29-608 (5) 47 STONE RIDGE DR BP-2018-1330
GIS#: COMMONWEALTH OF MASSACHUSETTS
May-Block:29-608 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categom INSULATION BUILDING PERMIT
Permit# BP-2018-1330
Project# JS-2018-002356
Est Cost: $3000.0
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: IDEAL HOME IMPROVEMENT INC 091207
Lot Size(sa.ft.), 83591.64 Owner. LUSARDI PAULA&ROBERT
Zoning: Applicant: IDEAL HOME IMPROVEMENT INC
AT: 47 STONE RIDGE DR
ApplicantAddress: Phone: Insurance:
142 BOYLE RD (413) 863-2128 WC
GILLMA01354 ISSUED ON.611412018 0.00:00
TO PERFORM THE FOLLOWING WORIK900SQ FT R37 CELLULOSE OPEN ATTIC, 202SF
FOAM BOARD COMMON WALL, 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 OccuoancV signature:
FeeTvoe: 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
Department use only
City of Nort ampton Status of Permit
JUN 12 2%gldin De artment Curb CuYDdvewey Pemffi
212 ain treat Sai edSeplicAvailatodity
orn 00 WeterNyell Availability
DEAN 0113 uaowc�"dI
NORTH HRT on, A 01060 Two Sets of Structural Plans
- 40 Fax 413-587-1272 PtouSite Plans
Other SpecNy
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.f Property Atltlresa: This section to be canpleted ofice
kAI S� 17�\Y- Map Lot=it
Unit
YI OYQr1y. I nvl U Zone Overlay District
Elm St Dbtrlot CB District
SECTION 2-PROPERTY OWNERSHIPIAUITHORIZED AGENT
2.1 Owner of Record:
F)"X-y l Axsar d u 0-im _ I&Aqe , . For c--
vNaAym¢(Pont) Curie tre
"
Telephone
Signe um
In2.2 Authort A ant:
t; iu�)- 6wU SIA 6111 mac
prinQ n ,r Current Maiilliinng,Address: (�
Si nature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bpermit 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=It +2+3+4+5) 300o I Check Number
This Section For Official Liao Only
Date
Building Permit Number. Issued:
Signatur .
Ili,Zing of Buildings Date
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
@is column to be filled in by
Building DoWmem
Lot Size
Frontage
Setbacks Front
Side L: R: U R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage
(Lot area minus bldg&paves
parking)
N of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW YES Q
IF YES: enter Book Page and/or Document p
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW `C/ 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 (2
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O 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 O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicablel
New House ❑ Addition ❑ Replacement Windows Alteration(.) ❑ Roofing ❑
or Duos D
Accessory Bldg. El Demolition EJ New Signs [0] Decks [p Siding[Ell O:thr
Brief Dp,en n f Pro sed
Work
QOD �2AIUI(xnWPYI D/SfZrrbowr7l cxrmor\ uxltO�ra.(1c.�
Alteration of existing bedroom_Yes If No Adding new bedroom Yes ! No
Attached Narrative Renovating unfinished basement Yes ! No
Plans Attached Roll -Sheet
so. If New house and or addition to existina housing-complete the followina:
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. Mamcheck Energy Compliance forth attached?
In. Type of construction
L Is construction within 100 ft.of wetlands?_Yes _No. Is construction within 100 yr. floodplain Yes—No
f 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 IOR CONTRACTOR APPLIES FOR BUILDING PERMIT
Jj
I, (1lNYA- �.I A,�f/Y(,�A as Omer of the subject
property (��`
hereby authorize C �AY111 ( C.LIIS
�to Ct on my behalf, in all matters relative to work authorized by this building permit application.
�IdAAA t-
Signa ure of IOvmer Date
as Owner/Authorized
Agent declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed and he pains and penalties of perjury.
Print me
Signature of4.,/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction
Superviisor:J�,l NotApplicable ❑ 'l
Name of License Hcher:C 1)�l.Q l l� mo 1
License Number
lw- lR Io )(P1K
eAlldres Expiation Date
�t3.slQ� aiaC
Sign ure Telephone
9.Re 1 to C � r: Not Applicable ❑
�1k I nymuur, I uIDLha
Connipi Name Registration Number
l k2 �JDyU , C21( MA U- ;l-( - o)
Expiration Date
Telephone) J' pW�df Ap
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.162,§25C(6))
Workers Compensation Insurance affidavit '.at 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....... No...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings ofone(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(s)who own a paroel 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 farm
structures.A person who constructs more than one home in a two-yea r Period shall not be considered a homeowner.
Such"homeowner'shall submit to the Building Official,on a firm acceptable to the Building Official that he/she h ll be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion ofthe 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)ofthe Massachuseds Gencral 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,Some 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: 41 SkAk, Il&( l�C
0
The debris will be transported by: 011
The debris will be received by: nIe
Building permit number: L
Name of Permit Applicant
u0 1111
C/
Date Signature of Permit Applicant
City of Northampton
Massachusetts F=
�`-•� �( i
DEFa . OF BOZZDRIG ZPSil' OAS
\ 2122Hain S suiltling
rton, 1 01060
tith iSYh YJ1��cA
Property Address: 1j JIUUC �)U� iJr•
Contractor 55��
Name: n C�IIS
Address: \qa- 4',/JyIS��I�,LD I(_,♦�.
City, State: 070
Phone: Li13-�lQ�'��r)•D
Property Owner
Name: �
Address: LA-1 Ulu�.c, d IJY•
City, State:
I, C "„ r
V” ( ,1. l IS (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 signal
Date
�A.11 al I�
The Commonwealth of Massachusetts
Department of Industrial Accidents
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(Business/Org mNindividygl): Ir1,.4A.2 NimP_ Improyerr�f.rF-
Address: I�'la. YJ 1 IC_V�.
City/state/zip: `)111 'M(A 013 Phones: 1; -- 3l W
Are y u an employer?Check he appropriate box: Type ofconstruction
1. am an employer with 4. � I am a general contractor and I Please Check One
employees(full and/or part time).* have hired the sub-contractors o 6.New construction
2. .7 I am a sole proprietor or partner listed on the attached sheet. o 7. Remodeling
ship and have no employees These subcontractors have o g.Demolition
working for me in any capacity. employees and have workers' 0 9.Building addition
[No workers'comp.insurance comp. insurance.j 0 10.Electrical repairs or
required]. 5. IJ We are a corporation and its additions
3. f, 1 am 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]t c. 152, § 1(4),and we have no
° 63'Roof repairsemployees. [No workers'
3.O[her��$t,1Q(.� p[�
comp. insurance required.]
*Any applicant Mat cherlo box#1 must also fill out the xedon helaw showing their workers'compensation policy information.
tHomeowoers who submit this amdm it indicating they are doing all work and then hire madde matadors..at submit a new amchoit
indicating such.
tConantom that check thin box must attach so additional sheet showing the name orthe sut-conomxft s and state whether or not those
cndtlea have employees.tithe subcontractors 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. Etk(, VC 1n5W_� Co .
Insurance Company Name: /� -,1
Policy#or Self-ins.Lic.#: yW�,,Lg06,r1(0 Qj Expiration Date:�y_y���Q�'_�,�
Job Site Address:yl silif p— Iy[(rlg fir. City/State/Zip, CL ,It tyt
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration(date).
reduce to secure coverage as required under Section 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 u civil penalties in the form of a 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 frRiJya oraepid an pendal.ojperjury that the lnformarionponidt, a_ha1'e� nue and eonoM
Signature: \ Dafe.' liok(G�a ,�, ��))
Prins Name.' �4,('( gL IIS Phone#:LAL�'VU >,e l A)
Of akil use only Do not write in this area to be completed by city or town official
City or Town: Permit/liceose#:
Issuing Authority(circle one):
].Board of Heath 2.Building Department 3.Cityrfowu Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact person: Phone#:
ACORo® CERTIFICATE OF LIABILITY INSURANCE
01222018
THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND,EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS,AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER
IMPORTANT. H Me eertiRub holder Is an ADDITIONAL INSURED,Me polic,ges)must have ADDITIONAL INSURED plovblom or be endorsed.
HSUBROGATIONISWAIVED,--bledWMetwinsamoondh mofthe W4,mHalnpoliticM n uimanendorsement AstaWmnton
this certificate does not confer rights to Me certificate tickler M lim of such endotaement(s).
PRODUCER OCNCPArdres Feeley
NE'
NObbeYBGdnnell PNoxE (413)5860ifl M4q (413)5865481
8 NoRh King Street ADDRESS: afeeleydpMM'ebbersTAgdnnell.mm
INW RER(aIAFFGggHGCGYFA/,nE MAIC•
NORhomllton MA 01060 .9URERA: SBIBCINe In5Ce0(SCsnAm
INSURED EIwNER B:
DURI Home ImPIOVamenL IDC, INSURER C:
Aft,:Laurie Ell. WRURER.:
142 BOyl2 Road RU UREA E:
Gill MA 013549731 NSIIRER F:
COVERAGES CERTIFICATE NUMBER: EV 11QOIB REVISION NUMBER
THIS IS TO CERTIFY THATTIE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUFDTOTHE INSURED NUAEDABOVE FOR THE POLICY PERIOD
INDICATED. NOTVHTHSTANDINGANY REQUIREMENT.TERM CR MNOTION OFANY CONTRACTOR OTHER COCUMENT`MTH RESPECTTO MICHTHIS
CERTIFICATE MAYBE ISSUED M MAY PERTAIN,THE INSURANCEAFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJEGTTOALLTHE TERMS.
E CWSIONSANDCONDITIONSOFSOCHPOLICIES.LIMn55HOWN MAY H4VE BEEN REDUCED BY MIO CLAIMS.
N
LT0. TYPE Ci INSURANCE o Wyo pg1CY.U.. N" YMIIS
COM"ENQN-GENERAL LIABILitt FACH OCCURRENCE S 1'W0.000
CIAIMSMADE ®OCCUR pgEMISES� � S Sm.mO
MEDE%P(AMMNWmmn) S 15'000
A 52291380 11117IM17 11117/2018 PESOMLa ADU11UURY S 1'000.000
GCN'LAGGRECTEUMITAPPVESPE GENERALAGGREOAE 52mOm0
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[:1JET 0 LOC PRODUCTS-COMPIOPAGG s 2.00000O
OTHER 3
AUTOMMIIE LIABILITY COB NNED151XGLELIMIT 51,000,000
ANY AUTO RWILYINIURY(P-Lemnl $
A OWNED $CHEWIED A91O5410 1111712017 111172%0 aOOILYINIURY(PxvaL' Iq S
AUTOSONLY AUTOS
HIRED NONOKNED PROpERTI dWI.GE
AUTOSONLY AUTOS ONLY 5
UNmsuled mmDdst Bl s 100,000
X UMBRELLA UAe OCCUR E&C URRENCE S 1000'00'
A EXCESSMB CIAIMSMADE 52291368 11/1]201] 1111712016 AGGREWTE 5 I'm COS
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WOIU{ERS COMPENSATION PTIIIE OTW
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CERTIFICATE HOLDER CANCELLATION
SHOULDANYOF THEABOYE DESCRIED POLCIES BE CANCELLED BEFORE
THE EXPIMT NI DATE THEREOF,NOTICE WILL BE DELIVERED IN
ENdence of Imumnce ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHDARED RFPRESEII.
�(l - - -I
01988-ZDiS ACORD CORPORATION. AN rights nee5ved.
ACORD 25(20161103) The ACORD name and logo aro registarsU Marb of ACORD
Massachusetts Department of Public Safety
-` Board of Building Regulations and Standards
" ,cense CS-Og11207
JAMES PEWS
142 BOYLE RO
GILLMA 0134
�-J..M apiration:
- — ---- - -- Commissioner.. 10/1612018
HOME IMPROVEMENT CONTRACTOR
TYPE:Carpaa0on
Redstra0on Expiration
:1p 02 "21/2016
IDEAL HOME IMPROVEMENT INC.
JAMES -
142 Boylele Rd Rd
G11,MA O1354
Undersecretary