16A-020-038 (2) BP-2024-0713
308 FAIRWAY VILLAGE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
16A-020-038 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-2024-0713 PERMISSION IS HEREBY GRANTED TO:
Project# 2024 HEAT PUMP Contractor: License:
GENERAL MECHANICAL
Est.Cost: 12000 CONTRACTORS INC
Const.Class: Exp.Date:
Use Group: Owner: BARON, JOSEPH S. &BARON, DEBRA R.
Lot Size (sq.ft.)
Zoning: URA Applicant: GENERAL MECHANICAL CONTRACTORS INC
Applicant Address Phone:, Insurance:
29A SWORD ST (508)754-7366 8008336
AUBURN, MA 01501
ISSUED ON: 06/05/2024
TO PERFORM THE FOLLOWING WORK:
.HEAT'PUMP CONDENSER ON 1ST FLOOR
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:
Fees Paid: $78.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
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J 53I AN
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The Commonwealth of Massachu etts 5 20 /
Board of Building Regulations and S.and -0
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Massachusetts State Building Code, 780 CM4'K�r4%0noi ICSE LITY
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Building Permit Application To Construct, Repair,Renovate Or Dei I ego ''vise Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Buildingia
rmit Number: 5P^�V•' 7/3 Date Applied:
iv AJ 1.....Z /7 l- --7,0Zil
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro erty Address: 1.2 Assessors Map& Parcel Numbers
308 Fairway Village 16A-020-038 16A-020-038
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
residential 695
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) N/A
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: N/A
Public 0 Private 0 N/A Zone: OutsideFlood Zone?
N/A Checkkk if yes❑ Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Joey Baron Northampton. Ma. 01053
Name(Print) City,State,ZIP
308 Fairway Viallage 7818832091
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other GMSpecify: renovation
Brief Description of Proposed Work': install 1 heat pump condenser on first floor.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee: S Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: S
4. Mechanical (HVAC) $ 12,000.00 List:
5. Mechanical (Fire $
Suppression) Total All F ifia
Check No ` r Check Amount: l Cash Amount:
6. Total Project Cost: $ 12,000.00 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
David Tomasino- please see attached sheet metal lic. License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
—
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted I&2 Family Dwelling
City/Tdie.te,Z�' M Masonry
RC Roofing Covering
`- WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State,ZIP 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 . O
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 General Mechanical Contractors
to act on i, alf, ' all , .r ave to work authorized by this building permit application.
oil
4. 7. May 31, 2024
Print Own �c game 1.6ctronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereb atte der the pains and penalties of perjury that all of the information
contained in this .pplr,ation; tru=QI 0 e to the best of my knowledge and understanding.7. May 31, 2024
Print Owner's or • . orized T I is Name(Electronic Signature) Date
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 not 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
?�at~AMP'�'V S,, s(�'
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it t � •41 u DEPARTMENT OF BUILDING INSPECTIONS s `
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� Northampton, MA 01060 SSW ^``c
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: back to our shop dumpster that is picked up by EL Harvey
Location of Facility: 29A Sword St. Auburn, Ma. 01501
The debris will be transported by:
Name of Hauler: EL Harvey
a
Signature of Applicant: Date:
^�\ The Commonwealth of Massachusetts
LIa.el. Department of Industrial Accidents
_` 5 1 Congress Street,Suite 100
Tr, �i�tijW it
Boston,MA 02114-2017
jd www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leeibh
Name(Business/Organization/Individual):General Mechanical Contractors
Address:29 A Sword Street
City/State/Zip:Auburn, MA 01501 Phone#:508-754-7366
Are you as employer?Check the appropriate box: Type of project(required):
1.SI I am a employer with employees(full and/or part-time).* 7. New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. �✓ Remodeling
any capacity.[No workers'comp.insurance required.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]• 9. El Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
10[] Building addition
ensure that all contractors either have workers'compensation insurance cc are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ]3.0 Roof repairs
These sub-contractors have employees and have workers'comp.insurance?
6.0 We are a corporation and its officers have exercised their right of exemption per MGL a 14.['Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t 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.
Insurance Company Name:Associated Industries of MA Mut Ins Co
Policy#or Self-ins.Lic.#:80°8336 Expiration Date: 10/03/2024
Job Site Address: 308 Fairway Village City/State/Zip: Northampton, Ma. 01053
Attach a copy of the workers'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 violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: L 7/ <" Date: /t?/3/ 3
Phone#:508-754-7366
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):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
•
Fold,Then Detach Along All Perforations
COMMONWEALTH OF MA ACHU
DIVISION OF OCCUPATIONAL LICENSURE
BOARD OF
SHEET METAL WORKERS •
ISSUES THE FOLLOWING LICENSE
MASTER-UNRESTRICTED
DAVID P TOMASINO z
{{1
GENERAL MECHANICAL k
29A SWORD ST z
AUBURN,MA 01501-2146 •Ill
l 1 1
556 08/28/2025. 494280
LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER
Fold,Then Detach Along All Perforations
CONTROL# J 212 3 8 61
IMPORTANT
If your license is lost,damaged or destroyed; is inaccurate;or
needs to be corrected,visit our web site at mass.gov/dpi
for instructions to ensure the proper mailing of your Renewal
Application and any other correspondence.
