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36-159 (5) 1112 BURTS PIT RD BP-2019-0994 GIS 4: COMMONWEALTH OF MASSACHUSETTS Map-Bl k:36- 159 CITY OF NORTHAMPTON Lot. -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv: INSULATION BUILDING PERMIT Permit ft BP-2019-0994 Project# JS-2019-001636 Est Cost. $3000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: IDEAL HOME IMPROVEMENT INC 091207 Lot Size(sq. R.): 10497.96 Owner: BURROWS BARBARA M&MICHELLE D KWASNEY Zoning: Applicant. IDEAL HOME IMPROVEMENT INC AT.- 1112 BURTS PIT RD ApplicantAddress: Phone: Insurance: 142 BOYLE RD (413) 863-2128 WC GILLMA01354 ISSUED ON.311312019 0.00.00 TO PERFORM THE FOLLOWING WORK:960 SF R38 CELLULOSE OPEN ATTIC AIR SEALING 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: FeeTvpe: Date Paid: Amount Building 3/1320190:00:00 $65.00 212 Main Sweet, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner �,ci s v C.lt riU,V Department use only'., City of Northampton StatusP �"t Building Department Curb cuvDpwev7aY Perm it , 212 Main StreetSewegSeppc Avadability. 'Y1rt E4 #se Room 100 WaterNVell Availabill � 'ts .r. Northampton, MA 01060 Two Se`tSy tNdu phone 413-587-1240 Fax 413-587-1272 t a -1- i. }:d APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR EMyN H A ONE OR TW FAM LY DWELLING SECTION i'-SITE INFORMATION 1.1 Property Address DEar�NIBt&.QP61p rAA11,A9R&lele byofgce NORTHAMPION.IAA C'•Cfi6 Map'. Lot1�61 Unit 2 �ORTS PT. 0.0 zppe Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: ffdLQ u � Y1V�PlA Illy 6ux�s Rt Cpl Nc�vencA Name(Print) 1 Current Mailing Atldress: ' tl� a re Telephone _7 Big 2.2AuthorizetlA ent �s 1 aka , Cn(I Pik Na a Pdn - Current Mailing Address: V� I'413 $U�s alA Signator Telephone SECTION 3:-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bpermit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of ["s Construction from 6 3. Plumbing Building Permit Fee 7/y/ 4. Mechanical(WAC) 5. Fire Protection 6, Total=(1 +2+3+4+5) Check Number This Section For.Official Use Onl Date Building Pemnt Number Issued: Signature: 3-13' Zb�q Building Commissionerllnspectar of Buildings Date Caitg of Wart4amptan ,Y Au5sur4usetts DEPARTMENT OF BO/LD/NC INSPECTIONS 212 Main Street • Municipal Uuilding Northampton, MA 01060 LOU aPHASe,bucl< BUILDING PERMIT FEES Phous: (413)58]-1240 BUILDING COMMISSIONER Effective July 21,2008 Fax: (413)58]-12]2 DEMOLITION $ 20.00 ACCESSORY STRUCTURE $ 35.00 PRINCIPAL BUILDING-Residential $200.00 PRINCIPAL BUILDING-Commercial "NEW CONSTRUCTION $ .50 per square foot for l"floor .30 " 21d floor .20 " '/,floors,stile,basement garage STRUCTURAL ALTERATIONS IN ALL USE GROUPS $6.00 per thousand dollars of estimated cost or fraction thereof, with a minlmum fee of$55.00 $25.00 WOODBURNING STOVE 'NEW ACCESSORY STRUCTURES one hundred twenty(120)square feet and over $ .20 per square foot with a minimum fee of$25.00 'NEW ACCESSORY STRUCTURES under one hundred twenty(120)square feet $25.00 per inspection -SWIMMING POOLS $30.00 for above ground $60.00 for In-ground 'SIGNS 8 AWNINGS $30.00 'DECKS $50.00 REPLACEMENT WINDOWS $35.00 SIDING 8 ROOFING Residential $35.00 perstructure Commercial $55.00 min.Per structure OR$GfK of estimated cost TENTS $25.00 'ZONING REQUEST FORMS $15.00 (Includes home occupation registration) REISSUE OF LOST PERMIT $25.00 CERTIFICATE OF ANNUAL INSP. $100.00 (minlmum) Tampere"Certificate of Occupancy $25.00 PERMITS REQUIRING ONLY 1(1)INSPECTION WILL BE A MINIMUM OF$25.00;ALL OTHERS WILL HAVE A$50.00 MINIMUM. PERMIT FEES SHALL BE PAID TO THE ORDER OF THE City of Northampton AND SUBMITTED,WITH THE COMPLETED PERMIT APPLICATION,TO THE OFFICE OF THE BUILDING INSPECTOR. WORK STARTED WITHOUT PERMIT IS SUBJECT TO DOUBLE NORMAL FEE. 11 NO CASH -CHECKS OR MONEY ORDERS ONLY fl 'Filing deadline Is 12:00 pm(noon)on Wednesday. Section 4. ZONING All Information Aust be Completed.Permit Can Ife Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled a by Building Departmem Lot Size Frontage Setbacks Front Side L: R: - L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % put area minus bide& *a bl arkin a of Parking Spaces Fill: volumc&L«ation A. Has a Special Permit/Variance/Finding ver been issued for/on the site? NO O DONT KNOW YES O IF YES,date issued: IF YES: Was the permit recorded at the Regi ry of Deeds? NO O 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 O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: E. Will the construction activity disturb(Gearing, grading ex5Wafion,or filling)over t acre or is it part of a common plan that will disturb over 1 acre? YES O NO 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 ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doo s D Accessory Bldg. ❑ Demolition ❑ New Signs [0) Decks [O Siding[0] Odrer Brief Dy10ppdillWork ( gherpl (&)` QeW ab(- -0UV,SeAhE4 Alteration of existing bedroom_Yes I/ No Adding new bedroom Yes "No Attached Narrative Renovating unfinished basement Yes ✓No Plans Attached Roll -Sheet ga.if New house and or addition to exhdina 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 L Is construction within 100 R.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 'f I, r 1 I i uu' 'e— rrrVUGIS( as Owner of the subject property hereby authorizeto my behalf, in all matte r lative to work autho ' ed by this building permit application. 'fA a IJ Signature of Omer Date / as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knoWedge and belief. Signed under the pains and penalties of perjury. CIr 1 S Print e Signature jif OrmenAgent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su rvisor: ss Not Applliicable ❑ Name of License Holder: �. �' Vb (� �cI l A o 1 License Number Uri V � 61 vD w ao A cess Expiration Date Signatur Telephone 9 Registered Home Improvement Con4acWr: Not Applicable ❑ ld rA p 1 �xv e rn dV0( �Xy 2r1� I Lf' L(6�I- Company Name Registration Number ddressJ, Expiration Date Telephonetd 1 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit at 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....... V No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellines of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a paroel 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,attached or detached structures accessory W such use and/or farm structures.A vera"n who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such workperforated under the building p 'L As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts Cenral Laws Annotated,you maybe liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: 1 1 I a b)'A 7 tai The debris will be transported by: nIn The debris will be received by: n A Building permit number: Name of Permit Applicant cJarvu S 96S S Date Signature of Permit Applicant City of Northampton Massachusetts 9 s DBPAN� OF 9UILurNc IaSPECTIWS 2 212 Main Street • N icipal Buil,iing �L No[,�Nampton, !W 01060 Property Address: � IJV�� T 1+ Contractor Name: LL' YU. IIS Address: /)�� rbL�J City, State: Phone: Property Owner Name: rV11LhkIIR. �GLYI<ll Address: (11� C`xAY-fS f I'+ C City, State: CI'I()Y?I'l C.f fY1.Q I, Jan's( S GLI IS (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 .t/yLWy� Date SI I I m The Commonwealth oJMassaahasets Department ofIndtstrialAaridemir I CongressStreeti Sane 100 Boston,MA 02114-1017 wwlamass.gov/dIa TIV'riters'Campenottlam Insurance AfBdavk:BoiidadCantracterMethi lam/Plamben. TO BE FRED WITH THE PERaBTTmO AUTHORITY. Name(Baso dotgmin��tiowmvidual): a. . Adalem: M� , -W te— h City/statelzip: LO MA Ola Phone#: LA Are/ou mempbyer7 CYeekrheappnprmhEsc e0(project 1. I/maemamierreilh UU wilmTa etas waw mm).• 7. o 1 construction d): LY J� pat' 7. p New,mnswetion 2.01ans.wmpopnnrmptw hipwehawmmpbymwetlyfx.is 8. []Remodeling evy mpaeiry.OVowmkwa'eavw.hrvaae rWaEeai 3.plemahrmwwvwdoiogaa wok mwlL lRo warlm'wm.imiveemwquirmlr 9. ❑Derrratirion a.pl®ahmwwoccodwiLab'bi.g mcmwoba0wakwoapycty. twin 10[:]Building addition m.menn ellemmnmaeuhwawaaaes'rnvgmutimimtwceauewb Il.❑Electrical repairs or additions papmmmwYhay.pbw 12.0Plumbingrepairsoradditione s.plamagmealcmha m wd[a ekkranembwwa ton ae maaawanrdd hah 76ereaabcaonxmnaveempbyewrdawwmkm'omp.iwmrwel 13.,❑Roof rcpairs E.p We eeamrymWmrm moS aaLwarnmdae ah de..pd wMOLc. 14.�vma 1l 1C AD(p�1(Yl ISR It(a),avd scow vc mPlaYea Itaovwlam'ra�.haarevarequadl •Any appamwaatcacblox YI mu[aiw BII paaateetimbelow aEotrmglhekwwlme'moaeowtlm plfrymfommm t Homwwma warubnamir aBdova vdkr4aadayeaddyaBwak avdthm Eua w4idewmedmmuwruhodtavma6Nvkmdimdyaah tCmkadwsmnchaJtahaxmmnmiedm Wdidmddm rawkaaemmeafde PUgv aasadttnewhUwor aUtlwveafidm hew rnstm'«.. lira wbemevcmwhmv mptlyra,nay uW pmvidaMeir wmhem•wmp.paymwhw. lamannrptlmwdwispmNdingwuken'mnpeneadonlnauranmlormyemployeer. Bdowlstbepuaryandlobsae InJorenamoa Insurance CompanyNamc Sl eC l],,I (n Policy#.Self-ias.Lic.#..�OC.QUS101 Expiration Dam: I ,.O ao Job she Address: -'tI I J, Ew fs�i+ 12D,� . aryiswazip: f"I OrP,(1(R, t YYIA Attach a copy of the workers'compensation polity declaration page(showing the policy number and expiration date} Failure to soars coverage as required under MOL a 154 425A is a criminal violation punishable by a fine up to 51,500.00 and/or ooe yeu imprisonment,as well u civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.OD a day agaimtthe violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for iaeomnce coverage Verification. Ido hereby dmpnhts/1�'.--1��j-.,-I olperlury that the fnJormndonPro vWestal— ttruepandcorrect c'e„ AJ✓��L�C i1 /� Date, 3�la'I E I phone P. L413 Rw, Offidd use only. Do actm1n,in A&ams,to be eompidedbyal y or tam gOielel CityorTown; Permlt/lAaaee lf Bsuia;Authority(circle me); I.BomlofUean2.BaUdingDepwbl t3.CR5•frown Clerk 4.FAulrkdlmpector S.Piambhhglmpator 6.other Contact Person: Photo 1. ACOROM CERTIFICATE OF LIABILITY INSURANCE 141 1 01/242019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSNNG INSURIIMS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If line oe1TI mW holder Is an ADDITIONAL INSURED,the pollcy(fes)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,cartain policies may require an andon ameld. A Statement on USE cartificate does not confer tights to the ontifipte holder in lieu of such endol o mends). PROWLER WATA,CT Andrea Fefley SUM Webber$Gon,dt PNONX (q 13)588-0111 �. (413)58 F fi-64B1 B NOM King Street Fcon.: eiANNsy@webbamMgfrne1I.mm MMRSq$IPFFORMNGCOVERPOE NAIC9 NOnbamptOn MA D1060 lX RMA: Selective ins CO DfBCemIi1M 19259 INSURED INSURERS: MQQ HnmQ ImprnVB111en1,Inin. IXSVRERC: Aft l(arida ERIN INSURER D: 142 Boyle RWtl INSURER E: Gill MA 01354-9731 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 1I2019 REVISION NUMBER THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT MALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LM AWL SUM TR TYPEOFINWRANCE HISD LyyD MILADY'NUMBER An. 1. UMTS X COMMERCMLGENERALWMSTY EALHGCLURRENCE bI00000) CIAIMSLACE ®LCLUA PREMISES Ea 00oUAMmeIW S 500,000 MEDEXP(A•yAAAA $ 15000 A 52291368 111172018 111112019 PERSON5LNADVINIURY $ 1,00,000 GENLAGGREGAM UNIT APPLIES PER: GENERALAGGREGNTE S 2.000,WO PoLICV ©jELT LCC PRCOUCTS-03NPpPAGG S 2,000000 OTHER AUTOMOBILE LIABILITY (EO A_ANAN GIE LIMIT E 1000,000 ANYAUTO EDDILYMIURY(PNW,un) S A OWNED $CHEWLEO M105410 11/172018 1111]2019 SOCILYIWURY(Far mbar S AUTOSONLY AUTOS HIRED NON-0NNEO PROPEAr WS M E S x AUTO50NLY AUTOS ONLY avdW S X UMBRELLA A. x aWREACH OCCURRENCE E 1000,000 A EXCESSUAS LWMSMADE 52291368 1I/17 2018 11/17 2019 AGGREGATE E 1.000,000 LED I X1 RETEMION S 0 1 S WORKERS COMPENSATION PER �/ OTH- ANDEMPLOYERTLABn1TY y1H STATUTE ^ ER ANY PROMETOnIPARTHEWEXECUTIVE EL EACH ACCIDENT S 50000 A Of,C.EMeER EXCLWEDx ula VVC905]6W 01282019 01/26/2020 IMmdmryln nXl ELDSFASE-EAEMPLOYEE S 500,000 If y06 d0UAW uxer 9ES31RIPPONOFOPERATIONSAAm E.L.DISEASE-FGUCYUMT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Add lRMlwb SCIIMIK MAN a++B+ca+dtlmme span M NAAAAR) CERTIFICATE HOLDER CANCELLATION BHOUIDANYOF 111E ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE EXPIRATION DATE THERE05 NOTICE WILL BE DELIVERED IN Evidence of InBMmnce ACCORDANCE WITH THE POLICY PROVO$IONS. AUTIDIIMEDREPIESENTATWE �l l -D -V-- @1988.2015 -- ®1988@015 ACORD CORPORATION. All rights reserved. TCORO 36(3Pt003) TTPACOMD moondiM ommglBOPrsdmaraa MACORD �. Commonwealth of Massachusetts Division of Professional Licensure Board of Rulldina Regulations and Standards onsir _'ren 9uaervsor CS-0912G7 Expires'.101161202E JAMES P ELLIS _ 142 ROYLE RX, CILL MA 01356 All, �A�J - -- Commissioner call of CanSumer Atbin B euvnesa Regulation HOM E IMPROVEM ENT CONTRACTOR TYPE:Comomtiou R 'ad 00 io 146,102-' 0612112021 IDEAL HOME IMPROVEMENT INC. JAMES P.ELLIS 142 ROYLE RD U GILL MA 01356 Undersecretary