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24C-181
� €04,14-tvoluveatig yczitciada,e460ein Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massacijitetts 02116 Home Improvement dr(intrac tor Registration Registration: 146402 Type: Private Corporation • Esph 4/2212013 Trig 209431 IDEAL HOME IMPROVEMENT INC.:, JAMES ELLIS 142 BOYLE RD GILL, MA 01354 Update Address and return cat* Mark reason for change. Address fl Renewal Employment ID Lost Card DPS-CM 0 5014-0414-G101216 _ ------_— — — - Massachuetts - Department of Public Sart'. ' Board of Building Regulations and Standards Construction Supervisor License License: CS 912W JAMES P EWS 142 BOYLE RD GILL, MA 01354 Expiration: 10/16/2012 ( ommis‘inner Tr#: 3269 •• • ACp CER TIFICATE OF LIABILIT INSURANCE f n PRODUCER nom 4158634373 Fi0c 4158838658 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION A.H. RIST INSURANCE AGENCY, INC. ONLY AND COI RS No RIGHTS UPON THm CERTIFICATE 159 AVENUE A Hotoei. MS CERTIFICATE DOES NOT AMEND, EXTeD OR P.O. BOX 391 ALT ALTEit THE COVERAGE AFFORDED BY THE POLJCIES BE ow. TURNERS FALLS MA 01376 INSURERS AFFORDING COVERAGE NAIC 9 INSURED INSURER A NAUTILUS INSURANCE COMPANY IDEAL HOME IMPROVEMENT, INC. INSURER it PILGRIM INS. COMPANY 142 BOYLE ROAD . C TECHNOLOGY INSURANCE COMPANY GILL MA 01354 D: INSURER E: COVERAGES THE POLICES OF INSURANCE LLSTED BELOW HAVE BEEN ISSUED TO THE WSLRE) NAMED ABOVE FOR THE POUCYPE1IOD INDICATED. NOTWITHSTAMDNG ANY REQUIREIERT. 1BBA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHEN THIS CERTIFICATE WAY BE ISSUSI OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE PONS DESCRIBED HEREIN IN SUBJECT TO AMITE 7EIMS, IMCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATEL00TS SHOWN WAY HAVE WEN REDUCED BY PAN (MAWS. ineat TYPE OF INSURANCE PO1LICY AMBER MUM(' EFFECTIVE GL. T$ LIR DATE NeeULe YY! DATE AeylpOfYY, GENERAL LLABUJTY GL. 20109227 ti /19110 11/19111 E/ACN . «« �_ $ 1,000,000 X COf IAN_ GENERAL �, a 100,000 © Ate. E� (Amy me person) $ 5,000 A 1 PERSONAL &MTV MIRY S 1,000,000 GFlNF�RIU wTT $ 2,000,000 OCCUR GERLAGGI EGATE LNBTAPPLES PER STS - /OP S 2,000,000 1 TAY n IFT T nL AUTOMOBILELTABInY PGC10009703302 11/17110 11/17/11 coNswaD SINGLE LBW AN 5 1,000,000 ----+ Y AUTO LEs accsay 0 - AU.OWNED AUTOS �/L s X SCHEIRAED AUTOS 8 X now AUTOS 9004.1 mi X NONGINNED AUTOS (Per accident) X tt1ASS i+at1CYFORM S GARAGE UABII.tTY AUTO EAA[9T s ANY AUTO O MERTHAN EA .« $ AUTO OM.Y: AGG $ EACH OCCURRENCE $ EXCESS /UL UMBRELLA UABam► OCCUR Q CLAIMS MADE AGGREGATE $ $ S DEDUCTIBLE s HETENflON 3 r 11118110 11118111 X l uee 1 J E pp g usuo ATTON AIM VtIC 1136680 EL. EACH nc S 500,000 EMPLOY � tJA� -TTY rra EL DISEASE -EA B 'ROY $ 500,000 C 4 © El_ DISFASEPOUCY LIAM $ 500,000 gyos,aaaobsmmor spECULniovi amiti • OTHER DESCRIPTION OF opERAnoNtatocaThotaNsucLEsiexcLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS Classification: simulation CANCELLATION CERTIFICATE HOLDER ANY OF ABOr1� DES 0 Be cewoa . L ORE THE 1 SHOULD IDEAL HOME IMPROVEMENT, INC. EXPIRATION DATE THEREOF. THE INSURER yyLLLFJWEAVr]RTO 11AAI Io DAYS WRITTeI NOTICE TO THE RTE HOLDER NAMED TO THE LEFT. BUTFAILURE TO 942 BOYLE ROAD 00 SO SHALL DOSE NO 08UGATION OR LNBMY OF ANY KEW UPON THE INSURER, ITS GILL MA 01354 AS OR � REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ; fib kid 1Lx Attention: M 4088-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (Z I) The ACOCertificate RD n an kw are registered marks of ACORD • • <_''' The Commonwealth of Massachusetts Department of Industrial Accidents a - ----- 4 x Office of Investigations rf �;; 600 Washington Street . , :f: Boston, MA 02111 '' ":F"w www.nurss.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information / Please Print Legibly ! Name ( Business /organization/individual): att__,i4 0 1\t / Mel? 0ll- .xiC! Air Address: i y id ec4 City /State/Zip: 2 , I j MA- 013C Phone #: 4 4 - 4-- i • . 3-- 02/ of y I Are an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 1 4• ❑ I am a general contractor and I s employees (full and/or part- time). * have hired the sub - contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp. insurance COmp. insurance' required] 5. 0 We are a corporation and its 10. ❑ Electrical repairs or additions 3. ❑ I am officers have exercised their a homeowner doing all work 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12. f insurance required] t c. 152, §1(4), and we have no L�l� employees. [No workers' 13.L1j Other / n S u-1 GCIl fvt-J comp. insurance required.] =Any applicant that checks box #1 must also fill out the section below showing their workers' 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. tcontractors that check this box must attached an additional sheet showing the name of the sub - contactors and state whether or not those entities have employees. lithe have employees, they must provide their workers' comp_ policy number. I am an employer that is providing workers' compensation insurance for my employee& Below is the policy and job site informadon. Insurance Company Name: J-QCA 1'10 43 // f'til-ef----- pia - Policy # or Self -ins_ Lie_ #: ` tit C. 113 (, jv O Expiration Date: /I 1/ S l J Job Site Address: O� `-« I 0 rezc h+ City /State/ZiW/O (APIA, r, r 6 14' Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 $750.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby a fl under the pars and penalties of perjury that the information provided above is true and correct Si L . / If ri 5 Date: [ L t' 1 \ r Phone #: " ( 2 6 3 - cs2lr? Official use on Do not write in this area, to be cong►Itted by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City!Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Property Address: Ri d (tecen 1 �- , f' rq-L- is 6' /o 6 c / t Contractor Name: i f --itC - fk 1 Mei2 b V'I'M -G nlT Address: I ( frA de 1 City, State: ( 11 N4 01-& -\i' Phone: Tt L? ?o.3 X21 & Property Owner / �� Name: U d - Address: aA / 9 / eresci-rtf- 1 r City, State: NO r am —f il, d4-- Q 10 66 I 1 , ..- a vYle .S Fill S (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signatur 2___e)L .,..____, Date 31 1 44 I I 1 1 r SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction S c ervisor: / C Not Applicable ❑ Name of License Holder : .. Me S F` / f J License Number / ► , ��le_ e� l I1 M4 O(3' � /v --- �a / (0� Address J Expiration Date ,10. -- Li/ 810 3 r,9 E Si ature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ l 4 L. M.Q i !�( I°�Ovat- e n! r / /QC . / 46 `to =\ Com n N m Registration Number Addr ss ( r Expiration Date (-- P II'.-P S . Telephone3 - 213 " BAs 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 .1;ir" No ❑ 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 ) 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 fa • dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more 1 . 1 one home in a two- yea�period not be considered a homeowner. Such "homeowner" shall submit to the Building 0 '.1, on a . . cceptable to the Building Official, that he /she shall be responsible for all such work performed under the ' • • ng permit. As acting Construction Supervisor your preses on the job s - will be required from time to time, during and upon completion of the work for which this pew' is issued. Also be advised that with reference . hapter 152 (Workers' Compensat .. and Chapter 153 (Liability of Employers to Employees for injuries not re . mg in Death) of the Massachusetts General La notated, You may be liable for person(s) you hire to perform wor, or you under this permit. The undersigned " : eowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton 0 • mances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing El Or Doors El Accessory Bldg. ❑ Demolition El New Signs [0] Decks [Q Siding [0] Other [ ' IIKu.l €Y\ Brief `j : ' H a . Eo t ,foposed ,� I �S - / ` Work: l ( � c�,�.�ic � � �( �,PdC.�Gt'IU� 14)601% f7! CC��r2C - 1 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes 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 rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT T r I, .�„� V �L-r`� d k.. , as Owner of the subject property hereby authorize jet riV S F 1 // to act on my bet lf, in afl ma rs relative to ork authorized by this building permit applicati / , Signature of Own Date I, ■ L .n(V5 ( S , as Owner /AL zed Agrgt hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Sign uder the pains and penalties of perjury. rill . S Print ame D Fil i Signature of Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete 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) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW if YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW 10 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, 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: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO it' IF YES, then a Northampton Storm Water Management Permit from the DPW is required. r A- 4 Jr 7,4 . , • S Department use only \ City of Northampton Status of Permit: ` '' Building Department Curb Cut/Driveway Permit 4 Itii ► 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability �,, �' Northampton, MA 01060 Two Sets of Structural Plans •,, ' , P phone 413 - 587 -1240 Fax 413 - 587 -1272 Piot/Site Plans ,, e, Other Specify PPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Properly Address: This section to be completed by office i g ere CCO 01 a-. Map Lot Unit Zone Overlay District Eim St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Ow per of Record: , -J a \/ Tlid. I c �S' m,' ac propel Name (Print) / J Current Mailing Address: t/ Telephone Ail _ 6 9,5_ 12,05) Signature �`�. ` __ ..= 2.2 Authp ized Agent: ■ fkineS Ell l S /L &yiC ieCsi 6 I i 1114 Oi33f Name (Print) Current Mailing Address: ( I - I 3 g(e3 Q i 3 ? Si. ature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2 +3 +4 +5) dcl, (:p Check Number /0 _ S This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2011 -0725. APPLICANT /CONTACT PERSON IDEAL HOME IMPROVEMENT INC ADDRESS /PHONE 142 BOYLE RD GILL (413) 863 -2128 PROPERTY LOCATION 218 CRESCENT ST MAP 24C PARCEL 181 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out / / 9 $6 Fee Paid Typeof Construction: INSULATE ATTIC & EXTERIOR WALLS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 091207 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFWAIATION PRESENTED: V -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 Commission _ Permit DPW Storm Water Management Demolition Delay 1 S lr of B ilding 0 ficial 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. 218 CRESCENT ST BP- 2011 -0725 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24C - 181 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit # BP- 2011 -0725 Project # JS- 2011- 001205 Est. Cost: $2926.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: IDEAL HOME IMPROVEMENT INC 091207 Lot Size(sq. ft.): 11848.32 Owner: HAMKINS SUELLEN & JAY INDIK Zoning: URB(100)/ Applicant: IDEAL HOME IMPROVEMENT INC AT: 218 CRESCENT ST Applicant Address: Phone: Insurance: 142 BOYLE RD (413) 863 -2128 G I LLMA01354 ISSUED ON :3/16/2011 0:00:00 TO PERFORM THE FOLLOWING WORK :INSULATE ATTIC & EXTERIOR WALLS 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 3/16/2011 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner