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37-035 (3) 306 ROCKY HILL RD BP-2021-1518 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 37-035 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-2021-1518 Project# JS-2021-002531 Est.Cost: $2800.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: IDEAL HOME IMPROVEMENT INC 091207 Lot Size(sq. ft.): 19514.88 Owner: COOKE PAUL zoning: Applicant: IDEAL HOME IMPROVEMENT INC AT:: 3. 06 ROCKY HILL RD Applicant Address: Phone: Insurance: 142 BOYLE RD (413) 863-2128 WC GILLMA01354 ISSUED ON:6/22/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATE ATTIC, SLOPES, WALL, FLOOR & 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. 10 51-1'1 • Certificate of Occupancy Signature: FeeTvpe: Date Paid: Amount: Building 6/22/20210:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner •- -; City of Northampton DepI— ok . Building Department (,J t4( 212 Room 00 et INSULATION . ..... t, ,,c ,w Northampton, MA 01060 •-,......„__,- •_:-- phone 413-587-1240 Fax 413-587-1272 QJ4JL. Y APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT 1.1 Property Address: Th''>section to be completed by office 3dW ntaX1 `ill t,d . Map 37 Lot 0 3 5 Unit 1 -y.+, c cn t Zone Overlay District 1r 1 1 '1'� Elm St District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 24AA Awner of ecord: I,VUu_ 30+0 6da lilt( ���y l forth ' t(� Name(Print) Current Mailing Address: 1W`' Telephone • ���- � � Signature 2.2 uthorized Ape t: OU'Y1fS tt�s ly- 6vLe 4) Gig m k ( Current Mailing ddress: Signatu Telephone SECT ON 3-ESTIMATED C NS RUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building SOO (a)Building Permit Fee 2. Electrical `J (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee - bS•- a v 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) CJ1•Soo .w Check Number -1710 7 J This Section For Official Use Only Building Permit Number: 13P-Zoz/— l5 I/2 s .--• ssuu ed: A I 2 It I Signature: rdi . 1 i • (0/6.)/ 1 Building Commissionerllnspector of Buildings Date el t t SAP e Com cast . n d- EMAIL ADDRESS (REQUIRED; El':HER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:s Not Applicable 0 Name of License Holder: L j &tt S q o,0 1 License Number )4a, (JJQ a.alk 61 ( Ka Lo•�to•��- • Expiration Date Sign e Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 1.ULU& tine rmp we r I (4co4-1 Company Name Registration Number "*a. ' lA G u VY�A u• �(• �-3 •:dress Expiration Date Telephone�J-I(1)•(J7p i)1 r A SEC ON 5-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit ust 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. 0 Brief Description of Proposed Work NOTE: INSULATION ONLY lQt-FS S-J C&UW cM (rota path c, ' D,sf L lotS 0Jti Tl60Y j al C.%/ -A( J I, cJc S at1S ,as Owner/Authorized Agent hereby declare that the statements and information or.' e foregoing application are true and accurate.to the best of my knowledge and belief. Signed under the pains and penalties of perjury. • ilk S BLS Pri 11411.11 Signature of Own' /A Date I. I V. . % r ,as Owner of the subject property hereby authorize _SurM.51 5. to act on my behalf, in all matters relative to work euthorizv; irry this building permit application. Lice, Lit III xi Signature of Owner Date -. City of Northampton t," Massachusetts tom' V!: \"4w:. ? DEPARTMENT OF BUILDING INSPECTIONS S_ -', 212 Main Street • Municipal Building 3ar�.,, yc' �``� S '; Northampton, b 01060 J _. 31 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 301/40 5OCL'j Hi I IZU . Contractor Name: S C«S Address: lu X t9:0y u Cc( City, State: 50 Aka O i' '3I Phone: vl I ). UU2 " r I ?4 Property Owner 44:144,`� �OeName: Address: 3b10 (ocr I fi,i( 2d City, State: nuiytiviebn I, dui'.a S as (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 signature( '2,3y\,,. Date\g1141 City of Northampton • fly ` Massachusetts t {`e DEPARTMENT OF BUILDING INSPECTIONS :?i 212 Main Street •MuniciPa Building 1 nq Northampton, MA 01060 ssy ._, j,ta Debris 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. The debris from construction work being performed at: 30k0 YSoUc� 61i 12d • (Please print houselnumber and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Id►er0 