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29-027 BP-2024-1529 31 BIRCH HILL RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-027-001 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-2024-1529 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est.Cost: 4000 JAMES ELLIS CS-091207 Const.Class: Exp.Date: 10/16/2026 Use Group: Owner: JOHN PINKHAM Lot Size(sq.ft.) Zoning: WSP Applicant:pplicant: IDEAL HOME IMPROVEMENT INC Aaalicant Address Phone: Insurance: 142 BOYLE RD (413)86 3-2128 WC9057697 GILL,MA 01354 ISSUED ON: 11/18/2024 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: Douse# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: 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. Signature: /7/71 Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner (qV .Rt M� �• City of Northampton N DepFOR� \ Building Departm /, N. 21 -41lain Street 7 \' RoOm 100 ` � SULA TION Northampton, MA cow • phone 413-587-1240 Fa*�3- . 1272 oNL APPLICATION FOR INSULATION FOR A ONE OR TW AMILY DWELLING ONLY SECTION 1 -SITE INFORMATION I NV V L TION PERMIT 1.1 Property Address Th• section to be completed by office CkrOn `I tU{ • Map Lot Unit I1 o(triCu � � Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: John R -hcuyAniLharn 3i gvvch kAlkl ect HorefC-e. Name(Print) y^� 1A /� ^u:•::nt lq\ 2 -.lcsilirr d:..-, 1 _lvD Signature 2.2 Authorized Agent: 16 _ luaddU ( Gth YYIA Nam: - Current Mailing Aress IN Signature Telephone SECTI• 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 400° (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) v 5. Fire Protection 6. Total=(1 +2+3+4+5) 00 _ Check Number ]V V v This Section For Official Use Only Building Permit Number: 4P Pd- i..5'�9' -� Date- Issued: Signature: �/ 9 2 Building Commissioner/Inspector of Buildings Date Sjp ►i ± EMAIL ADDRESS (REQUIRED: EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: 1 1 Not Applicablelili ❑ Name of License Holder: Jems o`1 _ i I?)0 7 License Number ell+4 Lt El ait 011R- oi), q A ress pci,....j,„ Expiration Date Signatur Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Id-au t tomz lniprovetili &- i Lice u a- Company Name Registration Number Li& OWYYI& (4-011. 6 •• I I Expiration Date �I./ll`& Telephone41 ' aim? 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 buildin permit. Signed Affidavit Attached Yes No 0 Brief Description of Proposed Work NOTE: INSULATION ONLY lOulos+ Wt Ctitulos� 39tri CurlC% 13a1P - Sills ; 0( rSelf 1. _1 e , 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. Pnnt Na Jlii Signature of Owne gent Date I. cii5 116 Pill v-hli(,( I I _ , as Owner of the subject property hereby authorize U V-I l c (_,-?A (C to act on my behalf, in all matters relative to'i r- , ... : .:y this building permit application. Se-e_ attame4 Signature of Owner Date p� City of Northampton � Massachusetts :; • �' , ':-' N: : DEPARTMENT OF BUILDING INSPECTIONS S:'. . 212 Main Street • Municipal BuildingJii......... • s. Northampton, MA 01060 ryw_ �.k MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 3 1 6 (YLil Hut ed . Contractor Name: dOt -e5 E1 `l S ��� � l� Address: 1y� &MU fejik City, State: OW rn i4 012) Phone: Li 12)' UIK))' ) PropertyOwner Name:ame: John Cil. 'Address: 3 1 O t ral r l Rd City, State: \ o (\cL 1m I, da t v_S El t l 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. Contractor signatu e Date 1 1 1 7 ik._1, _-__ • City of Northampton O<$ '\ S .)-t t�t Massachusetts A,5, 4r, w t . * DEPARTMENT OF BOZLDING INSPECTIONS i` ° `z' . c 212 Main Street • Municipal Building v1 , i. ;, Northampton, MA 01060 �SN�y jC�C . t _ AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). NI.G.L.Chapter 142A requires that the"reconstruction, alteration,renovation, repair, modernization, conversion, improvement,removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner.`h'as contracted with a corporation or LLC,that entity mast be registered. Type of Work: I VAsul +U"l Est.Cost: 14000 Address of Work: 31 61 r 'j fin ( ed Date of Permit Application: 1117 Ic t I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): __Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for • :.• , •-rmit as ti t of the owner: 1 Iii iaLf A I quit—Nei-- Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton r r/ •'ttom Massachusetts ��'<< I DEPARTMENT OF BUILDING INSPECTIONS ® ;►$11P �.= 212 Main Street •Municipal Building �,� . �� Northampton, MA 01060 �s'Y�y �10 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: 31 Hi ( d . (Please print house number 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: 1.G1— Addrover► - No), 6 Oil (Company Name and ess) ��— ! I 1 17id� Signatur f Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. Permit Authorization CLEAResu It mass save Form Project ID: WRK-47774435 Customer: JOHN D PINKHAM I, JOHN D PINKHAM , owner of the property located at: (Owner's Name,printed) 31 BIRCH-HILL RD FLORENCE (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: Joha Puakhazu Date: 10 / 16 / 2024 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date CLEAResult • 112 Turnpike St,Suite 111 • Westborough,MA 01581 • 1800-480-7472 Rev. 08.24 Document Ref:N5QFS-CWYLW-XPJGP-Z2LNX Page 3 of 5 i •♦•.••.••: i:•..•ii:ti•Jii4.P:•:.Pi•i❖•4•P.••'•..•Piiii•: : O:iiiiNiii4•:iiiiitii :i'i::iiiii'iii• eh i•••i :.•.