23B-037 25 DANA ST BP-2021-1572
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23B-037 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Porch Repair BUILDING PERMIT
Permit# BP-2021-1572
Project# JS-2021-002605
Est.Cost: $20232.00
Fee: $131.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MICHAEL PHILLIPS 082683
Lot Size(sq.ft.): 15420.24 Owner: GARRETT JAMES L&MARIE S MARCHESE
Zoning: URB(100)/ Applicant: MICHAEL PHILLIPS
AT: 25 DANA ST
Applicant Address: Phone: Insurance:
POBOX514 (413) 250-79900 WC
GOSHENMA01032 ISSUED ON:7/1/20210:00:00
TO PERFORM THE FOLLOWING WORK:REPAIRS TO PORCH
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Sienaturl1 , ' , A �
FeeType: Date Paid: Amount:
Building 7/1/2021 0:00:00 $131.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
/1/ ,•.„
IY 3 0 490
• .
The Commonwealth of Masa • ;.14,:Palm
FOR
Board of Building Regulations and Sta I,. ..„4,NVG/
*A4 ,11' roA, /lisp
Massachusetts State Building Code, 780 CMR 9'ki .ciio !VI CIPALITY
• , ,- °7060 Als USE
..,.
Building Permit Application To Construct,Repair,Renovate Or Demobs i ; _ ',iced Mar 2011
One-or Two-Family Dwelling
__ ...
This Section For Official Use Only
Building ermit Number: ga"-•••1)"./S ).2.°1— Date Applied:
EUI0 (0's-
/
/1 7- i-20Z I
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro5rtIdress: .,...e.f 1.2 Assessorsglap&Parcel Numbers
.3 1
1.1a s this an accepted street?yes no MaP Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use 1 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.1-c.40,§54) 1.7 Flood Zone Information: L8 Sewage Disposal System:
Public Private
Zone: — Owside Flood Zone?
Fr 0
Check if yes° Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'o d:
TV\Atnr ri\ktzafteSe clEA_____LY)At.c.1.014_
Narne(Print) Ci , ate,ZIP
--- --1--- IS. 1 Sr"
No.and Street Telephone Email Addres
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction_ _ Existing Building 0 Owner-Occupied 0 Repairs(s)X Alteration(s) 0 Addition 0
. .._.
Demolition 0 Accessory Bldg 0 j, Number of Units _ Other 0 Specify:
Brief Description of Proposed Work i: till Er .. ........ 1k ,.41,., , ' ,- .A
a
a E I e/1•411 I Ir I Illi a 0 I I I I le• (41211 cliat ' . ,. . - , +yr " Jiir ' '''.40 •'
46 silk . s...s
SECTI 4: STIMATL CONSTRUCTION COSTS
Estimated Costs:
item Official Use Only
(Labor and Materials)
l.Building $
D °I VAS ` 13 1. Building Permit Fee:S Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $
- 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: S
4. Mechanical (HVAC) S List: I
5. Mechanical (Fire
$
Suppression) Total All Fees i Et tii , 31
Check No.1 Si I Check Amount I Cash.kmount
6.Total Project Cost: $ )13 '•3 .63 0 Paid in Full 1:1 Outstanding Balance Due:
_ —
SECTION 5: CONSTRUCTION SERVICES
--- .
5.1 Construction Supervi aor nse gcsiw` t OkkO‘ WW1
c‘i\":46\1\Rie 0 V 5
IL
------T (--- -ej ‘SC-3
, License Number Expiration Date
Name of CSI Holder
List CSL Type(see below)
Type Descripticm
No S
U _ Unrestricted(Buildings u_p_to 35.000
. R Restricted I ct2 Family Dwelling
CitytTown, te, P M Masonry
RC Roofing Covering
...
WS Window and Siding_ .
SF Solid Fuel Burning Appliances
I Insulation —
Telephone Emhil addr
........akm D [ Demolition
i----
5.2 Register Home linpro neni(-Infractor )
______ (\' AAIN SAC * 1-7Taistrati on umber Lxpi it ion I Yale
IIIC any Nam Rip,Iran N
No. M Y...Q11:k 1:0 c liti fi
St Email address
_ .. ,.
MA4
Cu own Siate, .. 6 I C
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
.1...\,.,‘ . , n r ---
I,as Owner of the subject property,hereby authorize 1 li ‘i.this building permit application.
it41,1, , li A A
CigdedAk_ 4g 1
t 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 lication is true a. ,t;'. to the best of my knowledge and understanding.
AiP
iy_Ais fOb°1 )/Z!rb I
Print CT'S or uthorized Agent ame 7.,-...1,1 :40 c Signature)
NOTES:
1. An Owner vtbo obtains a building permit to do hislher 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
Information on the Construction Supervisor License can be found at
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) _(including garage,finished basementiattic-s,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms__ Number of hal flbaths
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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
Massachusetts
...
ill-- ' .1 DEPARTMENT OF BUILDING INSPECTIONS
212 Main Strant • Muni cipal Building 13, 47
Northampton, Ilk 01060 s flv ar)\\
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: VI pi ‘
\Cit , \
1i • t olcl.W5
R.:Q.
The debris will be transported by:
......---
Name of Hauler: .(\., C
Signature
-
Signature of Applicant: i\AI\,,,,uq Date:
.........„....
,..,
--- The Commonwealth of 3fassachusetts
Department of:industrial.4cridentr
1 Congress Street.Suite 100
Bostott_111-1 02114-201--*
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ll Sake:Ts (.0mpensatitin Insurance ArriaA,it;Builders.Votitractors'Electricians`Plu in tier.,
i ti BE. k ILED NN I I It I Ilk,l'hIL.N11 11 ING Al. I 110RI I N,
Antal:fain Information 1,, ,,,I i t ,
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Name(tiuslr.zNs ork.tn.7..ation! R kininv -It 4 C
City State Zip: -A Af'i Phone g: k,
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/ain an employer thin is providing ocorAerA*campensutif:a in ranee'for my employees. Below is the policy and job Sire
information.
I p,.. ..../'.
Inuranee Company NAM.' INI :cAf\Prt(
Polt; or Self-ms,L..),:.11:7#12)00°....."411043 S)• ''... 0 t h‘ptration Oat,.
Job Site Address. niLi (, 9--):WP 71 City State tilk t
1,ttach a cor of thr iorktrA' omprmation ludic, det kiration page(%hoviing the polivk numbrr a d eipiration dale), Olcitz
/-1711ure to se,:ure eo‘erage as regurrvt.1 under\IGL t.. 15:: 2.5A r.s a tr-nrrunal tt.tlairon puntsfutblb> a ft e up to Si.500. )0
and or orte-,:ear onptt>onment.as%%ell as.co ii penalties .:.: :he tomtit'a STOP\VORK ORDER And i.i ti .ot up to S250 00 a
dad S',.!;itn.si the 1,tt3lator A cops of this statement ina> be .q-st ardod to the Office of In\esttgationN of the'DIA for
...-ok kl-...1:4::
I do hereby certify under the p '3N and nen "..1,f f rill 9.that the information prorided abort't, ;rile and corrett
Stenaturv. lit Da:, (Oci 1 . ..Y.:211
ti k-2)
• L,
Official use mill. Do not write in this area,to be completed by city or town official
(its or Tmin: Perna:License P
i
• Issuing Autborit (rirrie oar):
I.Board of IlcaIth 2.Building Department 3.( it, roma Clerk 3. Eketriral Inspector 5.Plumbing Inspctior
6.Other
Contact Perron: rhttor 4:
VDAC
7
CHUBE3 WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
TYPE AR INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (6S62UB-4N43852-5-21)
RENEWAL OF (6S620B-4N43852-5-20)
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.
Z. The policy period is from 06-24-21 to 06-24-22 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
Orsoomm
Bodily Injury by Disease: $ 500000 Each Employee
110111M1
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
=mom.
CralleaMMI
1111110111,
11•••••••••
D. This policy includes these endorsements and schedules:
••••••161161
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: 06-09-21 WC ST ASSIGN: MA
OFFICE: RMD CHUBB 24M
PRODUCER: AQUADRO & ASSOCIATE INS 26XDW
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Cuirononwealth ot Niassachusetts
1111-
w owsmn 0 Professional Li-censure
&.,ard ELabrUniq Regulanons and Stanaara,
Constfttetkr,4knoaramot
c S08263
L'apires:
MICHAEL J PHILLIPS
PO BOX 514
GOSHEN MA 01032
Commissmner
Office at Consume,'Wows&Businese Pee$J1eIrori
HOME IMPROVEMENT CONTRACTOR
TYPE:Corooralori
Registration Expiratign
171266 03:04 20.22
MICHAEL PHILLIPS.INC.
MICHAEL PHILLIPS
31 MAIN ST
P.0 BOX 514
GOSHEN,MA 01032 Undersecretary
Top View of Your Deck
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