Loading...
31C-002 48 WARD AVE BP- 2011 -0308 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31C - 002 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2011 -0308 Project # JS- 2011- 000506 Est. Cost: $515.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: IDEAL HOME IMPROVEMENT INC 091207 Lot Size(sq ft.): 50529.60 Owner: BRUMBAUGH SAMUEL & GALAXY CRAZE Zoning: RR(72)/URA(28) //WP Applicant: IDEAL HOME IMPROVEMENT INC AT: 48 WARD AVE Applicant Address: Phone: Insurance: 142 BOYLE RD (413) 863 - 2128 GILLMA01354 ISSUED ON:10/8/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL ATTIC & CEILING INSULATION 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 10/8/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner File # BP- 2011 -0308 APPLICANT /CONTACT PERSON IDEAL HOME IMPROVEMENT INC ADDRESS/PHONE 142 BOYLE RD GILL (413) 863 -2128 PROPERTY LOCATION 48 WARD AVE MAP 31C PARCEL 002 001 ZONE RR(72)/URA(28) //WP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out / Fee Paid /.•ll Typeof Construction: INSTALL ATTIC & CEILING INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 091207 3 sets of Plans / Plot Plan THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER: § Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission - Permit DPW Storm Water Management Demolition Delay /0 /0/V/i Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. ! Department use only City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/SepticAvailability ' Room 100 Water/Well Availability �G `Northmpton, MA 01060 Two Sets of Structural Plans phone 41 375'87 -1240 Fax 413 -587 -1272 Plot/Site Plans c � ' Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit r ^ r rl i � r ym A f 0 + 6 (0 Zone Overlay District v t/ 1 '"t Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 gagfner of Record: S c�h'l r ,- h � r )-1,ti a p czy - Name (Print) ` , -` Current Mailing Address: j e .— Signatur Telephone `q .. 5 0 :1 a 2.2 Authorized Agent: ._..V rYve S E' I I , S l Li CO \i l.Ckc 6 I ( Ni 74- 0\ Na rint) Current Mailing Add ss: ) - 1'- g3 , /,1J Signa Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 6 -' `5 ` (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) _5 -' I 5 - _ Check Number /. 7 3 S J This Section For Official Use Only Building Permit Number: I sssuu ed: Signature: 9 ,id —/ 0 Building Commissioner /Inspector of Buildings Date Section 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 Building Department Lot Size Frontage + . Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot 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 0 DONT KNOW L..' YES C IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES i IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO l IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 6) IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition El Replacement Windows Alteration(s) n Roofing n Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding [O] Other [M Brief Description of Proposed l} t� �/ / G / u e r T . � ((I /1 y�Gt J � t,t_� Work: i L___ Alteration of existing bedroom Yes — No Adding new bedroom Yes — No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa. If 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 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 OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, S /'Y1 (,c-a_. 6atma_baktt , as Owner of the subject property hereby authori ...4 S / 1 to act on m If, in afters O - ` ve . wor thorize by this building permit pplication. i■ '(._ q /67 / 0 Signat re caner Date I, 6 i,S P ( ( r , as Owner /Authorized Agent here y declare that the statemerfts and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Si d under the p in�enalties of perjury. Pri ame c J12Z rries FYI / Z(SII° Signature of Owner /Agent Date SECTION 8 - CONSTRUCTION SERVICES + " 8.1 Licensed Construction S pervisor: C Not Applicable ❑ Name of License Molder : --I a- Y� -Q S C l t ] ( t 43-o License Number ' v1 I *a, 60 /''.c .) ) i 1 t ���, 3 � - . t ( Address Expiration Date 1 +R — go —) L) Siature Telephone 06 9. istered Home Improvement Contractor. Not Applicable ❑ I L I mre._Ov ,l.1 , 1 61 C... t 9-(a4 -o a. Company Name t Registration Number " &k eA. lid � tf 4 Oi:. L -.1.4- - (I Address ,_ Expiration Date Telephone - x3 - 3 1 d ( SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L c. 152, § 25C(5)) 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. J No ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner - occupied Dwdlines of one (1) or two(2) families and to allow such homeowner to a an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Section 10833.1. Definition of Homeowner: Person (s) who a t arcel 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, or detached structures accessory to such use and/ or farm structures. A person who constructs more than sue home o-vear period shall not : . considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form . • -, .. , e : uilding Official, that he/she shall be res • onsible for all • . work . armed under the buildin ��_ r : As acting Construction Supervisor your presence on the jo .. will be • . -. , , , time to time, during and upon completion of the work for which this permit is issue4.— Also be advised that with reference to Chapter 152'[Workers' Compensation) and Chap - 153 (Liability of Employers to Employees for injuries not resulting in r • of the Massachusetts General Laws Anno , . on ma be : .1 for person(s) you hire to perform work for you ,„, this permit. The undersigned "homeowner" : fies and assumes responsibility for compliance with the State ::ding Code, City of Northampton Ordinan •:. .. and Local Zoning Laws and State of Massachusetts General Laws • , I : ted. Homeowner Signature • The Commonwealth of Massachusetts +-.o_ Department of Industrial Accidents `-I _ : O ffice of Investigations a "E= 600 Washington Street �:' 2 t Boston, MA. 02111 '`= t.r��.:y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): / act 4.- NE i I 0 \/ Her t J j 1 NC . Address: / 4' &1 K . City /State/Zip: aill OLA 4— 01 35 Phone #: L i' 1 2 b D 0-7 _ Are you an employer? Check jj th a appropriate box: elm of project (regncraed ). 1. 1 am a employer with c, 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub - contractors 6. ❑ New construction 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. 0 Building addition [No workers' comp. insurance comp. insurance required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. Plumbing repairs 3. ❑ I am a homeowner doing all work ❑ � 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' 13.0 Other comp. insurance required.] * Any applicant that checks box #1 mast also fill out the section below showing their workers' compensation policy 1 t Homeowners who submit this affidavit indicating they are doing all work and then hie outside contracOrs must submit anew affidavit indicating such. $Contractors 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: 1 -1 — i Policy # or Self-ins. Lic. #: l [ tl L LI r7() Expiration Date: / / - 1 � " c)G / 0 ,� Oa Job Site Address: Oa r 0 . ye City/ State /Zip: A r 7 k t me fl /f of (c' d 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 Riot 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 hereby ce • seder the pains and penalties of perjury that the information provided above is true and correct LE Signature: { 'r S Date: Phone #: i t/ 3 - 2 (' 3 - 0? id `2. Il Official use only. 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 Person: Phone #: L �.r. !I ZUI 4410 1V• Yi ..,.y J..a.w T! • • VDAC �/ " WORKERS COMPENSATION AND EMPLOYERS UABiUTY POUCY TYPE AR INFORMATION PAGE WC 0000 01 ( A) POLICY NUMBER: (6S601,8-9694L1 7-0-0e 3 RENEWAL OF (5560US -9664 L17 -0 -08 ) 04SURER: HARTForm LAS VERWRITERS INs RANGE CON'ANY 1, NCCI CO CODE 80411 INSURED: PRODUCEIt IDEAL .HOME IMPROVEMENT INC A H RIST * 142 BOYLE ROAD 159 AVE A GILL MA 01354 PO BOX 391 TURNERS FALLS MA 01376 Insured Is A tORATTON Other work *.. 9_ 1!le ! e hin ntentws are shown In the echadtde(s) attached. 2. The policy period !shorn 11 -1 8-09 to 11 -t 8 -t 0 12:01 A.M. at the N med's maNtrig address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy apdies to the Workers Compensation Law alive std, listed he MA 8. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed In itetn 3A. The limits of our ilab*ky under Part Two are Bodily Irby by Accident $ 500000 Each Accident Bodily Injury by Diseasor S 500000 Policy Limit Badly Injury by Disease: $ 500000 Saab Employee C. OTHER STATES INSURANCE Putt Three of the policy applies to the states. If any, listed here: {AVERAGE REPLACED SY ENDORSEMENT WC 20 03 OSA D. This policy Indudes these endorsements and scheduler _ - SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The p rJurn far t,t pc-May we be d xt rm 1 by Our MahtAs of lames, Ciassifications, Rates and Rating PM. A0 lewd kionnetkin is subject to verMcadon and change by audit to be made ANNUALLY . DATE OF ISSUE: 12 -18-09 DR ST ASSIGN: MA OFFICE: MAIM DA HTPD OW 2SLTL PRODUCER A H MST name • Property Address: i? Name - YI L 11� P 1\3 �ML. I ) 13 Address: O l (Z City, State: GILL_ J ! f\ Phone: 1-1 - S"(o 3 Property Owner Name: (2.L) .t\ �uG1 Address: y'% PC �v City, State: fJ FIRMp1� (:\ I, Zits Ems' (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 111P N Date �1 3© , (0