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36-137 (9) BP-2023-1422 20 LONGVIEW DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-137-001 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-2023-1422 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 3000 JAMES ELLIS 091207 Const.Class: Exp.Date: 10/16/2024 Use Group: Owner: REARDON, JAMES P. &FARRELL, JILLIAN E. Lot Size (sq.ft.) Zoning: URA/WSP Applicant: IDEAL HOME IMPROVEMENT INC Applicant Address Phone: Insurance: 142 BOYLE RD (413)863-2128 WC9057697 GILL, MA 01354 ISSUED ON:10/13/2023 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 3-1 ap • � yam " Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner / 6,: 4,),„ )q 76 o .c- - s.; City of Nort mpt C� DepF0 ��`` BuildingD art nt 007 p� C*' ,t . i& 212 M In Sr et i SULA T ON ,, -•!x p Roortt\06'i' rd Northampton, ,_� .A phone 413-587-1240 Fax 46' /A:� `5�:, Qftjf_, Y .`q,�' 2..:7 APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY(SECTION 1 -SITE INFORMATION INSULAN PERMIT 1.1 Property Address. Th'•-section to be completed by office to wrv,, k _vo N . Map Lot Unit nr��l�' •- �,L ,n� A. Zone Overlay District V ��(IYT,T('X` 1 1 V Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Jonv- q-ecu-Guin rho Lint v vi N', for npkin Name(Print) Current Mailing Ac dress Telephone Signature 2.2 Authorized Agent: lt.S 114a 6,(4 It a. OH( ovi e( tint) Current Mailing Address: Signatur Telephone SEC ON 3-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 (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee kii 4. Mechanical(HVAC) u 45. Fire Protection f� 6. Total=(1 +2+3+4+5) 3cQ — Check Number L-j70/ This Section For Official Use Only i Date Building Permit Number: 6P' )l t Nab• i Issued: Signature: /6- 12-2023 Building Commissioner/Inspector of Buildings Date t[kk4. rli arrACCICi•nt4- EMAIL ADDRESS (REQUIRED. EITHER HOMEOWNER OR CONTRACTOR) , SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not A licable 0 Name of License Holder: , O (Ykl S a t f3 CI DI 0 1 License Number a eN ( Glt( MA 1aIU.a4- Address Expiration Date 0 /v\ t--43• 5 I& Signa re Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 ôia NXIM MO liNi ea- I uUuoa- Company Name Registration Number ►au,i u t , C?1( � u.,)(.Q.5- Addres CC,, Expiration Date \� TelephonV14)' Q -a ( ll2 SECTION 5-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c.152,§25C(6)) Workers Compensation Insurance affidavit ust 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 No 0 INSULATION /� J v Brief Description of Proposed Work NOTE: ONLY 1 S O S Cr Cti t u tom o cultic t oq In c Si I tc; w n ore. hcci(. e_- av cseA1 I. dam -s li t k s 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. 0.C1l�,5 llS tint Name Signature of nerlAgent Date I. J(mYus ' €Lt+ thin . as Owner of the subject property I ,�^J hereby authorize SJOX1 r , b S to act on my behalf, in all matters relative to work torized by this building permit application. J o,N far- 91/s!a>) Signature ofer Date ; T City of Northampton G� Slir j ' 1 J, ti ' 'i,i �IA Massachusetts I;i_ Esc ry 'r.sue + DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Suildin y', �/. :' te�-!.�' Northampton, MA 01060 4 �J��S "‘�� MANDATORY IC l FOR HOUSES BUILT BEFORE 1945 Property Address: AO L V(� �r Contractor d '/ Si-- lName: wC ,✓/ �+ Address: 1 -4 l� ' City, State: 511 Phone: 4 t"J • ( P) - al a D PropertyOwner �J Name:ame: arru 6-euctcn Address: a d L ` Vi,cuo I r• City, State: 1 1 Whan OW rn P' 1, Ja.m.tc 1.A5 (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 signatur Date \ AO \ ' 3 City of Northampton L. Massachusetts ��S,•s r.;s,.%t DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building s CJ Northampton, MA 01060 �'jY °J 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: \Y'Y UU.lC1\11.)n Est.Cost: 3000 Address of Work: a Q V i evo • Date of Permit Application: t o I LO 1 a 3 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.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 building permit as the agent of the owner: 101u Olio lifiekt 1 iy Date Contractor Name 1 HIC Registration No. OR: Notwithstanding the above notice, I hereb For a building permit as the owner of the above property: Date Owner Name and Signature • City of Northampton til' Massachusetts ' \�' DEPARTMENT OF BUILDING INSPECTIONS ,*sue 212 Main Street •Municipal Building �f ,ra ...,- ) •�r """ Northampton, MA 01060 I.,o!, '� 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: ao S_Yl Vtao L( , (Please print hOse 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 onsite rented or leased from: 64 (Company Name and Address) C----- I, Z.:.,._(__A__),, ioiCila-3 Sign.. ure 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. Department of lnaustrtal Acciaents Office of Investigations (k Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 "�'r�� 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 #:413-863-2128 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 10 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. 0 New construction listed on the attached sheet. 7. 0 Remodeling 2.El I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.: required.] 5. D We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] " c. 152, §1(4),and we have no insulation employees. [No workers' 13.1. Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit 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-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:1/26/2024 Job Site Address: l,<) W y City/State/Zip:fN _ f Z ► (fl Attach a copyof the workers' ensati n p o 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 he eby certify un er the pa s an0enalties of perjury that the information provided above is true and correct. Signature: n Date: l O I (o I A 5 Phone#: 41 632128 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): I DBoard of Health 20 Building Department 30City/Town Clerk 4.1:Electrical Inspector 50Plumbing Inspector 6.00ther Contact Person: Phone#: AC CERTIFICATE OF LIABILITY INSURANCE DATE(MM(DDIYYYY) iltio..--'-- 01/25/2023 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 Brandon Andrade NAME: Alera Group,Inc. PHONE (413)586-0111 FAX A/C,No,Ext): (AIC,No): (413)586-6481 Webber&Grinnell Division ADDRESS: bandrade@webberandgrinnell.com 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC# 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: Evanston Insurance Company Attn:Laurie Ellis INSURER D 142 Boyle Road INSURER E: Gill MA 01354-9731 INSURER F: COVERAGES CERTIFICATE NUMBER: EXP 11/2023 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 AODL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER _ (MMIDD/YYYY) (MM/DD/YVVY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO REN I ED 500,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) S MED EXP(Any one person) $ 15,000 A S2291368 11/17/2022 11/17/2023 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE 5 2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG 5 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO _ BODILY INJURY(Per person) S A OWNED v SCHEDULED A9105410 11/17/2022 11/17/2023 BODILY INJURY Per accident S AUTOS ONLY X AUTOS ( ) X HIRED �/ NON-OWNED PROPERTY DAMAGE AUTOS ONLY /� AUTOS ONLY (Per acddentl $ Uninsured motorist BI $ 100,000 X UMBRELLA LIAR XOCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB CLAIMS-MADE S2291368 11/17/2022 11/17/2023 AGGREGATE $ 4,000,000 DED XI RETENTION$ 0 5 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y N/A WC9057697 01/26/2023 01/26/2024 E.L.EACH ACCIDENT 5 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Pollution Liability Per Occurrence 2,000,000 C TBD 01/25/2023 01/25/2024 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers Compensation Excludes 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS • Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Corporation Registration Expiration 146402 04/21/2025 IDEAL HOME IMPROVEMENT INC. JAMES P.EWS 142 BOYLE RD GILL,MA 01354 Undersecretary Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Constzst Vg4:9,ivisor CS-091207 . hires: 10/16/2024 JAMES P ELYS 142 BOYLE ISO GILL MA 019t ir ��1`�t.E: Commissioner draaQtanca. : _. • 1