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29-421 (8) Prom:Angeia DiAUgustino Fax1L): L)ate:6/b/zoib 12 : :33 PM Page: 2 of 2 -� PHILB-1 OP ID:AD I�°R° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 06/0512015 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 ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Angela DlAugustin0 _ PHILLIPS INSURANCE AGENCY INC PHONE 413-594-5984 alc1 No):413-592-8499 97 CENTER STREET (A1C No Ext):_ _ __ CHICOPEE,MA 01013 A DRIESS:Angela@phillipsinsurance.com Chris Rivers INSURERS)AFFORDING COVERAGE NAIC p INSURER A:Selective Insurance 12572 INSURED Phil Beaulieu&Sons Home INSURER B:A. I. M. Mutual Ins. Co. 33758 Improvement Inc. INSURER C: Phil Beaulieu 217 Grattan Street INSURER D: Chicopee, MA 01020 INSURER INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDlYYYY (MMIDI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 51928165 02/25/2015 02/25/2016 DAMAGE TO RENTED 100 000 PREMISES Ea occunece CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&Al INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APP-IES PER PRODUCTS-COMPIOPAGG $ 3,000,000 X POLICY PRO-$ LOC AUTOMOBILE LIABILITY Ea aBude nl) NGLE LIMIT $ 1,000,000 A ANY AUTO A9092812 02/25/2015 02/25/2016 BODILY INJURY(Per person) $ ALL 01 X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNFD PROPERTY DAMAGE $ included X HIRED AUTOS X AUTOS (PER ACCIDENT)_ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAR CLAIMS-MADE S1928165 02/25/2015 02/2512016 AGGREGATE '£ 2,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION X WCSTATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS I I ER B ANY PROPRIETOR/PARTNEPIE<ECUTIVE Y 1 N WMZ8006205012013 02/25/2015 02/25/2016 EL EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? 111 A (Mandatory in NH) EL DISEASE EA EMPLOYEE $ 1,000,000 If yes,deSCrlbe Under 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ A Selective Insuranc S1928165 02125/2015 02/2512016 Leased Eq 200,000 A Selective Insuranc S1928165 02/2512015 02125/2016 Building 216,615 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION CITYNOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Northampton Building Department AUTHORIZED REPRESENTATIVE �� No Main St. ^' `^'"—`, Northampton,MA 01060 � �'►� �1 � ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD SECTION 8-CONSTRUCTION SERVICES 7 8.1 Licensed Constructior - - Not Applicable ❑ Phil Beaulieu&Sons Home Imp.,Inc. / } Name of License Holder: 217 Grattan Street,Chicopee,MA 01020 ±r1 HI REG#100073 Exp.6/8/16 License Number CSL#CS62638 Exp.6/13/15 �'132 1 Address Alain Beaulieu PH:(413)592.1498/Fax:(413)594.6008 Expiration Date Signature Telephone 9.Renistered Home Improvement Contractor: Not Applicable ❑ x/00073 Company Name Registration Number fi/./ Purl � 1M �� 6 1Y 116 Address / Expiration Date d/7 �,�z77`a� � C�6A 01'0 Telephone&3� S1)- 141gf 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....... ❑ 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 1� Or Doors ID Accessory Bldg. ❑ Demolition ❑ New Signs [E3] Decks [M Siding[0] Other[ Brief Description of Proposeed. v1 I L J n/I 6 t 31L,_'t" ce l/-/W Work: .n!-n n nxiAi da Aid7� ./� /Lt� 0A � � IB�SJk(� lJn "oit.a 6f 1�i4i( - �3���/ d,v�e�,.QfL Alteration of existing bedroom Yes X 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 housino, 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, \ Z e/�' ' PI)/V "�/� as Owner of the subject property hereby authorize � I /lPa�,/l�U Z't�d `V 16 AV /Ur/IQ to act o my ha in all ters relative to work authorized by this building permit appli tion. J Signature ortwner Date I, 7T/ 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 they pains and penalties of perjury. ,14/V 1 [/rLrV !"(p 1, Print Name 6 G � Sign ure 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 Q DON'T KNOW YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW ja YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO � DON'T KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: .... .. . .. .......... .......... C. Do any signs exist on the property? YES Q NO 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 Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. [)epaaalr#frient u;�: City of Northampton Stat of permit ((� r� n \�� '- Poa ilding Department curbuttCriveray- irsit ' � 12 Main Street Av I I Room 100 WaterMi/eIlAyilg JUN 5 i . l: ampton, MA 01060 T, '%ts 2015 f #u xtrai'Pia _ _ hone 13- 87-1240 Fax 413-587-1272 Electric Piumb'ng&Gas<� Inspeclionsr. ,- Nrthaillpt, N 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 3 1 661 d ep dll'J P 01 Flog oJq , kA 01 0 b d Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) C rrent Mailing Address: 1413) a(4y- %g /lti(3) 335 _ y530 Telephone Signature 2.2 Authorised Anent: Phil Beaulieu&Sons Home Imp.,Inc. 217 Grattan Street,Chicopee,MA 01020 HI REG#100073 Exp.6/8/16 oe Name(P' CSL#CS62638 Exp.6/13/15 dress: Alain Beaulieu PH:(413)592.1498/Fax:(413)594.6008 ignature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applic ant 1. Building I d (a)Building Permit Fee 2. Electrical r7 (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) 13,'7 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-1259 APPLICANT/CONTACT PERSON PHIL BEAULIEU&SON HOME IMPROVEMENT ADDRESS/PHONE 217 Grattan St CHICOPEE01020(413)592-1498 PROPERTY LOCATION 31 GOLDEN DR MAP 29 PARCEL 421 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Z El cbo'j Fee Paid T Tyneof Construction: INSTALL INSULATION 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 INFORA'�ATION 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 ti elay Sig ature of Building CNci 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. 31 GOLDEN DR BP-2015-1259 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-421 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2015-1259 Project# JS-2015-002317 Est.Cost: $13785.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PHIL BEAULIEU & SON HOME IMPROVEMENT 062638 Lot Size(sq. ft.): 13721.40 Owner: DUNLAP LEIGH& SUSAN MILLER Zonine: Applicant.- PHIL BEAULIEU & SON HOME IMPROVEMENT AT. 31 GOLDEN DR Applicant Address: Phone: Insurance: 217 Grattan St (413) 592-1498 Workers Compensation CHICOPEEMA01020 ISSUED ON.61912015 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL INSULATION, STRIP & 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 6/9/2015 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner