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29-316 (6) BP-2024-1378 123 BROOKSIDE CIR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-316-001 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-2024-1378 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est.Cost: 2800 J P GEORGE AND SON INC 099372 Const.Class: Exp.Date:02/11/2025 Use Group: Owner: JASMINE HARDY Lot Size (sq.ft.) Zoning: WSP Applicant: J P GEORGE AND SON INC Applicant Address Phone: Insurance: 64 HAYWOOD ST (413)774-3604 4220066477 GREENFIELD, MA 01301 ISSUED ON: 10/22/2024 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: Ga : Fire Department Dri%may Final: 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. 72- Signature: Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner _......... ..... . .. ._ . 1-3E_Lci-E.:7EL-TL:i Z.VD , e Commonwealth of Massachusetts FOR 1 T 1 8 2024 ' Board of Building Regulations and Standards MUNICIPALITY ' ' ' Massachusetts State Building Code,780 CMR USE DEPT of rtj,Lpi -.; ° :.:. : „; Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 e NORTHA'IAnTQfV,MA TIOVS One-or Twa Family Dwelling • o,ono ' Thu Section For•Officiai Use Only V , • .. `Dui tht g brmitNumber.. ,�!tit zT- ,pile.** • . Handing Ordinal(Print!4smc) - , .• P . SECTION i:.STrE Yhl1ti"O1 !AT .s . . 1.1 pper•ty Address: /` t 1.2 Assessors Map Parcel Numbers 8/ c i iy "2c P. /l�/ �a i,ij r 1.1 a Is this an accepted street?yes no / Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions; Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.6 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private© Zone: — Outside Flood Zone? Municipal ClOn site disposal system ❑ Check ifyes0 . • .. .SECTION 2: OP IRT OWNER '. . 2.1 er'of Record; --/n s..4241/ ficy-att Alvd1,4-irrwl p i -49 C)/ (e;', Name( ) i City,Stete,ZIP /a3OSiv sj (i% 7fJ35D-2a 3 /A4, aS�61Nr:,1.66 No.and Street Telephone �J Email Add6eb . SECT1(1 13:,'cES:CRI P'Y'ION Or.' PROP SED WOW lebeck nil#t;t apply) ` • New Construction 0 Existing Building D Owner-Occupied 0 Repairs(s) 0 1 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.❑ Number of Units Other III Specify:/j,.s , /cji< 11 Brief Description of Proposed Work2: - ' 0 ^i c - /04, - , lei//iAj lrIn r(e) . S ON•4:E A cowl .7C�siort corn!. : .- : . • Estimated Costa: Item (Labor and Materials) 02460 ZUea 1.Building $ ,2 '0 0 1: Builditig:Permit Fey;$ . ., ,',Indicate bow fee is dete mined: 2.Electrical $ 0 StandardCity/Town Applieatioat Pea• ,-❑:Toted l ecs.Cost3<Item 6)x multiplier• ‘ x y 3.Plumbing $ 2. Ot .er.Pees:.$..........:._.. . . 4.Mechanical (HVAC) $ Liet: . 5.Mechanical (Fire $ Total Alf if . Suppression) •. 6.Total Project Cost: $ C/� ' Check No. . t Amount:.U' 'cal ;� . j 2 0 0 0 •QPaid in Full • ©Outstanding Balance Due: - SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /Sft oii 579. a-%`-a.s -(' Cyeef%e_ License Number p� Expiration Date Name of CSL Holder �� ‘Li &Nit/J.100d l gt�iList CSL Type(see below)No.and Street Type Description (5 f � ,ak D (30 ` U Unrestricted(Buildings up to 35.000 Cu.ft.) Ci lIo� Stat ZIPkt\ I tit + R Restricted 1&2 Family Dwelling n' /°vet, M Masonry RC Roofirin .. siz-Alt• WS Windowng and Siding SF Solid FuelCove Burning Appliances „3 5311616 NQ.,e�t�(tok•011A I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /S6/ S6 11f.,25' • ccr k�Y im HIC/Registration Number �ExpirationOD'ate HIC Co pany me or HIC Registran amee No. d St4 t •. �.