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30C-073
568 BURTS PIT RD BP-2018-1329 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:BIOCk:30C-073 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-2018-1329 Project# JS-2018-002355 Est.Cost: $2000.00 Fee, $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: IDEAL HOME IMPROVEMENT INC 091207 Lot Size(sp ft.): 32931.36 Owner: GEORGES YVES M zonine� SR(100)/WSP(l00)/ Applicant.• IDEAL HOME IMPROVEMENT INC AT. 568 BURTS PIT RD ApplicantAddress: Phone: Insurance., 142 BOYLE RD (413) 863-2128 WC GILLMA01354 ISSUED ON:6/1412018 0:00:00 TO PERFORM THE FOLLOWING WORIG488 SQ FT R37 CELLULOSE OPEN ATTIC, WHOLE HOUSE AIR SEALING 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 6/14/20180:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner SGEIVED Department use only •.- -- lyo No hampton Status Of Permit g Idi gD partment Curb CWOrivessy Permit JUN 12 20141 Mai Street SesedsepticAvailabft oc 100 Water/Well AsmilabiNy DFPT OF aDILDING I t0 MA 01060 Two Seta of Structural Plans NORI TW41IDW-124 Fax 413-587-1272 PW]Site Plans Otlrer Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONEORTWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 18_ 13Z 1.1 Procell Address:'� ,� '�^ This section to be completed by officee r,u% 4 /. F')� Map w o" Lot 0 -73 Una Zone Overlay District Elm St District CB Dishict SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 21 Owner of Record: \�uQ,S �2F�YYGI�S Name(P nt) Cueen thM ' dre ai L4l • - qOBb Telephone ature 2.2 Authorized Anent:c� ��GmPS utiS IUa- r'�crflR � ��ll t�YIA, Current Mailing Address: a w Ula gU3 ata8 Sign ure Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial 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) �`J Check Number Q This Section For Official Use On Building Permit Number: DateIssued. Signal / Budding missionerlinspector of Buildings Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This wlumn to be filled in by Building DVartment Lot Size Frontage Setbacks Front Side U R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot mea minus bldg&pavW trucking) #of Parking Spaces Fill: volume ffi Location A. Has a Speciat Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW (D' YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW Q— YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW (2r YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O 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. VVII the construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO Q— IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION S-DESCRIPTION OF PROPOSED WORK icheck all applicable) New House ❑ Addition ❑ Replacement Windows At national ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [q Siding[0 Other MIAV 4."n Brief D.QsFgptipn Pmpse � du�� t�lOQ11 ,� /L;G ] iA� .Q_Yl(A,I%P (1 LY�IAPt� Wark WII'86�SJJrr 11 l/U(I Alteration of existing bedroom_Yes ✓ No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes ✓No Plans Attached Roll -Sheet Ga. 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? In. Type of construction 1. Is construction within 100 R.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. L Septic Tank_ City Sewer_ Pnvale well City ureter Supply SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �Uf,S as Owner of the subject property �1 herebyauthorize cJCAAM-cs �atis to act on my behalf, in all matters relative to work authorized by this building permit application. 