•., •••••: %%• ••••••.• is Signature Certificate ❖: ••. ..Qti' Reference numbe• N5QFS-CWYLW-XPJGP-Z2LNX ❖: .4*•. Signer Timestamp Signature ,�•4•4, we John Pinkham : Emil:pinkhamjohn@gmail.com :•i;; :❖• :00•. 4. Sent: 08 Oct 2024 13:55:36 UTC •• .•ii •;••••• Viewed: 08 Oct 2024 15:21:38 UTC (7okf ha' kl�atu ......... n*:.: Signed: 16 Oct 2024 15:56:52 UTC ;•�•:• •0.O'. Recipient Verification: •••••S ;••.• 'Email verified 08 Oct 2024 15:21:38 UTC IP address:174.192.12.109 ••0•' ••••••. Document completed by all parties on: ��� ;•. 16 Oct 2024 15:56:52 UTC :•�•;: Am ti•: Page 1 of 1 0•:•: 44 �•... •4, . .•i•: 00: ••• ••• me. :i•. i .•.. •� i•� A•••: i•: ••••: .... ••• .AN i•••: •••• • ;•••••, �•.�'. ♦•. ••• •,•�•; •••••; .4.100. • :•••• • •••• •❖1 :.:.0 ••••�. •••.� ••• ••••; Signed with PandaDoc Q. a !:•i•: ::•;; PandaDoc is a document workflow and certified eSignature , ' ). .:40 4 Pid solution trusted by 50,000+companies worldwide. El I '0— ;•;•;' :•i.' 'X•X•. %•.' ••• :•••. :••L❖i ••:.•i•: i•t*:::: ii::::;:**:::ice **:::*::: i•:*iii:i:iii::!:!*::::: iiiii**:::$:•:•::::•:iii::•:!:iii::4:*ii•:•:•:%%ii••:•:4: ' \\ The Commonwealth of Massachusetts ' Department of Industrial Accidents 9Office of Investigations Lafayette City Center s 2 Avenue de Lafayette, Boston,MA 02111-1750 '''4 '''� 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. ❑New construction listed on the attached sheet. 7. 0 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P h' x 9. 0 Building addition [No workers' comp. insurance comp. insurance. 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation and its 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 12.0 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. :Contractors 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 Company Policy#or Self-ins. Lic. #:WC9057697 Expiration Date: 1/26/2025 Job Site Address: 31 ISIvciel kiikt kd City/State/Zip:� .0(e ria. ' a 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 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 hereb certify u the p ' d penalties of perjury that the information provided above is true and correct. Signature: Date: t 1 ti j al1 Phone#: 413- 3-2128 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): 10Board of Health 21:1 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 51:3Plumbing Inspector 6.0Other Contact Person: Phone#: A RL CERTIFICATE OF LIABILITY INSURANCE DATL(MM,001YYYY) / i t 12/2024 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 Anya Osman ' NAME: Alera Group,Inc PHONE (413)586-0111 FAX (413)586-6481 (AC No,Ertl: � (A/c,No): S North King Street E-MAIL aosman@aleragroup.com ADDRESS: , INSURER(S)AFFORDING COVERAGE NAIC A Northampton MA 01060 INSURER A: Selective Insurance Co of SC 19259 INSURED INSURER B: Selective Insurance Co of The Southeast 39926 Ideal Home Improvement,Inc. INSURER C: Evanston/XSB Attn:Laurie Ellis ' INSURER D 142 Boyle Road INSURER E: Gill MA 01354-9731 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 11/25 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WWI POLICY NUMBER (MM/DDIVYW) (MM!DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 '1 EACH OCCURRENCE S CLAIMS-MADE XI CCCUR PREMISES(Ea oco.nence) S GE TO RENTED , 500,000 MED EXP(Any one person) S 15,000 A S2291368 11/17/2024 11/17/2025 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 POLICY n JPERQ n LOC PRODUCTS-COMP/OP AGG S 2'000'000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) S - A OWNED X SCHEDULED A9105410 11/17/2024 11/17/2025 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS XHIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY X AUTOS ONLY (Per accident) Uninsured motorist BI s 100,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE S 4,000,000 A -- EXCESS LIAB ~ CLAIMS-MADE S2291368 11/17/2024 11/17/2025 AGGREGATE S 4'000,000 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ER B R: ANY PROPRIETOR/PARTNER/EXECUTIVE N!A WC9057697 01/26/2024 01126I2025 E.L.EACH ACCIDENT S 1,000,000 OFFICE1t1EMBEREXcLUDED? 1,000,000 (Mandatory in NH) El DISEASE-EA EMPLOYEE S If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S Per Occurrence 2,000,000 Pollution Liability C CPLMOL121454 01/25/2024 01/25/2025 Aggregate 2,000,000 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Construction Supervisor Division of Occupational Llcensura Unrestricted-Buildings of any use group which contain less than Board of Building Rettlilations and Standards 35,000 cubic feet(991 cubic meters)of enclosed space. t+;; 40 r.frvisor CS-091207 l tpires: 1011612026 JAMES P EL1S m 142 BOYLE RD GILL MA 0134 Z OC gw,: f�A��l.T,VdSI�.0 . Failure to possess a current edition of the Massachusetts State •x> Building Code is cause for revocation of this license. Commissioner t / rn� Contact OPSI!(617)727-3200 or visit www.mass.gov/dpl/opal THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation IDEAL HOME IMPROVEMENT INC. Registration: 46402 142 BOYLE RD Expiration: 04/21/2025 GILL, MA 01354 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Corporation Office of Consumer Affairs and Business Regulation Registration xplratiort 1000 Washington Street -Suite 710 146402 04/21/2025 Boston,MA 02118 IDEAL HOME IMPROVEMENT INC. JAMES P.ELLIS 142 BOYLE RD ,A: • v!' GILL,MA 01354 Undersecretary Not valid without signature