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17D-027 (11)
73 STRAW AVE BP-2019-1003 Gls#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 17D-027 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-2019-1003 Pro ject# JS-2019-001656 Est.Cost:$2500.00 F b .00 PERMISSIONIS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group IDEAL HOME IMPROVEMENT INC 091207 Lot Size(sp.ft.): 16335.00 Owner: IUNNO DAVID&CARMEN Zoning:URB(100)/ Applicant.- IDEAL HOME IMPROVEMENT INC AT. 73 STRAW AVE Applicant Address: Phone: Insurance: 142 BOYLE RD (413) 863-2128 WC GILLMA01354 ISSUED ON:3/15/2019 0:00:00 TO PERFORM THE FOLLOWING WORK 230 SF FOAMBOARD ATTIC SLOPES, 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 OccuoancV Signature: F T e: Date Paid: Amount: Building 3/15/20190:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner 1 YA cvL Department use only City of Northampton Status of Permit Building Department Curb CWDrivewey Permit 212 Main Street SewegSeptie Availabft Room 100 WaterANell Avaderoliry Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/She Plena Other S `Na APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DE IS DW LING SECTION 1 -SITE INFORMATION 6P-109- t UO3 MAO 1 4 2019 1.1 Property Addr}ess::' his r Ion to be completed off 0,3� Map op FM Cta4aLDINe 1N3PECTDNa flit NOnTHAM�P�A�M�1p�— Zone Onday,District Norenu— , EIm SL District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of R o Caxmen 1(10 -)I S-Vra u 6j-,1Pn, FI arPn e, Name(Pont) Cu Mail' Address'. Telephone $19nM11R 2.2 AuthorlzetlA ent: oi-m LS PA ,S 14a l�iyle ICd ,Cell YYIA me( t) Cu1rtIeM mlinpg Sign u a Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bermitapplicant 1. Building (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee ln{ 4. Mechanical(HVAC) lX J 5, Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: 3- 1S -Zofq Building Commissioner/Inspector of Buildings Date Se:tion 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 Buildingnepartment Lot Size Frontage Setbacks Front Side L R: L: R: Rear Building Height Bldg.Square Footage Open Space Footage (I.ot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW Gr YES O IF YES, date issued: IF YES: Was the permit recorded at the Regis of Deeds? NO O DONT KNOW YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW (D" 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 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. VVII the constriction activity disturb(cleaning,grading,ggWation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoolicablel Now House ❑ Addition ❑ Replacement Windows Atieratlon(s) ❑ Roofing Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs (0] Decks [p Siding[[-]I Other Brief Description of Proposed Work: !71'��-{ �CNAA'Y1bCQkt7-- Wi"�l�-S� S � Ck(V "SW(— Alteration of existing bedroom_Yes ✓ No Adding new bedroom Yes ✓No Attached Narrative Renovating unfinished basement Yes ✓No Plans Attached Roll -Sheet ea. If New house and or addition to existing housing-complete the foilowina_ 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 R. 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. I. Septic Tank_ City Sewer_ Private well_ City water Supply_ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT , O�R CONTRACTOR APPLIES FOR BUILDING PERMIT opjI, IY w �1.1.Y\YL0 as Owner of the subject property hereby authorize CIQd'V1.CS cads to ac[ n my behalf, in all matters relative to work authorized by this building permit application. ala 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 55gins and penaPogg��,,of perjury. cJGlYl1. r,fP7 Pnnt Name p q lrlti�l 3114 l I Signature of OumenAge Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction S/uI arrvirsor: $` Not Applicable/❑ Name of License Holdeli r: "I 1ACI License Number 1q,� Y'�u 0 Gul M-a- /b I U -dd Expiration Date t ti� (4 1 3 JUS a a� Signatu Telephone 9.Re Istel ra . orNot Applicable ❑ -11 Q AA � f(M ift ) qu"116a- CompanyName Registration Number til ( VYI� U-a( ,if tlress Expiration Date tiL Telephoi93 AP21 pp SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C. Workers Compensation Insurance affidavit at be completed and submitted wth this application. Failure to provide this affidavit will result in the denial of Me issuance of the buildin ermit. Signed Affidavit Attached Yes....... N.-.... ❑ 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 ads 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 build'buildiny 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 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: —1 ) (Sfi'6t,t l) r)I, fi U-( ' Even U— The debris will be transported by: n[A The debris will be received by: n A Building permit number: Name of Permit Applicant J n'n is f I l5 Date Signature of Permit Applicant City of Northampton �S C •" Hassachusette 1� � r DEFMmMr' OF EDILDIEG IESFECTIMS 212 Main Ntraet a Municipal Neil&nq irtri ,1P< ,L.,� Northampton, MR 01060 Property Address: St[ w Atnut 1 { oy-enE-Q-- Contractor ) U -s Name: CS +�n.il Address: 4` ' YL tm X City, State: Gl ( WU Phone: ' a� Property owner Name: — Address: t�An� City, State: I, _QQ J, I k S C l 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 signature � /ln Date L4 Me Commonwealith ojMassaMusets . Department oflndathialAccidents I Congress Street,Suite 100 Boston,MA 0211¢1017 wwlemass.gopfdia WWorker'Compensation Issuance AiBdav)t BuRderdContmctordElectrlcluur/Plombem TO BE FB.ED WMITHE PERMITTU4O AUTHORITY. Nam(BminWOBmi>ado wivww): 1N. f. Address: lila f)jq u— �& City/Statelzip: ills f{l a 013 -1 Phone#: '�1'� 81,73 a l 3L`6 Ars Y.wupbY.rl Cbeutths.ppwprbnees: Type of project(required): lo,isace•' O^YQwiW7. ❑Newconswction 2.❑[emrmkpagimratmme&EpmdNwmemplym wadi.$ f.rm.in E. E]Remodeling sur-pcaty IN.eodsu ewer w..ax newldl 3.❑lem&bommwoedeng dl wakvgsl[[No wvdaa'emp.aeamarequldlt 9. ❑Demolition 1.❑lam&b.mmwm cod w0l bekir®a®trxbnmcwao.t.a wahmmypapnry. less 10[:]Building add0on ueuvthe.amdrecanesbaNve walmr'containdo.nesse,a a.ole 11.0Electricol repairsoreddidans mepdnen wadesempbyaa. 12.E]Plumbing mpabs or additions $.[]I&aa amenlcuaz arwdI Nue Neddeau.®Yamn Nido.anaNdwdehnl Tier,subcodaNa be.a iy.cod Nw wan®•mop insua l 13.E]Ruofrepails a❑W.m.emT dM and NvM.bw,,mealdek Wsf.,uptiesWMOLe. 14.E16ther i flC A_DU,'11()'� 1St•01(4),and we leve m eso[ .[Noworks'mop.imwanengaNd] •AoY eppllaa datchecks box el cam she an oa do mukubekw dweigdebwmium'mmpemtlon pofry idaa&dea - 1Flommwom,who stunk d,&®drublu iadegd r ae notes as wakaodamabo aunts,usstudes,aunt mbdta sew rdm&vb oawgvg nob. IC�da.bmk d'e ler sera ana m.d&wul,hendowim da vase dd,&ubmanda&odes,wNdammtdae edWa Nue emp[oyar. Rlbomb,mmcwmNro enployea,d•Ymmprovide their wda.a'a pallrynuba. Iam an employer"Isprodding Worker'anapensadon£rnurearejeray emptoyees Bel wtrhepoliey andlobste information. J., Insurm eCompanyNama Co ec ll Irfko-Mu-, Co rr�� Policy#m � Self-ins.Lie.#. 00AD61\-Uql Expirctian Dme: I �Q a� Job Site Addreas: Cty/Statd7lp: I(wen tk- , )'✓l.�t Attach a copy arths worker,'compensation pulley declaration page(showing the potiry number and expiration date). Failure to seams coverage as required under MGL c.152.$25A is a criminal violation punishable by a fine up to$1,500.00 and/or one year imprisunmeut,as well as civil pesltim in the form of a STOP WORK ORDER and a fine of up to$250.00 a day aga rot the violator.A copy ofthis"uncut may be forwarded to the Office of Investigations of the DIA for insurance coverage verification fdo hveby=the palsa derofperfurythat Me lnformadonprnrldutabove,is",andcorrect Phone#: k413 - R10�, a1 aK OfJrelal use pn(p, Do not swiss to eht area,to be completed lryefiy arson aJYh'faI City or Town- Permi011cese# Issuing Authority(circle one); 1.Boardafflenhh 2.1ls11dimg Department 3.Cityfrown Clerk 4.Electrical Inspector S.PlambinglspeeNr 6,Other Contact Peron: Phos#: aco CERTIFICATE OF LIABILITY INSURANCE o1n4Y1019 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOTAFFIRMATNELY OR NEGATIVELYAMEND,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: lithe certificate hOMer is an ADDITIONAL INSURED,the poficy(ims)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 endonelrent. A statement on this certificate does not confer rights to the ceNReate bolder in lieu of such andoeement(s). PRODUCER MIME: Mon..PAN, Webber&Gnnnet IP"ac�xc (413)586 0111 uc xo o (413)5864481 8 North King Sheal pODRES3: a fealey(gwebbelandgmarell wra INSURERS)AFFOOW COVERAGE NAICe Nonhampton NAA 01060 IMSURBRA: SelerUvelne COMSCamlina 19259 INSURED IMb11ftER B: Ideal Home Improvement,Inc, INSURERC. Arm Lau.EIIIS INSURER D: 142 BOyla Road INSURER E: Gill MA 01354-9731 MSURERF: COVERAGES CERTIFICATE NUMBER: Eq,1112019 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTW THSTANDINC ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT MALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILSIR T0. TYPE OF INSURANCE INSO W E POLICYNUMB MSVpCY SF (MM � UMMS x COMMERCMLGENEMLMNUW EACH OCCURRENCE 5 1,00DWO CIAIMS.MACE ©OCCUR PREMISES Ee aaneva E 500,000 aUNn XpVva—ovvcm1 E 15,000 A 52291WS 111172018 11/170019 pEaEo.anovlmURY S 1.000000 GENLAG AF%TE OMIT APPLIES PER: GENEMLAGGREGATE 5 2.000,000 WLICV ®jET ❑LGG PR000CT5-COMPA,`PAGG 5 2,000,000 OTHER $ AUTOMOBILE UASIUTY C WNNEEDSINGLE LIMIT 5 1,000.000 ANYALTO BOOILYIwUm'IPa I S A OWNED SCHEDULED A9105410 111172018 1111712019 BODILY IwuRv tPa xd4anD S AUTOSONLV AUME HIRED NON-0NXED pROPS.'iJa.E 5 X AUTOS ONLY AUTO$MY Para S UMBRELLA WB OLCUR EACH OCCGRRENCE s 100,000 A EXCESS Luc CVJMSNADE 52291368 111172018 11/172019 pGGN,,TE S 1.000,000 DED X RETENTION$ 0 5 WORKERS COMPENSATOR R 0TH' ANDEMPLOYERSIJABIISTY YIN STATUTE ER A ANYOFFICEORMEIMBER FIICLUDE ECMVE F-1 NIA VIC9057697 01262019 OlcN2020 EL EACHACCIDENT S 500'000 onalitory In mn EL.DISEASEEAEMPLOYEE 5 50,000 II Yes d.w..' 500,000 DESCRIPTION OF OPERATIONSMvv EL.DISEASE-POLICYLIMIT S DESCWPOOKOFOPEMTONSILDCAlpNa1VEMCLES(ACORDID1,A44e iRenurb Stb %TsybeeaeMWKMMPpSSNrp�) CERTIFICATE HOLDER CANCELLATION SHOULOANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEL VEREO M EVldenm Of Insurance ACCORWNCE WITH THE POLICY PROVISIONS. AUTNOIIDED REPRESENTATIVE 111t- -a ®1988-1015 ACORD CORPORATION. All rights naserved. ACORD Z5(1018(03) The ACORD name and logo are registered mart of ACORD �. Commonwealth of Massachusetts Division of Processional Licensure 3oard oBuili inq Regulations and Standards -OSli LM1i r:'_'Jn S /101 _ CS-091207 Expires- 10116;2020 JAMES P ELLIS 142 BOYLE RD ` GILLMA 01356 ' ' - - - Commissioner .7 / .ri./// W.of Consumer Mrelrs B Business R"i lnion HOME IMPROVEMENT CONTRACTOR TYPE Coroora0on Rmslration Ex,q DDon 146402- 04/212021 IDEAL HOME IMPROVEMENT INC. JAMES P.ELLIS 142 BOYLE BOYLE RD �\ GILL,MA 01354 UndemecretarY