Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
17A-050
144 BRIDGE RD BP- 2011 -0715 GIs #: COMMONWEALTH OF MASSACHUSETTS Map:Bloc 17A - 050 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit # BP-2011-0715 Project# JS- 2011 - 001175 Est. Cost: $1364.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: IDEAL HOME IMPROVEMENT INC 091207 Lot Size(sq. ft.): 11935.44 Owner: HARDER JASON C & STEPHANIE Zoning: URA(100) //RI Applicant. IDEAL HOME IMPROVEMENT INC AT. 144 BRIDGE RD Applicant Address: Phone: Insurance: 142 BOYLE RD (413) 863 -2128 GILLMA01354 ISSUED ON :31712011 0:00:00 TO PERFORM THE FOLLOWING WORK: INSTALL 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 3/7/20110:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner r' • HLULIVED Department use only City of Northampton Status of Permit 2011 212 Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability DEPT. OF BUILDING INSPECTIONS orthampton, MA 01060 Two Sets of Structural Plans N THAMPTON MA 1OW 3-587 -1240 Fax 413 -587 -1272 Plot/Site Plans 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 / /� I ,, 1 ^(„ „ � • Map Lot Unit o h C Zone Overlay District Elm SL MoAct CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Qw= of Record: r -S�Ci ryw a s ,4J Name (Print) Current Mang Address: Telephone I J Signature 3 ' 2 44 — 0 2.2 ho zed Agent: 1'YUt Name (Print) Current Mailing Address: L4 1 -3 - Si ature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only comp leted by rmit applicant 1. Building (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 =0 +2+ 5) ( — Check Number This Section For Official Use Onl Building Permit Number. Date Signature: / 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 p arkin g) # of Parking Spaces Fill: volume & Location)- A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO O DONT KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW © YES O IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW � YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained ® , Date Issued: C. Do any signs exist on the property? YES O NO ky 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 O NO V IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION & DESCRIPTION OF PROPOSED WORK (check all analicable) New House Addition [] Replacement Windows Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks Siding [p] Other[ Brief Dycri Proposed PS ! work: 3' 1 12 +1 ltwlL C �(0 211 S' �OY� , JR, 0@9 l�'oce0joil', iC � R3c� kil[rwuJl Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. 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, r C r as Owner of the subject property hereby authorize to act on my / behalf, in all TfterOlative to work authorizedby this building permit application. 4� Signature of Owner Date I, 1(.A, W !� �/ I S as Owner /Authoriz 6Zt 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_ �1 / Prin m ©,� 4 : �-, J) 1 Signature of Owner /Agent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Suptryisor / Not Applicable ❑ Name of License Holder S �b ( " li / ] L 6 / License Number 10 - - Address /� _ Expiration Date S' ature Telephone 9. Registered Hone Improvement Contractor. Not Applicable ❑ Company Napr- Registration Number Address Expiration Date p Telephone SECTION 10- 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 pqrmit Signed Affidavit Attached Yes....... No...... ❑ 11. - Home Owner Exemption The current exemption for "ho m :ngag7e ens" was extended to include Owner- occuQied Dwellines of one (1) or two(2) families and to allow such homeowner t an i ndividual for hire who does not possess a license, provided that the owner acts as su ervisor. CNIR 780 Sixth on Section 1083.5.1. Definition of Homeowner Person (s) own a parcel 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 d g, attached or detached structures accessory to such use and/ or farm structures. A erson who constructs more than on we in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, form acceptable to the Building Official that he /she shall be responsible for all such work performed under the buildin 't. As acting Construction Supervisor your presence on the job site wt e r om time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to C (Workers' Compensation) d Chapter 153 (Liability of Employers to Employees for injuries not res ' in Death) of the Massachusetts General Laws otated, you may be liable for person(s) you hire to perform w or you under this permit. The undersign omeowner" certifies and assumes responsibility for compliance with a State Building Code, City of Northamp Ordinances, State and Local Zoning Laws and State of Massachusetts Gene Laws Annotated. Homeowner Signature Property Address: Contractor 1� i /� ►u-�. r� /' ��e Name: Address: y`'a V City, State: Phone: Property Owner jam �(1 r �'r Name: Address City, State: (contractor) attest and affirm that the building 1 intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that 1 have provided the property owner with a copy of this affidavit. Cont or n Date '.3 / I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street �.- Boston, MA 02111 v.A • ' www.mass.gov1dla Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Lezibly Name ( Bus inesslOrganization /Individual): Address: , 4' k �� e4 City /State /Zip: A- D 13 1 ; -1 4 Phone #: q'jo --- A�tn employer? Check the appropriate boz: Type of project (required): 41 a employer with 4. ❑ 1 am a general contractor and I 6. E] New construction employees (full and/or part 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.❑ 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. ❑ Zther f repairs ' insurance required.] t c. 152, § 1(4), and we have no 1 P employees. [No workers' 13. n S �( comp. insurance required.] *Any applicant that checks box #I 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. *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. _y- Insurance Company Name: 1-ec Ytio /4 / ran l"1 Policy # or Self -ins. Lie. #: f/� cm / to +) Expiration Date: /i 1% I 1 Job Site Address: — H `4 e c City/State /Zip: 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 hereby certi under the pains and penalties of perjury that the information provided above is true and correct Si ature: Q S Date: [ r7111 Phone #• / P3 — , 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 #: ACO DATA P&MMYN m CERTIFICATE OF LIABILITY INSURANCE 11119/2010 PRODUCER Phone: 413-0634373 Fax 413 MM-9658 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION A.H. RIST INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 159 AVENUE A HOLDER. THU CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. BOX 391 THE COVERAGE AFFORDED BY THE POLICIES BELOW. TURNERS FALLS MA 01376 INSURERS AFFORDING COVERAGE NAIC I# INSURED INSURER A: NAUTILUS INSURANCE COMPANY IDEAL HOME IMPROVEMENT, INC_ INSURER W. PILGRIM INS. COMPANY 142 BOYLE ROAD INSURER C: TECHNOLOGY INSURANCE COMPANY GILL MA 01354 INSURER D. INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD INDICATED, NOTWITHSTANWMG 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 SUBECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LETS SHOWN MAY HAVE BEEN REDUCED BY PAIN CLAW LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTWE POLICY EXPKATION LIMITS OAIE GENERAL LUU38 Y GL 20100227 11119/10 11119/11 EACH OCCURRENCE a 1,000,000 MERCIAL GENERAL LIABi.RY DAwars TO R&M, n s 100,000 PREP 0000anoe CLAIMS MADEQ OCCUR N ED. EXP (Arty one P�) a 5,000 A PERSONAL & AIN INJURY $ 1,000,000 pX n 0 GEHERALAGGREGATE a 2,000,000 GEWL AGGREGATE LI APPLIES PER PRODUCTS -COMPIOPAGG; a 2,000,000 POLICY PRO LOC $ A UTOMOBILE QTY POCI ODWO3302 11/17/10 11M7111 COMBINED SINGLE LIMIT ANYAUTO (- ) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per Person) a B X HIRED AUTOS BODILY INJURY = X NON-OWNED AUTOS (Per ) X MASS. POLICY FORM (Per PROPERTYDAMAGE S GARAGE LIABILITY AUTO ONLY - EAACpDENT s ANY AUTO OTHER THAN EA ACC a AUTO ONLY- AGG a EXCESS I UMBRELLA UASRY EACH OCCURRENCE a OCCUR Q CLAIMS MADE AGGREGATE a s DEDUCTIBLE a RETENTION $ s woRxERS COMPENSATION AM WC1136680 11118N0 11/18/11 X =ice mH�a EMPLOYERS' 1.1141111M YIN EL EACH ACCIDENT S 500,000 C OFFICIOMIRRIM Fxa� a ELL DISEASE -FA EMPLOYEE s 500,000 I�Imr In MM "ym 1 esd a wra ` E.L DISEASE- POLICY LIMIT s 50a aoo SPECw. PROWSKM ealow OTHER DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLESIEXCLUSiONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Classification: tnsub ion CERTIFICATE HOLDER CANCELLATION IDEAL HOME IMPROVEMENT, INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THE, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS 142 BOYLE ROAD WRITTEN M07CE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO GILL MA 01354 Do SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 1 AUTHORrZED REPRESENTATIVE �f Attention: �fdCE. JRU CZ ACORD 25 (2009/01) Certificate # 23873 ®1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Efusiness Regulation 10 Park Plaza - Suite 5170 Boston, Massac� 02116 Home Improvement 041;, for Registration Ron: 146402 Type: Private Corporation ExpNatio(t: 4/2M13 Tr# 209431 IDEAL HOME IMPROVEMENT ING ;" JAMES ELLIS - — 142 BOYLE RD - - GILL, MA 01354 Updaft Address aid ret� card. Mut reaseB for cltaage. ❑ Addrrss ❑ Beaewal ❑ Employstest ❑ Lost Cara DPS -CA, 0 SOM-O 04-G 01216 tilassachusetts - Department of Public Safet+ Board of Building Regulations and Standards Construction Superviscr License License: cs 91207 JAMES P EWS 142 BOYLE RD GILL, MA 01354 ,. s Expiration: 10116/2012 ' l'ommicxionrr Tr#: 3269