Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
29-545 (6)
B '-2022-1429 37 INDIAN HILL COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-545-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-1429 PERMISSION IS HEREBY GRAN D TO: Project# INSULATION Contractor: License: Est. Cost: 4000 JAMES ELLIS 091207 Const.Class: Exp.Date: 10/16/2024 Use Group: Owner: INC STIEBEL PROPERTIES Lot Size (sq.ft.) Zoning: FFR/WSP Applicant: IDEAL HOME IMPROVEMENT INC Applicant Address Phone: Insurance: 142 BOYLE RD (413)863-2128 WC9057697 GILL,MA 01354 ISSUED ON: 11/02/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIO ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I To ' I Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner \ .� . .. vlLs 19�75 _ ` / Dep j ;� 1; rs City of Northampton �\ F ,` R -04 t,.,. h: Building Department vCT u ``¢' � 212 Main St{ 7 �� '• Room.100 T o�-, ;.?� l S�L� T,O ,' Northampton, MA 06"tp/A,G • . phone 413-587-1240 Fax 413 5 - #2 7-,o / ONL Y Bo NS APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWE1:Y-ING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: /MTh',section to be completed by office 31 11r ��) Map �`/ Lot 6-y5- Unit ro�e(1et (Y1 A Zone Overlay District 1 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Si'i ec-el 4 cxtif S dy6)1 &i fol y&-i-J 1- 1Q o tu__ rr a o i oy0 Name(Print) Current Mailing Address: �t 60 dad Telephone Sign ure 2.2 Au horized Agent: _.........-A, I ,,1 1 I-O\EN U eA 6 I ( )()( 4 Name(Print) Current Mailing Address: Signature Telephone SECTIO 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant _ 1, Building �-�, t 000 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) . 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) IP 'a 5. Fire Protection 6. Total= (1 +2+3+4+5) (+000 Check Number 4 This Section For Official Use Only Building Permit Number: li�f— iAo'l — I q21 pate Issued: Signature: Je ; `-- Y� it 2- ZL ZZ Building Commissionerllnspector of Buildings Date 1314 @ CO nai- +• ►" e EMAIL ADDRESS (REQUIRED: EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Ap icablje�❑ Name of License Holder: C./O1.V` jl( � 9I?v 7 License Number .e( 1 l Z to p wlay Address Expiration ate vP)'(Jl0) •C ( 0'� Signa re Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 # I '4jYlke I mpIrM)( q1��f0� Company Name Registration Number ...111.14. ( A. 0 • CI ( ram u-(;-i. a3 %ddress Expiration Date Telephone 13 ' I SECTION 5-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 buildi permit. Signed Affidavit Attached Yes No 0 Brief Description of Proposed Work N E; INSULATION ONLY LNo S# c-e\ ose co to a-tn c; air Seal ill I, G�S , 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 pains and penalties of perjury. P 1L... ►0 ae as Signature of awn: /Agent Date )to- ( , as Owner of the subject property hereby authorize jcwka s k1 ttJ-_ to act on my behalf, in all matters relative to work authorized by this building permit application. AuLd,, 0 Akfe t_. 101 as I Signature of Owner Date ri City of Northampton _ + • �� Massachusetts ��• { rr y Y. DEPARTMENT OF BI7ILDZNG INSPECTIONS R T „' 212 Main Street • Municipal Building ��" y ....; s., P 4 sr 1 Northampton, MA 01060 �Yµ8+J1 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 31 Ind la(\ 1fi It Contractor �1 Name: dCkt4.12S l V.S Address: ILI?, 60\4\2 Rd. City, State: all r t'. Phone: 1-119)-(1(9)Y0)1)' 15 Property Owner �l,��l Name: '1 ( 9ti'6 Address: at-UN SulrO 11C- S • City, State: \\i* cu mA I, 'JOJONe- -t-I�tS (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 \ (_Li;j1) Date 10\d6)?-6Y City of Northampton a, ..,4a `5 s, /, Massachusetts /t 5 cfc DEPARTMENT OF BUILDING INSPECTIONS �; .'' iL 212 Main Street •Municipal Building ��k C.r' Northampton, MA 01060 Jsf mi~ , 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 isposed 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: 31 1 Ica Bann l-h\ (Please print house number and street name) Is to be disposed of at: \.d-.cam HoytAc [ r3(o v c (Please print name anc location of facility!, Or will be disposed of in a dumpster onsite rented or leased from: \,ck Q,a) \YY1 . \id. nil (Company Name nd Address) (1-100A& I-o/a id'aSign of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall n•tify the Building Department as to the location where the debris will be disposed. ,. The Commonwealth of Massachusetts Department of Industrial Accidents 'u Office of Investigations .. =w _ , Lafayette City Center -� a;' 2 Avenue de Lafayette, Boston,MA 02111-1750 lc =�=} 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#:413-863-2128 Are you an employer? Check the appropriate box: Type of project(required): 1.El I am a employer with 10 4. [] I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. 0 New construction 2.El 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. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 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.D Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.0 Other Insulation employees. [No workers' 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 eiptities 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#or Self-ins. Lic. #:WC9057697 Expiration Date:1/26/2023 ‘4"- n Job Site Address: 31 I no(tC&f\ RI 1 I City/State/Zip: I-t U(� . O 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 DIA for insurance coverage verification. I do he eby certify under he pains aloes of perjury that the information provided above is true and correct Signature: Date: Phone#: 413-86 -2128 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): i DBoard of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: ACORD® CERTIFICATE OF LIABILITY INSURANCE �' DATE(MM/DD/YYYY) `--� 01/20/2022 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 he 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 Brandon Andrade NAME: Webber&Grinnell PHONE (413)586-0111 FAX (A/C,No,Ext): (A/C,NO: (413)586-6481 8 North King Street ADDRESS: bandradeQa webberandgrinnell.com I INSURER(S)AFFORDING COVERAGE NAIC# 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 01354-9731 INSURER F: COVERAGES CERTIFICATE NUMBER: EXP 11/2022 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 CONTRACTOR 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 AUDL-SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) UMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) 5 500,000 MED EXP(Any one person) S 15,000 A S2291368 11/17/2021 11/17/2022 PERSONAL&ADV INJURY S 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG S 2,000,O00 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) S A '---- OWNED v SCHEDULED A9105410 11/17/2021 11/17/2022 BODILY INJURY(Per accident) ' S AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) S Uninsured motorist BI $ 100,000 UMBRELLA LIAB - OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA WC9057697 01/26/2022 01126/2023 E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE i S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,O0O,D00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers Compensation Excludes Coverage for James Ellis. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ... ibt_.--3 ,r..,J,y) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Moe of Consum- Affairs&Sualness Regulation HOME 1MPR OVEMENT CONTRACTOR • • E:Con:oration gxpludimi • • 14v,02 04/21/2023 IDEAL HOME IMPR• EMENT INC. JAMES P.ELLIS 142 BOYLE RD a 12.riedo-,4* GILL,MA 01354 Undersecretary 10/24/22, 1:07 PM Details Licensee Details (Demographic Information Full Name: JAMES P ELLIS Owner Name: License Address Information City: GILL State: MA Zipcode: 01354 Country: United States 1 icense Information �.. _.� __ _ - License No: CS-091207 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 10/21/2022 Issue Date: 10/16/2010 Expiration Date: 10/16/2024 License Status: Active Today's Date: 10/21/2022 Secondary License Type: Doing Business As: Ideal Home Improvement Status Change Reason: License Renewal Prerequisite Information .___..�. _.....w_^Information No Prerequisite Information No Available Documents • https://madpl.mylicense.comNerificationlDetaiis.aspx?result=131 babcc-423f-4781-8b47-e5f62b2977fc ill