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17C-154 (16)
88 HIGH ST BP-2018-1165 GIs#: COMMONWEALTH OF MASSACHUSETTS Mau:Block: 17C- 154 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-2018-1165 Proiect# JS-2018-002092 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.): 13590.72 Owner. LEVI DINA zoning URB(100)/GB(o)/ Applicant: IDEAL HOME IMPROVEMENT INC AT. 88 HIGH ST Applicant Address: Phone: Insurance: 142 BOYLE RD (413) 863-2128 WC GILLMA01354 ISSUED ON.519/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:600 SO FT R49 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 sienature: FeeType: Date Paid: Amount: Building 5/9/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner y„ .sit,lccy-f 1IY� ` Depattrnerltise ony , - Northampton Statin of Permit CIEIVEDBDil ing Department Curb GutlOavewayPermit 2 2 Main Street SeviamSeptic Availability - Room' 4 2018 Room 100 WahmWell AVMMbIky orth mpton, MA 01060 Two Sets of Structural Prem hone 4 58 '-1240 Fax 413-587-1272 PIotISRe Prens�^_ DFPT OF SUILONG INSPECTIONS Other Spa* APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I -SITE INFORMATION ^' 09— Y Y—I I (L 1.1 Property Address' This section to be completed by office n�n.,//' Map�� Lot r Unit Gtr oruic I. ,1, w� zone Overlay District f Elm St District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Hina WZ 3'�) Ni n �s1 , Ftn&nck- _ Name(Pant) CurrentCurent Mailingo_ it� ID_Akq Teleplwns Signature 2.2 Authorized Agent: J mo< bilis I�Fa 1�UI lr 0111 YY�O N rm Current Mailing ress: LA I'j ' Slo; CA 1'N Signatule Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official 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) I aDOC) Check Number 3� This Section For Official Use Only Dale Building Permit Number: Issued11 7 '. Signatur : C4^ ^.4/f Building ammimimedlnspectorof Buildings Dale Section 4. ZONING All Information Mast Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning this column to b,fined in by Building nepar mcnt Lot Size Fronts e Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Int area minus bldg&paved arkin #of Parking Spaces Fill: vowme&kocaaon 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 Regi ry of Deeds? NO O DONT KNOW 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 lr 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 011, 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(Gearing,gradingrye�xcayetion,or filling)over 1 acre or is it part of a common plan that vnll disturb over lam? YES O NO IJ IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ❑ Or Doo s Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [p Siding[D Other Brief Descnphon f opose Work 1,;Ir �P 1 A tK8 (�Qa'y 0, t (_ WholA h(AAy WV S2FA.P-(y:) Alteration of existing bedroom_Yes ✓No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement _Yes �LNo Plans Attached Roll -Sheet Sa. If New house and or addition to existina housing- colnolete the followina: a. Use of building: One Family—Ae— Two Family Other b. Number of rooms in each family unit Number of Bathrooms c. Is there a garage attached? J, Proposed Square footage of new construction. Dimensions e. Number of stones? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. 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. 1. Septic Tank_ CitySev,sr Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject Property hereby authorize ��G TY�.I,\ C 111 to act on my behalf,in all matters relative to work authorizetl by this building permit application. Signature ofII r � , Date I, Vq.mfS C.1U -� 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 tha pains and penalties of perjury. JC1N1K5 �ySIS Pnnt Nam!� ^ ^ c Signature of Ovine gem Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su rvlsor: Not A pli;ble Name of License Holder k k l 0 l sLicense Number 5uA qua 4 flet Gm Y" io f i3O. 6 res5� I Expiration Date 4193 a-Ian Sign t re Telephone N 1 Im M veru ContradlIn Not Applicable 17 Company Name Registration Number Address yy� pI 1 I, Expiration Date bit 11 Telephone'I �� )I SECTION 10-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 denialof the issuance of the buildi permit. Signed Affidavit Attached Yes....... No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(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 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 stmctures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such`homeowner"shall submit he the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buihline permit. As acting Construction Supervisor your presence on thejob 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 persons) 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: Shea The debris will be transported by: n Pr The debris will be received by: nu - Building permit number: NameofPermitApplicant JWyy\ &ts Date Signature of Permit Applicant City of Northampton Massachusetts A' DEPAR94SSNT OF BIIILDZSG ZiPSPECTZOES 1 212 Main 9t[ t n l iciWl Build nq xorUampt., M 01060 ], hA 1'01 Property Address: 6'b lip Si-y'e-u Contractor I_ __ <S �lts Name: �.y'Y�.0 /� �� _ Address: ��`4�- 6XI U a City, State: m,U1� l I !, Phone: � )-Ty� o IA Property Owner 1� i nG U. I Name: ��oJ Address: UU �I LGh J� City, State: I, S �l l5 (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 \ Date 5��11� The Commonwealth ofMassachusetts 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 ,A� ^^ 1 Please Print Legibly Name(Business/Organi>gpowin1di^vidugl)�'1/.Aal p_ Improu(IryyrF Address: Ma, 19 xK City/State/Zip: `�,� M(A 013 Phone#: 1;54 3• al 34 Are y u an employer?Check he appropriate box: Type of construction 1. V am an employer with b 4. 0 I am a general contractor and I P/case Check One employees(full and/or part time).- have hired the sub-contractors o 6.New construction Z I am a sole proprietor or partner listed on the attached sheet. o 7.Remodeling ship and have no employees These sub-contractors have u S.Demolition working for me in any capacity. employees and have workers' o 9.Building addition [No workers' comp. insurance comp.insurance.I ❑ 10.Electrical repairs or required]. 5. 1- We are a corporation and its additions 3. I 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 O ' _Roof rep, aws employees. [No workers' 3.Other comp. insurance required.] *Any appointee Mat eheeks but 41 must also fill out the aredon led.showing their-workers'm ia,mustio. It,information. tHom m mm who submit this a16Javit htdicalm,they art onto,sol work end then hire oaulde mnrearmrs must submit a new amdavit indicating such. tConhrtom that check this boa must attach an m[ditionnl short showing the name of the sub-uontmrtors and shit whether or not those entities have employees.If the sub-comtravers have employees,they must provide their workers'camp.policy number. I am an employer that It providing workers'compensation insurance for my employees.Below is the policy and jos site information (�F1��-hut 1n5VX�CC Co. Insurance Company Name: J f� (1 Policy#or Self-ins.Lic.#: w Cgc6110 9j Expiration Date: 11 W LL Job Site Address: N Itl( l S+' City/State/Zip: ,-l0iPna ,01A _. Attach a copy attic workers'compensation policy declaration page(showing the policy number and expiration(date). Failure m secure coverage as required under Section 25a of MGL 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 Bne 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�t�gvm�ter thepad as penaider ofperlury thin the informadonprovided�ge is true and caned. signature: \ A+k^�C -e A-4 Date: 6IL411I (� Print Name: f 'Q fwk, Ft 11 S ___Phone#:qV,>' p VL�J'olI doh Offrial ase only Do not write in this area to be completed by city or town official City or Town: Permit/license#: Issuing Authority(circle one): 1.Be and of Heath 2.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: A OI CERTIFICATE OF LIABILITY INSURANCE 011=2018 THIS CERTIFICATE IS ISSUED AB A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGAMWLYAMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE GOES NOT CONSTITUTE A CONTRACT BETYYEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER IMPORTANT. If the cerHRcate holler N an ADDITIONAL INSURED,Me pdicy(les)must hate ADDITIONAL INSURED provisions or he andomed. If SUBROGATION IS WAIVED,subject to Me Moms and corMNions of the polley,ceNnln policies may require an endonemerR Astatement on this ceNtkab does not corder rights to the werM holder In lieu of such endomemanNs). PRODUCED MAME Andres Fee" OONU WANNN&GnnrINI MOW (413)5FI(40111 1-�No_ (413)5868481 B North King Street AppNars_ aleeley�wrbbelalldgdnMl.mm INBUREW8IAFPORNNGCOVEAAGE NMC. NOnhamplon M4 01060 INwRill Sesco-lns CootSCerdire INSURED WORMS' ideal HomelmplOuenlEll Im, AM:Laune Ellie InsuRER O: 142 BG)9B Road INWRER E: GIII MA 013548731 INW.F: COVERAGES CERTIFICATE NUMBER: EV 1112018 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTMTHSTANDINGANYRMUIREMEW..TERMMCMDITKK OFANYCONREACTOROTHERDCCUMENTWTHRESPECTTOV ICHTHIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE MI.)RAMCEAFFORCED BY THE MUCIES DESCRIBED HEREIN IS SUBJEGTTOALLTHE TERMS. EXCWSIONSAND CONDITIONS OF SUCH PO.ICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LWift TR TYPE OF IONNAINCE PIXJCYNUNBER M M..d Us"COMWACMLGBIEIW.Mast FgLN CCLURN.. S "wo,OOo CUIuSMADE ©OCCUR FNNI 5 800,W0 MEOEFP I—F—) 5 15'L03 A S2291368 1111712017 111172018 PERSOHALAADVIwUBY f I'00o,000 GEXLAGGREWTEUMFIAPRJESPER. GENAMLA.WGFTE 5 2,0"0'000 I POIJCV JECT LOC PROWCT9.UNIPgPAGG f 2'000'DDO O ER AUTONDNI IJABIIJTY �CMBINED H IEUM 5 1,000,000 Auto eODia lwuRrlPMoa�Il $ A OWNED X scnEwLEo A9105410 1111712017 11/1712018 scolll NNY(PY.vI]mp $ „OTOS OMLY AUTO$ EO �/ NONONNED TV OPWGE S AUTOS ONLY ^ A.—ONLY UMnsured mocrut BI s 100,000 A IUMBREtJA UPB OCCUR aCH OCCURRENCE 51000'COD E%CF98 Wa LLTIM3MADE SZ01388 1111712017 1111711018 AGGREGATE E I'000'WO oEo I RETENTIOx a $ WORNEAS COMPENSAFON X - ANOEMPLOYERSUAMIITY YIN A A YPROFRIETORNARTNER/11UTIVE ❑ NIA YJGWS/89] 0112&2016 0112812[118 ELEACHACCIUENT E 560,000 OGGICERMEMBER EYOWGEGi nl-n .wv In Ice ELDIBEAW-EAETIPLOYEE E 5W000 DE0x11111 0M- L 508000 SCRIPTION OF OPEMTbXS ttbx DISEASE-GIX1CV UNIT scwr,Ia+Or ORNUTNWeILOCA1NM161NEMCIFa Mconc 1N.AaeMa..IA.m.nsxA.a,IM,..Y Ne.NFMNXnm..POM MW..I CERTIFICATE HOLDER CANCELLATION 3HOILDANYOF THEABOIE DESCRIBED PODCIES BE CANCB DBEFORE THE EXPIRATION DATE THERE917,NOTICE WILL BE DEMEREO IN Evitlence of Inwrarrc ACCORDANCE WITH THE POKY PROVISIONS. AU HORNEW REPPFSEMATNE �4 -') -r-4 9)INS.2016 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD nems and logo are registered marks MACORD Massachusetts Department or Public Safety r Board of Building ReguleUons and Standards ,cense:CS-0912O7 JAMES P EWS 142 BOYLE RD iilaw dLLMA 01344 `' r lzz-'� Expiration: _Commissioner_. ta1101201a Oalof C4muearA T uHOME IMPROVEMENT CONTRACTOR TYPE Carp� Realitra0on FADIraw 146Q204/21/2019 IDEAL HOME IMPROVEMENT INC. JAMES ELLIS 142 Boyle Rd Gill,MA 01356 Untlersecrelary