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41 NORTH MAIN ST BP-2014-0378
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-251 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2014-0378
Project# JS-2014-000660
Est.Cost: $21500.00
Fee: $129.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: KRIS THOMSON 084152
Lot Size(sq.ft.): 29969.28 Owner: SCHNABEL BROOKE
Zoning:URB(100)/SI(0)/ Applicant: KRIS THOMSOIV
AT. 41 NORTH MAIN ST
Applicant Address: Phone: Insurance:
362 KENNEDY RD (413) 549-1027 0
LEEDSMA01053 ISSUED ON:101212013 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRUCTURAL REPAIR & UPDATE KITCHEN &
BATH
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: /D //3 Rough: h `r ' 1 House# Foundation:
Driveway Final:
Final: e� 7 Final: `
6 Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: oil: Insulation:OKII_I Y� Is
Final: 3� /� Smoke: Fin ,a —/
4 n 6
THIS PERMIT MAY BE REVD BY THE CITY OF NORTHAMPTON UPON VI AATI N OF
ANY OF ITS RULES AND RE IONS ,/ fa"/
Certificate of Occupancy ature:
FeeType• Date Paid: Amount:
Building 10/2/2013 0:00:00 $129.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Oro
mass save "Iffiftoxm
rim rrl 0
PERMIT AUTHORIZATION FORM
I, Susan North ,owner of the property located at:
{Owner's flame,printed)
30 Avis Cir. Northampton
(Property Street Address) (city)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
X
Owner's signature
Date
FOR CSG OFFICE USE ONLY
Conservations Services Group has assigned the following Mass Save Home Energy Services Participating
Contractor to the above referenced project:
Participating Contractor Date
0$f 0
0�
Far office Use only
Rev. 12132011
City of Northampton
Massachusetts r
DEPARTMENT OF BUILDING INSPECTIONS �i• �
'L 212 Main Street • Municipal Building
:-� Northampton, MA 01060
Property Address: �� " `y i '.((it
Contractor
Name: jose?� (Tent l���� WTI okk SDnl In(.
Address: b v�y wood S$ce2}
City, State: G&e r4I l j MA 0130 1
Phone: ('113)-77q, 304
Property Owner ( o���
Name: ,, ���r\
Address: 30 No
City, State: N'-)f fl� ol VV%n, [AA
I, ion (Ttn y (contractor)attest and affirm that the building I intend to
insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit_
Contractor signature
Date
The Commonwealth of Massacltttsetts Print For
-u Department of Industrial Accidents
--
Office of Investigations
- I Congress Street,Suite 100
Boston,MA 02114-7017
ivzvm rnass.g ov/rlia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
F)]21icant information Please Print Leaibh-
Name (Business/Orsanization/individual):J.P. George and Son, Inc./Joseph George
Address:64 Haywood Street
City/State/Zip:Greenfield/MA/01301 Phone#:(413)-774-3604
Are you an employer?Check the appropriate box:
1.❑✓ 4 4. I am a-eneral contractor and I Type of project(required}:
I am a employer with ❑
employees(full and/or part-time)-* have hired the sub-contractors 6. ❑New construction
2-❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑ Remodeling
sub-contractors have
ship and have no employees These S. F-1 Demolition
working for me in any capacity- employees and have workers'
? ca p n 9. ❑Building addition
[No workers' comp. insurance comp. insurance.<
required-] 5- ❑ We are a corporation and its 10.E] Electrical repairs or additions
3.❑ i am a homeowner doing all work- officers have exercised their 1 L❑ plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.]' c. 152, §1(4);and we have no
employees. [NTo workers' 13511 Otherinsulation
comp. insurance required.]
"Any applicant that checks box=1 must also till out the section below showing their workers'compensation policy information.
Homeowners tvho submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
-Contractors that check this box must attached an additional sheet showing the name of ilia sub-contractors and state whether or not those entities have
empioyees. if the sub-contractors have employees,they must provide their workers"comp.policy number.
I anz an employer that is providing workers'cozlmpensation Insurance f03•nzy employees. Below is the policy and job site
t ifbrination.
