25C-016 (7) BP-2022-0748
174 NORTH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-016-001 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-2022-0748 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS Contractor: License:
Est. Cost: 9900 PHIL BEAULIEU 62638
Const.Class: Exp.Date:06/13/2023
Use Group: Owner: HELMUS DENNIS LEE
Lot Size (sq.ft.)
Zoning: URB Applicant: PHIL BEAULIEU & SON HOME IMPROVEMENT
Applicant Address Phone: Insurance:
217 Grattan St 413-592-1498 WMZ80062050
CHICOPEE, MA 01020
ISSUED ON:06/22/2022
TO PERFORM THE FOLLOWING WORK:
REPAIRS TO SIDING
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:
• 2Tit •.
Fees Paid: S65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
i` C---_---__
i___F
14 The Commonwealth of Massachusetts i
Board of Building Regulations and Standard JUN 2 1 FO"
W
Massachusetts State Building Code, 780 C 202 ICI E LITY
Building Permit Application To Construct, Repair, Rknovg e r & R Wised ar 2011
�T'�7YFfaZ,f�1
One-or Two-Family Dwelling r arTT�N lSP iotis
This Section For Official Use Only
Building ermit Number: . P' „b-7 Y 9 to Applied:
e,w (055 G 2z zozz
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
/ 96 /lio/'/I .ct 2S C. b Ke
1.1 a Is this an accepted street?yes /./. 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 0 Private 0 Zone: Outside Flood Zone'? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ow er'of Record:
ey'ziiS / et, z�s /f/o�'1/�a��01�d.Ti
Name( rmt) City,State,ZIP
/71 / ,)Z S, 5 -gs'67dr cdee4.1:a e/,+as e'laae.i`, Ccvsi
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building Owner-Occupied Gir—Repairs(s) 131-'Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': 5,L1I,J .�,444 F/p,,, />e,/ ceeee a.eo/ ekvv, T2s //
_76— Pfivyl fX 4lteS ooc b• 'Zisi,l Ahow n
— y�� .1. 4. . f - �"r€ d 6,, 4 / r�o t-er Pi -A 1�a 4G�
}'4 /I/t,.�,. 7/,t.Y,
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:
❑ Standard City/Town Application Fee
2. Electrical $ ❑Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $ r
Check No.14 UI I Check Amountki Cash Amount:
6. Total Project Cost: $ ?Fa0 ' 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL ""
List CSL Type(see below)
'�1'1'" Phil Beaulieu&Sons Home Imp.,Inc,
No.and Stret 217 Grattan Street,Chicopee,MA 01020 Type Description
HI REG#I00073 Exp.6/7/23 U Unrestricted(Buildings up to 35,000 cu. ft.)
CSL#CS62638 Exp.6/13/23 R Restricted 1&2 Family Dwelling
City/Town,c Alain Beaulieu M Masonry
PH:(413)592.1498/Fax:(413)594.6008 RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Ho' - ^--•-��*�--n�rir�
Phil Beaulieu&Sons Home Imp.,Inc. — HIC Registration Number Expiration Date
HIC Comp e 1 217 Grattan Street,Chicopee,MA 01020
HI REG#100073 Exp.6/7/23
N . CSL#CS62638 Exp.6/13/23 Email address
Alain Beaulieu
ty/Town,State, PH:(413)592.1498/Fax:(413)594.60Q8
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 . ler 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 /78/71_,T
to act on my behalf,in all matters relative to work authorized by this building permit application.
`- 9eAe.Z.s..._ 7
Print Owner's Name(Electronic Signature) , Date
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 f my knowledge and understanding.
Print Owner's or Authorized Agen s 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
r 'e: Massachusetts ��
j
,, DEPARTMENT OF BUILDING INSPECTIONS y;
' 9.::
� / 212 Main Street • Municipal Building J`
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: 71/440e-e //C�-/S1\/' A., Ss
The debris will be transported by:
Name of Hauler: //?
Signature of Applicant: /� Date: _ ,�,5S-.,`
The Commonwealth of Massachusetts
=f Department of Industrial Accidents
1 Congress Street,Suite 100
=:° Boston, MA 02114-2017
www mass.govWdia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING:AUTHORITY.
Applicant Inform' Please Print l..eeibh
Phil Beaulieu&Sons Home Imp.,Inc.
Name h H ustncs4(hgantzat
217 Grattan Street,Chicopee,MA 01020
Address: HI REG#100073 Exp.6/7/22
CSL#CS62638 Exp.6/13/23
Al Beaulieu
City/State/Zip: pH.(411)592.1498/Fax:(4131594.( 0L.,r
Are yen as employee Cheek the appropriate box:
Type of project(required):
l.®1 am a employer with X_' crnplo}+eta(full and'or pan-bier)_• 7. 13 New construction
20 lam a sole proprietor or portnershrp and have nu employees working forme in 8. Remodeling
any capacity.[No waters'comp.insurance required.)
30 1 am a homeowner doing all wur♦1 myself.[No workers'cutup.nwtrancc required] 9. El Demolition
10 0 Building addition
4.0 lam a homeowner and will be hiring contractors to t onduct all work on my property. 1 w ill
ensure that all oust actors either dot c wrsrlcn'cun>pcmatiun uourance or an:sole i i 0 Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
50 I am a general contra:tor and I has a hared the sub-contractors listed on the attached sheet_ 13 Q hoof repairs
These sub- untracwns base employees and have workers'comp.insurance.[
60 We are a corporation and its officers have exercised their ngln of exemption per AKA.c. 14.0Other
132,I 1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant titer checks boa n I must also fill out the section below show ing their workers'compensation pulicy information.
t homeowners who submit this aftidas it mdicatine they arc doing all work and then hire outside contractors must subnut a new atfidat it trs dicatrng such.
[Contractors that check this box muse attached an additional sheet show ing the name of the subcontractors and scat:w hether or not those...mattes base
employees. If the sub-contractors base employees.they must prat ide their workers'comp.policy nuinls.•r
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. ,Q
Insurance Company Name:
Policy#or Self-ins.Lic.#: mo d?/ Z 7OC 6 2 OS l-:.v pleat rtrn Date: ..2 _S
Job Site Address: /< i/!/d/'�!j Si. Ci y slateiZip: /�� //�//
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 ns 'tallies of perjury,that the information provided above is rue an correct.
Stpiature: Date:
Phone#: .
Official use only. Do not write in this area,to be completed by city or town officiaL
City or To n: Permit/License#
Issuing Authorit► (circle one):
I. Board of Health 2.Building Department 3.City/Town('fork 4.Electrical Inspector 5. Plumbing Inspector
6.Other
('untact Person: Phone#:
Office of Consumer Mal &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 06/07/202' 1000 Washington Street -Suite 710
PHIL BEAULIEU&SONS HOME IMPROVEMENT,INC. Boston,MA 02118
ALAIN M.BEAULIEU
217 GRATTAN STREET
CHICOPEE,MA 01020 Undersecretary Not valid without signature
e
Commonwealth of Massachusetts
' Division of Professional Licensure
- Board of Building Regulations and Standards
Cons , ' iStlprvisor
CS-062638 Etcpires:06/13/2023
ALAIN M B �t ,4
7.
217 GRATTAIIA S ''
CHICOPEE MA 01 -
/4,1C :*U1a
Commissioner dig!> iti° `t�Fr,cl.�a,
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