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24C-003 (6) BP-2023-0599 291 PROSPECT ST COMMONWEALTH OF 1NASSACHUSETTS Map:Block:Lot: 24C-003-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0599 PERMISSION IS HEREBY GRANTED TO: Project# ROOF/SIDING 2023 Contractor: License: Est. Cost: 62500 THOMAS KELLIHER 88261 Const.Class: Exp.Date: 03/19/2024 Use Group: Owner: C HUMPHREY ELIZABETH L&JON Lot Size (sq.ft.) Zoning: URB Applicant: THOMAS KELLIHER Applicant Address Phone: Insurance: 25 BEADRY AVE 413-575-8428 CHICOPEE,MA 01020 ISSUED ON: 05/09/2023 TO PERFORM THE FOLLOWING WORK: ROOFING PARTS OF HOUSE AND GARAGE, NEW SIDING ON GARAGE 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I. • >9 . Tit Fees Paid: $813.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner I The Commonwealth of ' ass husY "*.,i)1 Ifri, Board of Building Regulabbns a d Standards i FOR MUNICIPALITY Massachusetts State Building C6de1 r,,,,,__;,ukonvc USE Building Permit Application To Construct,Repair Renakte - a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building P it Number: A a 3-5 if q Date Applied: Zvi 055 5.9 Z6Z3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Addr 1.2 Assessors Map&Parcel Numbers 1.1a Is this an accepted street?yes L.....---no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private❑ Zone: Outside Flood Zone? Municipal E 6n site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 wner'ofRec ord: " fL'zA- e.%/ >iviiphr-e. PUrTh,¢4 g/UAi H4 O/() 6- Name(Print) City,State,ZIP l! 9.3 T rO5i2 _I S i 1/1.c-37— ys ---- No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building l9 'Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units J Other 0 Specify: Brief Description of Proposed Work2: I p —7 g F ( n.J S of f�vc�S� �f-�� CTiAlli9�'C ,t)a. S,S,J.—f ps.) �,¢/34yC SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ - ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $Suppression) Total All Fees: $ � j /, Check No. V Check Amount: `�/ Cash Amount: 6.Total Project Cost: $ J C., ) ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) g7a 6/ b„ �� 01 6/ i ,y a s /mil h . 7 � �[�.�.� •{r' License Number Exp' ate Name of CSL Holder List CSL Type(see below) v N reet Type Description o.and Street `cC „J� i 64 �/0 �j /� U Unrestricted(Buildings up to 35,000 cu.ft.) /'i y([�/Z / d�CJ R Restricted 1&2 Family Dwelling City own, ate,ZIP M Mp sonny RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 R gistered Home Improvement Contractor(HIC) / l i/5 76 oEllo Pi4 S j W A C.i i7� BIC Registration Number : on Date HICCo-6- c RegistrapL-Name "/14 rfAt iL No.an Street y f� �7 , C J, 'cv-ry `J� UIL*016 Email City/Town, tate,ZIP / l Telephone SECTION 6: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 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize J AOh fS Y z to act on my behalf;in all matters relative to work authorized by this building permit application. [ ''7g1)-e-07 Aityph o 000:7/ 3 Print Owner's Name(Electronic Si ature)/ SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. l/rah,¢-S k.e,14, AK r o oS .�-�� Print Owner's or Authorized Agent's Name(Electronic Signature) ate NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will ad have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton > Massachusetts 4a 4'>, I DEPARTMENT OF BUILDING INSPECTIONS +_� 212 Main Street • Municipal Building ', , Northampton, MA 01060 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: ---- Location of Facility: ((,]-i C 4_, _ The debris will be transported by: Name of Hauler: 05 ,4 1-14 ./,7 Si nature of A licant: erz Date: �SA`)//._.3 g pp The Commonwealth of Massachusetts kw �r err Department of industrial Accidents 1 Congress Street,Suite 100 ° 4 Boston, MA 02114-201? � ,„ s-0' www.mass.gov/dia Vi others'Compensation Insurance UTidavii:Buildersit'ontractor•sfl:kctriciansfPlumhers. It)BE EILEl)S 1'l'11 THE PERMUTING At'THORlll. Applicant Inforanation Please Print I.t•,,ililt _— s Name(Id us Lacs,t)ratttr�tuot ltdt%tduai}. nrlfi< 5G 1,-(r-, Address: t S &cc'dr / 4i ' City/State/Zip: C/7►C Phone#: '/3—.57-S —, VJ-15 Are yen 22 employer:t hi,.k Ulu appropriate bus: Type of project(required): I 1 ar •mplover with cntpioyves(full intros part.time).• 7. 0 New construction re2. am a sole proprieetx or partnership and have nu employees working for Inc in 8. 0 Remodeling any capacity.(Nu workers'comp.imuranr_r is-gaited.] 301 am a homeowner doing all work mpelf.[No worksms'Lump-insurance required.]' 9. ❑Demolition .1.0 I am a homeowner and will be hiring arwaclura to conduct all work on my property_ I will I a Building addition tt.. ensure that all c nttr:tun either have workers'comps-uatsun insurance or are sole I I.a Electrical repairs or additions prvprieturs w isle nu employees. 12.0 Plumbing repairs or additions 50 I am a general contractor and I have hired the nuub's:anttrr:tors listed on the attached sheet_ 13.❑Roof repairs These sub-cuntractun base employees and has c w orkeri comp.tnaurancc.' 6.0 We an a corporation and its officers have exercised theirright of exemption per MGL c. 14.0Other 152.§ltat.and we have nu employees.[Nu wurken'cramp.insurance required.] 'Any applicant that shvtks L.o.+..1 must also fill out the section below showing their worker.'carnpertsatiun policy information. r Ronny%nets whit subunit thus atlidasit indicating they are doing ad w ark and then hire outside contractor.mint subnut a new afftdas it indicating such. :Contractors that check this bus must attached an additional sheet show ins the name.'f the,u t- imtr:t•_t..r,and state whether ut not those entities have ctrrplugccs. If the sub-conic aetr t Isar c cmpluyces.then pith i pros ide their workers . r I rent on employer that is pro►'idin, workers'compensation insurance,for cry employees. Below is the policy and job site in formation. Insurance Company Name: Policy#or Self-ins.Lic.#: _ Expiration Date: Job Site Address: City/State-Zip: Attach a copy of the corkers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152.§25A is a criminal N.iolation punishable by a fine up to S 1.500.00 atulior one-year imprisonment,as well as civil penalties in the fonts of a STOP WORK ORDER and a tine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cuscravrc N crificatiori. I do hereby certify edit der painsand ►molt.es of perjury that the in farnuatieur provided above is true and correct. Date:{T-1 CO 3 Phunc x: I/-1 , — -.k s`� Ofcial use only. Do not write in this area.to be completed by city or town official ( it or Town: Permit/License Issuing authurits (circle one): I. Board of health 2.Building Department 3.('it ,l'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Commonwealift of Massachusetts Division of Occupational Licensure THE COMMONWEALTH OF MASSACHUSETTS Board of Building R ulations and standards •Office of Consumer Affairs and Business Regulation ��"S �°^'wiso� 10 1000 Washington Street - Suite 710 Cs-088261 y' spires:03/19/2024 Boston, Massachusetts 02118 THOMAS M/ELLI _ 311fi ' p - 25 Home Improvement Contractor Registration CHICOPEE Y�AVE �I 010 't Type: Individual 4U/s/NA i 3 Registration: 145469 Commissioner K. "73ltentif q THOMAS M. KELLIHER Expiration: 01/30/2025 D/B/A TOM KELLIHER HOME IMPROVEMENT 25 BEAUDRY AVE l CHICOPEE,MA 01020 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Individual Office of Consumer Affairs and Business Regulation Registrayon expiration 1000 Washington Street •Suite 710 145469 01/30/2025 Boston,MA 02118 THOMAS M.KELLIHER D/B/A TOM KELLIHER HOME IMPROVEMENT THOMAS M.KELLIHER eZ 25 BEAUDRY AVE - G(a THOMKEL-01 ALYSSA ACOR>D CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD YYYY) 2/7/2023 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 have ADDITIONAL INSURED provisions or 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). PRODUCER ',NAME CT Alyssa Perusse Phillips Insurance Agency,Inc. PHONE 97 Center Street (A/C,No,Fes: I WC.No): Chicopee,MA 01013 keijitiss,ayssa c@phillipsinsurance.com INSURERS)AFFORDING COVERAGE NAIC S INSURER A:Atlantic Casualty Insurance Co INSURED INSURER B:Travelers Indemnity Company of America Thomas Kelliher DBA INSURER C: Tom Kelliher Home Improvement - - 25 Beaudry Ave INSURER D: - Chicopee,MA 01020 INSURER E: 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 POLI IES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITION S OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED B PAID CLAIMS. INSR 'ADDLISUBR POLICY EFF POLICY LTR TYPE OF INSURANCE INSD YYVD. POLICY NUMBER ( gym UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 1261001030-6 2/11/2023 2/11/2024 DAMAGES o enoe) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL a ADV INJURY $ 1,000,000 GENE AGGREGATE pCT UNITRp�APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JE LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LABILITY aCOMBINEDac )INGLE LIMB ANY AUTO BODILY INJURY(Per person) _ OWNED _AUTOS ONLY _ SCHEDULED SSULED BODILYB INJURY(Per ecddentl $ — AUTOS ONLY AUTOS ONLYY (P� � � $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ _ DED RETENTION$ $ B WORKERS COMPENSATION I X AND EMPLOYERS'LIABILITY ST TUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 6HUB-4912P37-6-22 10/22/2022 10/22/2023 EL EACH ACCIDENT $ 500,000 'OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) 500,000If yes,describe under EL DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 9 }eel aabnb1s u'saaid 6 t Y/4)• ---0-. ..la _ • 9Z as, N.�� Otr` � 6Zp l9 v. IIIIIIIIIII":41-118 ma 90Z pi ,.^' L6 ZVlg . Zb t�� 11111111111.1111.11111.111111.11 IJ L9£ NM V ilallest,PI IWO inoH up laPun ui sp°da8 poll �,�e CI SOON S�aW� - FREE ESTIMATES INSURED Proposal No. Tom Kelliher Sheet t,ro. HOME IMPROVEMENT SPECIALIST CT Reg.#0611395 Date !VIA Reg,# 145469 SIDING- WINDOWS -ROOFING Lic.#088261 Cell (413) 575-8428 Proposal Submitted To Work To Be Performed At Name . ' II j _- — Street 9,� k��% ,c� ---- City State /Street 1`7./ ,V;u5 . c / / /.� City State /7f/ ' Date of Plans / c 1 Telephone Number ?_ i P'- Architect �7o1-7 We hereby propose to furnish all the materials and perform all the labor necessary for the completion of t( G✓i, _- • ,^ �C• All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of Dollars(S with payments to be made as follows: %Da C-r Lf2Cf//CY)Any alternation or deviation from above specifications involving extra costs,will be executed only upon written orders,and will become an extra change over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire.tornado and other necessary insurance upon above work. Respectfully submitted Per Note-This proposal may be withdrawn by us if not accepted within days ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. Accepted Signature _v --- Date Signature ----