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32C-111 (13) BP-2024-1262 23 SMITH ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32C-111-001 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-2024-1262 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: Est. Cost: 10500 THOMAS KELLIHER 88261 Const.Class: Exp.Date: 03/19/2026 Use Group: Owner: GORFINE TETTY Lot Size (sq.ft.) Zoning: URC Applicant: THOMAS KELLIHER Applicant Address h ne• insurance: 25 BEAUDRY AVE (413)575-8428 CHICOPEE,MA 01020 ISSUED ON: 10/01/2024 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF 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: j/ Fees Paid: S60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RE, �IJ / ' SEppti 7 sue00)_..., The Commonwealth of Ma sac ' ` FOR Board of Building Regulatio S f i8 nr M ICIPALITY Massachusetts State Building Code, ',ti.�;;SP eri USE Building Permit Application To Construct,Repair,Renovate Or Demo 1 6 R ised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: ice✓)'-1 y-'/J,`f..Z Date Applied: 5 c//%/ Z,V /d't-zY wilding Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers a3 sM. �h �— 1.1 a Is this an accepted street?yes t,--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❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Re�c rd: � 'T iTy (roe t-11,> k)� / /")t�i�?7 c.�1 HA n l v 0 Name(Print) city,State,ZIP / 23 5/ r h St 77s—1S67 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other IZl•'pecify: c 1<0*J-, Brief Description of Proposed Work': _7,7,/1 ..)4 Si Si i.- 04-,F 4- 7� S . 2 Z lv r-w �5/01,,.�'i Si,�J j S SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ /� v 6 I. Building Permit Fee:$ Indicate how tee is determined: 1 1 ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees• $ Suppression) �� } r ,l Check NO -) Check Amouri : �J0 Cash Amount: 6.Total Project Cost: S/I) S e)V ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /1 A s )�� L /)`r (— License Number Ex rati n Date Name of CSL Holder Av c/y .4v'C List CSL Type(see below) a 5 � No.and Street Type Description / Unrestricted(Buildings up to 35,000 Cu.ft.) /J (c 1/), r /"//i U/t) Restricted 1&2 Family Dwelling City/Town,Sdite,ZIP M Masonry RC Roofing Covering WS Window and Siding � �/ SF Solid Fuel Burning Appliances /` IpPjC•L�(,h<! �y 1 Insulation Telephone Email addre • D Demolition 5.2 Registered Home Improvement Contractor(HIC) /1 U/74 S keLL h`t HIC Registration Number E irat' Date HIC Company Name pr HIC Registrant Name No.and Street ✓ 4 r( ja.-7 L I t i O C'/7/1 c ( r`f Y-C /�4 O/o.91) _ 4/3-S7 Email addreasl Ciwn,State,ZIP 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 PERMIT I,as Owner of the subject property,hereby authorize ' jp/��¢S KY U. p1 v r to act on my behalf,in all matters relative to work authorized by this building permit application. Yrr Go( F1 --� y Print Owne s Name(Electronic Signature) • e 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 best of my knowledge and understanding. Pri 7:4 Owner's or Authorized Agent's Name(Electronic Signature) e 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 N1V.'%.mass.gov;oca Information on the Construction Supervisor License can be found at w1tw.mass.gucdps 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 halflbaths Type of heating system Number of decks/porches Type of cooling system Enclosed Opal 3. "Total Project Square Footage"maybe substituted for`Total Project Cost" 102 3j j� The Commonwealth of Massachusetts Department of Industrial Accidents • =*81 1 Congress Street.Suite 100 T+���' Boston.MA 02114-2017 www.mass.gor/dia 11tokers'Compensation Insurance Affidavit:BuildrrrContrttctorsT.Irctrici*ns"Plutnhers. Tu Bk.k II.ID WITH I III:PER:II l l I\(:Al"I 110141 11. Applicant information '� / Please Print l.ct ibly Name(l3usutes.Oreanuatwn Individual): —rho pl A S f r J--I�r/1'Lie Address: a s��CA ad,/ Ate,_ City/State/Zip: r`e e.-e e ttf O/O.2U Phone#: A//3- 575' \rc)141 an employer?Cheek the apprupriatt hot: Type � (required): Jam" 1.9[I am a employes w nth - employee,t full atd'or pat-tins t.• 7. 0 New construction .. . ant a suk proprietor or portna skip and have no employees winking for me in 8. Remodeling any capacity.[Nu worker comp.insurance nnpu all 9. p Demolition 10 I ant a I10mAt.Nn7 doing all work myself.lNtt worker::rung.insurance tenoned.)' cn I ant a Ituwon.ncr and will be hiring soma c1ors to conduct all work on my peup►Yty. I will lt)El Building addition eruute that all contractor,either hate workers'cuu ten atton ttnuranct on are sole a Electrical repairs or additions pruptictur,w nth no employees. 12.0 Plumbing repairs or additions tin I ant a general eontraetot and I hate hued the sub-contractors listed on the attached sheet_ 1 rT�(oof repairs These.ub�emtracturs hale employee, ploye ,and hat a workers'comp.ue. cr uran . �K 60 We urc a corporation and at,officer.hate evereised their nght of caesttpttont pet\K&L c. 1cI.QMet 152 511a1.and we late no employees.l Vo wutters'comp.insurance required.) •Any applicant that cheek,boo"1 must also till out the section below show ins then wor\ere'cumpensutiun policy udexrnaticm. f Iknneowncts film submit flu,allidatit indicating they ate doing all work and then hire outside contractor.must submit a new alitdm it attdicattng such. :Contractor,that check this hot must attached an adehttorul sheet show tng the name of the sub-contractor.and state whether in not those.attntes hat e employ ee-.- If the sub-contraeon,lute ertirluy cos,they must pro%tole their workers'amp-polity number. I am an emplo ter that is providing a•ortte rs'compensation Insurance for my employees. Below is the policy and%oh site Win-motion. _ Insurance Company Name: _ Policy#or Self-ins.Lic.#: Expiration Date Job Site Address: City State Trip: Attacb a copy of the workers'compensation police 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 tine 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 line of up to S250.00 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 herein certify under the pains and penalties of perjtert•that the in/orntutiun pruritied above is true and correct. �IL11Jt111�: - 1, --144/1 Dal /9/0 I'hont t�/ 3 — 7 � c9 Official use will-. Do not write in this urea.tea hr t cnrtplt°tc'rl by city or town official (it) or Town: Permiii license t'r Issuing Authority.(circle one): I. Board of Health 2.Building Department 3.('ih down Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton �S SAC Massachusettse` t .� DEPARTMENT OF BUILDING INSPECTIONS *; 212 Main Straat • Municipal Building Northampton, MA 01060 •�sf,p VON' 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: 1),;,-1i? S/-‹ Location of Facility: . (�-JJ '� C' Su( CT— The debris will be transported by: Name of Hauler: U Sri S Signature of Applicant: Date: /,;'yc,) / THE COMMONWEALTH OF MASSACHUSETTST. Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston,_Massachusetts 02118 Home Improvement_Contractor Registration L 1"ia. anr�.Yam...r. w _ 4 Type: Individual ro r m Registration: 145469 THOMAS M. KEVER rot -- Expiration: 01/30/2025 • D/B/A TOM KELLIHER HOME IMPROVEMEN ;,{ ^ a • 25 BEAUDRY AVE ej i CHICOPEE, MA 01020 ) W 1 C ' ,—.—/' /, 1111 �_ 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:Individual Office of Consumer Affairs and Business Regulation f3ealajrgtion Expiration 1000 Washington Street -Suite 710 145469 01/30/2025 Boston,MA 02118 • THOMAS M. KELLIHER 1 i )/B/A TOM KELLIHER HOME IMPROVEMENT HOMAS M.KELLIHER A 5 BEAUDRY AVE f _.........,/: i.L._AC./t, HICOPEE,MA 01020 u4.x.r' rk' UnderSordBtary Not valid without signature Commonwealth of Massachusetts g;1 Division of Occupational Licensure Unrestrict Board of Building Regulations and Standards 35,0( Consongglipvrvisor CS-088261 w spires: 03/19/2026 THOMAS M KELLIHER 25 BEAUDRYAVENUE CHICOPEE MA 01020 r � Failure B1 Commissioner Z1vtiA s.. Conta -----"III THOMKEL-01 ABI, ACORp" DAre 0,...lYYrrl �.� CERTIFICATE OF LIABILITY INSURANCE 2i52024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERT7F7CATE 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 4 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certific.ts holder Is an ADDITIONAL INSURED.the polky(les)must have AbOmONAL INSURED provisions or be'Indorsed. If SUBROGATION IS WAIVED, subfect to the terms and conditions of the policy,certain polkhs may require an endorsemnsnt. A statement on this c•rtifkats does not confer rights tot.certIRcat'I holder In INu of such endorssnant(s). - PRcouCER =Act Abijanled Fontansz Phillips Insu,n,mce Agency,Inc. rlahE _ 97 Center Street tArc,Ne sulk(<13)59<588< Chicopee,MA 01013 wabephRllpoInsuranes.e.om ----.-.----•_______pmformei Among.°COWRA06-._--__--.. 1YM'# .No airdenei Spedry Ungar 4 re'ne one;Cemyesp, ,NSlrten kNRnet.•Trayshm .-.. Thomas Kelliher DBA _I- ----mY_Ct>a Torn m Kelliher Hoe Improvement O19.1--. -----._ ---- 2.5 Baaudry AveNtQ4;-- Chicopee.MA 01020 — _'_WORMER F: .Srg.__3' C_1I2 :_R• 1A :wry THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE.FOR THE POUCY 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.Ten OF INSURANCE iNt;OItUOR POUCr NUreER _ ..�olaUg _t Q► --- UM* A X IC0fI CIALGENERALLuauWY i 1.000,000 OCCUR cx-+n sus r X _Wm OCCURRENCE_--_-.3 1 CSt0224852 2/11/2024 2111/2025 kgTO TE° _ 100,000 — € cot•perscei i 5.000 ? 4 MvuRY _t AGGREGATE LassAP�s eat — �iEM9pAL AOaRFtiATF t 2,000,000 POLICY X I 1 LOC DTHER rlwga+cra-powroPArxl I s 2.000.000 Ayroro EJ eLE UABTYja.tiEDssmouE I: ANY AUTO ._._AURTOOS D Or4Y AUT OgWV{lL1E�D _ i.� O�Ef oRbnl IS --A DALY R,WrQS UYZY PE Y110EY ._--,ume•ELLA LIAR I •OCCUR EXCESS Liu CiAeI4�1 BSACkalg OLQ S DEO RETENTION f --- 1. Oi& 8 'AND EY;WORKERS LAM _I PER ON' 8 6NII8.1912PIJ7 8 29I I I': 'ANY PROPRtETORF -_ ri c E tBER EXCLUDED? NIA 1A7212023 10/2212024; -� _ I s 300,000 i i i-.1.4ay io I IIIyru,wer .J�I� •EA EMPI O, I .000 DES'RIPT,ON OF OPERAT• ,. ( L DISEASE_POLICY UNIT 500.E 1 DESCRIPTION OF OPERATIDNs/LOCATIONS I VEHICLES IACONO 101.Addltlo.M Reworks Schedule.may be attached M mere some is rpulret0 CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE ACCORDANCE WITH THE POLICY PROVISIONS. E�- AUTHOREO REPRESENTATIVE ACORD 25(2016/03) A 19884015 Acorn)CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • FREE ESTIMATES INSURED • Proposal No. Tom Kelliher Sheet No. • • HOME IMPROVEMENT SPECIALIST CT Reg.#0611395 Date MA Reg.# 145469 SIDING— WINDOWS—ROOFING /� Lie.#088261 decks & framing Celi(413) 575-8428 Proposal Submitted To Work To Be Performed At Name /r ! ` Cry J Street / 2 .SM/!A Street _ 3 S,1,7 o i City �Dj .4/E-p/t City ) r" o State "� State ,7 / Date of Plans • 9 ,..1L,a ," Telephone Number 77 S - / 7 Architect / • We hereby propose to furnish all the materials and perform all the labor necessary for the completion of • �' -=Tcr )� ,z/5. /6 sre / F/c L-/y�,C'�cit-,�- /)4 k'4hr/ �yr,- T! r„4„4 L 1 . /�Yf / ! L //✓CIYY ✓i/ ,-7 ,,/- .5.c�i,L J . ,.,,•.4 7 I �/ [J/ 1 c_4e ,(i�r'.c_,%_ (ram r�/Y 7-3— 1750_471 cz.,t �,- � r � /J)4L -���r All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of Dollars($/(�j��� ). with payments to be made as follows: I ( - 7''/.)C�S� l J. � � t ii c )r 6-2 2o.� Any alternation or deviation from above specifications involving extra costs,will be executed only upon written orders,and will become an extra change over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.,Owner to carry fire,tornado and other necessary insurance upon above work. Respectfully submitted Per Note-This proposal may be withdrawn by us if not accepted within days ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. Accepted Signature e Date Signature d� �