�__a J -(�� ` p 1 _ K__ �ctem I m ' e vc?rt Cyi.0 s311107 6 Email address City/Town. State.ZIP `� .Telephone • SECTION 6:WO' i RS'COM EN ATION 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 pennit. Signed Affidavit Attached? Yes A No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES F`O,R BUILDING PERMIT I.as Owner of the subject property.hereby authorize 3bs€_ 1 Geo to act on my behalf,,in allmatters relative to work authorized by this uil tng permit applica ton. LJ4SftV,€ / c,rifJ s� Q et c\A- /D//y/2�i Print Owner's Name(Electronic Sign ) Date SECTION 7b: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 contained in 1 this application is true and to to thbe of knowledge and understanding. A 6-et)rcre . ialiM11- /eAV/-27 Print Own 's or Authorized AgFfit's N to(El, .nic gnature) Date 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.I..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.mass.aov/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" .nu %.41Mtilonweattn of Massachusetts ---�-� Department of Industrial Accidents r Office of Investigations = % Lafayette City Center =` ; 2 Avenue de Lafayette, Boston,MA 02111-1750 - www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ADnlieant 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: contractor and I Type of project(required): l. 5 4.® I am a employer with 0 i am a general employees (full and/or t-time).* have hired the sub-contractors 6 El New construction pat 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 8. ❑ Demolition working for me in any capacity. employees and have workers' 9[No workers' comp. insurance comp. insurance.# [DBuilding addition 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' comp. right of exemption per MGL 12.0 Roof repairs - insurance required.] t c. 152, §1(4),and we have no INSULATION employees. [No workers' l3.® 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. $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 an employer that is providing workers'compensation insurance for say employees. Below is the policy and job site information. Insurance Company Name:Arbelia Policy#or Self-ins. Lic. #:42220066477 Expiration Date:8-1-2025 Job Site Address: /d.3 6roOk-i'/e Cr c City/State/Zip: / • --1 1 7' , Attach a copy of the workers' compensation policy declaration page(showing the policy number and exp tion 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.: 11 and penalties of perjury that the information provided above is true and correct. Signature: // i: r Date: /6�/4/�a�� Phone#: 13-774-3604 1� `" 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): 10Board of Health 20 Building Department 3.DCity/Town Clerk 4.0 Electrical Inspector 5alumbing Inspector 6.0Other Contact Person: Phone#: r tidy. C®MMOO��Q�V LT. OF ASSACH, SEllI. S D � .E5 DEPOSALAFFI[DAVIT Town of Riassechusetts 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/MONSTER FIRM 0-3 l3t()c,S/de (in , , A hAM /°' /121q: d/O(? CONSTRUCTI9A SITE ADDRESS pimpl PS GNATURE OF RM APPLICANT /A /;V p``r DATE 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&SON INC JOSEPH P.GEORGE / 64 HAYWOOD ST u.,tn:;' V'`• GREENFIELD.MA 01301 Undersecretary Not valt with ut signature Permit Authorization CLEAResu It mass save Form Sz.ru s tMouy',energy,H,:fonGy Project ID: WRK-47604948 Customer: JASMINE HARDY I, JASMINE HARDY , owner of the property located at: (Owner's Name,printed) 123 BROOKSIDE 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. Owner's Signature: Jaructuce rdy Date: 09 /23 /2024 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: :Ss -Cje"Se4S6, /0-120- `1 Participating Contractor Date CLEAResult • 112 Turnpike St,Suite 111 • Westborough,MA 01581 • 1800-480-7472 Rev.08.24 Document Ref:FTRH2-TWNVFJEJK8-OCMXV Page 3 of 4