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35-077 (2)
Property Address: Z ` tj (u .. LO OC i Contractor ,,�� >> ``^, Name: i t L-- 1 1 t` eCO V e ►'fit VV - r — Address: t 4-t2\ 4 L ve(4 - City, State: � I k\ 4 A b I -"'� - Y' I Phone: 4 gl --)- --i Property Owner ` Name: I i s '1e I )� G G r avk._ Address: `t D. 1 (A. el ''ZC i City, State: 0 , rer re e 1A-4 I, IYYY_.S ;' 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. 9 c._N,.....„, Contractor signature f r`h e Date )t 1 i a•-1 t1/4) . 6 d L000£98£117 }uewanoiduai aWOH ieepi a9£:60 0l ZI. AoN Property Address: 3 L'1 . Zy AO L Contractor _ Name: �-- OCYY\ --\___M \ .tom C. Address: i L kZ & \`G 1` City, State: @7 k- ) . Phone: t i \ (o - - eXi_ � Property Owner _ c Name: t CE\,LLLc J t'LOWN.Ot.) Address: g \ \ LAN ' City, State: k QL.LCk. C / I, P\1 S ELF-- 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 provid - • - • - • owner with a copy of this affidavit. Contractor signature • ,-----....._ 0 PZ , Date l l - _ 10 • r _� - 4, -,, u> . , , 4, i• Board o : ur .rig ns an, tan. are s = = One Ashburton fia. :e - Room 1301 Boston. Mass chtusetts. 02108 Home Improvement _ Registration: 146402' Type: • Private Corporation • Expiration: 4/222011 Tr# 281991 IDEAL HOME IMPROVEMENT INC. JAMES ELLIS - - - ~- 142 BOYLE RD - � - GILL, MA 01354 Update Address and return card. Mark reason for chna, Addre$s 3 Renewal D Employment {" Lest G DPS - G. ,, A DssuPOfl! A1O$212oos �l u‘sachuxrtts - Department of Public �atct■ B oard of Buildin0 �, Rc„ulaiionz and 'standard. License: CS 91207 , JAMES P ELLIS 142 BOYLE RD GILL, MA 01354 i Expiration: 10/16/2012 (, uuuts.. ,rep r Tr3269 »: • VDAC aar WORKERS COMpENSATtOAL AND EIIIPL VERS LABIUM POLICY TYPE AR 1IPORMATION PAGE WC 0000 01 ( A) POUCY NUMBER: (65601 - 86641.17 -0 -09 ) RENEWAL OF (056008- 9661L17 -0 INSURER: HARTFORD LNERWRITERS INS COMPANY 1. _ NCCI CO CODE: 80411 INSURED: PRODUCER: • IDEAL .HCINE IMPROVEMENT INC A H RIST 142 BOYLE RooAD 159 AVE A GILL MA 01354 PO BOX 39t TURNERS FALLS MA 01376 Insured b A CORPORATION Other work = mrd Iriiintftargrt nrlrfltY,P5 are ahem: In the drie(e) attached. 2. The policy period isfrtn 1 i -18-09 to # i -t6-10 MT Mk at the Itwumd's Mating address. 3. A. WOR EPS COMPENSATION wisiRANce Part One of the policy applies to the Workers Compensation Law of the shags) Ind h MA B. EMPLOYERS LIABIt i7Y INSURANCE: Part Two ONE policy applies to work In each state iMed In Item 3.A. The limits of o Ilablity under Pert Two arm Sony Irby by Accident $ 500DOa Each Accident Badly Injury by abeam S 500000 ply urns Bodily Injury by Disease 3 sonogO Each Employee C. OTHER STATES INSURANCE: Pact Tinged the policy applies to the stems. If any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 OGA D. This pcityt halides these endorsements and schedt - - -,_ SEE LISTING OF E AENTS - EXTENSION OF INFO PAGE be determined ed by' WM �€ of Was C� R and Rating 4. The purl= AS realized infonuation R to vadiketkm and ohehge by =Rio be made ANNUALLY . ST ASSIGN DATE OF ISSUE 12- 18 DR OFFICE ORLANDO DA MED 05G 261.11. aaae The Commonwealth of Massachusetts :_,= t / D epartment of Industrial Accidents _ _ Office of Investigations S4.131.1 1 a 600 Washington Street �' ��° ' Boston, MA 02111 ^ zr•rL. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /organization/Individual): / t Ci L_ i4 f' L i � 1.-:( 0 V e N (t I NC . Address: / `1 o' .1k(i_ c.1 . City /State/Zip: a M 4— pi 3`-Z{- Phone #: t- }' i 3-- 2 Ln - i Are you an employer? Check a appropriate box: Type of project (required): 1. t1 I am a employer with Q 4. ❑ I am a general contractor and I employees (full and/or part-time).* s 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' [No workers' comp. insurance comp. insurance. 9. Building addition . required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no ❑ employees. [No workers' 13.0 Other comp. insurance required.] , *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. i t Homeowners who submit this affidavit indicating they are doing all work and then hoe outside contractors must submit a new affidavit indicating such. $ Contractors that check this box must attached an additional sheet showing the mane of the sub - contractors and state whether or not 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. j Insurance Company Name: f L/-4C(i ' 1( ' 1 _ Policy # or Self-ins. Lic. #: l (( (' L i I - Q I L Expiration Date: II — / 2 )C;i L. Job Site Address: 0 1"1 6a/it iCcl City/ State/ Zip: o {C/j"C, N 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 fuse 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. 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 ce under the pains and penalties of perjury that the information provide correct. above is true and correc Sip ature: '�l, -` -- -, , t' ' S Date: / i i , Phone #: ` I f/ 3 C ' 3 - = l Official use only. Do not write in this area, to be completed by city or town o 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 #: • REM*, -41' tJSV , 8.1 Licensed Construction S pelrvisor. Not Applicable ❑ Namo Of ki s9 Holder : (` r ►e $ ( / / 1 S qta.07 6.54/c 101/(c, pal-I-- License irriber Address Expiration Date S tore Telephone Not Applicable ❑ / c_ / - ' 4 L / NPt_O i"/e AI1 /z-f-6 4.0 0� Com Na Regi on Number a ail .() Address • l l �/ Expiration Date ( S Telephone { r �J el sc 10- VVOR*ERWOOMPOWATIONNSMANCE viTtuAL c. 15X,1204.4 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 build permit Signed Affidavit Attached Yes No ❑ 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 E ' • n 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 f: ily dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs m than one home in a two-year period shall not • considered a homeowner. Such "homeowner" shall submit to the But . • , Official, on a form : , a e : ui ding Official, that he/she shall be responsible for all such work performed un the 1 ' ' , . ermit. As acting Construction Supervisor your prese i e job site will be required from time to time, during and upon completion of the work for which this is issued. Also be advised that with refer - . Chapter 152 (Work ompensation) and Chapter 153 (Liability of Employers to Employees for injuries not • Lilting in Death) of the Massachu - General Laws Annotated, you may be liable for person(s) you hire to perform for you under this permit. The undersigned " homeowner" certifies and assumes responsibility f• compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of sachusetts General Laws Annotated. Homeowner Signature • New House C] Addition ❑ Replacement Windows Alteration(s) ❑ Roofing El Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [a Siding [O] Other [lia Brief Description of PJ (},,,�., Work: G�� "` r f /Y t S` fiStA (K�' b r1� Alteration of existing bedroom Yes No Adding new bedroom Yes e Attached Narrative Renovating unfinished basement Yes – No Plans Attached Roll - Sheet 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 SWOON 71 OWO RI TION • TO gie 0014 W$gt4 oVitags pc 1, t M Ci r j , as Owner of the subject party he. :by a , . . S c " ii to -' « on m , - in a - i relative to work authorized by this building pe it a . . lication. Signature of Owner Date 1 . I, ..- -- Y S p/1/ S , as Owner /Authorized Agent hereby dedare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed u • - the pains and . - fl' ,, of perjury. nitS iv Print Name it )i0 Signatu 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 r – __ Lot Size I L Frontage Setbacks Front 1 I Side LL__ R:______J L: R s �1 _r_...i Rear I - 1 .I Building Height 1 Bldg. Square Footage pj % F-1 1 I L Open Space Footage % (Lot area minus bldg & paved j f I L_J parking) # of Parking Spaces —•-i t £ 1 • Fill: (volume & Location) ,--, A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW ® YES Q IF YES, date issued:1 w IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES 0 IF YES: enter Book I Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained Q , Date Issued: I C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: I D. Are there any proposed changes to or additions of signs intended for the property ? YES Q 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 pion that will disturb over 1 acre? YES Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is•required. • City of Northampton Building Department ''' 212 Main Street -, Room 100 Northampton, MA 01060 phone 413 -587 -1240 Fax 413 -587 -1272 I j APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING 4. .. 1 1.1 ProoertVA ,1 � „,, . SEO" 2 fri V 2.1 Owner of Record: � f� /y L 60 Ve.r n i n , n l +1' V f'` r A J !.r 1 l F' H 21c, 4 tt.+'V & j C*O I 5 � Z me (P current Mailing Address: Ci 1 1 — 9 9 1-2.7•0 Lil i Telephone Signature 2,2 Authorized Anent: Current Mailing Address: S " . re Telephone St#TQ�t; #1I:iT1'�N€:#t Item Estimated Cost (Dollars) to be tl completed by permit applicant 1. Building. 2. Electrical (t� )i�d fi z`. tttiavf , 3. Plumbing Pte 4. Mechanical (HVAC) 5. Fire Protection 6. Total ( *2 +3 +4 +5) C7 J q 0 t0 N� � tniding n , rr rn�isslor or o€ u, 1 File # BP- 2011 -0432 APPLICANT /CONTACT PERSON IDEAL HOME IMPROVEMENT INC ADDRESS/PHONE 142 BOYLE RD GILL (413) 863 -2128 PROPERTY LOCATION 842 RYAN RD MAP 35 PARCEL 077 001 ZONE SR(100) //WSP II THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid by / Tvpeof Construction: INSTALL ATTIC & RIM JOIST INSULATION 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 INFOATION 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 Commission Permit DPW Storm Water Management Demolition Delay 5 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. st n r < BP-2011-0432 'k GIS #: COMMONWEALTH OF MASSACHUSETTS :t3 � on CITY (iF 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- 2011 -0432 Project # JS- 2011- 000704 Est. Cost: $3059.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: IDEAL HOME IMPROVEMENT INC 091207 Lot Size(sq. ft.): 19906.92 Owner: SOLOMON MICHELLE Zoning: SR(100) //WSP II Applicant: IDEAL HOME IMPROVEMENT INC AT: 842 RYAN RD Applicant Address: Phone: Insurance: 142 BOYLE RD (413) 863 -2128 GILLMA01354 ISSUED ON:11/8/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: INSTALL ATTIC & RIM JOIST INSULATION 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 11/8/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner