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24D-208 (7)
BP-2022-1148 236 STATE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-208-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-1148 PERMISSION IS HEREBY GRANTED TO: Project# skylights .Contractor: License: Est. Cost: 16070 PHIL BEAULIEU 62638 Const.Class: Exp.Date:06/13/2023 Use Group: Owner: M KALISH BENJAMIN Lot Size (sq.ft.) Zoning: URC Applicant: PHIL BEAULIEU & SON HOME IMPROVEMENT Applicant Address Phone: Insurance: 217 Grattan St 413-592-1498 WMZ80062050 CHICOPEE, MA 01020 ISSUED ON:09/13/2022 TO PERFORM THE FOLLO WING WORK: • REPLACE 3 SKYLIGHTS 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: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Buildine Commissioner RECEIVE=D The Commonwealth of Massachusetts , Board ofBuilding Regulations and Standards FORMUNICIPALITY / S E P 1 2022 Massachusetts State Building Code, 780 CMR r USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 DEPT.OF BUILDING INSPECTIONS One-or Two-Family Dwelling NORTHAAIPTON.MA0]0a0_ This S on For Official Use Only Buildin Permit Number: Co A 4),— j I K6 Date Applied: rv,N a.5.) /, 9-13-zOz2 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assesso ap& Parcel Numbers 23 L. S+o.1-t St sect No '±tic mpIon a �.Ug 1.la 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. eI e of Record:rin k G / 5 h Na/- ,�� ivy-, , MP 0106,0 Name(lot) City,State,ZIP 23t, Sfaft S f ( /3) (p7-7738 bka fish Q ma: 1-corn No.and Street Telephone Email Adchtsi SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other Specify: S I tf RAOI4a,0'0r�fBrief D cription of Proposed Work2: „(J\ ( And. r t/2k, U 3 S L�- . -- 1 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 Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fs: $ 7, Check No.1 7d tl►eck Amount: Cash Amount: 6.Total Project Cost: $ I 1 _ Q"i O r00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS_Q „2(?c6 co - ( -3 - 23 mri.ri Phil Beaulieu&Sons Home Imp.,Inc. License Number Expiration Date 1 217 Grattan Street,Chicopee,MA 01020 HI REG#100073 List CSL Type(see below) CSL#CS-062638 Type Description N Alain Beaulieu PH:(4131 592.1498/Fax:(413)594.6008 U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling ty M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 5 !q 2-!L41' m b kt kAA W P Q bT Z I Insulation Telephone Email address D Demolition 5.2 Registered Home Imnrovement Contractor(HIC) +000-13 0 7/2 q HIC Corii Phil Beaulieu&Sons Home Imp.,Inc. HIC Registration Number Expiration Date 217 Grattan Street,Chicopee,MA 01020 HI REG#100073 ChbtGua�i-Gt�l�a �311 •b`2- No.and CSL#CS-062638 Email address Alain Beaulieu - City/To PH:(413)592.1498/Fax:(413)594.6008 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 .❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING Phi PERMIT _ut �e I,as Owner of the subject property,hereby authorize I J3ea . i -{.Lc B Son c (c► yaV 4�-1 I to act on my behalf,in all matters relative to work authorized by this building permit application. FOeri emirs �A 1isk 9•- `�- 22 Print Owners (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 e and accurate to the best of my knowledge and understanding. 9- - 22 Print Owner's or Authorized Agent'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 ?%SH___MP '• SAS"' Si /. `� Massachusetts Q? 1._ �'e w' m *, `i DEPARTMENT OF BUILDING INSPECTIONS �'. j„ w• f 212 Main Street • Municipal Building tiJ �':, ! Y Northampton, MA 01060 'rst , 3;0C�`1 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: 15 M( J k Road oad En 4-e- r c. el- The debris will be transported by: Name of Hauler: USA Hauwar,,, t f2t Cy G l i Signature of Applicant: `r 0 Date: ? — '_ 72 ACC0 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/02/22 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 CONTNAME: ERIC ERIC MASON THE MASON AGENCY INC PHO laic,No.Ext1: (413)569-2307 A/C, No): (413)569.2308 504 College Hwy ADDRESS: themasonagency@american-national.com Southwick, MA 01077 INSURER(S)AFFORDING COVERAGE NAICN INSURER A: FARM FAMILY CASUALTY INSURANCE 13803 INSURED INSURER B PHIL BEAULIEU&SONS HOME IMPROVEMENT, INSURER C: INC. INSURER D: 217 GRATTAN STREET INSURER E: Chicopee, MA 01020 MA 01020 _INSURERF: 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 REOUIREMENT, 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. INSR TYPE OF INSURANCE INSO SUER POLICY NUMBER L POLICY EyFY)y POLI CY LIMITS INSO WW1 X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 300,000 BUSINESS OWNER'S MED EXP(Any one person) $ 25,000 A x x 2001 X281 D 02/25/22 02/25/23 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 X POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO BODILY INJURY Per person) $ A AWNED AUTOS ONLY X AUTOSULED X 2001C7139 02/25/22 02/25/23 BODILY INJURY Per accident) S XHIRED V NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY ". AUTOS ONLY (Per accident) X UNBRELLALIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS�/UAB CLAIMS-MADE 2001E1738 02/25/22 02/25/23 AGGREGATE $ 3,000,000 DEC X RETENTION$ 10,000 $ WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY YIN STR ATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,say be attached if sore space is required) CARPENTRY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SAMPLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIV ©1988- 01 ORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD PHILBEA-01 CHRISTINE ACORO- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 2/18/2022 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 caN�ACT Christine Sullivan N M Phillips Insurance Agency,Inc. PHONE 97 Center Street (NC,No,Ext):(413)594-5984 FAX I(A/C,No):(413)592-8499 • Chicopee,MA 01013 ittAh ss:christine@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:A.I.M.Mutual Insurance Company INSURED INSURER B: Phil Beaulieu&Sons Home Improvement Inc. INSURER C: Phil Beaulieu 217 Grattan Street 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYYI IMM/DD/YYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ _ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 7 POLICY j n LOC PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILECOMBINED SINGLE LIMIT LIABILITY fEa accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED A�T AUTOSEE�� ONLY _ AUTOS WN BODILY INJURYp (Per accident) $ AbRTOS ONLY _, OS ONEp LY (Perr acEcident)AMAGE UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY WMZ-800-6205-2022A 2/25/2022 2/25/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE YNN N/A E.L.EACH ACCIDENT $ (iFFICER/M MBER EXCLUDED? 1,000,000 (Mandatory n ) E.L.DISEASE-EA EMPLOYEE $ tf yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I 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 I�°1'1 _ ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Department of Industrial Accidents 9 ,, Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-I 750 _t www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Phil Beaulieu & Sons Home Improvement, Inc. Address: 217 Grattan Street City/State/Zip: Chicopee, MA 01020 Phone #: 413-59 2-1498 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 25 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition (No workers'comp. insurance comp. insurance.* required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 mployces. lithe sub-contractors have employees,they must provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site nformation. nsurancc Company Name: A.I.M. Mutual Insurance Company 'olicy#or Self-ins. Lic. #: WMZ-800-6205-2022A t- Expiration Date:2/2512023 S'�ol IY`�-�"� City/State/Zip: (V( I—-k !tt n tJ/ ob Site Address: Q(OUZO lttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 if up to$250.00 a da/against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations oftht,plA for insurance coverage verification. •do hereby certify under the pains and penalties of perjury that the information provided above is true and correct ;ignature: 11 t Cla Date: I — 2 Z 'hone#: 413-592-1498 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority (check one): 1DBoard of Health 20 Building Department 3OCity/Town Clerk 4.0 Electrical Inspector 50'lumbing Inspector b.❑Other Contact Person: Phone#: Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstrubtibtY8dpervisor CS-062638 Expires: 06/13/2023 ALAIN M BEAULIEU 217 GRATTAN STREET CHICOPEE MA 01020 ,. ' I/• )!\'l i,ll�:`` mow. Commissioner n �ItL ><% UFi-nLYta._ THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration C'T; `--- (Yl7. 1" ' r. " Type: Corporation d., Registration: 100073 PHIL BEAULIEU &SONS HOME IMPROVEME ,I Expiration: 06/07/2024 217 GRATTAN STREET CHICOPEE, MA 01020 - ;..; / • "rs r �. 7 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:Corporation Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 100073 06/07/2024 Boston,MA 02118 'HIL BEAULIEU&SONS HOME IMPROVEMENT, INC. LAIN M. BEAULIEU !',r 2 17 GRATTAN STREET.! s,,.._d_?7 J ' ,,i( la,(%/ 4 HICOPEE,MA 01020 ' `��'ti ,.-�`�' 7t-±5„ Undersecretary Not valid without signature