24D-168 BP- 022-0875
203 STATE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24D-168-001 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-2022-0875 PERMISSION IS HEREBYGRANTEI TO:
Project# RENOVATIONS Contractor: License:
VALLEY HOME IMPROVEMENT
Est. Cost: 52000 INC 077279
Const.Class: Exp.Date:06/21/2024
Use Group: Owner: CURRIE-RUBIN, RACHELJ & MARK ESPOSITO
Lot Size (sq.ft.)
Zoning: URC Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON:07/25/2022
TO PERFORM THE FOLLOWING WORK:
RENO BEDROOM
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL• TION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I >2
i t • '1 6
Fees Paid: $338.00
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
�/ \ CPC#ns i�- ;;��
The Commonwealth of Massada etts dip �a J' FQ�
T° Board of Building Regulations and tan •rds 22
rIC ALITY
Massachusetts State Building,Co 78EP IA -e ���� SE
N�°F
Building Permit Application To Constuct,Repair, Ren 64444 • ish a evi.r dMar•2011
One- or Two-Family Dwelling. pTO•41Ao'Co,°AIS�
This Section For Official Use Only
Building Permit Number: �?P- A,). 87 Date Applied:
I I
t i r i ,HT,&.:6
' 1 (Print Name) I Signature Da
Building Official CP e
SECTION 1; SiTF.INFORMATION
1,1 PropertyF
Addr ss: ` y ! 1.3 Aesesc r�Map & Parcel Nurrib
:Tel g
1.i a is this ari accepted street?yes -no - Map T umber 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 Srde Yards Rear Yard
Required Provided Required Provided ' Required Provided
1.6 Water Supply: (M.O.L c.40,§54) 1.7 Flood Zone information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: — Chheckk ifyes�Outside Flood Zone? Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2 i ( w -F of Record: •
4616 CO T(t C -(Z,',A9,i t- ho k E `� -Wailt rri in 0 G i Oto O
Na t) City,.Start,ZIP •
?,tom Y 13--32o 2c) .
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) 0 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number ofUnits . Other 0 Speci1:
Brief Description of Proposed Work: k14.t"od to 4111111.140ftr c x2 4' p-3 Eo— U-N. .
n-0 e X-b .,) !-fit c S+u-- -ro„ . "Iv -.-« C'GU"- sp e-y ! -.N. � .jr-ee4,ec Gt
SECTION 4:ESTIMATED CONSTRUCTION COSTS •
.
.Item Estimated Costs: Official Use Only
(Labor and Materials)
l Building $ % ) 1. Building Permit Fee: $ Indicate how fee is determined:
0Standard City/Town Application Fee
2.Electrical $ 411k CI.Total Project Cost'(Item 6)x multiplier x
3.Plumbing $. B K 2. Other Fees: $
4, Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total At Fees:
Check No4. aClheek Amoutit 0 Cash Amount:
6.Total Project Cost: _ $ cZ . 6 Paid in Rai CI Outstanding Balance Due: -
�.... SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
e\ri-\ 70 e -1 nay--. licenseNtruiber Expiration Date
Nam of CSL Holder
List CSL Type(see below)
P- cl< (CO(021 •
No.and Street Type Description
d� p �� rr Unrestricted; uilain s up to 5,000 cox.!t
`Qc'en,CC— tv (o7✓ _. R Restricted I&2 Family Dwelling
City/Town,State,ZIP L M. WWIIry .
RC Uuiing Covering+.
WS Window and Siding
SF Solid Fuel'Burning Appliances
14 'Lt 7/j22- I Insulation
. Telephone Email address D ( Demolition
5.2 Registered Home Improvement Contractor(HTC)
`� . l DSS(k3 8 zo ��
�!t 71.� A�*5 T Q.La�(T�V`1'Y7' 1 1 FIIC Registration Number Expiration D
CCo Name orHlC12e istr t Name
t,. oiG (oocoz,-/ c 1.0,r5-)C•e.CY lPs 010 b7—
No. and So-eet fi"ail address
4t2)-S'-t=iS22
t City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFTDAVIT.(M.G.L.c.1 S2,§ 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 lif No 0
SECTION 7a:OWNER+R AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize I -" Cr Cj i, ,- ea_
to act on my behalf,in ail matters relative to wor auth ' by this building pr unit application.
R - , ,0 ,Av
'Fruit Owner's Name( 1ectronic Signature). Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
1---
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained '‘this a/plication is true d accurate to the best of my knowledge and understanding.
7ifit!
Print Owner's or Authon.z d. 'e;tt's Name(Eleco-onic Sigaauac) 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 hind under M.G.L. c. 142A.Other important information on the HIC Program can be found at
w w rnass.szovr/oca Information on the Construction Supervisor License can be found at wrcvw. ass.Qov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or parch)
Gross living area.(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halfbaths
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 Uorthampton
f_ t L. h�assachusetts ��t''
LLL L DEPP.RTKENT OF BUILDING INSPECTIONS 'it t '
c 212 Main Street • Municipal Building
�: P
w v
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 sha it be disposed of in a
properly licensed waste disposal facility, as defined by MGi_c 111, S 150A. .
•
The debris will be disposed of in:
Location of Facility: \la l OC 3C1 ., t VP 10 . Q,,�h -�
The debris will be transported by:
Name of Hauler: \l }l , •
Signature of Applicant: Date: r1I{I (zo22
•
mac-_\=
The Commonwealth of Alassaclausetts
.'-- 9 Depar•tnterzt of Industrial Accidents •
( '7. ;3)
t .I Congress Street, Suite 16'01�` Boston,MA 02114-2017
1
?\,. 1411,111.inass.gov/dia
W rkeis' Cr3tarpereatsh.n Insurance Affidavit:Eitilder•sICcinh"grtnrsUecctr aats/P1uFubei-s.
TI)RP,r;ii.F,i)WiTii Ti-i17,Fn.icM ITT'NC;AiIT i ORI T Y_
Applicant Information 11 r I� l�4{f_ Please Print Legibly
Name_.Y ` y -V -j �" fJY' CO\if nnP c1,1- i , r
mange in nNines.creirganizai.icmiinciiviritiai):
Address: L l) ��v-f,(50,.-C-- ---- tr l ?- 0 . (C,G (c)0 Co 1-
City/State/Zip AQre C e .\A,G-CAL) 2-- Phone#: t-4,t2j- Sc2,9—I S22.-
Are you an employer?Check the appropriate boL: Type of project(required):
1.`mot I am a employer with i 1g employees(full and/or part-time)." 7. 0 New construction
2.❑I am a sole proprietor or partnership and have no employees working tor me in 8. ® Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.n I am a homeowner doing all work myself. No workers'comp.insut-auce required.''
10❑Building addition
4.0 I am a homeowner and will be hiring contactors to conduct all work on my property. I will
•e s-ure that ail contractors-e+ther•have woilcere compensation i,ns-orance or arc sole • • 11.0 Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5 Tam a general contractor andT havt hired the Sub-contractors listed on the auachedsheet.
❑ 13.0Roof 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,§1(4),and we have no employees. [No workers'comp.insurance required.]
'Any applicant that checks box n1 mast also fill out din section bclow showing the.r w orkm '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.
1Cvatrectum that tdzec-k this tog toast attached—as-additional shtet showing name ut the sail-contrtxtars and state'whether or'nut those entities have
employees. If the 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 r( ,ii, c c-,t.oa i c ( v'O1-.
Policy
4 -.S ]fi_ #: CO5r ,CJ vL\ Expiration Date: a } i l 0a3
rvrlCy tr�i Self-ins.L1i:. tt. tt �� gl.-..
a:n li'atior7 Lraw.Job Site Address: .b ,k,' City/State/Zip: , ('[1L,, kt—i. i 0l 0
Attach a copy of the workers' compensation policy declaration page(showing the policy number and eapir4tion 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 err'ns and penalti of per' e information provided above is true and correct.
Signature: Date:
Phone#: "l l - Q"1- 1¶22-
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/I,icense.#
•r
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Persoa: • Phone 4:
•
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Cons"r. itiki {5visor
C5-077275 . pires:06/21/20214
•
• STEVEN A S ERMAN"C; I
PO BOX 6062.7 _ •t. n
FLORENCE M9 0106 � s•
cy rr. � q
•
0130 : '
{t y•.
Commissioner f. �. cremilita.,
•
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: 08/20/202q
FLORENCE,MA 01062
Update Address and Return Card.
1 i, 20M-OS/117
17 ,o
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 1/e'`✓V , U
340 RIVERSIDE DRIVE - .�t r'G
FLORENCE,MA 01062 Undersecretary Not valid without signature