24A-098 (3) BP-2023-1233
15 DICKINSON ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24A-098-001 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-2023-1233 PERMISSION IS HEREBY GRANTED TO:
Project# KITCH HOOD 2023 Contractor: License:
Est. Cost: 6418 MICHAEL PHILLIPS CSL082683
Const.Class: Exp.Date: 10/10/2024
Use Group: Owner: ADB-2 PROPERTIES LLC
Lot Size (sq.ft.)
Zoning: URA Applicant: MICHAEL PHILLIPS
Applicant Address Phone: Insurance:
P O BOX 514 (413)250-7990
GOSHEN, MA 01032
ISSUED ON: 09/11/2023
TO PERFORM THE FOLLOWING WORK:
VENT KITCHEN HOOD, REMOVE WINDOW AND INSTALL DOOR
EXPAND CLOSET
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: '
! 2
b ' I! , c ' `I •
' I
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECEIVED
The Commonwealth of Massachusetts
Board of Building Regulations and Standards S E P — 8 2Q� C 1
Wt Massachusetts State Building Code, 780 CMR MLNIIbALITY
USE
Building Permit Application To Construct,Repair,Renovate `_io ana';'i VA1 or4ed Mar 2011
One-or Two Family Dwelling
This Section For Official Use Only
Buildin Permit Number:6 l -?3" 12 33 Date Applied:
e-vj ) /Z-, //!12 9-11.2 z
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1Prope Address: 1.2 Assessors Map&Parcel Numbers
1 S c C.Y . i' 3t)t'4 �'.1 •
I.I 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 Private❑ Zone: ' Outside Flood Zone?Check if yes0 MunicipalOn site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 ,l � ork,pi.01�+ . r A
Name(Print) City,State,ZIP
No.l c Street Dt-af
oin g; i' A-
Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other Specify:
Brief Description of Pr•po`ed or 2:
- i K.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ L%-i\..k% 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fe {t Ali
Check No.1 "1 Check Amount: Cash Amount:
6.Total Project Cost: $ i'C 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Super sor L se(CS I.,),. Q .�;r�j 3 }01 t0 LI
• V t>1 E L' i i l License
Number Expiration Date
Name of CSL Holder '
'-Q ,r .
.) Oy 5 ,4 List CSL Type(see below)
No.a d Street ✓ Description
()" 2*
-fit �� Unrestricted(Buildings up to 35,000 Cu.ft.)� CV\13' 1. i� Restricted I&2 Family Dwelling
City/ wn�State,Z
M Masonry
RC Roofing Covering
'�j�� l�CA - t 1 + WS Window and Siding
SF Solid Fuel Burning Appliances
L��IT %5 y 7 ' r 6 -14( (544,r 1) , I Insulation
Telephone Email address D Demolition
5.2+ RMegistered Home Ij ` me t Co(itt(ractor IC) S-, ..It ' ` ;c 1 e �r " `t It.,t .3 ce H Re('stra • umber irata ate
� h� !
HIC /. fame�(.3 v C Re Str 1 1 t itlP 141(�'�..—� G 1 kl�
No._ ��//Stre 3 Emailaddress
),, o
City��Stat ZIP Tele hone
P
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 .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 4 CNA(S ,`; ! C r
to act on m/ behalf,in all matters relative to work authorized by this building permit application.
09' Jj�i,:,e, 9/7/23
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 appli tion is d accura to the best of my knowledge and understanding.
c —' ' t')013
Print Own 's or Aut onzed Agent' e( c Signature) ate
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
wW.w_.mass.Ito vluca Information on the Construction Supervisor License can be found at,,A- ,w.:nass.gov"tips
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
(,.., Massachusetts ...,_ c�i 'A A.A.
