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17C-056 (6)
174 CHESTNUT ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1936 Map:Block:Lot: 17C-056- 001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1936 PERMISSIONIS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 3900 IDEAL HOME IMPROVEMENT INC 91207 Const.Class: Exp.Date: 10/16/2022 Use Group: Owner: CURRIE JACQUELINE P& STEPHEN E L Lot Size (sq.ft.) Zoning: URA Applicant: IDEAL HOME IMPROVEMENT INC Applicant Address Phone: Insurance: 142 BOYLE RD (413)863-2128 WC9057697 GILL,MA 01354 ISSUED ON:09/24/2021 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERIZATI ON 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. Signature: ( • `�, ff, • ety� It1 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 19) -th City of Northampt n �4 FOR R Pro ' : ` Building Depart ent a 212MainSr et Room 1 �Ar 0 ,.o ULA TlON Northampton, MA ,°r c01 �1 u, ;:may phone 413-587-1240 Fax 413-5; nto r, ONLY N ��n?'r/„ APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY D !•.. ING • LY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: Th'`r section to be completedte� by office 11'- iS 1►1 - S{-. Map l 1 C/ Lot Ve5.(' Unit V;ram,^!,a Mill Zone Overlay District ,vl�.1 M.C, 1, Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Si WW1- Vdt 114 U t' uut St. Name(Print) Current Mailing Address: __ y13 3a,�- 51r38 Telephone Signature 2.2 Authorized Agent: '[ I OVA ame t) IS 0r«� 9k I` 1 Current Mailing Address: q+3.i• Ao- xia-g C1/41W%- OCA*"/"` Signatu Telephone SEC ION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3-1O(() (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing _-- Building Permit Fee 4. Mechanical(HVAC) Ce 5. Fire Protection 6. Total=(1 +2+3+4+5) 3C100 Check Number ff3j This Section For Official Use Only 60— r Iq3(� l Building Permit Number: Date Issued: I Signature: �� 9' 23-Z6Z1 Building Commissioner/inspector at Buildings Date -eit i‘ e @ cc m CL&+. -- EMAIL ADDRESS (REQUIRED;. EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder:do `'ems cc¶ -1 I?c7 License Number lua. Nu ea 1 Go (ru 10.1u.a-1)- 41V- ;k,.AA/k. ?A/-\,-... ii5- 6\.e • a ( g dr Expiration Date Signatur Telephone 9.Rea'stered Home Improvement Contractor: Not Applicable 0 Ill. \-lux2. 1 eAcittut^tak ILIA. in-- Company Name/� J ,nn n Registration Number 1 resk \U �. 1(eI . I G(( V► U_ �(-e3-t-�-j Expiration Date Telephone 1 3. 8-al d D 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 buildi permit. Signed Affidavit Attached Yes 1 No 0 Brief Description of Proposed Work NOTE: INSULATION O L Y yrposf Ctcctilutc‘e, c c 1-ic; Lf3is-f ywestn-( o Slopes i O trse r( 1, icuvusa. ,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 th pains and PIties of perjury. Sc , S Print Na e R.,";..A.,,s g1141c 't Signature of Owne Agent Date I, (S4 Ut,1 t L& A1 t ,as Owner of the subject property `�� y�� hereby authorize J k_sk LS 2,1,S to act on my behalf,in all matters relative to work authorized by this building permit application. cittola4 Sig trf�ur of Own r Date City of Northampton sM=!--s4,.. Massachusetts , *. s. DEPARTMENT OF BUILDING INSPECTIONS S. >^ �, 212 Main Street • Municipal Building Jj • y' Northampton, MA 01060 nP. �1 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: %1Lk S cti- •k'} r(otenCe. Contractor 0 S US Name:ame: v Address: NI jU 1 nn__'' City, State: 3it 1 `R Phone: t6. O elk A Property Owner /� t1u Name: (� Cetel<PS Address: 1114 Chust7.'ut" SA- .-- City, State: 4CX&t ct. 1 Y `"/ I, daxikes EictS (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 OtiMv` Date ci l"4 4. City of Northampton �5 Massachusetts ; ,* - s.° DEPARTMENT OF BUILDING INSPECTIONS 7' t" _ 212 Main Street • Municipal Building v� rah Northampton, MA 01060 y. `:16 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 registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered. Type of Work: \nSt A '(�,"ti1(,\ Est.Cost: 100oo Address of Work: 1� CQ5iTwi- S' Date of Permit Application: CI I 1 (e)-I 1 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.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a b ermit as th g iaf the o ner: °I 1'u I � CA-/LIVN VeAk 1406e,101ii Lf 4 _- Date Contractor Name HI Re istration No. OR: Notwithstanding the above notice, I herebti appi : ,r a building permit as the owner of the above property: Date Owner Name and Sienature • A_ City of Northampton Massachusetts % *:144 4 DEPARTMENT OF BUILDING INSPECTIONS 3 212 Main Street •Municipal Building Jb •a 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: ‘11k CLSlVnwt- a (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onstte rented or leased from: tittAS 1—bleC lmi1K� 'a.► '� 1�t,(te- 2� (Company Nam and Address) Signat a 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 Commonweahh of Massachusetts Department of Industrial Accidents Office of Investigations 1 )-4 Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Ideal Home Improvement, INC Address:142 Boyle Road City/State/Zip:Gill MA 01354 Phone #:4138632128 Are you an employer? Check the appropriate box: Type of project(required): 1.© I am a employer with 10 4. ❑ I am a general contractor and T 6. El New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.® other insulation comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tConr actors 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-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Selective Insurance Co Policy#or Self-ins. Lic. #:WC9057697 Expiration Date:1/26/2022 Job Site Address: 04 CIf t.Sj flU4 SA • City/State/Zip: ti otenC.Q.. Ink Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb nder the ' and penalties of perjury that the information provided above is true and correct. Signature: Date: q I I`LIl(<1) Phone#: 413 Ike)• aIa`$ Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 30City/TownClerk 4.0Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: ACC)REI® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDYYYY) 01/29/2021 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 ADDITIONAL 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 CONTACT Patrick Gooden NAME: Webber&Grinnell (AHG No.Est): (413)586-0111 'AAA Na): (413)586-6481 8 North King Street E-MAIL pgooden©webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL# Northampton MA 01060 INSURER A: Selective Ins Co of S Carolina 19259 INSURED INSURER B: Selective Ins Co of Southeast 39926 Ideal Home Improvement,Inc. INSURER C: Attn:Laurie Ellis INSURER D 142 Boyle Road INSURER E: Gill MA 01354-9731 INSURER F COVERAGES CERTIFICATE NUMBER: Exp 11/21 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 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. INSR ADOL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MM!DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 D CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 15,000 A S2291368 11/17/2020 11/17/2021 PERSONALSADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $ 2,000,000 RO- POLICY n PECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A `— OWNED AUTOS ONLY X SCHEDULED A9105410 11/17/2020 11/17/2021 BODILY INJURY(Per accident) $ _ AUTOS XHIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY (Per accident) Uninsured motorist BI $ 100,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B 1,000,000 oFFICERIMEMBER EXCLUDED, Y N I A WC9057697 01/26/2021 01/26/2022 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ ,000,000 If yes,describe under 10 ,00000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation IDEAL HOME IMPROVEMENT INC. Registration: 46402 142 BOYLE RD Exxpi ration: 04/21/2023 GILL, MA 01354 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 146402 04/21/2023 1000 Washington Street -Suite 710 IDEAL HOME IMPROVEMENT INC. Boston,MA 02118 JAMES P.ELLIS 142 BOYLE RD GILL,MA 01354 Undersecretary •t valid without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Con5tr,yet OA1Sa ViSOr CS-091207 ycy Aires:10/16/2022 JAMES P ELUS f. 142 BOYLE RD GILL MA 01354 10/SS",1 1iL Commissioner �ia z /. fj&'+ - • .- -•.• vvflnt MOOR-MCI v _ .Tr I e(viwr.r/Yfr t" .,//erstiere/rirde//i _ .. Office of Consumer Affairs&Business Regulation ' HOME PROVEMENT CONTRACTOR TYPE:Corporattin�o,..'�yj� • a 1!Y!1.f t : . . 04121/2021 IDEAL HOME IMPRDV" a INC. JAMES P.ELLIS/: 142 BOYLE RD alb GILL,MA 01354 Undersecretary •