29-172 (9) 98 DEERFIELD DR BP-2017-0607
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:29- 172 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-0607
Project# JS-2017-000984
Est.Cost: $3207.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOSEPH GEORGE 99372
Lot Size(sq.i): 16770.60 Owner: BIGGS SUSAN J&ELIZABETH RYAN
Zoning: Applicant: JOSEPH GEORGE
AT: 98 DEERFIELD DR
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774-3604 WC
G R E E N F I E L D MA01301 ISSUED ON:I1/1/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:AIR SEAL ATTIC AND BASEMENT. ADD 11" OF
CELLULOSE TO EXISTING INSULATION IN ATTIC
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 11/1/20160:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0607
APPLICANT/CONTACT PERSON JOSEPH GEORGE
ADDRESS/PHONE 64 HAYWOOD ST GREENFIELD (413)774-3604
PROPERTY LOCATION 98 DEERFIELD DR
MAP 29 PARCEL 172 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 4 L�
Building Permit Filled out �r
Fee Paid
TTypeof Construction: AIR SEAL ATTIC AND BASEMENT.ADD 11"OF CELLULOSE TO EXISTING
INSULATION IN ATTIC
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
INFQRMATION 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
-molition/D ,
fig, �-i- ///4(
_y. e . cut + tmal 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.
C "\ v �V Department use only
\City of Northampton Status of Permit:
/ Building Department
212 Main Street Curb Cut/Driveway Permit
Sewer/Septic Availability
Room 100 WaterMell Availabiliity
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address: 618 Deer(ie0 I)ri\fe
rr-6I` 1. /r,1 Map Lot Unit
` o�e�r e'�l j�M Zone Overlay District
"' I0 V).. ELm St District GB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2A Owner of Record:
Sn5un BID 18 `Deer fit1cia Drive
Name(Print) s) 44a Current Mating Address: e{3)-346- g 371
See, Telephone \
Signature
2.2 Authorized Anent
SOS 2,13\-\ C&PAr+At 69 Hv,twooe S, GreemlegiM.A olno\
Name(Print) rLatent Maiin9 Address:
)�q-1 ��T�1V(l{' �� i i3 -77t-36c k
Signature \ Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit 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)
& Fire Protection
6. Total=(1 +2+3+4+5) 3)a.o7, 65 Check Number 8733 Sa6
This Section For Official Use Only -
Building Permit Number Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings
Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) n Roofing ❑
Or Doors 0
Accessory Bldg- ❑ Demolition ❑ New Signs ICI] Decks [p Siding p] Other Hyl]
1nite lakton
Brief Description of Proposed f� ,At}�� �f7' �I 1 f0 QYf1�l^9
Work: Alr Sed AtiC CMN 1 ftierhefft R Ir 01 eaktilie
inJul M lion
Alteration of existing bedroom Yes No Adding new bedroom Yes No i^ “fl;t.
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ga.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
I, S>14t^n B inc ,as Owner of the subject
property
hereby authorize SOsept &enrIC
to act on my behalf,in all matters relativef'o work authorized by this building permit application.
See Mktnc ell IC)47/16
Signature of Owner Date
I. SD Se fiery, ,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.
3OSe0x. Gecr t
PrintName I
)31/41/41\1‘ . h
Signature or Owner/ en nate
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:
f � ,,,p Not Applicable 1]
Name of License Holder:•
So3tp' G1eorc• 0.3161013-1'),
ILicense Number
b i Hcy ors ret; CTceenct4, M 013°1
a,-11- aDi !
Address "" Expiation Date
‘„ �� I'�V` j\eit yC�� • Q103)-Pit-3b°4
Signature I P elephone
9.Registered Home Improvement Contractor: Not Applicable ❑
J. P• George &And' Son, YDt, IS 6686,
company Name Registration Number
" i t`0111%00 dl S+reel &ree$\e 111 MA .0130\ 7—a3 -aur 1S
Address p ,,1 (((��� //�� ppp p Expiration Date
\I\X`„j\Vciik,PI .� YA,�yl--' TelePhane41;)-77ti-36 4
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 ® No 0
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings 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 10835.1.
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-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building.Oficial.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 per form 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
City of Northampton
i 1 Massachusetts
;NV 'i
\ i ' i DEPAR'!WENT OF BUILDING INSPECTIONS V alp
1-7,:< ir
212 Main Street • Municipal Building
('� p Northampton, MA 01060 /�,�
Property Address: Gig (Jeer{Iel� ID
br, Fbrence, A oI°6
Contractor
Name: 11 Joseph Geor t, / a,P. Georg6,4a,6,4a, $.un
George 6,4a, ant
Address: U4 Hr' wood Sireer
City, State: Greens;ewk, MA ol301
Phone: (x(3)-7N^ 3604
Property Owner SUS(An B'93)
Name: 9 y C 1 J
Address: p U Deertlele! Dr,
City, State: fhrencet MIS NO 6),
1, 5oseph &eorr Q (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 ,,,ml ( yt a - t/
))
Date 10 /9w/}l^I'6
f Rini Form $
The Commonwealth oj"Massachusetts
Department of_ndnsfia/Accidents
__ Office of Investigations
Congress Sti eel.Szike 100
ie,Boston, 41A 02!14-2077
wu,w.massgo idia ISI
Workers' Compensatioa insurance Affidavit Waders/Coot=actors/tier7iciaas/PlambeTS
_»E cant imfomation .. Please PrintLezib1v
Name(Cosiness!Oreanizatim ndl•idual)'. P- George and Son, Inc-/Joseph George
_ddres3'a= Haywood Street it
City/State/Z-ip:Greenleid/MA/01301 Phone#:(413)-774-2604
11
Are you an employer?Check the appropriate box: Type of project(required):
1. ✓[ I am a em lover with 4 0 i am a general cont-actor and 1 _ If
L P fi_ New construction
employees(Fell and/or par time).° have hired the nib-contractors 1
2. I em e sok proprietor or parme:- listed on the attached sheet. T. 0 Remodeling
ship and have no einplo ees There sub-contracmrs have S. 0 Demolition •
working forme in app capacity. employees and have workers'
_ 9. Q Building addition
o Workers'comp.insurance camp.insurance;corporal
required 5_ We are a corporation end is t6_{Y]Electrical repairs or additions
f
•• ocexs have theirexercised
a.`i ! am a homeowner doing ail work 1i� Plumbing repair or additions
myself. [Nis workers'camp. fight or emptian per ti?GL I 0 Roof repairs r
insurance cequised.]: e. I52, §I(e),and we have no
employees,to workers lip Os nsula o
comp-insurance required./ ,I
applicant dial cheh boo a I must also fill our dm saation Mimeslim:me their Worker,compensation poliev information.
'linmcowrrero elm submit this anibla vii indicating they um doing all work and stn hire outside commuters mustsubmit a nor affidavit indicadnesucii.
sruntructors that check this box most eLLached an eddrionai shearshmeinn the name or rhe sub-contractors anti safe whether or not IflQe ontiiiees have ti
employees If ilk:sub-cora/actors have employem,they must provide their workers"comespokeynumber- 1
hall an eng,lover that is providing workers'crikveannio J ifSWYMO2for n'eluplol•eec- Below is the policy and job she o1
inebnizatian.
Insurance company NameArbella _ „-, .._ Ij
{A F9 ("'J
Policy or Self-Mg Lie.
``tqk ci j _c9.`6 1 -. r F.—) Expiration tDate:4/297g0(( ��e /� t�
Job Site Address: `7 tl DC& ±e lfl Dti' CnydStatWZip: Florence] / a A , V i o . ,,
V
>tach 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 o: MGL c. 152 can lead to the imposition of criminal penalties of a
one up to S?;5O0.00 and/or one-year imprisonment_as well as civil penalties in the arm of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator, 3e advised that a copy of this statement may be forwarded to the Office of
invesri2arion5 of the CIA for insurance_coverage errfcnron.
0,0404.5,
I rip hereby ecenTij•under the pains an penalties ofperjarr that the irrformarimi provideft above is irtne Alla correct �l
Ai
;i!gnahtre.: 'bIll.a\I\ „sada gate: Ili ) 1 Ili) _
oh.,,p_x113)'774_3604
Oficial use only. Do not'Prize in this area,to be completed by airy or town officiaL
ti
li City or Town: �Permit/License
I Issuing A.uthoriry(circle one):
i.[ 1. Board of health 2.Building Department 3.City/-own Clerk 4.EElectrical inspector 3-PIumbing inspector
ilt .Other.__ — ._
1,1
',H RET'Person: _ Phone#'^.
i
, Massachusetts -Department of Public Safety
Board of 3widing Rcacir ices and Standard_
:um
ructhic,Soper,b..' Sprtwit-,
_,cense. CSSL-099372
JOSEPH PGEORfE a.
64 HAYWOOD STREET _
GREENFIELD PFA 01301
1
1usv' =dpi ration
commissioner 02/11@017
iGr f,.,,,.,,,..,r.r,///./-jf(?J i ,.,/c
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
-_--HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 156686 Type: Office of Consumer Affairs and Business Regulation
Expiration: 7/25/2017 Private Corporation 10 Park Plaza-Suite 5170
•
Boston,MA 02116
JP GEORGE&SON INC
JOSEPH GEORGE — \c
64 HAYWOOD ST
GREENFIELD,MA 01301 Undersecretary Ni valid without signature
•
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