17D-027 (12) BP-2022-0297
73 STRAW AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17D-027-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Penn it # BP-2022-0297 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS/DOORS Contractor: License:
Est. Cost: 8350 PHIL BEAULIEU 62638
Const.Class: Exp.Date:06/13/2023
Use Group: Owner: CARMEN JUNNO DAVID &
Lot Size (sq.ft.)
Zoning: URB Applicant: PHIL BEAULIEU & SON HOME IMPROVEMENT
Applicant Address Phone: Insurance:
2l7 Grattan St 413-592-1498 WMZ80062050
CHICOPEE,MA 01020
ISSUED ON:03/25/2022
TO PERFORM THE FOLLOWING WORK:
REPLACEMENT DOOR AND 6 WINDOWS
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:
Gas: Final: Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
`r
. 51.41i
Fees Paid: $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-I272
Office of the Building Commissioner
• -' -- C Department use only
C`lal?.f...—/„ City of Northampton ---�I i'' Status of Permit:
,: , , Building Department orb Cuf7Driyeway Permit__
, , 212 Main Street �,�� Sewer/Septic Availability_
Room 100 �� Water/Well Availability
fir, ' ,,; Northampton, MA 01060 Two Sets of Structural Plans__
_ �'"" phone 413-587-1240 Fax 413-5.87= Plot/Site Plans
,r:(- Other Specify
___APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE-DR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map `7 0 Lot Od 9 Unit
-73 S}cGw Ave
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Carmen Junnc 73 5-1-raw A,rf NOTIharmp1an
Name(Print) Current Mailing Address:
Nl3 - 3v 7yaa
,..-a..‘,1 Telephone
Signature
2.2 Authorized Agent:
Phil Beaulieu E 5ons c17 6ra)1i-i 1 5f• Ckcopee
Name(Print) Current Mailing Address:
- qr3• 592 - 1`198
Signa re Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be '
Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
4 $, 3600
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) C/°
5. Fire Protection
6. Total=(1 +2+3+4+5) 13s 1 ? — Check Number /4. /
This Section For Official Use Only
Building Permit Number: J���1 7 Date
Issued: s
Signature: /72 J- 25 - ZQZ,Z
Building Commissioner/Inspector of Buildings Date
of beau 1'►et. @ Fbh i . b;z.
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[:1 Siding[DI Other[P]
Brief Description of Proposed
Work: ln5i4ll (I) replacement pcal;o dcor > (6) replacement double hunjs -U 34
Alteration of existing bedroom Yes .t' No Adding new bedroom Yes ✓ 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, Caf men Juno° , as Owner of the subject
property p
hereby authorize t"h \ Beau t e u 5on 5
to a on my beh If, in all matters relative to work authorized by this building permit application.
3)Jyjaa
Signature of Owne �� Date
I, P 8 H l ,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.
A) Pie tA)
Print
D ly1aa
t e of caner ent Dire
. Tt.
City of Northampton
X Massachusetts T\� s,
R DEPARTMENT OF BUILDING INSPECTIONS
',+v 212 Main Street *Municipal Building
Northampton, MA 01060 Aar")‘>
Debris 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.
The debris from construction work being performed at:
7 3 Straw A-4e.
(Please print house number and street name)
Is to be disposed of at:
fi G\Sh fru(K - Ibrohorn trc\nsfe( 5iodier,
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of ermit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
City of Northampton
Massachusetts
E DEPARTMENT OF BUILDING INSPECTIONS
C4
212 Main Street • Municipal Building
Northampton, MA 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation,repair,modernization, conversion,
improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC, that entity must be registered
Type of Work: W 1 nap i g 00kCerneilt Est. Cost: ' `d 500
Address of Work: 3 >}rO•v,l
Date of Permit Application: 3. 14- a a
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law(explain):
Job under$1,000.00
Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
3 . iy as 1)BF11, lo0U73
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
The Commonwealth of Massachusetts
*� t Department of Industrial Accidents
Office of Investigations
[ 600 Washington Street
Boston,Mass. 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): Beaulieu Home Improvement
Address: 217 Grattan St.
City/State/Zip: Chicopee, MA 01020 Phone#: 413-592-1498
Are you an employer?Check the appropriate box: Type of project(required):
I.9C I am an employer with 30 4. 0 I am a general contractor and I 6. ❑New construction
employees(full and/or part time).* have hired the sub-contractors 7 ❑Remodeling
2.0 l am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have 8.0 Demolition
working for me in any capacity. employees and have workers' 9.❑Building addition
[No workers'comp.insurance comp.insurance.t
required] 5.0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 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..-ligekbeffefsiis
employees.[no workers' 13.0 Other i„-,'or/ow-5
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
tHomeowners 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 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: AIM
Policy#or Self-ins.Lic.#: WMZ8006250 Expiration Date: 2/20/23
Job Site Address: 73 5tr(t J AJQ_ City/State/Zip: WI thahgrlvn
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 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
$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 the pains and penalties of perjuiy that the information provided above is true and correct.
Signature: .A 0.- Z32aed¢tz Date: //22
Print Name: Alain Beaulieu Phone#: 413- 92-1498
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 Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact person: Phone#:
/4,74:rir/(fiie//i
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
100073 06/07/2022 1000 Washington Street -Suite 710
PHIL BEAULIEU&SONS HOME IMPROVEMENT,INC. Boston,MA 02118
ALAIN M.BEAULIEU
217 GRATTAN STREET
CHICOPEE,MA 01020 Not valid without signature
Undersecretary
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constr`ucti n1Su} rvisor
CS-062638 expires:06/13/2023
ALAIN M BEAULIEU
217 GRATTAN STREET
CHICOPEE MA 01020 •Y
Commiss,oner d, .., / Verna.,
/h K9,91,Ani1-1.1t a e✓ 2��1.1or z1P/Gi
Office of Consumer Affai &Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
100073 06/07/2022 1000 Washington Street -Suite 710
PHIL BEAULIEU&SONS HOME IMPROVEMENT, INC. Boston,MA 02118
ALAIN M.BEAULIEU
217 GRATTAN STREET
' 4 •
CHICOPEE,MA 01020 Undersecretary Not valid without signature
A
•
Commonwealth of Massachusetts
Division of Professional Licensure
• Board of Building Regulations and Standards
Coned tt6nSLpervisor
CS-062638 > Wires:06/13/2023
ALAIN M BEAULIEU :"
217 GRATTAN STREET
CHICOPEE M4 01020,
Commissioner djo ' 'nv/m„ •
•
•
r