Insurance Company Name:Arbella _
Policy it or Self-ins.Lic._: "� �Xn ' 4/29/2014
/� Expiration Date:4/29/2014
^n
Job Site Address: 1 �y�� e R f i f� City/State/Zip: Nb r'��F�13 A F (1/ A i 7
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 and/or one-year iinprisonmem as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the parrs and peizqwes of perjarp that the information provided above is true and correct.
S[anature: Date:
Phone :(413)-774-3604
Official use only. Do not write in this area,to be completed by city or town official_
City or Town: Permit/License
issuing Authority(circle one):
L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.dither
"Contact Pelson: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor. Not Applicable ❑
Name of License Holder. 3o5e�k G2ot CD I R_bl 1"A
License Number
H"W04 S�tfeN Gre fn W, A 01301 a,-►I-aoII
Addres Expiration Date
(� (4I3)77�-3 64
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
J- e� Geor�e tn4 �O11, 1-n" ISRSC
Comoany Name Registration Number
0 ki p 3 Slrf-e' &ree,,t�wl MA o1301 7-3s-bIl
Addre I I
Expiration Date
Telephone 41;1-774- 0 3
SECTION 10-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....... R No...... O
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellirt9a of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 1083.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-vear period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Of&cial,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated_
Homeowner Signature
SECTION 5 DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [17) Decks [M Siding[O) Other fnM
1 tnStA ic,}ion
Brief escription of Proposed n ,� Sew T�1L j ��"`)�Cl�n 5,+ 4t C2�Cut1� �n
1
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.if New house and or addition to existing housing, Complete the following:
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
I. Is construction within 100 ft,of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,
5`A S w, 1 v O r�� as Owner of the subject
property
hereby authorize St se 6 Geor*�e
to act on my behalf,in all matters relative fo work authorized by this building ermit application.
See � cnc�et� /14
Signature of Owner Date
70S$�� ral� as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
uose , CseAf 2
Print Name � '� /J f,
Signature of 0wbV/A9ePk Date
Department use only
City of Northampton Status of Permit:
u' Building Department Curb Cut/Driveway Permit
F 212 Main Street SewedSeptic Availability i t O 2`)i Room 100 Water/Well-Availability.
rthampton, MA 01060 Two Sets of Structural Plans
Electric G;��� �c;�r,�,c: �_.�:�<.php c 9 -587-1240 Fax 413-587-1272 PloVSite Plans
p,!..,rtr•t IT ptc .,060
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: Nis �r(12
This section to be completed by office
�
Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
�IASL* No r�\-\ c ilrot
Name(Print) Current Mailing Address:
Telephone
See p�'t A49A u 7
Signature
2.2 Authorized Agent:
3osep� CTeoc�� 64 H�� aDO, s . Gjeer.�;�I�,MA 01301
Name(Print) Current Mailing Address_
Signature Telephone
SECTION 3-E TIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from.(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) a)LA J 7 Check Number f
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building CommissionerlInspector or Buildings Date
File#BP-2014-0961
APPLICANT/CONTACT PERSON JOSEPH GEORGE
ADDRESS/PHONE 64 HAYWOOD ST GREENFIELD (413)774-3604
PROPERTY LOCATION 30 AVIS CIR
MAP 22D PARCEL 117 001 ZONE URA(100)/WSP(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildin Permit Filled out
Fee Paid
Typeof Construction: INSTALL ATTIC INSULATION&AIR SEAL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 99372
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFqPMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
ignature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
30 AVIS CIR BP-2014-0961
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 22D- 117 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2014-0961
Project# JS-2014-001675
Est. Cost: $2470.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOSEPH GEORGE 99372
Lot Size(sq.ft.): 21300.84 Owner: NORTH SUSAN
Zoning:URA(100)/WSP(100)/ Applicant: JOSEPH GEORGE
AT: 30 AVIS CIR
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774-3604 WC
GREENFIELDMA01301 ISSUED ON:312412014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL ATTIC INSULATION & AIR SEAL
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 Signature:
FeeType• Date Paid: Amount:
Building 3/24/2014 0:00:00 $55.00
212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272
Louis Hasbrouck—Building Commissioner