22D-089 (5) BP-2022-0249
131 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
22D-089-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2022-0249 PERMISSIONIS HEREBY GRANTED TO:
Project# REPAIRS Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 15000 INC 077279
Const.Class: Exp.Date:06/21/2022
Use Group: Owner: A LATUNER ROGER J & CHERYL
Lot Size (sq.ft.)
Zoning: WSP Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON:03/16/2022
TO PERFORM THE FOLLOWING WORK:
REPAIRS DUE TO TREE DAMAGE
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:
Gas: Final: Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
.52 .
Fees Paid: $97.50
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RCI
^The Commonwealth of Massa .use r. MA
0 Board of Building Regulations an.. St.... -ds 1 5
; Massachusetts State Building Cos-, 7 t 2022 PirC°1-PRALITY
- . , pT OF USE
Building Permit App li atio To Onenor 71vonFanti[y Dwelling. � ' "�- Tom.°=ono o�pN, Rev'.ed Mar2011
This Section Fdr Official Use Only
Building Permit Number: 219' .2 a"da C / • Date Applied: — -
t-Fl)I IJ -55 ./71 .3- 15-26z2
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1,1 Property Address; 1.2 Assessors Map &Parcel Number O
13 r Florence � .7a]
1.1a Is this.en accepted street?yes Ti o Ma-p Number Panel liumbe.r
'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 Side Yards. i Rear Yard
Required Provided Required Provided Required Provided
l.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❑ On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP"
1 Owner"of ord•
Name{Pt) City,•State,ZIP •
131 rlUle.r1cE. )6 gt2)� ''Clams
No. and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s).❑ Alteration(s) 0 Addition 0
Demolition C Accessor f Bldg. Number of'Cinits Other ❑ SpecEf}:
Brief Description of Proposed Work': 0'� f,
Fe��r<C� ¶H° NiF' Sr,-.t4'.c. V will zeik '1-c .
G4 f
• SECTION 4:ESTIMATED CONSTRUCTION COSTS -
•
Estimated Costs:
Item Official Use Only
(Labor and Materials) •
1 Building $ / /( 1. Building Permit Fee:$ Indicate how fee is determined:
i3•Standard City/Towm Application Fee •
2.Electrical $ _ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees:-$
4. Mechanical (AVAC) $ List: ' '
5.Medial-deal (Fire -
$
Suppression Total All Fees/:'$ 7 �D .
Check N oa(7� heck Amount: I' Casb.Amount:
6.Total Project Cost: $ 16#-it - .Paid is F Cl Luts#rnding Balance Dale: 1 .
[ - • SECTION 5: CONSTRUCTION SERVICES
5_1 Construction Supervisor License(CSL) ,�`07 ,2,1 p (�12, 12,02-2
af.,..X.1__ 1 -ZQr\ License Nurribcr i Expiration (Date
Name of CSL Holder
-C) C6cAx (.0(-)021 List CST,Type(see below)
No. and Street tf} tG} Type Description
r� Q`�r9,� U Unrestricted(Buildings u�:to-35,000-cu.ft.
City/Town,State, ic' ,V b •t R ` Restricted l&2 Family Dwelling
ry ir% / b.{ Adaa o�irl,
I -- RC ,RoUiing:CuverIng
WS Window and Siding
2C SF SolidFuel'B�urning Appliances
Ltt3— Lt 1S22- 1 Insulation •
Telephone Email address D Demolition -
5.2 Registered Home Improvement Contractor(RTC)
l 05��� 8iza�zs3zz •
Q� n-� 1-UC Registration Number Expiration Date
VC Compar Name or RTC Registrant Name
.QC)/ (c o(A2: -lort°nce m b v cot
No.and Street Email address
City/Town,State, ZIP Telephone -
• SECTION.6:WORKERS' COMPENSATIONTNSURANCE AFF1DAVT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit wi l F result in the denial of the issuance-of th e building permit.
Signed Affidavit Attached? Yes liti No...........O
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 A-,T. l ` c F\
to act on my behalf,in all matt elative to work authorized by this building permit application.
L 41 , • -Va-2,- cg.z
Print Own s Name(Electronic Signature). Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering m name below,I hereby attest under a pains and penalties of perjury that all of the information
contained in • plication is u and ace e best of my knowledge and rstandi-ng.
Print Owner's or prized A is 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(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
www.mass aovloca Information on the Construction Supervisor License can.be found at www.mass.Qov/dos .
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including-garage,.finished basementlattics,decks or porch) .
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms • Number of 3ia1 1 sths •
Type of heating system Number of decks!porches
Type of cooling system • Enclosed Open
3. `Total Project Square Footage"maybe substituted for"Total Project Cost"
City of Northampton
� ir_rl
!A: �,:.- .SAS . .
' i Ci3SS�CttLSEL�S �y1••'' Y !C`1
i
•
t � `. DEPARTMENT OF BUILDING INSPECTIONS -I S ,;,_
�.\� "�`,,` ` 212 Main Street o Municipal Building S Ja
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
•
In accordance of the provisions of MGL c 40, 554, a condition of Building Permit
1 - 1 11 debris
work 1 1.1. 1
Number is that all debris resuiting from this she,: be disposed of in a
properly licensed waste disposal facility, as defined by NI&c 111, S 15-A. .
The debris will be disposed of in:
Location of Facility: r\JQ U 'eQ( 3c1 U\ , ',VP 10 , 1'1
The debris will be transported by:
Name of Hauler: \10.1/ cY6(Yv4 .. 7rtt .
Signature of Applicant: Date: 3-/0 0)j
The Commonwealth of lifassachusetts
(., jrr} Depa £ lett of Industrial Accidents
1 I ;i= _ 1 Congress Street, Suite 100
V,, r�(r Boston,MA 02114-2017
-•• '• wwwmass.gov/ctia
Workers'Compensation Insurance Affidavit:Builders/Cana:-actors/I ic;ctrician€/Pininber's.
TORP FILED yriiH iHr,Pi.retvlTT TING ATJiriCir'2iTY.
Applicant Information Please Print Legibly
Marie (mixing~ciirrgtmirai..i(miindiviuriai): `)(����-P,(.A m rQ ,�9r0\)•e.ry-).cIS�s3.- J p)(
Address: (� \\1 V� � �l� ��- O 9+~- (- 4 "Th
City/State/Zip c- O,rex2C P . ,G-CAO(62_..- Phone#: 1 4,42 J -i S 2 2-
Are you an employer?Check
the appropriate bur: Type of project(required):
1.g i am a employer with \$3 employees(full andfor part-time).* 7. 0 New construction
2.E I am a sole proprietor or parinecship and have no employees working for me is 8. ® Remodeling
any capacity.[No'workers'comp.insurance required.]
9. ❑Demolition
3.� m I ama Iomeowner doing all work myself. 1hlo workers'comp.insurance required.]'
r 10❑ Building addiiion
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will
.ensure that all•oonti'acrors either-have wadies'compensation in ,a-ancc•ar sic s cie - - 11.l]Electrical repair's or.additions
propnetorswith no employees.
12.❑Plumbing repairs or additions
5.0 Tam a general contractor and I have hired the sub-contractors listed on The attached sheet. 13.nRoof repairs
Tese sub-contractors have employees and have workers'romp. insurance.t
6.0We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other
152,§1(A),and the have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box 41 must also fill out the sccticn bcicw.she;. ,.g:.heir workers'compeasatien 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.
*Cvnaatxors that cheek:this box=Lust at`actiedanadditivaal sheet showing the name of the sub-curtrauisrta and state-whether ur•nut'ehuse 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 nay employees. Below is the policy and job site
information. /'
Insurance Company Name: Ai(�C Y'1�Li'i r( (-slyt —
Policy#or See-ins.Lic.#: -^O j C") CD2\ - Expiration Date: c9 L I 1 pZ0rt.
Job Site Address: \?)\ I' LOreir 1C 00--6 City/State/Zip: IOA-hatift (1 l.--), 1 -4/40'O(
C
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expir taon 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 maybe forwarded to the Office of Investigations of the DIA.for insurance
coverage verification.
I do hereby certify under e ,,,ins and penalti ofper• e information provided above is true and correct. •
e
Signature: Date: c7 jet-{I' -
'
Phone#: . 4 l S"l——1 S 22—
Ofcial use only. Do not write in this area, to be completed by city or town official
City or Town• Permit/Lic_ense# rr
Issuing Authority(circle one):
1.Board olfHealth 2.Building Department 3.CitytTown Clerk 4.Electrical Inspector S.Plumbing Inspector
6. Other
Contact Person: Phone#:
•
Commonwealth of Massachusetts
Z irj Division of Professional Licensure
Board of Building Regulations and Standards
Cons AiSO visor
CS-077279 c�' ," spires:06/21/2022
STEVEN A S ERMAN S
PO BOX 6062.7,•
FLORENCE M9 01062
Oils 30 a '.f OM Tr.
1-4
".�
• f't
Commissioner DI t. Bfirax.:..
•
•
•
•
• 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: 08J20/2022
FLORENCE, MA 01062
Update Address and Return Card.
A 1 20M-05/17
gZe Fan.noeuz•eez&c��5r4�acic'u.:e,(4
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 r ( O/I,/
340 RIVERSIDE DRIVE- = yc �.ga < K
FLORENCE,MA 01062 Undersecretary Not valid without signature
•
•