38B-026 (2) 117 SOUTH ST-APT D BP-2014-0699
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B-026 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:ROOF BUILDING PERMIT
Permit# BP-2014-0699
Project# JS-2014-001190
Est. Cost: $3600.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: PHIL BEAULIEU & SON HOME IMPROVEMENT 062638
Lot Size(sq. ft.): Owner: ESWORTHY DYLAN
Zoning:URC(l00)/ Applicant: PHIL BEAULIEU & SON HOME IMPROVEMENT
AT: 117 SOUTH ST - APT D
Applicant Address: Phone: Insurance:
217 Grattan St (413) 592-1498 Workers Compensation
CHICOPEEMA01020 ISSUED ON:12/10/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:STRI P & SHINGLE ROOF
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 12/10/2013 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2014-0699
APPLICANT/CONTACT PERSON PHIL BEAULIEU&SON HOME IMPROVEMENT
ADDRESS/PHONE 217 Grattan St CHICOPEE (413)592-1498
PROPERTY LOCATION 117 SOUTH ST-APT D OQeatle_6P 1131
MAP 38B PARCEL 026 000 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
Fee Paid j�7
Typeof Construction: STRIP&SHINGLE ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 062638
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ON PRESENTED:
pproved 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
D- OM."lay
/2—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.
7---) r .7 N
' i Department use only
L„;,)! I City
of Northampton Status of Permit:
I!r- 4 20(3 :I ) uiiding Department Curb Cut/Driveway Permit
LI l DEC —) 212 Main Street Sewer/Septic Availability
Room 100 Water/Weil Availability
I nict " hampton, MA 01060 Two Sets of Structural Plans
phorre-4-M587-1240 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 Eb�"' i
This section to be completed by office i'k 1.1 Property Address: ,�1 �` I
in So AIL S\, A(s ,0 �(4".(1'V ) f Map. Lot Unit
1 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Recor ``_ `',,,e
;vi s jliJ t7 f' � r� So.Jkf1 S\--, Act. 0 7 t') 4 `
Nance '� t) Current Mailing Address
1 Telephone(4 1 ) 5 ) I c
Sic at 'e r `'1 (p
2.2 •uthorized Agent: s Phil Beaulieu&Sons Home Imp.,Inc.
'"EJ 217 Grattan Street,Chicopee,MA 01020
HI REG#100073 Exp.6/8/14
Name(Pr CSL#CS62638 Exp.6/13/15
Al Beaulieu
• ti. ure PH:(413)592.1498/Fax:(413)594.6008
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building A 3 1 J 66 t'� (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 ,o
6. Total=(1 +2+3+4+5) (y 00 Check Number (4931( 't) -
This Section For Official Use Only
Building Permit Number: Date
Issued:
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
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO N T KNOW YES
IF YES, date issued:
IF YE& Was the permit recorded at the Registry of Deeds?
NO @NT KNOW YES
IF YES enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? JO 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 N
IF YES describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,gr excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 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 f-et;':
Or Doors ("A
Accessory ry Bld . Demolition New Sig ns [ ] Decks [ ] Siding ] Other
[ I
Brief Description of ropos-d ^+
Work: o f u I t 0 1 t Z0 C - tov J 454 ilzt:
Alteration of existing bedroom \ Yes No Adding new bedroom Yes X 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, f2) v/a b, f,,s wof T n(� , as Owner of the subject
property J j� /
hereby authorize f'/. #2-
to act m ehaif,in all matters relative to work authorized by this building permit ap lice' n.?
Sign a of Owner Date
I, /474 �'ai I 6v O P /2J Z- ,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.
�G itt f,
Print Nam _ , / /3
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder - Phil Beaulieu&Sons Home Imp.,Inc.
217 Grattan Street,Chicopee,MA 01020 License Number
HI REG#100073 Exp.6/8/14
CSL#CS62638 Exp.6/13/15
Address Alain Beaulieu Expiration Date
PH:(413)592.1498/Fax:(413)594.6008
Signature Telephone
9.Reuistered Home' - Not Applicable ❑
-‘622: . Phil Beaulieu&Sons Home Imp.,Inc.
217 Grattan Street,Chicopee,MA 01020
Company Name HI REG#100073 Exp.6/8/14 Registration Number
CSL#CS62638 Exp.6/13/15
Address Alain Beaulieu Expiration Date
PH:(413)592.1498/Fax:(413)594.6008
Telephone
tin
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 112. No ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings 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 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 dwelling,attached or detached structures accessory to such use and/or farm
structures.A person 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 work performed under the building permit.
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 General Laws Annotated,you may be 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
The Commonwealth of Massachusetts
• * ;t, Department of'Industr•ial Accidents
office i'f Investigations
•
600 Washington Street
Boston,Mass. 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
B u:emu Phil Beaulieu&Sons Home Imp.,Inc.
� 217 Grattan Street,Chicopee,MA 01020
Name(t 3usiness/O(ganizationilndividual): HI REG#100073 Exp.6/8/14
CSL#CS62638 Exp.6/13/15
Address: _ Alain Beaulieu
PH:(413)592.1498/Fax:(413)594.6008
City/State/Zip: 11 V11CTr.
Are you an employer?Check thOy propri ate box: Type of project(required):
I.�. I am an employer with 4. 11 I am a general contractor and 1 6. New construction
2. employees(full and/or part time).: have hired the sub-contractors
7. f Remodeling
I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have 8.CI Demolition
working for me in any capacity. employees and have workers'
9.Ial Building addition
[No workers' comp.insurance comp.insurance.:
required] 5.0 We are a corporation and its 10. Li 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 perm MGL
insurance required] c. 152,§ 1(4),and we have no 12. I 1 Roof repairs
employees.[no workers' 13. El Other
comp. insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
rllomeovners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contactors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If
the sub-contractors have cm loyecs,thev must_provide their workers'corn.. .olicv number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.nCompany ompany Name:
Policy/-or Self-ins. Lic.II: 14 t.� OO L l(}j Expiration Date: '10-0/ 6�
Job Site Address: � 0,4_._.__✓ f ' 1J City/State/Zip: �,, if u �Q l �� 01040
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 152 can lead to the imposition of criminal penalties of a tine
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
$250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for coverage verification.
I do herby certify under tit 'ns penalties of perjury that the injormation/ 3 pfovi dd ab ve is true and correct.
(?Signature: Date: /3
Print Name: A a eau I I e(J Phone#: 011'5 J ' /y q
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):
)..Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact person:___ Phone#:
Phil
Bear I eull
&SONS
HOMEEIMPRQVEMENT,INC. '?
413-592-1498
wwwpbhi.biz
December 9, 2013
Attn: Chuck Miller
Assistant Building Commissioner
City of Northamton
Town of Williamsburg
RE: Modification Waiver
To Whom It May Concern:
I request that you grant a modification to waive the requirement for control construction
for the project located at 117 South Street,Northampton, MA. The work is of a minor
nature and will not affect health, accessibility, life and fire safety,or structural
requirements and is impractical in that the cost of control construction is considerable
when compared to the cost of the proposed work.
Should you have any questions or concerns,please contact me at(413) 592-1498.
Thank you for your consideration.
Alain Beaulieu
President