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22B-034 (2)
16 CORTICELLI ST BP-2019-0988 GIS 4: COMMONWEALTH OF MASSACHUSETTS May:Block:22B-034 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 Perm # BP-2019-0988 Proiect# JS-2019-001623 Esc. Cost$2000 00 F99: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: JAY BOLAND 101880 Lot Siu(sp.fi.): 10193.04 Owner: ROSENFELD EMILY A Zoning,URB(100)/WP(441/ Applicant. JAY BOLAND AT. 16 CORTICELLI ST Applicant Address: Phone: Insurance: 233 COLLEGE HWY (4131203-2454 0 WC SOUTHAMPTONMA01073 ISSUED ON:3/11/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:BLOWN IN INSULATION AND AIR SEALING 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: Drivew.y Final: Final: Final: Rough Frame; Gas: Fire Department Fireplace/Chimney: Rough: M 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: FeeTvpe: Date Paid: Amount: Building 3/11/20190:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner .:;t-wjC/e ids✓ Depa avant:use,only �- City of Northampton shafts of Pemt Building Deparhnent Cum.Cutfp ray Pm* �. 212 Main Street Ssae0SepScAuatabft Room 100 WabalYyeRAvaIOblity NoAhampton, MA 01080 Try Soft ef PW 7- phone 413-587-1240 Fax 413.567-1272 PbusiiePbws �dD�erS APPLICATION TO CONSTRUCT ALTER,REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING ED 3v , 9- I SECTION I-SITE YFORMTION o9iP This segion b be aomplsW iw o1Ru +.+ Pmortb MAA 11 2019 � 3 Lt cord cc(6Lkt iT OF BL'1!DING INSPECTOverlay DieUiCl NORTHnMPTpJ alp n.nvp I EImaL DYtrict Ca Distkt SECTION 2.PROPERTY OYYII3MOP/NnWOROED AGENT 2.2 X33 (ID(leaz I �wlr MA- Name(Phd) PJtffFS — T laphwe SECTION 3_ESTMATED CONSTRUCTION COSTS bem EsWaW Cost Pola s)to be Official Use Orgy 1. Blrllra nl (a)Bu Wog Pemd Fee 2. Eiectriml V (b)Eslimaod Tran of Conalfwbon 3. Plumbing Buiig Farialk Fee .}b i 4. Metl rwal(HVAC) •�/ 56.FTre (I -2 +3t4*5) Ctrerx Number This Secdon For Official Use Dere BuildN Pemdt Iseued: sGrewre: 3 eWk1ia9Gwr.*wnwAnspvctura 8cddkW Data gib EMAIL ADDRESS(REQUUtED: EITHER HOMEOWNER OR CONTRACTOR) � namMMus eopW—qAwjo,-a ow a' npmWWareuwmadde&VO No A-uonmtw mmsw ewPw wmw&PAuuQBei wmmft _ \�m_ p iMared 6�M�eMc Nt PMMPWM 4�%aAwlwwqpwF 4Au W7eo, NM dwd tow MLLm wgeo1-MUVZAOFLM NMVAO--I.W 1L33S Nadns,MwMNp —n-4wwd _.—AM SAID —*013005 .1 ON MM/. 'N oN WA7--u2MM009 "JA DO L LWAIM UOWAIW=4 'ON— MMA—isP 90 79 00 44PN WW 4%M4 '1 W MdRg '4 f LPa PMB ULM + O 4LW3 9 'M;M+M!IdwrrJ UORWUBWJOO 46 W 3 '6 4a JO M gwMN SMOMMM JP 90090 ki ZOPM 94 JO Pm" I l LswimPN 'a V -Vpx u9O wwngaum, p M6Mroq ap+mS Pasodwd 'P � 'POLPOW 96MIM6 M awP s{ 'o -=AM10 AWN —4—N4-q 4P wsuMML p lagwnN 'q j P� 31 zU 7MM4S- Eo2iP�PeilV suelK! ON— WA waaMe4 Peen 6m arm OAPJRN PSV ON sA—Uu Mgtneu 64PPy oN—sMA'MM 4*q&mwo 10PP9jgv r qty v W iPesddwd- M lo YMPS (ill-too Cid&"s [71 M pMa Dtil aL6!s�+N ❑ a ❑ -6PM8 kmsM v j ❑ 6"yOna ❑ Is)Pa�+wiy sriv a ❑ uoo�PV ❑ +dwN IMMN i SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction urberinsor: /, Not Applicable ❑ Name of License Holder: �/ (1I6 l m-o License Number Twp Rd 0/c�3 G /97 /V a Address / Expiration Date a� 73 Signator Telephone g Not Applicable ❑ y U �m c Inr 1938�� Com an Nam¢ Registration Number �X n�,� n�� 01013 19 /�Z/2(5 Address —� 7 Expiration Date Telephone ,J gy SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.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....... W No...... ❑ City of Northampton Massachusetts s� AWARnfillET W 130=] aG Ia scrlom s ` 212 141n Stoat • ramieipal B 11m y cs X--th lap o , m 01060 ono AFFIDAVIT Home Impmvemest Contractor Lsw Supplement to Pernik Application The Office of Cousunrar Affairs and Business Regulation("OCAHX)regulates the registration of contractors and subcontractors performing M3pr0vements or renovations on detached one to four family homes.Prior to Performing work on such homes,a coenactor must be registered as a Home Improvemeut Contractor("MC"). M.G.L.Chapter 142A requires that the"reconskrc4m,altetabon,mnoyaWM mpw,,ntodern®Oon,cartversiort, aptivemerd removal,dsmoBion, orconffiucbm of on adddion m WVPv xbdnD aerterotapkd tang cmdk tB at 198M one WA not rrare Oman kwd vWW wdts.._orb structraes stYch are a4scant to such residents,or b~be done by resistered contractors. Noir IJtie kamm ser ins conbacfed wi'd,a caMmu in,or LI.r,tin eatdy asst be"paged. Type of Work. Fut Cost: Address of Work: I(1) r ©J/—,( Date of Permit AppUcatioa�� / I hereby certify that: Registration is not required for the following reason(s): _Work exchtded by law(explain): Job under$1,000.00 _—Owner obtaining own permit(explain)_ _Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RFSPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby"pi Sar a building permit as the agent of the owner. �/, JJo &", W, CkeU I$K7--�Z/ Dkfe Contractor Name IHC Registration No. OR Notwithstanding the above notice,I hereby apply for a building permit m the ovner of the above property: Date Owner Nam and Signature Columbia Gas of MaSSkhUSettS 60 Shawmut Road, Unit 2 Canton, MA 02021 A NlSo C mpo y OWNER AUTHORIZATION FORM Emily Rosenseld (Owner's Name) owner of the property located at: 16 Corticelli Street _.. . . (Street) Florence, MA 01062 _.... (Town. State, Zip) .... hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. The Permit will be secured by the insulation contractor.. at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. i /-Customer Sigature -Sign Date 3/2912018 City of Northampton n Massachusetts � a DIU`M 6tlT or BVILDIM IMFYCrrWs 132 win ati•at • Municipal Building,a y man:Uumpton, w. Ca\'voao Property Address: I Contractor E ntv L O v l U Name: // .. hy Address: City, State: ff,�, `�� t�Ynito d Phone: Property Owner Name: Address: City, State: I-�Q V� C � I, ) wl (contractor)attest and affirm that the building I intend to insulate does not have any open air(knob and tube)wirin a spaces to be insulated and that I have provided the property owner wit py of this tub;) 6 Contractor signature Date / �`