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24A-146 (3) 377 PROSPECT ST BP-2019-0708 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A- 146 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv:INSULATION BUILDING PERMIT Permit# BP-2019-0708 Proiect# JS-2019-001158 Est. Cost:$9000.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO.- Const. O.Const.Class: Contractor: License: Use Groep: IDEAL HOME IMPROVEMENT INC 091207 Lot Size(sa.ft.): 9931.68 Owner: CAHILLANE ROBERT P&MICHAELA Zoning:URA(100)/ Annlicant. IDEAL HOME IMPROVEMENT INC AT: 377 PROSPECT ST Applicant Address: Phone: Insurance: 142 BOYLE RD (413) 863-2128 WC GILLMA01354 ISSUED ON.1211312018 0:00:00 TO PERFORM THE FOLLOWING WORK.-CELLULOSE ATTIC SLOPES, DENSEPACK EXTERIOR WALLS 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 Signature: FeeType: Date Paid: Amount: Building 12/13/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner T/ 0/1"/ Department use only City of Northampton Status.ofPermi't. Building Department Curb Cu"Veo r Permit 212 Main Street Sewerlsept" vailatiNiy Room 100 Wa*fiV ltAwaailail y Northampton 'of t$ lP�ris ; phone 413-587-124 Fax 4 �1V E . APPLICATION TO CONSTRUCT,ALT R,R PAI NpVAqk D OLI H A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION TIONS 1.1 Property Address: NORTHAMPTON,MA 01060Thid section to be completed by office ?x"1'1 Pf 0S (A 5i . Map Lot 4/0 Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: r-)01-0+ Ca,h(I I" e 311 erg�'&a si 0�Y��x1 Name(Print) Current Mailing Address:4G V�P-1 Awl _ Telephone Signature 2.2 Authorized Agent: 1.1 ; tI( S a- is Joy lk ( PQ . Gn I i r'1.81. Nam \Current Mailing Address: f Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 9 000 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) jz- 5. Fire Protection 6. Total=(1 +2+3+4+5) CuD Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissidner/inspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Fronts e Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: _ volume&Location A. Has a Special Permit/Variance/Finding er been issued for/on the site? NO Q DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Regist of Deeds? NO © DON'T KNOW a7 YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,exca tion,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO 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 Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks (Q Siding[0] Other Brief De2guf�?��J�T I lL�1 l J1Jc J . ��X.0 l�_1�1�X�- l�/✓ �� S Work: Alteration of existing bedroom Yes '-X No Adding new bedroom Yes %-�No Attached Narrative Renovating unfinished basement Yes VNo Plans Attached Roll -Sheet 6a,If New house and oraddid 6 to existing housing, complete the following: 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. 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 City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 16V6e� k- cck� 1 t tC(,ras Owner of the subject property hereby authorize ( S <<S to act on my behalf, in all matters relative to work authorized by this building permit application. I..),I�I�d Signature of Owner Date 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 an nalties of perjury. kwS Print Name ��Ito�l`6 Signature of Owner/ nt Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: t liI A ("7 License Number o,3c3I 10 -- u - (96 s , Expiration Date Signa re Telephone 9.Realstered Home Improv Contractor: Not Applicable ❑ Idia I Yu C/a a- Company Name Registration Number 1140-)- YL u - al - f6) Address ►�� /y I` l Expiration Date t /' kyI)� Telephone'' ��D� o+�)'� 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 denial of the issuance of the build! permit. Signed Affidavit Attached Yes....... V 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 structures 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 to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildine permit. As acting Construction Supervisor your presence on the job 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 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,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: 31 �P.L;- S� The debris will be transported by: The debris will be received by: 016- Building 16- Building permit number: Name of Permit Applicant Inv S l I � Qlx�A A L2�� Date Signature of Permit Applicant City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main street • Municipal Building Jsf•. p�`D Northampton, MA 01060 Property Address: I 8T:2V'Uj Contractor Name: JMUn I 1 S Address: �I4a kmsY.ti /a K. G, . ' - City, State: �a Phone: 41'�> Property Owner Name: Address: City, State: I, c_6V S E ('t (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 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/Organi on/Individu ): r d Address: 11, bN City/State/Zip: Phone#• Are y u an employer?Check he appropriate box: Type of construction 1. am an employer with_n 4. ❑ I am a general contractor and I Please Check One employees(full and/or part time).* have hired the sub-contractors ❑ 6.New construction 2. 1 am a sole proprietor or partner listed on the attached sheet. ❑ 7.Remodeling ship and have no employees These sub-contractors have ❑ g.Demolition working for me in any capacity. employees and have workers' ❑ 9.Building addition [No workers' comp.insurance comp.insurance.$ ❑ 10.Electrical repairs or required]. 5. E We are a corporation and its additions 3. ❑ I am a homeowner doing all work officers have exercised their ❑ 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 ❑ V.Roof repairs employees. [No workers' oa-43.Other lh&uld on comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach 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 employee&Below is the policy and job site information. �`ot fi� ,nS�U_ Q) Insurance Company Name: J Policy#or Self-ins.Lic.#::—w t Q05,u qi Expiration Date: I( Ra Site Address: ?1-1 `t'YLa�fi City/State/Zip:() ]d 1Q, wVbo tl 1p a Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration(date). Failure to sectue 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 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 i r the p a penalties of perjury that the information provided abo is /u and correct. Signature: Date: 1�I I��1 Print Name: (� ,5 �� 5 Phone#:LAI Q3• �1� Ofjlcial use 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.Board of Heath 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: +Ac CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY1) ,1/19/2016 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 ADIJ17IONAL 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 NAME:CT Andrea Feeley Webber&Grinnell PHONE (413)586-0111AX (413)586-6481 No.Ext• A1C No 8 North King Street E-MUL afeeley@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA• Selective Ins Co of S Carolina 19259 INSURED INSURER B: Ideal Home Improvement,Inc. INSURERC: Attn:Laurie Ellis INSURER D: 142 Boyle Road INSURER E: Gill MA 01354-9731 INSURER F: COVERAGES CERTIFICATE NUMBER: ExP 1/2019 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 MAYBE 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. LTR TYPE OF INSURANCE INSD W ADDLISUORY POLICY NUMBER MNMNW LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 DAMAGE To ReNI tU-- CLAIMS-MADE a OCCUR PREMISES Ea occurrence $ 500.000 MED EXP(Any one person) $ 15,000 A S2291368 11/17/2018 11/17/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000 X POLICY JEOT- F]LOC PRODUCTS $ 2.000,000 C OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea acddenl ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED A9105410 11/17/2018 11/17/2019 BODILYINJURY(Per accident) $ AUTOS ONLY AUTOSNON-OWNEDHIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per dent $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1.000,000 A EXCESS LIAB CLAIMS41ADE 52291368 11/17/2018 11/17/1019 AGGREGATE $ 1,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH AND EMPLOYERS• YIN LIABILITY STATUTE X ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICERIMEMBEREXCLUDED? NIA VVC9057697 01/26/2018 01/26/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N more space is required) James Ellis&Bruce Rosewame are Excluded from Workers'Compensation Coverage. 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 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construct-,on Supervisor OS-091207 Expires: 10/16i2020 JAMES P ELL:IS 142 BOYLE RD GILL MA 01354 - ,, Q r• Commissioner y` Office of Consumer Affairs&Business Regulation = HOME IMPROVEMENT CONTRACTOR i'- RkTYPE:Corporation ' - Registration Expiration 04/21/2019 IDEAL HOME IMP_RWtMENT INC. JAMES ELLIS 142 Boyle Rd Gill,MA 01354 Undersecretary