1-6. Irrl � e,n+_ (Company Name an Address) WI NW Sign ure of Permit Applicant or Owner Date If, for any reason,the debris will not be disposes' of as indicated,the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. l ne tommonwealtn of Massachusetts Department of Industrial Accidents Office of.investigations -r Lafayette City Center " 2 Avenue de Lafayette, Boston,MA 021.I1-1750 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Ideal Home Improvement, INC Address:142 Boyle Road City/State/Zip:Gill MA 01354 Phone #:4138632128 Are you an employer? Check the appropriate box: Type of project(required): l.© I am a employer with 10 4. 0 T am a general contractor and6.T ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 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. 0 Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp. insurance comp. insurance.$ 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 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no insulation employees. [No workers' 13.® Other 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-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. Insurance Company Name:Selective Insurance Co Policy ft or Self-ins. Lie. #:WC9057697 Expiration Date:1/26/2022 Job Site Address: 3oe f2)0UCA.i ttt ezt • City/State/Zip 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$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 he certi der the p s penalties of perjuty that the information provided above is true and correct Signature: Date: VA 161 Phone#: 4I3' Q5' al ( Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 30City/Town Clerk 4.DElectrical Inspector 5E1Plumbing Inspector 6.0Other Contact Person: Phone#: ACG CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 01/29/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER 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: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER CONTACT Patrick Gooden Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 A/C,No,ExR: (A/C,No): 8 North King Street E-MAIL Ss: pgooden@webborandgrinnell.com ADDRE INSURER(S)AFFORDING COVERAGE NAIL;@ Northampton MA 01060 INSURER A: Selective Ins Co of S Carolina 19259 INSURED INSURER B: Selective Ins Co of Southeast 39926 Ideal Home Improvement,Inc. INSURER C: Attn:Laurie Ellis INSURER D 142 Boyle Road INSURER E Gill MA 01 354-9 7 31 INSURER F COVERAGES CERTIFICATE NUMBER: Exp 11/21 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL BURR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ,INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLANS-MADEOCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 15,000 A S2291368 11/17/2020 11/17/2021 PERSONAL&ADV INJURY $ 1,000,000 GENIIAGGREGATE LIMIT APPLES PER GENERAL AGGREGATE $ 2,000,000 POLICY PRO- PRODUCTS-COMP/OP AGO $ _JECT _ Lop 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OAUTWNEDOS ONLY X AU SCTOSHEDULED A9105410 11/17/2020 11/17/2021 BODILY INJURY(Per accident) $ X HIRED ONLY AU X NON-TOOS OWNENLY D PROPERTY DAMAGE (Per accident) $ _ Uninsured motorist BI $ 100,000 UMBRELLA LIAB - OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEO RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER D. ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? Y N/A WC9057697 01/26/2021 01/26/2022 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more apace is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 146402 IDEAL HOME IMPROVEMENT INC. Expiration: 04/21/2023 142 BOYLE RD GILL, MA 01354 Update Address and Return Card. Office of Consumer Affairs 8 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 146402 04/21/2023 1000 Washington Street -Suite 710 IDEAL HOME IMPROVEMEN—INC. Boston, MA 02118 JAMES P.ELLIS / 142 BOYLE RD Gv! q-a( - GILL,MA 01354 t valid without signature Undersecretary � Commonwealth of Massachusetts Division nf Professional ucensure . oo*nu of Building Regulations and Standards �mn 1W^�*er,iso, CS'091207 irew: 1O/16K2O22 ---- _ GILL Mwo11�� � °r � � V Commissioner ' '' -- -'---- � ~ � Office~Consumer~~.s~ HOME IMPROVEMENT CONTRACTOR . .P~.Co_--'—. IDEAL HOME � � JAMES P. 142 ' '