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
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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*
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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 �,-
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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� �