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22B-069 (5) 83 -85 SPRING ST BP-2021-0120 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22B-069 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-2021-0120 Proiect# JS-2021-000192 Est.Cost: $3000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: IDEAL HOME IMPROVEMENT INC 091207 Lot Size(sq. ft.): 8015.04 Owner: BIENIA MATTHEW Zoning: URA(100)/WSP(100)/WP(100)/Applicant. IDEAL HOME IMPROVEMENT INC AT. 83 - 85 SPRING ST Applicant Address: Phone: Insurance: 142 BOYLE RD (413) 863-2128 WC GILLMA01354 ISSUED ON:8/3/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSULATE OPEN ATTIC, BASEMENT CEILING, 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 Signature: FeeType: Date Paid: Amount: Building 8/3/2020 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner WCMr` City of Northampton DeP Building Department w ,- 212 Main Street Room 100 INSULATION Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 ONLY APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION --] __. INS ULA TION PERMIT 1.1 Property Address: Ttfc>section to be completed by office Map Lot_ Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Addr s: .� Telephone Signature 2.2 Authorized Anent: r,-)Lq La G Na`7% AA Current Mailing Address, X113. gl 3 a 1 a Signature Telephone SECTION -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3000 (a)Building Permit Fee 2. Electrical c/ (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection (JL 6. Total=0 +2+3+4+5) Check Number 7i This Section For Official Use Only Building Permit Number: /SP- 1''/ 0 Date Issued. Signature: U`3- ZOW Building Commissioner/inspector of E!Olding8 Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) e SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction§uvervisor Not Applicable ❑ Name of License Holder: O�Y�S t�(`�S -icI I AO-7 License Number lU�, 'may lQ CL Gil OA-k l O 11,7 Expiration Date Signature Telephone 9.Registered Home Improvement Contractor._ Not Applicable 0 =k4 LAYM 1 rn awl - 1 (4UQ0>- Com an Name —I Registration Number 1gX 66kit - a -a1 - I Addres � � /r�\\ �,( ,i2 .(/ Expiration Date 1, � ' "°` V��'-1 Telephone�3 �OlY7��i!o'6 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 ermit Signed Affidavit Attached Yes....... No...... ❑ Brief Description of Proposed Work NOTE: INSULATION ONLY q it Ce-i I u(o;.e_ of �y�� 1� 1�..�rn��rt- Cit►I I, 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. ckx.yyuCSL\ nt Nam (L� I I A ab Signatur of Owner/Agent Date as Owner of the subject property hereby authorizeCom-_t l_S to act on my behalf,in all matters relative to work authorized by this building permit application. -AUdbw 6; A_ 112,01-2-0 Signature of Owner Date City of Northampton Massachusetts t DEPARTMENT OF BUILDING INSPECTIONS s; 212 Main Street • Municipal Building Jar Sfia Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: � 11 Contractor c Name: V O A' s S 1 l S Address: rr� 1 OUN U City, State: y L l Phone: Property Owner Name: , 6 i.-O ick Address: 4110 Sfi City, State: I, �� 1 lS (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 1 Date City of Northampton Massachusetts _A DEPART20WT OF BUILDING INSPECTIONS 212 Main Street 0 Municipal Building Northampton, MA 01060 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"). M.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 regaistered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered. Type of Work:_ Est. Cost: 3000 Address of Work- Date of Permit Application--.-., C) 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.STICH OWNERS ALSO ASSUNIE THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PEP—MIT.SEE NEXT PACE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agem ol the owner: Date Contractor Namr HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property. Date Owner Nay re an14L! Signature City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street 9 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: v5 S emki a- (Please print house qu ffiber and street name) Is to be disposed of at: () A (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: 0'n --- --(Company Name and Address) Sign ue of 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. ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street _ Boston, MA 02111 r; www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name (Business Organization/fndividual): Address: b �_t Cw - City/State/Zi : V11MA u DVO- Phone #: 19 5 u3' o? ;)Jl? Aru an employer?Check the appropriate box: Type of project(required): 1. I am a emp Dyer with 4. ❑ I am a general contractor and I employees full and/or part-time).* have hired the sub-contractors 6 ❑ New construction 2.❑ 1 am a sole roprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and ha a no employees 'These sub-contractors have S. ❑ Demolition workingfo me in an capacity. employees and have workers' Y p tY• 9. ❑ Building addition [No worked' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a hom owner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [Nc workers' comp. right of exemption per MGL 12.❑ oof repairs insurance rc quired.] t C. 152, §](4), and we have no13. Other t Y)&L -0LAI(.f l employees. [No workers' comp. insurance required.] 'Any applicant that chccksbox#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who sul mit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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- ontractors have employees,they must provide their workers'comp.policy number. I am an employer hat is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie.#: q�5 Ut'"l Expiration Date:�l� Job Site Address: ► ka G1 City/State/Zip: Attach a copy of The workers' compaLation policy declaration page(showing the policy number and exp ration date). Failure to secure c verage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,50010 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 flie DIA for insurance coverage verification. I do here4l:cerfib un the pains nalhes of perjury that the information provided above is true and correct. Signature: i � Date: Phone : Official use on 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 Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Perso : Phone#: I ® DATE(MMIDDIYYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 01/14/2020 THIS CERTIFICATEI ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES OT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERT FICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the itificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS NAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does I tot confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CUNT CT NAME: Patrick Gooden Webber&Grinnell PHONE (413)586-0111 (413)586.6481 a Ext), A/C No S North King Street ADDRESS, pgoodenG"bberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC N Northampton MA 01060 INSURERA: Selective Ins Cc of S Carolina 19259 INSURED INSURER 9: Ideal Hon a Improvement,Inc. INSURER C: Attn:Laui a EIAs INSURER D: 142 Boyk Road INSURER E: Gill MA 01354-9731 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 11/20, REVISION NUMBER: THIS IS TO CERTIFY T T THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTH TANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BEI UED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND COIN DITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR K FUL.M71W POLICY EXP LTR TYPE OF I SURANCE INSD WV POLICY NUMBER MMIDD MM/DD LIMITS COMMERCIAL GE 4ERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MA ©OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any oneperson) 151000 A S2291368 11/17/2019 11/17/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIN IT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY I I j OT- 7 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILII V aBINEm 15 SINGLE I $ 1,000,000 (EaANY AUTO BODILY INJURY(Per person) $ A OWNED �/ SCHEDULED A9105410 11/17/2019 11/17/2020 BODILYINJURY(Peraccident) $ AUTOS ONLY /� AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAeCLAIMS MADE S2291368 11/17/2019 11/17/2020 AGGREGATE $ 2,000,000 DED RETENTION$ 0 $ WORKERS COMPENSA 1ONIO - AND EMPLOYERS'UA UY 1 N TY STATUTE ER ANY PROPRIETOR/PAR NERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICERIMEMBEREX UDED1 n NIA VUC9057697 01/26/2020 01/26/2021 tMandatory to NH) E.L.DISEASE-EA EMPLOYEE S '000 If yes,describe under SOD,000 DESCRIPTION OF OPE TIONS below E.L.DISEASE-POLICY LIMIT $ A DESCRIPTION OF OPERATIO IS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached N more space Is required) Workers Compensation I xcludes 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 lit- -D ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD I Commonwealth of Massachusetts Division of Professional Licensure 9oard of Building Regulations and Standards ."+al�?rE,1Ci:1;'1 ^e;3ar•�iso� CS-091207 Expires; 100612020 jJAMES P FLUS ({ 142 BOYLE RD HILL MA 01384 I � b Commissioner _ • Office of Consumer Affairs&Business Regulation {TOME IMPROVEMENT CONTRACTOR TYPE,Cornorallon Registration ellairation 1494112:; 04/21/2021 IDEAL HOME IMPR-0VW.4K—INC. sY.• JAMES P.ELLIS 142 BOYLE RD GILL,MA 01354 Undersecretary