31A-149 (4) BP-2024-1104
15 MAYNARD RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-149-001 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-2024-1104 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2024 Contractor: License:
Est.Cost: 9000 J P GEORGE AND SON INC 099372
Const.Class: Exp.Date:02/1 1/2025
Use Group: Owner: WOLF DAVID JUSTIN &JUDITH
Lot Size (sq.ft.)
Zoning: URB Applicant: J P GEORGE AND SON INC
Applicant Address Phone: Insurance:
64 HAYWOOD ST (413)774-3604 4220066477
GREENFIELD, MA 01301
ISSUED ON: 08/29/2024
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:
Fees Paid: S65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
44
&, The Commonwealth ofMassac Fa
Board of Building Regulations and dame ARTY
� 15 Massachusetts State Building Code,780 TN U, 0/410 SE
Building Permit Application To Construct,Repair,Renovate Or T o °tuiatis'evis Mar 2011
One-or Two Fatuity Dwelling °
Thii Section Foxe Use Only - „
;gt M bil.4h -Ay.1.1 oc .1.a tiA• lied: .
• 1guikatoffichd grin t.ate) • �' • . >
. Si'.1 A1EO11 .
1.1 Proper Address: 1.1 Assessors Map ik Parcel Numbers
1.14 Is this an accepLed street?yes no O/ Map Number Parcel Number
W
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Biding Setbacks(It)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.it Water Supppiyt(M.G,L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public D Private 0 Zone: _,_, Outside Flood Zone? Municipal aOn site disposal system ❑
Check ifyes0 .
. . • .. .�CfON 2: :1'1O TY•OWP `RSIE °' .
2.1 Owner'of R :
Name(Print) bty,State.
No.and Telephone �/ Email Address J
SECTIONS:.;e,ESCRn rION 0 PROI DIED"WOK .(cheekian tiiiit nppl') ` • , • ' •
New Construction Cl Existing Building Cl• Owner-Occupied Cl I Repairs(s) Cl Alteration(s) Cl Addition D
Demolition d Accessory Bldg.Cl Number of Units Other ® Specify: //1 SL''/t Ii('i^
Brief Description of osed Work': 'r . n ,J
. SECT ON.4i IST'1MVIA'1 D!CONSTRUCTION COSTS. . . • . .;
Estimated Costs:
Item .0E40 lTs;0: y. . ..•
(Labor and Materials) ,. •'
1.Building $ 9 n G) 0 1: Building Permit Fee:.$ •Indicate is detetia :
2.Electrical $ •Cl t:,vtiown Application tee•
•r i:Totet lijeoc•Cost3•(Item 6)x nxultiplier' • :t
3.Plumbing $ .2. At1ter.1<64: $ ;,_ .• . .. • •
4.Mechanical (f VAC) $ •
5.Mechanical (Fire $ Total •All 1#ees: ' . :` '
Suppression)
6.Total Project Cost: $ Ch ckNo.l 37CheckAti op • N,�:'cash llmeiu, „ w '
?(,)00 :Cf Paid itzFuli,. • fa Oatst.andiog lice Due: • -
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CIL O9i 57? a_%1.a'S
-SOse.�t4 &€C)(1._� License Number Expiration Date
Name of CSI.Holder W�/
� +4 , -Nkuood ]- List CSL Type(see below)
No.and Street �Q`• l Type Description
(€Cxv \d M • • U Unrestricted(Buildings up to 35.000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/I own,`. a;e.ZIP' �` M Masonry4 ,,,ithi RC Roofing Covering
• WS Window and Siding
,�
d - KQ-+On� 4�n I Insulation
SF Solid Fuel Burning Appliances
• I � � � 6K.�
elephone I address D Demolition
5.2 Registered Home Improvement Contractor(HIC) /SGL,46 ��11f�QS
a-T• G o ��h x H1C Registration Number Expiration Date
HIC Co parry,I me or HIC Re i tran%flame t
No. d Street pp'j" _����13"o76
Email address
City/Town,State,ZIP Telephone
SECTION 6:WO RS'C MPENSATION 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 it No .0
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 3'ase-911 GC
to act on my behalf,in all matt relative to work authorized b this buil mg permit applica ton.
iti 0/I'M if , cue- 6k cQs // V
Print Owner's Name(Electron' Signature) Date
SECTION 76: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
containedta in this application is true an c ate t th est my knowledge and understanding.
TO �a�.'/1 6-el)!' 'l' 6 fik �9
Print O«n�r's or Authorized Ag is ame 'l tronic Sign ure) to
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
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.tass.gov/dps
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 half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
lii
C®I`�IiMORWIFALTIHI Ok Mi ASSAC 1US ETTS
DIBI S EINSPOSAL AFFR AST
Town o P r(I &i/1 foY , Massachusetts
IN ACCORDANCE WITH THE PROVISIONS OF MGL Chapter 40, Section 54,
A CONDITION OF BUILDING PERMIT NUMBER
IS THAT THE DEBRIS RESULTING FROM THIS WORK SHALL BE DISPOSED OF
IN A PROPERLY LICENSED SOLID WASTE DISPOSAL FACILITY AS DEFINED
BY MGL Chapter 111, Section 150A.
Brattleboro Salvage 437 Vernon St. Brattleboro, VT
DISPOSAL/DUMPSTER FIRM
/5/1Gg na/ f9 AACAu ii AA 460
CONSTRUCTIOlSITE ADDRESS
4767 L i ffT,�� J"l
S G 4ATUR/EE OFMI`e'APPLICANT
Pa 2/
DATE
.Bne &ommonwealth of*Massachusetts
............. Department of Industrial Accidents
�. 7 Office of Investigations
"= = I.
Lafayette City
Centeri, - = yi
.1
2 Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):JP George & Son Inc
Address:64 Haywood St
City/State/Zip:Greenfield, MA 01301 Phone#:423-774-3604 ��_�___
Are you an employer? Check the appropriate box: Type of project(required):
I.® T am a employer with 5 4. C1 I am a general contractor and I
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. 0 Remodeling
ship and have no employees These sub-contractors have g. El Demolition
working for me in any capacity, employees and have workers'
insurance.x 9. 0 Building addition
comp.[No workers' comp. insurance
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' right of exemption per MGL
comp 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no INSULATION
employees. [No workers' 13.® Other
comp. insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
1.Conunctors 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 an employer that is providing workers'compensation insurance for my employees, Below is the policy and job site
information.
Insurance Company Name:Arbella
Policy#or Self-ins. Lic. #:4220066477 Expiration Date:8-1-112//025 L
Job Site Address: /5 M4 yfL %1/) , City/State/Zip: Z!/vrl�le i Or /1�i ()/Ot. '
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$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under t al and penalties ofperjusy that the infortnation provided above is true and correct.
Signature:y
"`]J ,,,, !�'�' Date: g/'/t /2y
Phone#: 413-774-3604
,
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(check one):
I DBoard of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5Ialumbing
Inspector 6.(]Other
Contact Person: Phone#:
_.
Akit
mass save
Savings through energy efficiency
PERMIT AUTHORIZATION FORM
I, Judith Wolf owner of the property located at:
(Owner's Name)
15 Maynard Road Northampton
(Property Street Address) (City)
hereby authorize the Mass Save Home Energy Services Program assigned Participating
Contractor to act on my behalf and obtain a building permit to perform insulation and/or
weatherization work on my property.
This form is only valid with a signed contract. The permit will be secured by the
subcontractor, at no additional cost.
Jd/� W$
Owners Signature
06-23-2024
Date
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor
to the above referenced project:
i or, -�- 1 P/i(' / /
Participating Cont for Date
Document Ref:XRRJS-CSA6G-HPRWD-LGPKD Page 3 of 5
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
JP GEORGE&SON INC Registration: 156686
64 HAYWOOD ST Expiration: 07/24/2025
GREENFIELD. MA 01301
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:Corporation Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
156686 07/24/2025 Boston,MA 02118
JP GEORGE 6 SON INC
JOSEPH P.GEORGE ♦ \ '
64 HAYWOOD ST G� r,N 2 if c' •
GREENFIELD.MA 01301
Undersecretary Not vali witCtIL,r4ArA-14
ut signature