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31D-175 . . . . ,..g.•.... ' ,_ - 6 0 r , e - 4 ' f l .._... r-,.: Board o I m • g - , ! e g u , l l ns a r o tan. . s s --,..---_—_----- - -- =',-.- ---- g -, . -- : f-, One Ashburtoiffla , Room 1301 _ ....._ , . „....".,--,..„ Boston. Massfchusetts 02108 . H ome I k: - - -,.. ,..,,.. . . ... . Registration,. 146402- Type: ' Private COrpOratiOn Expiration: 4/22/2011 Tr# 281991 IDEAL HOME IMPROVEMENT INC: JAMES ELLIS 142 BOYLE RD . GILL, MA 01354 1 . . . • Update Address and return card. Mark reason for chrtnL 1 Addreks— D Renewal ri Employment [-:, lAst G DPS-Ca .i7 ,DNI-08/08-CSSLIFORWA108212006 , . NI - Dcparttnent (it Public `saft.• B . IF, ;.....s_. , i ,vt 131.'11(11m.. Regulation, and :standards License: CS 91207 i . JAMES P ELLIS 142 BOYLE RD GILL, I1AA 01354 ' . ... , E xpiration: 10/16/2012 ,-.. Tnt: 3269 . 401 joirom ACO DATE (tAVDD/YYY1) CERTIFICATE OF LIABILITY INSURANCE I 11/19/2010 PRODUCER Phone 413 - 634373 Fac 413.683 -86ss THOS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION A.H. R1ST INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 159 AVENUE A HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. BOX 391 ALTER TIE COVERAGE AFFORDED BY THE POLICIES BELOW. TURNERS FALLS MA 01376 INSURERS AFFORDING COVERAGE NAM # INSURED INSURER k NAUTILUS INSURANCE COMPANY IDEAL HOME IMPROVEMENT, INC. INSURER It PILGRIM INS. COMPANY 142 BOYLE ROAD INSURER C TECHNOLOGY INSURANCE COMPANY GILL MA 01354 INSURER O: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWnHSTANDING ANY REQUIREMENT, TERM OR CONDIr1ON 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 POUCIES. AGGREGATE LMSTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS INSR ADDI POLICY EFFECTIVE POLICY EXPIRATION INSRG TYPE OF I ALICE POLICY NUMBER fIMtlDINT 1 DATE NMADD YYi UUS S GENERAL UABILI• Y GL 20109227 11119/10 11119111 EACH OCCURRENCE _ S 1,000,000 X COMMERCIAL GENERAL IJABIUTY ) $ 100,000 PREMISES Ea ocementa ' CLAIMS MADE © OCCUR MED. EXP (Any one person) S 5,000 A PERSONAL &ADV INJURY S 1,000,000 • —y GENERALAGGREGATE S 2,000,00 GEN1. AGGREGATE LIAITAPPUESPat PRODUCTS - COMP/OP AGG S 2,000,000 1 POLICY n n LOC $ AUTOMOBILE LABILITY PGC10009703302 11117/10 11/1 7/11 COMBINED SINGLE UM- ANYAUTO (Ea) S 1,000,000 --- ALL OWNED AUTOS BODILY INJURY X screautras (Per person) ED Au B X HIRED Autos BODILY INJURY S X NON-OWNED AUTOS (Per ) X MASS. POLICY FORM — DAMAGE S (Per =Merit) GARAGE LIAOILR Y AUTO ONLY - EA ACCIDENT — S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESS / UMBRELLA LIAR JTY EACH OCCURRENCE S OCCUR El CLAMS WOE AGGREGATE _ S S DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND WC1136680 11/1810 11/18/11 X 1 L I aniER EMPLOYERS' UASIUTY Y/ N EL EACH ACCIDENT S 500,000 C �Ofq� ri 1 y la N9 EL DISEASE FA EMPLOYEE S 500,000 tf yes, ee r SPECIAL PROVISIONS /Wow EL DISEASE -POUCY LMIIT S 500,000 OTHER DESCRIPTION OF OPERATIONSR .00ATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Classification: Insulation CERTIFICATE HOLDER CANCELLATION IDEAL HOME IMPROVEMENT, INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS 142 BOYLE ROAD WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO GILL MA 01354 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY 1014D UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE _ � Attention: . a a . ACORD 25 (2009/01) Certificate # 23873 ®1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ..$ , The Commonwealth of Massachusetts Department of Industrial Accidents 1-- - (Mice of Investigations ' 600 Washington Street ^_: _ Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): /6eit'L f /4() 'te 1 1PI aye/wok/7 Address: /4o l € '-e_ 6,4 City /State /Zip: C ' I J 14 01.3 Phone #: 4+43 -- 0 3-- Qi i i Are an employer? Checke appropriate box: Type of project (required): 1. I am a employer with 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. ❑ 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. ❑ Roof repairs ' insurance required.] f c. 152, §1(4), and we have no I 0-A-1 employees. [No workers' I3.� Roof er / n (�(/ comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. f 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. - i afhipg-ny Insurance Company Name: LfC`1f() I© /C r f ee____ Policy # or Self -ins. Lic. #: WC. l /3 {Q tel. 6 Expiration Date: 11 1/' l �O 1 J Job Site Address: 5 � � r f T'' 1 t 1 rra C e City /State/Zip: d r 44Ir r ify, 149-6 t 149-6 l 66 u 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 a " 1 penalties of perjury that the information provided bov is true and correct Si I ature: '( r-k s Date: 1 I 0 y Phone #: 'II °L gb3 - ,2/a 2 Official use only. Do not write in this area, to be completed by city or town o} iciaL 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 Phone #: Contact Person: 511,011 - • . , . Pea I e. Cell Phone: Ralph: (413) 4784593 or Summit Peak Electric, incorporated Bryon: (413) 627-9406 39 Ridge Road Email: South Hadley; MA 01075 rsair0590tyahoo.com License: 15001A & 18211W October 27, 2010 Jane Sommer 42 Fort Hill Terrace Northampton, MA 01060 (413) 584.1758 Re: Knob and Tube Replacement _ 4 TO Whom It May Concern: This is to certify that Summit Peak Electric, incorporated has carried out a complete knob and 'nibs Replacement which was active and located in the residential basement at the above address,. This installation is in compliance with the National Electrical Code (NEC) Published by the National Fire Protection Association. Knob and Tube wiring is currently present in the front Living Room outside walls. Summit Peak Electric, incorporated recommends that these areas remain free from future installations of any type of insulation. Please reference the enclosed diagram for the exact locations of existing Knob and Tube wiring. Best regards, Ralph 'Sauveur Master License Iii15001A • ' (413) 627-9406 • Kr;.- _ r ' 'sh . N. r -(400-5 C3,1 'A h g7CVN/N(Aci.,-, 1/1%) \.\.-\-\ -.413 , P I" --?P'W)1A1 \,■, 0,\IRk Property Address: ' 01 Or 111 /` ie ral r'_- Contractor Name: / e I ti('q OV- ,4A.t— Address: f `i"c9\ G y k l cd City, State: G1 1) 1 1 01 -\/. Phone: (2 - Q ), Property Owner Name: & Yi-( p rrme r" Address: Sa-rne lam_ eyx/c_ly City, State: N I i 1, Q tW $ -S (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 1 have provided the property owner with a copy of this affidavit. (( ...."____N____ Contractor signatur ... Date i / 0 Ste e � c ct� n ; 2e � 1/0--t av 41 11 nr t / fSdith i "6-a +- Lth rio r u oJI 7)1 .'71 /11:1 \ • • . I • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: I Not Applicabble❑ Name of License Holder : v..Ja �,S n/1 1 5 �io[ / License Number . i\-4A Addr s / Expiration Date C 6 J A 413 d 3. is Si ature Telephone 9. Reqistered Home Improvement Contractor: Not Applicable ❑ / M•- f i qpiu 'It1tWr' Company Name Registration Number t � 430y1 ecA 10 ) "1 Address t,( 2 '- , j/ Expiration Date (tic i 2 , S Telephone /[) h3 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 permit. Signed Affidavit Attached Yes 1?< No ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner- occupied Dwellin>:s of one (1) or two(2) families and to allow such homeowner o engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780 Sixt i Edition Section 108.3.5.1. Definition of Homeowner: Person who own a parcel of land on whi s e resides or intends to reside, on which there is, or is intended to be, a one or two fami • elling, attache ached structures accessory to such use and/ or farm structures. A person who constructs more tha i s n e in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Build' • • • ".'