Y
4 DEPARTMENT OF BUILDING INSPECTIONS ;,
s` 212 Main Street • Muni Municipal Building yvf 'e
Northampton, MA 01060 �S!jy ,D���
r,e..e
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:
l
Location of Facility: U :4 1t-e) T--PCA
I
t
The debris will be transported by:
of Hauler: 1\ � * It
t Namec c �J /� ,
,,,,,
‘Y Signature of Applicant: Date: _____ML6±6133
The Cortintnnifrealth of Massachusetts
t 1 Department of lndustrial.4ccidents
. • 1--::::::'= I congress Street,Suite 100
TIT-_- -':* Boston„WA 0211.-:01.7
wwrcanass.gin/dia
11411kers'Compensation Insurance.'Affidavit:BuilderstC'ontractors,ElcctriciansfPlumbers.
i ti BE FIELD W.tilt I HE PERT!ram;At 11tORI 11.
.tnniitallt tnh r,nation '} y�Pic.:ter Print Ieon �
Narn iBusin..•s rx or;anatutntnd:ttdual?= ____ C - c Wl.a.:Io.4.\. ,P Lli.ce _......_......_.......
r7-Qt.
Address: , 7e)c) )(--- ' 1..(1 ... .. .... ..__ . - _
cit,,,:state zip _.. _. P ,�► hunt, ,_.4,1,7 1 - iZco
„,...._,...
Are you Al:ennph serf Cheek Lbe appropriate but: , Type of project(required):
1 0 I arc,a u: I.?tta.<tia c:cpl+.icy(1c1E..ad or p:u?-tfa:t• 7- D Neu construction
:::D I.an s wle ir.+str;..1ur orrta�rart:�s,rd Bate no,:nplo *.v),s.z.ric r for r fi 8. i Remodeling
`—r pry caparei, :!sir worker.'crap r antis ..Nq trr4sl.)
9. 1 Demolition
.•D 1 ant a hat,nc+airs,dome all µW r.cr.wlf,I"'.es uc rktn urerr mh.r-se-e:rc;tufretl I"
I U J Building,addition
0 f an;a 1>t-r.r awr an e.t:t he )repro vo nlradm: Iti avicluct r1:Shutt.ort tt t rtupar:, I oat
r.-.ure tar:all ccrr._rak.a ctth.r irs4C-Ar rkcrs'vcnnive,.xifur rt ure t t or arc .1•. 1 I.0 Electrical repairs or additions
propacts,,.%dull no in lutic,.-. .--
1 .j PIurnbine repairs or additions
y I attt a 3....v r tat c._=;ttrat'.ot at3:1 I haxc ittrcci the>ab c•rttta4::ot.Listed on th.c attacltcd sleet_
�' 130 Roof repairs
Them:>ab c•antrra::t..rs Euc c,.rtpl.tt cc>aril b.tc c tc.t i.C:: ur_tp.errors uc.•
1 3_0�tltei
6
1% aSt'44;ra-1+s._span s:td a>ut r c ..twit:c:ccr,,t .1:lnrt:wilt ct eke-scrtron pc.r!�td,L,Tic -- —. _`...
_+.,11 4 1.4.11d i lass no c rs1+t :,c: (tilt a of a.,'i ump at,ur t t s cyutted.e
irl a;,p tc.tnt Tiutt c)yaks kot r.I rtiu>t r:vim till out IN:+..orals I Isis,,?tu K va their c4urLez>r cwnt:a,atta:t p,r - rn rIsstaa:.cat.
tt:ra,a,A ores vb;to i at til+ ;t tin,attiJaA tt rr:i tt z.inIF tb'.arc Ai.>tti'.air.'.4eRt.and lino ltilt a latch'..ontrza L°;x r.tu>t aL^n'.tt a Ile 14 at.€cal,tl trxxf.::tltn1`.ss.ti
-t,.,:err.c:c that tack.)ts`a:>KA rstn.t att::hcd a..a 4:e3111•.:lJ1 a.ec.-.iu sc t:t, .lt:taetce t Lit.:atzi*xur:tra.:tor,.ar:vr sate slasher ot:rut tits:ertuecs talc
_riptv4c,.> ft:ia.'ub-c,.=nt:.»::ota ba',c ct:ti+Iutcc.,.t ... tr:a-.t rnac tuff ut._t: xcuti.cr>' 49clp.t+.,tlrt'.ttirrtbcr
1 am cut employer er that is pro idirt workers"compensation insurance for my emplo{ees. Below it the policy 1 and jab sire
ityarmation.
Insurance Curnpxzs} Name... Pi`!_.a..Ye nd{ �---...� a3 _Co, _-__
t-f
Policy»or Sclt=tits. L . t .9S6
II. 0(2,7-j 5 s' 3 Expiration p I)aze.__GSAA__ _414 U
Job Site Address: r�/ 1/ ._ Ctit.State Zip: ..-Nr
.Attach a copy of the tcorkers'compensation dee aratioa page tsho the policy number and date). Kk
p. 1 policying I expiration0
E..nIt:rc :0 secure ctn cr.:_e as rega.red aria,,. N1GL c 152 ;25A i,a criminal tit:+lariun punishable by a fine up to S1.500.00
and or one-tear imprisonment.as tt ell � s cat it penalties in the forth cifa STOP\V()RK ORDER and a line ot up to`250.tX)a
_ .tr.twthe .fo ato .A eop> 01 lilt, 'steattct:t tt«:i be for:4.irded to the Of l c: ot Env esttr_>.ttto..,of the DIA for t::.st rani
co'.e:.ter t ert1ication.
/do hereby certify under the pal and penalties i fperjury that the information proriiled a rtre ist!{rt e and correct.
Str2natttre: �n
Date: L i U v3
PL& te:
,
U ciul use only. Do not write in this area.to he cotriple'ted by city or town official
City or l os%n: Prrmittl.icenSe x
Issuing.Authorit}(circle one):
1. Board of Health 2.Building Dtpart►nent 3.('ii I acsn Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone'
Commonwealth of Massachusetts
wt Division of Occupational Licensure
Board of Building Regulations and Standards
Consezdt on rSkipervisor
CS-082683 E yires_ 10/10/2024
MICHAEL.1 FJiILUPS
PO SOX 514 z
GOSHEN MA: 1032
1
se
rj r.LVd'?3
Commissioner ( 0 f. ixo za
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:Corporation
Reoistratiotl Expiration
171266 03/04/2024
MICHAEL PHILLIPS,INC.
MICHAEL PHILLIPS
31 MAIN ST c.14,4,,,,(4? laG�is "
P.O BOX 514 Undersecretary
GOSHEN,MA 01032
VDAC
C H U B B` WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
TYPE AR INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (6S62UB-4N43852-5-23)
RENEWAL OF (6S62UB-4N43852-5-22)
INSURER: ACE AMERICAN INSURANCE COMPANY
A STOCK COMPANY
NCCI CO CODE: 12165
1.
INSURED: PRODUCER:
MICHAEL PHILLIPS INC AQUADRO & ASSOCIATE INS
PO BOX 514 P 0 BOX 357
GOSHEN MA 01032 NORTHHAMPTON MA 01061
Insured is A CORPORATION
Other work places and identification numbers are shown in the schedule(s) attached.
2. The policy period is from 06-24-23 to 06-24-24 12:01 A.M. at the insured's mailing address.
3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers
Compensation Law of the state(s) listed here:
MA
r
B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in
item 3.A. The limits of our liability under Part Two are:
Bodily injury by Accident: $ 500000 Each Accident
Bodily Injury by Disease: $ 500000 Policy Limit
Bodily Injury by Disease: $ 500000 Each Employee
0 amamonm"""' C. OTHER STATES INSURANCE: Part.Three of the policy applies to the states, if any, listed here:
COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06B
INIMINMENNI
D. This policy includes these endorsements and schedules:
SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE
4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating
-N' Plans. All required information is subject to verification and change by audit to be made ANNUALLY.
DATE OF ISSUE: 06-14-23 AG ST ASSIGN: MA
OFFICE: RMD CHUBB 24M
PRODUCER: AQUADRO & ASSOCIATE INS 26XDW