25A-094 (6) 18 COOLIDGE AVE BP-2018-1271
GIS 9: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25A-094 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:Door Replacement BUILDING PERMIT
Permit# BP-2018-1271
Proiect# JS-2018-002270
Est.Cost $15850.00
Fee:540.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: PHIL BEAULIEU & SON HOME IMPROVEMENT 062638
Lot Size(sp. ft.): 8407.08 Owner: SAMOLEWICZ JOAN K
zoning:URB(100)/ Applicant. PHIL BEAULIEU & SON HOME IMPROVEMENT
AT. 18 COOLIDGE AVE
Applicant Address: Phone: Insurance:
217 Grattan St (413) 592-1498 Workers Compensation
CHICOPEEMA01020 ISSUED ON:615/2078 0:00:00
TO PERFORM THE FOLLOWING WORK.REPLACEMENT PATIO DOORS INTO EXISITNG
OPENINGS ON REAR PORCH
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 HE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeTvpe: Date Paid: Amount:
Building 6/52018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
City of Northampton � . :.... : ,���if
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DIMIULLINI
SECTION 1-SITE INFORMATION P7 Q " _ —t7 /
Cl Pmoertv Atloress: This section to be complslM by office
� 8 CC. MP 76f4 Lot hg' `( unit
Zone Owrlay Dlswct
Elm St District CB DISISct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Recortl:
Toa /vSG�hO lea f '� z �g Co6Z4e f��c
N e an Consul Wend Address /
elephone
.g
2.2 AW mnzetl AaeW. Phil Beaulieu&Sons Home Imp.,Inc.
' 217 Gmnan Street,Chicopee,MA 01020
HI REG#100073 Exp.6/8/18
Nerve CSL#CS62638 Exp.6/13/19
Alain Beaulieu
gOOk P.. ......9214"i Fac:(413)594 o009
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Hera Estgnatetl Coat(Dollars)k as Omclal Use Only
co lets l by penrit applicant
1. Bulking s (a)anthill Permit Fee
2. Electrical (b)Estimattetl Total Cost of
Consbuctlon from 6
3. Plumbing Bull Permit Fee
4. Machenkel(HVAC) yV
5.Fire Protection
6. Tahel=H +2+3+4+5) Check Number 1.2 y/
This Section For Official Use Only
oma
Building Permit N r: ISsuetl:
Signe
Belding mmissamedinspecharof Bukngs Dale
OBOLOVIN NO1dMH1a0N
SNDU33dSNl ONIU1010 dO 1d30
e10? v - Nnr
(13AB03a
-Sectlon4. ZONING Al lnlarmeliomaLsl Semmpleted. Ramp Gin Se Ounce Doe To lmompkHelntomehon
Existing Proposed Required by Zoning
Thu-lump n W atke m by
Hud&,,,Depveumt
LotSrze
Froutap
Setbacks From
Side L: R: L: R:
R.
Building Height
Bldg.Square Footage %
Open Space Footage Its
(Latin us bW6Rpvvd
0 Oarking,S aoss
Filt
voNmaa lunam�
A Has a Siecial Permit/Va 'pce/Finding ever been issued for/on the ste?
NO El YES
IF Y$ date issued:
IF YES: Well;the permit recorded at the Registry of Deeds?
NO YES
IFYER enter Book Page and/or Document #
B Does the ste contain a brook, body of water or wetlands? NO � YES
IF YEA has a permit been or need to be obtained from the Conservation Commission?
Needsto be obtained Obtained Date Issued:
G Do any signsexis on the property? YES
IF YID describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES
IFYE$ describe size, type and location:
E. Will the constmatlon activity disturb(clearing,gradi excavation,or Poling)over 1 acre or a It pan of a common plan
Mat will disturb over 1 Bore? YES NO
IF YES,then a Northampton Starm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK f hsck all applicuddle1
New Nouse Addition Replacement Wind AlteraUon(s) Roofing
Or Doore
Accessary Bldg. Demolition New Signs [ ] Decks [ ] Siding[ Other[ 7
Brief Dsscrlptlono rop 7 r
We k: olu /a{+a m(ooPs „ fd efnl�ie ��aae�(wt a.�� Caw �hG
Alteration of"Isting bedroom_Ves No Adding new bedroom /Vee s' No
Attached Narrative Renovang unfinished basement _Yes —Leo
Plare Attached Roll -Sheet
ea.If New house.and or addition to existing housing-complete the following:
a. UseotbWtling:One Family Mn Family Other
b. Number of rooms In each family unit: Number of Bathrooms
c. Is there a garage attached? 416,
d. Proposed Square footage of new com uctbn. Dimension
e. Number of alorles?
I. Method of heaWg? Fireplaces or Woodall Number of each
g. Energy Conservation Compliance. Wascheck Energy Compliance toms atlechetl7
h. Type of construction
I. Is construction within 100 ft.of wetlands?_Yes _No. Is consimctIon within 100 yr. floodplain_Yes_No
]. Depth of basamerd or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes_—No.
I. Sspdc Tank, City Sewer_ Private wall City water Supply
SECTIONTa-OWNER AUTHORIZATION-TO BE COMPLETED WREN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 TO�(iy `�Q�"/O�2W1'C7- ,as Owner of the"act
property fj (7 l�
hereby authorize / /J H
to cl on my al[In all matters relB to work authorized by this building permit application. T f,
J 11
g 1 bxner jj
Dab
Z.[ T
`/ i a Owner/ onzad
Agent hereby declare that the statements and Information on the kxegolrlg appllcatw ere true and accurate,bi the theater edge
and belief.
Signed under the pains and pena0les of peoury.
Pdnl Name
S
Sipreture nApenl pate
SECTION 8-CONSTRUCTION SERVICES
8.1 Licenced Construction Supervisor. Not Applicable ❑
Name of License Holder Phil Phil Beaulieu&Sons Home Imp.,Inc.
217 Gmrmo Street,Chicopee,MA 01020
HI REG#100073 Exp.6/8/18 License Number
CSL#CS62638 Exp.6/13/19
Address Alain Beaulieu Evinsion Data
PH_(413)i92 1498/Fax.14131594 6008
Sigre Telephone
0.Rswlemretl Notrw.lmorovm Phil Beaulieu&Sons Home Imp.,Inc Not Appllcable O
�eA:1nS 217 Grattan Street,Chicopee,MA 01020
.. HI REG#100073 Exp.6/8/18 Registration Number
CSL#CS62638 Exp.6/13/19
Alain Beaulieu
Atl
PH (413)192_1498-Fat:(413)51 6 008 Expiration Date
_____Telephone
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.L.c.152,S 25C(8))
Workers Oompenaatlon Insurance a18davl must be completed and submitted wlh this appliceeorl.Failure to provide this af8davll will result
In the denial of the Issuance of the bulltlln ermh.
51 nstl Alfidavl Attached Yas....... No...... ❑
11. -Home Owner Exemption
The current exemption for"Mmeownera"was extended to include Owaa,occunled Dwelinu ofone(1) or two(2)families
and to allow such homeowner to angape an individual for hire who does not possess a license,arovided that the owner acts
as supervisor.CMB 780. Stith Edihou Section 108.3.51.
DNIstal n of Homeawunr:Person(s)who own a parcel of Ind an which he/she resides or intends to reside,m which there
is,or is intended to be,a one or me family dwelling,attached or detached shuchues necessary to such me and/or farm
shu¢puea.A Person who ronsrrects mare Ideas one bane in v two-venr period shall Not be considered•he..
Such"homeowner"shell submit to die Building Official,on s form acceptable to the Building Official.that W*he fbvll be
resnundhle far all such work periotwed order me bPSdina Permit
As acting Conshaction Sularsvisor your presence on the job site will be required him Bine tp time,during and upon
complmiou ofthe work for which dua permit is issued
Also be advised Out with reference to Chapter 152(Workers'Compeuwtion) and Chapter 153(Liability ofPmployer,to
Employees far injuries net nandbng in Death)off.Massachusetts Genanl Lows Assurance,von envy be liable far persop(s)
you hire to perform work for you wider this permit.
The andensigned"homeowner'"certified and asmmu i responsibility for compliance with the State Building Code.City of
Northampton Ordinances,State and Local Zoning Laws and Stale offAmeachusem General Laws Amended.
Nmedem" Sigoatuuro
p The CommanwealthofMassachusetts
a _
Department
4*-."Af1p affnstrlas eats
Office oLtvestigation
600 Washington Street
Boston,Mas& 02111
wwremassgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Phil Beaulieu ee Sons Home Imp.,Inc.
Name Iaurine../OrgmiieeliuNlnJiviJunil: I 217 Grattan Sheet,Chicopee, 01020
- HI REG#100073 Exp.6/8/18 -
Address: CSL#CS62638 Exp.6/13/19
Alain Beaulieu
City/state/Zip: PH (413)592.1498/Fax:(413)594h008
Are Yy an employer?Cheek theee������PPPpropitiate box: Type ofproject(required):
I.�'I am an employer.with 4. i am a general commclorand 1 6.0 New construction
employees(full and/or part me)P have hired the subcontractors 7_i_t Remodeling
2.❑ 1 am a side proprietor or partner- listed on the attached sheet.
ship and have no employees Ther sub-emmettors have 8..'1 Demolition
working fir me in any capacity, employees and have workers'
[No workers'comp.insurance comp.insurance.j 9.n BuilAing addition
requiredl 5.0 We arc a corporation and its 10.1)Electrical repairs.,additions
3.G I am a homcoe•ner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself[No workers'comp. right ofexemption perm hIGL
insamnce required]= c. 152,§ 1(4),and we have no 12.[1 Ronfrepain
employees.[no wmkels' 13. ❑Other
comp.insurance required.]
'4nY ti,alm.s of W[fiMULop pl mW oho lla nul0eveetlon UNmv gonlnFNtlr warinra'—Pa"sulon pdi[Ylnrormnlon.
Fnomtowveraoemhna Na al.a. hdh mIlney art adngall mark vnE IM1m ante oulnlde tonnador[martmbmitnomr..Iii llndfl. vF nrtlr.
peonrvmvn IMr[M1teh Inlr hot mud vllv[M1 an nMhlond NttrNmvlvBlae nam<olrne fab-[anrntlan anO SLttt wM1elber or eat Illose en11HMMve employees. Ir
the mbtanln[ton bnveemobJm,mw mutvmvl4emelnvnrken'ronin pNld vumber.
I me anemp[oyerrhat ispreeidingewk .c'evmpensvdon maramcefarnryemployees.Belawiedtepollry andjahsire
interment..
Insurance Company
Poliey#or Self-ins.Lk.#: / k/r't 7 900 6/QOS Expiration Dare:
s: LD (..0 � S 1
Job Site AddresCity/Slale2ip:_ /L�O /�g
Attach a copy ofthe workers'compensation policy declaration page(shoving 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 fne
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 fne 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.
Ido herby certify aannddfl, d p 'es ofpegLry that the information povid d ab7 is hoe and correct.
Si manure: / D.1, ,6
Print Name: /, {q r/�j fat/ Pheor 9:
Official use only Do not write in this area to be completed by city or town o/ficlal
City or Town: Permlblirmse It:
leasing Authority(circle one):
I.Board of Heath 2. Building Department 3.Chy/rown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact person: phone#:
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: f '�?' Ca °//wyr '01aC
The debris will be transported by: 7e/2l-r
The debris will be received by:
Building permit number: 7^
Name of Permit Applicant
Date Signature of Permit Applicant