17D-038 (10) BP-2023-1465
24 HIGH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17D-038-001 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-2023-1465 PERMISSION IS HEREBY GRANTED TO:
Project# FINISH BATH RENO 2023 Contractor: License:
Est. Cost: 29088 MICHAEL PHILLIPS CSL082683
Const.Class: Exp.Date: 10/10/2024
Use Group: Owner: GANTZ ELSAESSER CAITLIN M & JEREMY D
Lot Size (sq.ft.)
Zoning: URB Applicant: MICHAEL PHILLIPS
Applicant Address Phone: Insurance:
P O BOX 514 (413)250-7990
GOSHEN, MA 01032
ISSUED ON: 10/19/2023
TO PERFORM THE FOLLOWING WORK:
FINISH BATH RENO FROM ORIGINAL BP-2018-0399
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:
I4; • )2 .
Fees Paid: $189.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
0
The Commonwealth of Mass usg, le
: :AL1TY
Board of Building Regulations and
Massachusetts State Building Code, 780
Building Permit Application To Construct,Repair,Renovate �N a R ised Mar 2011
One- or Two-Family Dwelling o'060/
0
4,s
This Section For Official Use Only
Buildin Permit Number: &O. )-3• i '(G5 Date Ap lied:
iL.)7Z 1// id"/6-200
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 roperty� r ss: v 1.2 Assessors Map&Parcel Numbers
�� t
1.la Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal El On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 O r'of Record: 6N012.....
'<akt\C'e oa o b Cif
(kern v1/4
Name(Print) City,State,ZIP
• , t� - (Q,,v.e( (�
No.an Stree • Telephone Email Address elf\A.d
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) C...
New Construction 0 Existing Building' Owner-Occupied 0 Repairs(s) 0 Alteration(s) Addition 0
Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify:
( _
Brief Descri ion of oposed Wo le:
• • g Pr
SECTION 4:ESTIMATED CONSTRUCTION COSTS OC.0 , f
Item Estimated Costs: Official Use Only
Labor andess)
1. Building 1,--,. 1. Building Pec{nit Fee:$ Indicate how fee is determined:
2.Electrical 043 CI 1.
City/Town Application Fee
0 Total Project Cost (Item 6)x multiplier x
3.Plumbing S t t V 2. Other Fees: $
4. Mechanical (HVAC) S List:
5. Mechanical (Fire S
Suppression) Total All Feek:
Check No.OU Check Amount t U Cash Amount:
6.Total Project Cost: $
\ o
0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor Lic se(CSLX (Abqts ms_o_N2az(-t
License Number Expiration Date
____AY\_,:ec\\Pi0 4, t(..-K
Name of CSL HolderCS
5)--------- y
List CSL Type(see below). V ,y
No.an StreetMINS (T T� a Description
Unrestricted(Buildings up to 35,000 cu.ft.)
���� R Restricted 1&2 Family Dwelling
City/To 5 � M Masonry
onry
RC Roofing Covering
y ,�T \
--�,‘t! f+psi,/ WS Window and Siding
W� SF Solid Fuel Burning Appliances
/� - ,N MA-0 t I — Insulation _.
Telepho a Emailaddress D Demolition
5.2 Registered Home Improveme t Contractor(HIC),,
e Iit.___-iNny(` \f ite. ( sW 1125c6----
t YS __ Il Registration Number Ex prat n to
Ll
IIIC.ccuffany dame 0 o Regist Na. t ►.
No d t et tEC
> it dress
Ci o State ZI ��v «Telephone (. PV 4 " k a�>
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 Issuan e of the building permit.
Signed Affidavit Attached? Yes H No 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
4 I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this bui ding permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I here attest der the pains and penalties of perjury that all of the information
contained in this ap ' ation is e d acc ate to the best of my knowledge and understanding.
1 611) ‘)f33
Print Owner's or Authorize gent's e ,e ic 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(IBC)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
44,
Massachusetts ,., s; �
1 f *4 r4
DEPARTMENT OF BUILDING INSPECTIONS 1
212 Main Street • Municipal Building V `,F,
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:
The debris will be transported by:
•
Name of Hauler: Mit6fk/1/1cce ((v)PS.
Signature of Applicant: Date:
1' ‘ The Commonwealth of Massachusetts
1=A=94 ,=r, Department ofhulrestrrnl,lcCir1e12ts
< ilit
, 1 Congress Street,Suite 100
. . Boston, MA02114-2017
'
: mot: dia
11-urkei''Compensation Insurance Affida%it:Builder:)t7ontractors1ElectriciansiPlumbers.
1'O BE FILED Weill CITE PERM!l'Illti(:At`1'#IORI l Y.
Applicant Infornmation Please Print Le_ibls
Ar
Name flitlsitl .fJr,ini:-ationititti>idttal}. '
( .. kj.C \M--- tQl)? ime--0 ,
Address:,_,(sT 0 e.g Si‘(.
City!State Zip• Phone : 4 ', ✓
Are act ctopiotet.?(beet,the appropriate hot: Type of p oject(required):
t
t. 1 sua 4 Vezptaltx stab etropiteLsoes 1f01 well s r pan-tilts.:: ;' -w construction
:t l ant u sole proprietor or partnorsksp:tat bao a at:c ntpkvp:::: o;:lakutM for stse is 8. Remodeling
:tan Lapsc-Sq.[Nu of url "cop.itttsuraare scostein
9. Q Demolition
i.0Ism a horrsoavo'nt tilla2 all tauck rttisel1.i?w tot cnl. ,`comp.:raWtruti:c roomed.]'
4.0 I am a hosn,:iu m an o' sc.'i
arid ill k bir cow:moors to ctaduut:ill oink cars thy prop :tp. I will
10 0 Building addition.
catc:re that all omitraciars"either hate workers'i°c.repe ts:ttsciat thorium: or are salt 1 I a E lixTrical repairs or additions
boon.lotto no c o6 co._
F"r"t' . ' 3 2.0 Plumbing repairs or additions
$0 I a gc..uicral coats ttor and I Ito a hued the sub-contractors listed on the at ache:xi.abed...
pest:xsh-c'ut:tr�i:tLrsbaic craplu}'cts:sati lets esiorlccni'.:cmrp.ut`.Lr`artte: 13 Rtxxi`rt repairs
14.0Other
6. 14`c are a serrposermon anti eta officers bate exert:no:I tixu n to ofco:misuses per!AUL e.
12.. t{.,I,nail we h:rrc au e2'a rk xc's.[No sitat$.e::'9:07nr.i_tsea'a.-ii: rrytrin d 1 I
'Aro applicant that t:leexks but Al must alua till out the xz:tion belctx:shoo t^to.their v:inkcv;eortiperoution rt,tiOr infeernassea.
'1lvtao.ton.rs tibu at:IMtut this afft i ata ittibeatitsr the),are dt,.ng all is oft:IQ tl•-n hatc.ttttaidr contra:t,..>3nt4st yubcnst a ratio-t idal tt trxlit:atinj suds.
.;Costsaacturs that cheek tt.sis box must atta:lt:d are additional sheet sltottirtst tlx cras:u'of du srtbeiuttr::.t.-.and scat uht:tht.::or not those sl t:Lies line
trnplua ei:t. It the st.h iur.:ruo:Los,.l ase er'lus ces.the",mast pito.ide their ttt"rt.zra'it rtp.t""t:.t.r t_;:tlt r-
I am an employer that is providing workers 4 compensation insurance for my employees. Below is the policy and job site
information. ..-'
Insurance Company ny Name:
_ac,,e_. _____es,,_ .i.,4N) _.,44,0sarl..,,,Lro Cia
Policy It or S lt-in .Li.. 6_S 3Ss 1•0.7t'tpirition Data:
_ ..i.t %,3# 1
Job Site Address: ( ei Site Cat}'.StateZip:_ �Q TIPA.S4.
�
Attach a copy of the ulcers'compensation policy declaration page(sbotking the policy number and expiration date).
Failure to secure coverage as required under NMI.,c. 152.§25A is a criminal t io1ation punishable by a fine up to SI,500.00
antL er one-year itnprisurtiient.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up t►S259.40 a
day against the'Violator_A copy of this statement may be forwarded to the Office of Investigations uf the DIA for insurance
t:ost:rage verification.
I do hereby cern)„.under the sins and pci I . of jury that the information provided oboe is true and correct
Signature: . ( Matt': i 3
Official use only. Do not terite in this area,to be completed by city or town officiaL `
Cite or Town: Penna./License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cityirot►n Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
(Contact Person: Phone#: 1
Commonwealth of Massachusetts
Division of Occupational Licensure
-"" Board of Building Re ulations and Standards
Constoftea Vikervisor
CS-082683 � ires: 10/10/2024
IVIICHAEL J elitLLIPS ,u
PO BOX 514v. V.
GOSHEN MA'1D1032
trltLEJJ"
Commissioner exh; FAI: 7
-M E COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:Corporation
Registtratien Expiration
17126E - 03104/2024
MICHAEL PHILLIPS,INC.
MICHAEL PHILLIPS
31 MAIN ST Ja144.4.
P.O BOX 514 Undersecretary
GOSHEN,MA O1032
VDAC
C I--I 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 Sc 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
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
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
D. This policy includes these endorsements and schedules:
.EEE 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
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
24 HIGH ST BP-2018-0399
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17D-038 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: KITCHEN RENO BUILDING PERMIT
Permit# BP-2018-0399
Project# JS-2018-000714
Est.Cost:$67542.00
Fee:$439.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MICHAEL PHILLIPS 082683
Lot Size(sq.ft.): 5749.92 Owner: GANTZ JEREMY
Zoning:URB(100)/ Applicant: MICHAEL PHILLIPS
AT: 24 HIGH S 1
Applicant Address: Phone: Insurance:
P O BOX 514 (413) 250-7990 () WC
GOSHENMA01032 ISSUED ON:1 0/23/2 01 7 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL KITCHEN - DEMO - FOUNDATION
REPAIR WORK
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: !l Footings: Ott `�
Rough:/2 / ///7 Rough: ? Z /_ /7 House# Foundation:
,/;� �.j� Driveway Final:
/
Final: Final: 'l + ,7.-I6 f,i i
Rough Frame:, 24 I
i Lf ! 7
Gas: Fire Department Fireplace/Chimney:
Final: #41 Smoke: Final: C4.0 z1/5/i d
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REG A ION . , / 4 }
Certificate of Occupancy / gnature:
FeeTvpe: Dat aid: Amount:
Building 10/23/2017 0:00:00 $439.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner