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36-114 (6) 199 BROOKSIDE CIR BP-2020-0990 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:36-.114 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-2020-0990 Project# JS-2020-001676 Est.Cost: $65.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sa.ft.): 16814.16 Owner: JAMES LOWE Zoning: Applicant: VALLEY HOME IMPROVEMENT INC AT. 199 BROOKSIDE CIR Applicant Address: Phone: Insurance: P O BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:31512020 0:00:00 TO PERFORM THE FOLLOWING WORK:ATTIC INSULATION, AIR SEALING, GUTTERS 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 3/5/2020 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ��4y �`` Dep ol? r-�� City of Northampton ` � � y . Building Department + 212 Main Street q 0 \� I NS ULA TION A . t ,,_ � : Room 100 ,;�n Northampton, MA 0'1 .-�' phone 413-587-1240 Fax 413- 72 ONLY APPLICATION FOR INSULATION FOR A ONE OR TWO F A �Y ELLI ONLY SECTION 1 -SITE INFORMATION INSULA-TION PERMIT 1.1 Property Address: This section to be completed by office Q,`3 f0 'i QI 01' Map ( Lotl Unit tc. 1. Zone Overlay District HA oto(; -2 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 'Tay A- s Lown _ ��Q �r� S l Czr�� Name(Print) Current Mailing Address: 403 - 7-1 el - 514 Telephone Signature 2.2 Authorized Agent: `` ' I 4 Name((Print), Current Mailing Address: <��2 - 413 - 860 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) g 2 s Check Number �'$s 7 This Section For Official Use Only Building Permit Number: aU DatIssued: Signature: -3- Building -Building Commissioner/Inspector of Buildings Date w ,r��� (,w �u-e-I , coin EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Q Not Applicabllel ❑ Name of License Holder: S t'eiQ ar ►a �- License Number C12- 1 Z010 Address Expiration Date HA / Signature Telephone ZM Z 9. Registered Home Improvement Contractor: � Not Applicable ❑ � 1 0 5 S 1 .3 Company Nami f / Registration Number `4t) � Ut'X�Jp- P() t cQx CaC,2`� 03- 1 ( � 1 ?n ?4--) Address �Q /� Expirati n Date L t7 Y�.L LCQ—0 1l'� Q�d tG�2, Telephone 4 1 -;;9 ---1S2-2 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 building permit. Signed Affidavit Attached Yes.......(Zid No...... ❑ Brief Description of Proposed Work NOTE: INSULATION ONL Y lolaw; In " 6�e- � , dame � ►�� �� P , I, r f I as Owner/Authorized Agent hereby declare that the statements and inforrOation on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. -F12ip-beQi C Print Name r Signature o7M.te-rTrgent Date I, "Teq p S L-0 w I as Owner of the subject property hereby authorize YA to act on my behalf, in all matters relatiO to work authorized by this building It rmit application. Signature of Owner Date f •- J SECTION 5-DESCRIPTION OF PROPOSED WORK(check all analicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [0 Siding[lam] Other[o] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. 1f New house and or addition 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 ]. 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 OWIHERS-AGENTOR'CONTRACTOfR APPLIES FOR'--BUIIoDING1P•ERMIT I as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. S[gt>a 4f'QsNr►@> 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 and penalties of perjury. STTA-T) L V h�Yti 4 Print-Name slgr#slur O e .ge;t lake City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS } ;� 212 Main Street •Municipal Building Northampton, MA 01060 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: Aq Rcamk %�da 0 '1LV- V6"'L' �qA (Please print house number and s reet name) Is to be disposed of at: U-31[Qkk 4�lOr't - (Please&int name and loc I ion of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 'f Signa ure of Permit Applicant dr Owner bate 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. ACOR CERTIFICATE,OF LIABILITY INSURANCE DATE(Ml14IOtUVYYYI THIS CERTIFICATE IS ISSUED AS A0410912019 OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS/09/2019 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($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the poNey(!es)must have ADDITIONAL INSURED Provisions or be endorsed. S SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this cartilicate does not confer rights to the certificate holder in Neu of such endorsemePRODUnt(s). Webb NAk E: Barbara GrynldevAca Webberr&Grinnell HONE . (413)586.0111 8 North King Street Iev�lcz W g c No, (413)586-6481 ADDRESS., ink Q ebberand dnnell.com Northampton INSURER AFFORDING COVERAGE INSURED NAIL p MA 01060 rISUKRA: ArbeBa Protection 41360 Valley Home Improvement,Inc. ENSURER B: Arbda Indemnity 10017 Attn:Steven Silverman INSURER C: P 0 Box 60527 WSURtiR o: J Florence MA 01062 INsuRERti: INSURER P COVERAGES CERTIFICATE NUMBER: Exp 2/1/20 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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. TYPE OF LTR COMArERCWLtiENESR LIABILITYPOLICYNUMSER Nlfd/D LIMITS k EACH OCCURRENCE 3 1,000,000 CLAIMS-MADE 5�OCCUR PR MISSESR Egoc t rt nca g ME100,000 r i A 8500063755 02/01/2019 02/01/2020 D EXP tAn one 51000 sENLAGGREGATE LIMIT APPLIES PER: pO &AOV INJURY 1,00 ,00 d GENERAL AGGREGATE 2.000,000 POLICY ©J`E`C'T 7 LOC PRODUCTS-COMPfOPAGO $ 2,000,0W OTHER: i AUTOMOBILE LIABILITY C M81NED ING LEXCUS E acc e _ S 1,000,000 A SCHEDULED BODILY INJURY(Per peon) $ -. .AUTOS 10200.37691 02/01/2019 02/01/2070 aODILYINJURY(Per acddent) E .. NON'MILV AUTOS ONLY 0 b Peracddent Uninsured motorist BI E 100,000 UMBRELLAU OCCUR AB E'XCHOCCURRENCE t b,000,000 CLAIMSaMADE 4600063756 02/01/2019 02/01/2020 AGGREGATE 5.000,000 RETENTIONS 10,000 WORKERS COMPENSATION g AND EMPLOYER&LIASLFY YINSTATUTE t B ANY PROPRIETORIPARTNERIXECUTNE I, OFFICERIMEM8£R EXCLUDED? a NIA 422005123702/01/2D19 02/01/2020 El.EACH ACCIDENT III 1,000,000 (Umdatory in Nit) If yes,desc be under E.L.DISEASE-EA EMPLOYEE1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 4 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached K more space is required) —CERTIFICATE H LDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Greenfield ACCORDANCE WITH THE POLICY PROVISIONS. 14 Court Square AUTHORQED REPRESENTATIVE Greenfield MA 01301 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetis Oivision of Professional licensure Board of Building Regulations and Standards Constru,.:ti66'WSi9pPrYISor CS-077279 1 -:' � �lrpires:06121/2020 f , STEVEN A SILVERMAN`` l^ 208 FOMER i 'pD .; .'' • ' SOUTHAMPTpA(M_.A ti9A73;' ?� t016 ,. COlnfriissioner t�/(� �:,/t�`�1�•f,2f�����L��>lf�G/C•' •G�' r / �//�^�"J•+��>�/�'�;.f�lYG"J Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration, - Type: Corporation VALLEY HOME IMPROVEMENT INC - - _ Registration: 105543 P.O.BOX 60627 Expiration: 07/16/2020 FLORENCE,MA 01062 Update Address and Return Card. $CA, O nt,l.'i1 '!;;,..,.,•Iry„r.,c• �„”�, • l � �:rc•%rig;Y� Office to Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corooration before,the expiration date. it found return to: Up- n ri Office of Consumer Affairs and-Business Regutation 1b5 37 r; 07jiSr- One Ashburton Place-Suite 13oi VALLEY HOME IpAPWC VAiIENT INC Boston,MA 02108 <`.':• F' SfEV1=N A.F,lLV4F1 J.' k..GGI. - 340 RIVERS1DFDl3;. NORTHAMPTON,MA 01062 Undere,earetary Not valid without signature _ The Co mots multh of Vussuchmsetts• Department o f bidush ial Accidetzts I Congress Street,Suite 100 Bostolii,-AM 02114-2017 WWW.mass.gov/dia 11-orkers' Compensation l ourance Affidavit: Bui]dt l s/Cuntrrcttars/Etectl icians, 'tuinbQrs. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant information ' Please Print Le-blv Nilm (business'Urgauizatipnludividtlalis V(7 t'� -S Address: -1,-1U � .���C1 -t�rc 1� i bcx C (r27 City/State/Zip: 1-- 1 b!--enLG k(� 01 00,?- Phone Are you an emplover'Check the appropriate hos: �-- 1 Type of project(required): i.�I art-,a elnpluyi r t<idlIF etvployees(full and or part tintej' 7. New construction _.❑I ant a aisle ptoprieter or p;utiiersitip and hat>c no cmplo eta a orkin� for , nt:in ar• czpac ~ Tiotok S. Remodelingis,cuttr.ituranc required.l 1.[]l aril it hamcowner doing:all tsolic,nvc lf.(�Iu tturker;;'comp.insur:mre requirrd.l r 9. Q Demolition K.❑1,mi a homcm- r and rill be binag conua,-tors to cnaduct all veal%on my propctt,. I wii,, 11) Building addition ensure that alt cnntfuctUrs either hat•[workers'cothrE,ema6M initlrancesole. 1 l.�Electrical repatI'S or addttlinls proprietors with nq erviployces. 12. Plumbing repairs or additions I 5.®1 am a;:neral contractor and I lim c hired the sul?-wntrace,)n listed an ch;auaehed;heel. Tilr,e;uh_,_ontlar.[or.ha c co,I,l+, ees an!1 h1r,,c,xkr,' c,:ml: i,;:nrarr 1 .❑Roof repairs i 6.Q 1Va are a colporatton and its ofti,er.,haee exer.ised their ri;zht<a,'•excmption pc[\Steil-c. 14.00ther-.- 151�1(-t).and we have nu crnpto}'ccs.No vrurkcls'cutru-iusmanr;requrrcd.l �~^� - -�- :_ _appiicat dint chec.kc bn>:t;l ntu.:t alao.till out the section belt,,i• o;ring dicir o:orker;'comp:sutiun palic' Infortuation. °Humaeovmeis trtiv;tthmit this af#ida'�it u;dicatim thty arc doilig all wos!•;and Thai hire UutSit{e C,iltlaC10rS MUSE Stlt)nLI a mny offidl it n lndicatina;inch. l.imtracl+.lV thM cliecl.this boa must uttached an additional sheet allotting dt_nano:oI chic sutu.Unuactors acid stare u bc(be or no;tf.r,.ic entitle;;leave etnrloye.,, [f the cph-rnntract[,t';have empli,YcC;.cher muni provide ihei• vvorl.en come.p,tli,, number. I aryl an ernpinyer that is Pilo ridhkg workerscompensation insurance for•lr?r esuplos•ees. Relorl•%r•the perliq?and job site in fvrtttatinu. In w•ance Cn,lrpany Name: _— .��_._..__ C-1-- Policy t'--or Self-ins. Lic, Expiration Job Site Address:�� Attach.2 COPY of(lie workers' compensation policy declaration page(showing the policy ruarbe)•anti eypiVatiop date). Failure it).secure coverag4 as r.quu•cd under MGL c. 152. §25A is a criarinai viotadon punishable by a fore:up to Sl,Sflf).Of) and or om-}ear imprisonment.a.;well as civil par ilties in the Corm of a STOP WORK ORDER and a fine Of till to S250.00 a dad•against the violator.A copy of this statement may be forwarded to the Orrice itf Investigations of the DJA for ilrsurance coverage v,rificathon. ` I do hercky rertifi�un I.the pa77— altie.s f p y circ' hat file ififovIllation provided abnre is trete and correct. Silmatw'c: � L7atc, Ofju•icrl rise mily. Do trot tt'rite ill this area,to be completed bt•city os•tower official —, Citi'or Town: Permit/License 4_ Issuing Autboril"'(cil•c.1c chic): 1.Roard of Health 2•Building Department 3.City/Town Clerk 4. Electrical inspector 5, i'lumbin;Inspector' Contact PCI-son: Phone i=• -