.1, on a form acceptable to the Building Official, that he /she shall be responsible for all such work perfo under the b • dins: permit. As acting Construction Su erv 7 , r your presence on the J.. site will be required from time to time, during and upon completion of the work fo ich this permit is issued. Also be advised that reference to Chapter 152 (Workers' Co • • ensation) and Chapter 153 (Liability of Employers to Employees for i • ''ries not resulting in Death) of the Massachusetts f• -neral Laws Annotated, you may be liable for person(s) you hire top= form work for you under this permit. The undersi I • ed "homeowner" certifies and assumes responsibility for co • liance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massach efts General Laws Annotated. Homeowner Signature • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing n Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [D Siding [0] Other [ / nSu_ GI 1/ d`rk- Brief Des,Cri,pptio Proposed Work: d�j ``� I/ �C: ri ru1G�I�S �0 ®� Co rp x `k Jar- Q/21., tie i1inG Alteration of existing bedroom Yes - No Adding new bedroom Yes No J 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, � 1 .. - - SOM i r , as Owner of the subject property hereby authorize tout__ - J A'1PJ.r V I Yenf to act on my behalf, in all ma rs relative to work authorized by this budding permit application. c ! ca 10 &-L Signatu ner Date I, du ..s PI / I 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. , tt.ti?S c2 /II S tor2S Print Name <1. C r.,.1,-- - ---. p r,t // I VO Signature of Owner /Agent 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 S YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO C) DONT KNOW YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW YES 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 ® NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 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 ® NO z") IF YES, then a Northampton Storm Water Management Permit from the DPW is required. t • Department use only City of Northampton Status of Permit: �, Bu ilding Department Curb Cut/Driveway Permit \`1, l 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability /` Northampton, MA 01060 Two Sets of Structural Plans phone 413 - 587 - 1240 Fax 413 587 - 1272 Piot/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 Map Lot Unit . . 0 r-I- t l i Jerry -e_ Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: JCL ne mrYu Same AS prOFer Name (Print) Current Mailing Address: V a'Vim — &) `- Telephone L4 2 9 Signature(., / 3 ° SX 4 t - / 2 5 2 2.2 Auth rized Agent: � �� � s i',� Wyk fc 6) I) 1 * Dl 3_ Name nnt) Current Mailing A .J '/ 263Lu204 Si nature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit 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= (1 +2 +3 +4 +5) p 'Vq--- Check Number /3. 7 0 �. This Section For Official Use Only Building ermit Number: I s g Issued: Signature: Building Commissioner /Inspector of Buildings Date i File # BP- 2011 -0630 APPLICANT /CONTACT PERSON IDEAL HOME IMPROVEMENT INC ADDRESS/PHONE 142 BOYLE RD GILL (413) 863 -2128 PROPERTY LOCATION 42 FORT HILL TER MAP 31D PARCEL 175 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out / y Fee Paid ��7 Ot" Tvpeof Construction: INSTALL WALL & BASEMENT 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION 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 % • - la S . re 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. BP- 2011 -0630 GIS #: COMMONWEALTH OF MASSACHUSETTS 31D -175 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 -0630 Project # JS- 2011- 001016 Est. Cost: $2609.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: IDEAL HOME IMPROVEMENT INC 091207 Lot Size(sq. ft.): 5880.60 Owner: SOMMER JANE Zoning: URC(100)/ Applicant: IDEAL HOME IMPROVEMENT INC AT: 42 FORT HILL TER Applicant Address: Phone: Insurance: 142 BOYLE RD (413) 863 -2128 GILLMA01354 ISSUED ON:1/13/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL WALL & BASEMENT 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 1/13/2011 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner