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29-036 (3) BP-2022-088.5 60 PIONEER KNOLLS COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-036-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-0885 PERMISSIONIS HEREBY GRANT TO: Project# insulation Contractor: License Est. Cost: 3161 JOSEPH GEORGE AND SON INC 099372 Const.Class: Exp.Date:02/11/2023 Use Group: Owner: MARTINEAU ANNE MARIE Lot Size (sq.ft.) Zoning: WSP Applicant: JOSEPH GEORGE AND SON INC Applicant Address Phone: Insurance: 64 HAYWOOD ST (413)774-3604 4220066477 GREENFIELD, MA 01301 ISSUED ON:07/28/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION 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: I• • '�• j cs- Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner •'13uiLT 16159 Department use only City of Northampton ;�tus of Permit: Building Deprtm t V`Carp ut7Driveway Permit 212 Main ittre Jill Se /Septi Availability ROom/100 5 Wat r/Well Availability Northampto 60 20�2 Tw Sets f Structural Plans phone 413-587-124 -Fax . ,� PI t/Site lans er S ecify ON ,Fr%2�.t3 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVA DEMO SH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be corn leted by office 1.1 Property Address: 60 0 Pow f C J o S S• ' _1 ` Map � Lot ' unit `°CAS'' Zone Overlay District 0100- Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: AInr* I�car►� N1 o r ov4t 69 f;,orof I(n o)11 S Name(Print) Current Mailing Address: it 13 1 0 010 See ffik0 4 Telephone Signature 2.2 Authorized Agent: Jose Gent 6�1 NUy�ioDo' S3, Gseer`i. �,/ ,J\ 013°1 Name(Print) \ Current Mailing Address: .6kA) lire 11\1\R li1L-Tik 431-779.-360k Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1_ Building 3 f 1 JU 1 I,1 1 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from.(66 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) /(� 5.Fire Protection (,� 6. Total=(1 +2+3+4+5) 3 W 1. Check Number / /! This Section For Official Use Only Building Permit Number: 60 !3,g,5.. Date Issued: 2 Signature: /�% 7. 28 Building Commissioner/inspector of Buildings Date SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors O Accessory Bldg. ❑ Demolition El New Signs ID] Decks [0 Siding[tom] Other[EgQ tnJv►Ira}Son Brief Description of Proposed/t`r S�, 0 „ _f buolmel. 6 of ce ll t.4ose to a+11 f Ihi• 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 r AAft Mo►�. �Yy n erAk ,as Owner of the subject property hereby authorize SbseQ\ Gear . to act on my behalf,in all matters relative fo work authorized by this building Permit application. Sce twc�,el� 0-7 /i7/ o a� Signature of Owner Date 3.0seFAN Crean ,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. ase GeeAt Print Name /17 Signature of Own-r/•e ent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable DI Name of License Holder: a'S ( t " (Rol, (S31 Gi C13 License Number b1 HrAywoo( S "�C�i ree,r tip, NA 01301 a,-ti. 2Or3 Address t Expiration Date 'try,..1.vv• 413)771-3��t Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 J• Q' &eorayt 0.4 ion,In(, 1S66$6 Company Name Registration Number ‘11 \NIA d1 Sire-6 &ref./41 id, Ma 01301 7-15 a© 3 Address Expiration Date { 2 Telephone 3 )' /-7 7hI'3 b Ott 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 Dwellif2S,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 108.3.5.1. 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-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,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 City of Northampton vty�1r�t� ``S :: c��f "•�f, Massachusetts t -1 J` C t; l �1 ''( �r DEPARTMENT OF BUILDING INSPECTIONS Ix h rr�: 3� 212 Main Street • Municipal Building ss.: Northampton, MA 01060 �` Property Address: p® I';orr Ki4IIS v)' • Fkr del MIT 1 0 I°0 Contractor Name: 1oSeo, &eorq, !/ a,P= Geor e r 4 so,, tr c. Address: ()It Hol\IWOOCA -ctree} City, State: GrQen$'eic , MA ot3o1 Phone: (LtI3 774- 3(,04 Property Owner AA� _.QI,nName: N�p- /�'It'i�(1 ►V 1N`t1112D1A Address: O 0 f o/1eer 10no c 5 fi,City, State: Florence, MA , ® l`J 6 2. 1, 3os ?b &eart 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 ,��4 .531,1 , Date I City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: .0 firr knp�� fl The debris will be transported by: Y,P Geo ale can JL sot,/ Inc The debris will be received by: g rC^ tie6f ro Building permit number: Name of Permit Applicant UoSerh, (re le 07j11 J)-rn , 1‘ • J 4 Date Signature of Permit Applicant ▪' The++�w•+..+.. Cow mo w eald of Massach:setts z —w = _ I Con vas Street:,Suite n00 . osto ,MA 02 `4-2'017 • Workers'Compensation iinstiranee Atf' v t:ullelersiCon.ractorsiElectricians/numbers. TO BE RUM WITH THE gr ,i'imuNG AUTHORITY. Aa .. rk a Pri t e i i ' Name(Business/organization/individual): Address: ' ("'e`� •. ,Q E;' 4:LAC. City/State/Zip: �' ` 'G A [tl i Phone#: `�E ) S-31 1678 Are you an employer?Check the ttoprnprlate bum C` Stir Type of project ct(trequiret 1 I.Ei f am a employer with II employees f h11}.andlor pan-titnc}c 7, Q New construction 2.0 l am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.tnsuttn ce required.]t Q Demolition li)0 Building addition .I.D 1 am a homeowner and will be hiring contractors to conduct e!!work on my property. I will ensure that all contractors either have workers'compensation insurance or arc sole 11.0 Electrical repairs or additions proprietors with no employees. 12.C3 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sh,-et. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 the ant a corporation and its°itreems have exercised their right of exemption per MGL c. 14.�Other ty35bf tC�,: iC.)V`t 152. lid),and we have no employees.]No workers'comp.insurance required.] :Any applicant that checks box#1 must also MI out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they am 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 the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am on employer that is providing workers'compensation insurance for my employees. Below is the policy and job.site information. lJ'nt § Insurance Company Name: L' )&ACka. Policy II or Self-lets.Lie.#: 0.4°C1 Expiration Dater I""."G . Job Site Address: (.)0 p o r nt S - �or pioneer s • Ctty,/StatelZip eice� MR , Ol062 . . ..... 's fiii.0: r t� t T 3 sa 1a (i.i ia�* `teaa>p* *21*** 44t '• Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to$1,500.00 andfor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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 hereby certify un the pains an, ,.. t Ities of perjury that the information provided above is true and correct. Signature: • , Date: 07/I !11041)\ Phone#: 913 774 3 604 Official use only. Do not write ire this area, to he completed by eiy or harlot official. 1l , City or Town: hex r€ait/Lkense# ]I Issuing Authority(circle one): I.ward of Health 2.Building Depnr icnent 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Cozi net Person: Phone ti: i Commonwealth of Massachusetts Construction Supervisor specialty ti Division of Professional Licensure Board of Building R ulations and Standards Restricted to: rSpeciattl CSSL-IC-Insulation Contractor L` tt^�a"ttt:1# `S !r. CSSL-WS-Windows and Siding Tres:0211112023 CSSL-099372 �" JOSEPH P GEORGE ; 64 HAYWOOD!'STREET ' W GREENFIELDYMA 01301 =y r •,. 14 � f�15,,.t. 0"- Failure to possess a current edition of the Massachusetts / State Building Code is cause for revocation of this license. Commissionerct, i7nc�fn For information about this license Call(617)727-3200 or visit www.mass.gov/dp! • Registration valid for individual use only � _ �G //� _� before the expiration date. If found return to: "off('��'f�`IMPR +ktF B 14t9on Office of Consumer Affairs and Business Regulation HOME IMPROVEMENT CONTRACTOR 1000 Washington Street -Suite 710 TYPE:Corporation Boston,MA 02118 Registration Expiration 156686 • 07/24/2023 JP GEORGE&SON INC r/ (:)\0 Not valid itho t sig tur2 JOSEPH GEORGE /� 64 HAYWOOD ST ua+'a•t.r/.fi GREENFIELD,MA 01301 Undersecretary DocuSign Envelope ID:E5579D3A-5465-4A6F-AC98-4DE93C8EBCE0 RISE ,...--7 ENGINEERING OWNER AUTHORIZATION FORM Anne Marie Martineau (Owner's Name) owner of the property located at: 60 Pioneer Knolls Street (Property Address) Florence, MA 01062 (Property Address) hereby authorize I I ' GCOI(; otAil 3OA) /Al, (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 subcontractor, at no additional cost. rDocuSigncd by: Q tn rn t, Hayti M.arntn c,aU. OwneP 'Signat7 re 7/8/2022 1 2:24 PM EDT Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RISEengineering.com