL
Zoning:URB Applicant: Valley Home Improvement, Inc
AT: 50 WARNER ST
Applicant Address: Phone: Insurance:
P 0 Box 60627 (413) 584-7522 "orkers
Compensation
FLORENCEMA01062 ISSUED ON:3/30/2007 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL KITCHEN
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:
FeeType: Date Paid: Amount:
Building 3/30/2007 0:00:00 $112.0022315
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2007-0912
APPLICANT/CONTACT PERSON Valley Home Improvement,Inc
ADDRESS/PHONE P 0 Box 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 50 WARNER ST
MAP 23D PARCEL 071 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid e g 3 / S eft.2.
Typeof Construction: REMODEL KITCHEN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 077279
3 sets of Plans/Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street C 'ssion
Z
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information. r
• Department use only
City of Northampton Status of Pet•rnit: ti .
Building Department Curb Cut/Driveway Rermit •
212 Main Street Sewer/Septic Availability
2 9 2GO Room 100 WAvailability •
ater/Well = ;
MA Northampton, MA 01060 TwoSets of tructural Plans -
phone 413:587-1240 Fax 413.587-1272 Plot/Site Pi
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address:
50 Lk) p. fj 5 ! Map Lot Unit
ll �✓- , Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: / 9 t L/e- S
.2 '//t �o/� ��Sa�t/` /0,-7 7 2 K, /174 o/CO o
Na Prriintt) Current Mailing Address: _ 2—
Telephone < <
Signature
2.2 Authorized Agent: Steven Silverman
Valley ome Imp—oveme • nc. P.O. Box 60627, Florence, MA 01062
Name(Prin , Current Mailing Address:
584-7522
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by permit applicant
1. Building 2-2 1-100 (a) Building Permit Fee
2. Electrical 2.0e) (b) Estimated Total Cost of
Construction from (6)
3. Plumbing 10 D Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 + 4 + 5) 2�1 400 Check Number ,71 o?3/ 50jlP--
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus Bldg&paved
parking)
T of Parking Spaces
Fill:
(volume d:Location)
A. Has a Special Permit/Variance/Finding ever been i- ued for/on the site?
NO DON'T KNOW Y.S
IF YES, date issued:
IF YES: Was the permit recorded at the Registry %f Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, bod of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been • need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
i
C. Do any signs exist on theproperty? YES NO
�z IF YES, describe si �,//type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES _
No
IF YES, describe size, type and location:
New House 0 Addition 0 Replacement Windows Alterations $ 1 Roofing 0
Or Doors LI k l'T'G Ne I
Accessory Bldg. ❑ Demolition❑ New Signs [ ) Decks [ ] Siding[ ] Other ! ]
Brief Description of Proposed Work: K I TC gCI i(ti 1_ — N p C ff.) c5E-- a
alteration of existing bedroom Yes No ACd:ng new bedreorn Yes leo
Attached Narrative'_ Renovating unfinished basement YC, --"Z No
Plans Attached Roll _' • Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rcors in each family unit: Number of Bethrcems
c. is teere a garage attached? •
d. Proposed Square IcolaRe of new Construction 0' ensions
c. Number of stories?
f. Method of heating? •',epiaces or WCedStoves Number of each
•
g. F.r,ergr Ccnservaticn Corrmp farce. Mascheck Energy Compliance form attached?
Type of ccestr4Ctien
;s CO'r•lre tiCf within 100 tt. of• et ands? Yes No. Is constrjceen withir I00 yr. 'Icoepla n Yrs fee
Depth of oa:ement or c- ,r floor below enisheC grade
Will building cent. rn to :he Building and Zoning regulaticns? Yes No .
Septic Tank City Sewer Pr:vate well Clay water Suop y
I SECTION 7a - OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
�.C e � .b.10/ti _._.. _., as Owner cf tie subject property
hereby aumarlee Steven Silverman, Valley Home_ Improvement,_.Inc. to act on
rn; t e77a_lf. in all rrtatterS relati,e to %yolk authorized by this bliifcmg p=unit aoplic,atici.
)(Te— CILLL-1(_71 ,A0(46.4411'`-- 367/7
Signature.or CrA*.r Date
Steven Silverman, Valley Home Improvement, Inc. , as Owner/Aumorized Agent
hereby declare that the statements and information on trio foregoirg application . true and accurate, le .he test of my
kncwledgc and belief.
Sigeed under the pains and ccnalties of peri.:•y.
S t even_$i esman
Pnrt Nina:
Signature or Ceener/Agent • Date
•
SECTION 8 - CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder : Steven Silverman _ 077279
License Number
268 Fomer Road. Southampton, MA 01071 6/21/08
Address Expiration Date
584-7522
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable 0
Steven Silverman 131945 •
Company Name Registration Number
268 Fomer Road 10/13/08
Address Expiration Date
Southampton, MA 01073 Telephone 584-7522
SECTION 10- 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 IS) No 0
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor. CMR 780. Sixth Edition Section 108.3.5.1.
Definition of 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.
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.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
tt A1d pi,
� Oic
6i0 of Nar til&1pthn ►-, 1t
if♦� y}a1aACllrSttlStWM‘ j"� /,r
"' -m DEPARTMENT OP BUILDING INSPECTIONS
212 Main Street ♦ Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, Nelson Shifflett - Valley Home Improvement Inc .
(Ii serlpecmittee)
with a principal place of business/residence at:
340 Riverside Drive, Northampton, MA 01060 (phonci.') 584-7522
(soya t/cit,'/s a n';'in)
do hereby certify, under the pains and penalties of perjury, that:
(X) I am an employer providing the following worker's compensation coverasze for my
employees working on this job:
A. I .M. Mutual Ins. Co. WMZ8005610 01 2007 2/1/08
(Insurance Company) (Pclicv Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (insurance CompanyiPolicv Number) (Expiration Date)
(Name of Contractor) (Insuu-ancr Company/Policy Number) (Ex-piranoa Date)
(Name of Contrac or) (Insurance Company/Pone:),N:unbel (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additiem1 dices if necessary to include information perminicg to all contractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homcow rrs who=ploy pesons to don nano construction or repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thereto are not ge»erally considered to be
employers rs under the works rnnpv--salion Act(GL152,ss 1(5)),application by a homeowtxr for a license er permit may evidence the
legal status of an employer under the Worker:Compensation Act_
r unde stand that a copy of this stab:ment may be forvnu•ded to the Do?rtaxa t of Industrial Acddonts Otf oo of Insurance for the
coverage verifttllion and that f ilure to seam coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a 1 ne of up to S 1,500.00 amdfcr imprisonment of up to one year and civil penalties in the form of a Step Work Order and a
fine of 5100.00 a de against me
Signed this ___day of For departmental use only
-� n _ Permit Number
J�/ a a....0 r".41
,YGLSe// 5/// 4
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A Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 131945
Type:
Expiration: 10/13/2008
STEVEN A. SILVERMAN
STEVEN SILVERMAN - -
268 FOMER RD.
SOUTHAMPTON, MA 01073
Update Address and return card.Mark reason for change.
BPS-CA1 o 5OM-osos-PCs4:3,: = address E Renewal = Employment — Lost Card
.�'1P ;Ie,nanuvea4A G��//TJuacAetze Gl _' '_.
Board of Building Regulations and Standards License or registration valid for individul use only
�'= HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
F= Registration: 131945
Expiration: 10/13/2008
One Ashburton Place Rm 1301
Boston,Ma.02108
Type:
STEVEN A.SILVERMAN
STEVEN SILVERMAN
268 FOMER RD.
SOUTHAMPTON,MA 01073 Deputy administrator Not valid without signature
/ee 4rnrnanuuval(A c` llauaclrulete6
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
• Number: CS 077279
3irthdate: 06/21/1964
Expires: 06/21/2008 Tr.no: 24270
Restricted: 00
STEVEN A SILVERMAN
268 FOMER RD
SOUTHAMPTON, MA 01073 ' '�—
Commissioner
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