11WAA W5, 5Ia S atuna ofOwner Date I, S st15 , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the painsand penalties of perjury. YY1k.S Exits Print Signature of dAgent Date SECTION 8-CONSTRUCTION SERMICES 8.1 Licensed Constructlon u rvlsor: Not ApplQicjble ❑� Name of Lt.."Holder'. S `)a License Number AUX r6y\Jto 1(0 -N ss Expiration Date e,-i l¢ S nature Telephone 9.Replstered Home Improvemerd Contractor: Not Applicable ❑ 1dAe P mQr�t�m2�1+ Number Comoanv Name /� Registration Number m s � ' Expiration Date Telephone "I l'�W3")I//1'� SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit in I be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildin ermit. Signed Affidavit Attached Yes.._... BY No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was emended to include Owner-occupied Dwellines of one(1) or two(2)families sod to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner sets 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 faun structures.A person who constructs more than one home in a two-yea,,perriod 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 buildine 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 City of Northampton 212 Main Street,Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: SIPS VO4- The debris will be transported by: n l R The debris will be received by: 1' A Building permit number: pp Name of Permit Applicant cJCa N S Zin S U1 Date Signature of Permit Applicant Q— City of Northampton Massachusetts � - s DEFABTTLCNT OF BGZLDIBG l'BBFECTZOBS \\ 212 Main Strut a t iaipal Building oys a�a` !1 p ,��II Nor/N'�') ton, I 01060 Property Address: qPS I-7 kfk'S R�1t(U . Contractor \_U_ S &- Name: 1hnfl ltS Address: /�)�-ta- t� tR (W City, State: 1Rtt MA Phone: 413 g�� a l dg Property Owner Name: /��1 (0Y CS Address: Clog 604-' I+ � . City, State: q1 c)fwL2 YY\k I, JWV'IS fA115 (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 signatu � Date l a1PA Iq The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Hnsumes/ogard ;o iaaAl>, p_ �YY1l7fOlJCYT�3/FE' Address: [� KP City/State/Zip: `Xtj M(t �l3 Phone#: 3ldhQ Are y u an employer?Check he appropriate bog: Type of xeconstruction L _ am an employer with 4. : 1 am a general contractor and 1 p/¢ase Check One employees(full and/or part time).- have hired the subcontractors o 6.New construction 2, r 1 am a sole proprietor or partner listed on the attached sheet. o 7. Remodeling ship and have no employees These sub-contractors have o g. Demolition working for me in any capacity. employees and have workers' o 9.Building addition [No workers' comp.insurance comp. insurance.: o 10.Electrical repairs or required]. A L We are a corporation and its additions 3. 1 Join a homeowner doing all work officers have exercised their o 11. Plumbing repairs or myself[No workers'comp. right of exemption per M.G.L. additions insurance required]i c. 152, § ](4),and we have no r: 1y.Roof repairs employees.[No workers' 3.Other��1.�(� comp. insurance required.] *Any applicant that cheeks box NI must also fill out the section below showing their workers'compensated policy Imformafion. tHomem ners who submit this affidavit indicating they are doing all wark and then hire outside contractors must submit a new affidavit indinfingsuch. tContacmn that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not these entities have employees.If the subarootractors have employees,they most provide their workers'temp.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: J r� 1 t lincz:evrD-n u-❑ (). Policy#or Self-ins.Lic.