This license is subject to Massachusetts General Laws and
regulations.Your license is a privilege,and cannot be lent or
assigned to any person or entity under penalty of law. Keep this
license on your person or posted as required by law and/or
regulations.
COMMONWEALTH OF MASSACHUSETTS
DIVISION OF OCCUPATIONAL LICENSURE
B• •' •F
SHEET METAL WORKERS
ISSUES THE FOLLOWING LICENSE ti
W
BUSINESS 7
Z
DAVID P TOMASINO
GENERAL MECHANICAL CONTRACTORS INC N
29 SWORD STREET
AUBURN,MA 01501
146 12/0712024 379973
LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER
Fold,Then Detach Along All Perforations
CONTROL # J2006719
IMPORTANT
If your license is lost,damaged or destroyed; is inaccurate;or
needs to be corrected,visit our web site at mass.gov/dpl
for instructions to ensure the proper mailing of your Renewal
Application and any other correspondence.
This license is subject to Massachusetts General Laws and
regulations.Your license is a privilege, and cannot be lent or
assigned to any
g person or entity under penalty of law. Keep this
license on your person or posted as required by law and/or
regulations.
ACORO® DATE(MWDOrFYYY)
^�� CERTIFICATE OF LIABILITY INSURANCE 10/3/2023
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 CONTACT
Marsh& McLennan Agency LLC PHONE Cindy Carey PAX
100 Front St.Ste 800 (Nc.No.Es0, 508-595-7934 ,A/c No):866-795-8016
Worcester MA 01608 ADD'RELss: Cindy.Carey@marshmma.cam
INSURER(S)AFFORDING COVERAGE -_ NAM*
INSURER AlPhoenix Insurance Company 25623
INSURED GENERMECHAZ INSURERS:Travelers Indemnity Co of America 25666E
General Mechanical Contractors. Inc.29A Sword Street ER INsuRc:Travelers Pr Casualty Co of Amer 25674
Auburn MA 01501 INSURER o_Associated Industries of MA Mut Ins CO _ 33758
INSURER E•Marketing _' 99999
INSURER F:
COVERAGES CERTIFICATE NUMBER:1356060850 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCEjigi :3t MD
POLICY NUMBER (MMIDD/YYYY) (MM/POLICY EFF 4/1' LIMITS
A `X I COMNERCLAL GENERAL LIABILITY C09N787370 10/3/2023 1013/2024 EACH ONCE S 1,000,000
CLAIMS-MADE LX�OCCUR PREMISESE�40Oparr«pS E 300,000
MED EXP(Arty one person) S t 0,000
•
PERSONAL d A13V INJURY _ $1,000,000
GEKL AGGREGATE LIMIT APPLIES PEtE GENERAL AGGREGATE $2,000,000
POLICY X IE r- LOC PRODUCTS=COMPIOP AGG $2,000,000
OTHER $
B AUTOMOBILE LIABILITY 8109N775198 1 10/9/2023 ' 10/3/2024 COMBINED SINGLE LIMIT 1.000,000
„AA acodent.
X ANY AUTO BOOLLY INJURY(Per poison) _
OWNED SCHEDULED BODILY INJURY(PeracddeM) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY ,AUTOS ONLY Ape PQeidenr)
8
C X U11111 ELLA U$ i X OCCUR CUP8T983425 10/3/2023 103/2024 EAcH OczuRRENCE $10,000 000
—' EXCESS IAS CLADAS-MACE AGGREGATE $10,000,000
,DE r (I RETENTION$itn non $
O WORKERS COOMPIDISATION 8008336 10I312023 1013/2024 X
STATUTE 1 I Qt
Am EMPLOYERS'LIABILITY
ANYPROPRIETORRARTNER/EJ(ECUTNE I l MIA El EACH ACCIDENT $1,000,000
OFFICEHA IEMBEREXCLUDED7
MNndivMry In NH) E.L.DISEASE-EA EMPLO $1,000,000
leaNyyMM,,desa+De under
tIPT1ON OF OrERATIONS below ,E.L.DISEASE-POLICY UNIT ' $1,000,000
E MIIdWaorFltr 6600P967600 10/3/2023 10/3/2024 Jobsda+Catastrophe S3,000.000
Property d� Properly Others $178,256
Equipment
Lad/Rented FrornOlhers $100,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Addillonal Remarks Schedule,way be Mfathed if more space Is required)
RE: Evidence of Insurance
CERTIFICATE HOLDER CANCELLATION
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
212 Main Street
Northampton MA 01060 AUTHORIZED REPRESENTATIVE
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