#:: w C"1,/�1(P`1l Expiration Date:_ Job Site Address: 5–C CAAY}'S P+ [7d —City/State/zip: f Iormu, le cog Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration(date). Failure to secure coverage as required order h'C xion 25a of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one year imprisonment as well as civil penalties in the form of STOP WORK ORDER and a fine of $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby othepait an prndaesofpevjurythmerefgtonewason .Signature: \ ro.' vidQ111a]blagqqer6�1eand core2 Date ((�' Print Name: ( uftllys �uls Phone#:�{,' pVG�' o1� t�h Official use a*Do not write in this area to be completed by city or town ofpalal City or Town: Permidlicense#: Issuing Authority(circle one): (.Beard of Heath 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phome#: A�a CERTIFICATE OF LIABILITY INSURANCE 01,�1201a' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIR IATNELY OR NEGATIVElYAMEND,EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT N the cerificae holder Is an ADDITIONAL INSURED,Me poliry(Ias)must have ADDITIONAL INSURED proAsionB or he endorsed. N SUBROGATION IS WAIVED,subject to the tarots and conditions of the pocky,certain policies may requirean endomemerR A statement on this cerNBcata does not toner rights to se certificate holder In Beu of such endmaement(a). PSC.CER iA Antlrea Fcesy VVeEber B Gnnnell %IoxE (413)5859111 (413)SBBfi481 8 NoM Nng Street AOOREss: a feeleYdTNebbemmlgrimeALrom AISIREWBIAFFORDINe COVEAABE HAIL. NMM1empton M4 SIGNS INSURERA Sekpivelns COMSCard'ma INBIIREO MuSuIen.: IOeal Home lmprovemeM.Inc. NsuREn C, AMLaune Ell,. W9VRER 0' 142 BPfle Road NBURER E: Gill MA 01350.9731 NWRER F: COVERAGES CERTIFICATE NUMBER: Exp11Y2018 REVISION NUMBER- THIS UMBERTHIS IS TO CERTIFY THATTHE POUCIES OF INSURANCE USTEO BELOW HAVE BEEN ISSUED TOME INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTVu1THSTANDINGANYREOUIRFAIEWTERMORCONDRIONOFAWCONTRACTOROTHERWCUMENTWA RESPECTTOWHICHTH15 CERTIFICATE MAYBE ISSUED OR MAY PERTAIN.THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALLTHE TERMS. ECOLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOM MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR WPEOPINWRANCE INBO WVY PNICYNYYBFA YYm YN CoSMEACIALGENEAALWBILITY EACH OCCURRENCE �$ 1'D00'D06 CUIMSMAOE FX-1CCCURf PREYIBE Eauumaw E 'aW MEDExPPWY-I—A S 15,000 A 32281368 1111)1201) 11I1TI2018 PERBONALBAWINIURY S 1,000,000 GEN'LACGHEGA UTAITAPRIESPER'. o.mNALAGGHEGATE s 2,000.008 x POLICY '– jR0- 2.000.000 ECT LW PROWCTS CCMP,WAGG E OTHER: AUMMOBILE LIABILITY lOOkffu..SI N..UMn E 1.006,090 PNYAU TO 8OMLYIWURYrywAmmr) $ q owNED AmEWIeBODPw D A9105410 111191201) 11/17IM18 LLYIILURY1a9sYq $ NL.DSLY NUi05 RED O.O.E. PROPERTY DAMAGE ALTOSONI AUYYS CRY E Ummrumol motorist Bl E 100.000 UNBRELLA WB OCW &J& 6CURII.E S 1'000'000 A ERCess.8 cLu.:eASE S229136B 1111)1201] 11H7SS18 AGGREGATE S 1,000,000 xT.E S W➢RKERa COYPERMTON PFA ANDENMOYER9'INBNTY IIN STATIRE FA ANY PROPRIEJCNFRAENFXECUTEIVE ELTl ACCIDENT E 500'O00 A TNOFFICERMBABERMLUDEDt NIA WC905]69T olim2 10 012 019 IMeMNory In Nm EL.USEISE FAEYROYEB S SMOCK) Nre:a:mix,mmsaD,88o OESCRIPHON OF OPERATIONS hW L'SeAASEKruNn-PCIs oRscxIPTN]N Or. fmk SILOCA .SI.c.esl.eono.o..A—.. CERTIFICATE HOLDER CANCELLATION SHWLOANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evuler Ce of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTgRBEO feenUsENTATNE 01383-2816 ACORD CORPORATION. AN rights mserYed- ACORD 26(21X8103) The ACCRD Trema end logo a e registered marks of ALCORD Massachusetts Department of Public Safety Or Board of Building Regulations and Standards tens.:CS-W1207 JAMES P ELLIS _ 102 BOYLE RD GILL MA 01366 nn '' �✓:n l._ apiratiom - - -- -- -- --_.-Commissioner 10/1612016 HOME IMMOrFNirsa CONTRACTOR HOMEI01PfiOVEMEM CONTRACTOR - TYPE:Carponsen Rw aim.n F Ira ion 1<, 04121/2018 IDEAL HOME IMPROVEMENT INC. JAMES EWS 142 Boyle Rd Gill,MA 01354 Undersecretary