24C-072 (6) r City of Northampton i A $``S
Massachusetts z * " DEPARTMENT OF BUILDING INSPECTIONS y, r � ..
• 212 Main Street • Municipal Building J!;rJ
Northampton, MA 01060 ?ry' Y?
Property Address: _ T uv1'ScJ -A St re€ Na \ () nji* oi
Contractor
Name: j fl S 4 p
(seor)
Address: b'i hcAy wood, ,Si -re6,
City, State: ( it'iei , Mh Oi3 I
Phone: 013 77 "3iv09
Property Owner
Name: tTci fne3 Fe
Address: 54 M Wjc o\V Si-reZ\
City, State: NO Ct1 arAp o, M A 0100
I, 3 fA' ( or (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 41 t Ilk
I l A iitv......
II
Date g - IA - -A i ).
Office o t��onsumer A air
License or registration valid for ►ndividul use only HOMi! IMPROVEMENT CONTRACTOR
before the expiration date. If found return to: _� Type:
Office of Consumer Affairs and Business Regulation Registration. 156686 private Type:
10 Park Plaza - Suite 5170 . k = % Expiration. 7/2512013
Boston, MA 02116
JP'GE`ORGE & SON INC
i
' - JOSEPH GEORGE
- : ,......k,..._ � . ¢ i `�.. 4 i' L : 64 HAYWOOD ST 4
i . Not valid +ithott signal re GREENFt6L0, MA 01301 Undersecretary
x - = I. laS.aChtiSttiN - Dt pailnwitt iii Public Saftm,
Board of Buildint! Ret;tiltaion■ and Stttnd trd.,
?fiv:n.sot,on. S 1p ,S ViSC: Sp°_ „c a _u::
.mac -: f:,,, ..>1._ 99372 2 4. sr. '; `i..;.', c
Restricted to WS,IC ::
JOSEPH GORGE
64 HAYWOOD STREET k,
GREErIFtE! f3, MA O'301 ; , %
�i._ -___ `,. Expiration: 2/11/2013
r ”nnnii..i" +r'' Tr`: 99372
`fi t; Office of Investigations
'='7 1 — 600 Washington Street
= :: .-: Boston, M4 02211
�Y� www.tnass.gov /dire
Workers' Compensation hisurance affidavit: Bu deS /CoA►trac on/Electricians/Plumbers
Applicant Information PI ease lP rint Legibly
( ' � � SOs � k) (---r
Name ( 1Business /Orgathationfindividuai): j :P. ,...__t _ -- .,
Address: fG — woo _
City /state/ � 4t ii• ��C1 \ r \t C) r3O Prone #:• (t-) 1 19 ) - -1
Are you au employer? Check the appropriate box: • Type of project required):
1.5. I am a employer with 14 4 ❑ I am a general contractor and I b. ❑ New cons: r fiction
employees (full and/or part time)_ * have hired The sub - cones .tuts
2.0 I aru a sole pwpAletor orpattaer- listed on the attached sheet I 7• ❑ Remo delit.g
ship and have no employees These subcontractors have S. ❑ DernOhtio 1
�• ins aoce. ' co
working for me in any capacity. Workers 9. 0 Building addition
[No tivorkecs' comp_ insurance • 5. ❑ We are corporation and its • 10.0 Electrical -epains or additions
regainecli officrts have exercised their
3.0 I ant a homeowner doing all work : light of exemptionnper-MGL 11.0 Phuubfng repairs or adddiovs
myself [No workers' comp. -:'c= k3.2 0.(4)i_and Wehaveno 12 - Roof repa
insurance required _] t employees, }No wohkers' 11E1 Q tl Tn5'1 t to ion
com0. insurance required.]
y eppiioanttl�at checks box #1 mast also fill and the section below allowing their workers' oompxnsaiian policy iufasmation —
1 Homeowners who submit &in affidavit indicating they alt doing all workand then hira-outside cantrnctotsmast submit a new all7da -pit indicating such.
TContractoni that atm-kens boom ettacbcd an additional sheet abowing the name of the sub- contractors and their annteIs' comp galley information-
Lean im employer that is providing workers' compensation insurance for my employees. Below is the polity and job Site
i ifor+ 'ion. - %
bnizrance Company Name: S
Policy 0 or Self -Ins. Lie. if; 5 } - t' Expiration Date: I I` ? d "
Job Site Address: S MKS LI3r),i SYi etv CitylStat&Zfp: f__r*(ntlto N\ f; 0 f069
Attach a copy of the workers' compensation policy ,declaration/ page (showing the policy ember and expiration date).
Failure to secluc coverage as required under Section 25A of MGL c. 152 can lead to Thei:uaposhion a` criudnal Penalties of a
rune up to $1,500.00 and/or one -year imprisonment; as well :as:civil penalties in the form of a STOP WOW ORDER and a fine
of up to $250.00 a day against the violator.. Be advised-theta copy of this statement may be forwards / to t to Office of
Investigations of the DIA for insurance coverage verification. -
I do hereby c- .5 under he ,a - d peruzkees of perjury information provided above is true and correct
- „All tri i _ Date: - c) — 0"
Phoae4: ` 'T jL`t
Official use only. Do not write in this area, to be completed city or town afrcu�
City or Tower: - -- -- PerrnWLteense # -
Issuing Authority (circle one)? :.. T— •
1. Board of licalth 2_ Building Department 3. CityiTowa Clerk 4.. Electrical inspector 5. l'lumting Inspector
6. Other
Contact Person: Phone #
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: (T f� t Not Applicable 0
Name of License Holder : ,SOW 4 �� v eD (- JS 1 v' ? - 1),
License Number
C4 H w;� S rte'\ CirPittieV, NIP 01 301 —ti - 3
A'.ress Expiration Date
\ ,P. ti ( +In 7 74 -3bo4 w S , Tt
Sig a re ` Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
VI HO WOO' SAM tree 'lelr,M 9130) 7- ?5 -D. ^i3
Add s 1 Expiration Date
4 0 (�fli) T 74 -36oy
Telephone
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 ❑
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 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
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) 11 Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [E Siding [DI Other [CO
Brief Description of p' e
Work: 7�V�N opu4 .)s� rn tg'i^3 IN∎A v��k 11� oleic Air ,Sepoil z CAlt Ugn611 bore eA
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
�) lnrne5 Eerra,r cA , as Owner of the subject
property
hereby authorize - 5D . 3e (TeDYV-
to apton my be , in all matters relative to work authorized by this building permit application.
Sign re of e Date
Soe , (re c _ , 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.
SnSep 6-eortjt LAM
Print Name \ M � ,
Signature of Ow er gen Date tT T
per C5it of Nnrtilumptart
,S . :s,
(� �, r Jt'4ttssarltusetts t i * * ' ‘c - ?
.
14` .� y y 1 DEPARTMENT OF BUILDING INSPECTIONS ` ;'
4
,,. 212 Main Street • Municipal Building '� ?�
Northampton, MA 01060
LO
INSPECTOR BUILDING PERMIT FEES Phone: (413) 587 -1240 ' ---• -.
BUILDING COMMISSIONER Effective July 21, 2008 Fax: (413) 587 -1272
DEMOLITION $ 20.00 ACCESSORY STRUCTURE
$ 35.00 PRINCIPAL BUILDING — Residential
$200.00 PRINCIPAL BUILDING - Commercial
*NEW CONSTRUCTION $ .50 per square foot for 1`` floor
.30 " " " " 2 floor
.20 " " " " % floors, attic, basement, garage
STRUCTURAL ALTERATIONS iN ALL USE GROUPS
$6.00 per thousand dollars of estimated cost or fraction thereof,
with a minimum fee of $55.00
$25.00 WOODBURNING STOVE
*NEW ACCESSORY STRUCTURES one hundred twenty (120) square feet and over
$ .20 per square foot with a minimum fee of $25.00
*NEW ACCESSORY STRUCTURES under one hundred twenty (120) square feet
$25.00 per Inspection
*SWIMMING POOLS $30.00 for above ground
$60.00 for in- ground
*SIGNS & AWNINGS $30.00
*DECKS $50.00
REPLACEMENT WINDOWS $35.00
SIDING & ROOFING
Residential $35.00 per structure
Commercial $55.00 min. per structure OR $6/K of estimated cost
TENTS $25.00
*ZONING REQUEST FORMS $15.00 (includes home occupation registration)
REISSUE OF LOST PERMIT $25.00
CERTIFICATE OF ANNUAL INSP. $100.00 (minimum)
Temporary Certificate of Occupancy $25.00
PERMITS REQUIRING ONLY 1 (1) INSPECTION WILL BE A MINIMUM OF $25.00; ALL OTHERS WILL
HAVE A $50.00 MINIMUM. PERMIT FEES SHALL BE PAID TO THE ORDER OF THE City of Northampton
AND SUBMITTED, WITH THE COMPLETED PERMIT APPLICATION, TO THE OFFICE OF THE BUILDING
INSPECTOR. WORK STARTED WITHOUT PERMIT IS SUBJECT TO DOUBLE NORMAL FEE.
!! NO CASH - CHECKS OR MONEY ORDERS ONLY !!
* Filing deadline is 12:00 pm (noon) on Wednesday.
Department use only.
City of Northampton Status of � e "� rmlt
RECEIVED B u it ling Department C r t/DnvewayPermit
ra 9 yv �.
2 2 Main Street Sewer /Septic Availability ��
Room 100 llyater/Well Avallablllty ��
SEP I n gum N rthampton, MA 01060 Two sets df ructuraC Plar s s xJ
phone 413 Fax 413 - 587 -1272 iot/Si e`I (a s
DEPT OF BUILDING INBPFCTIONS Other S eci,y
NUM I I1RMY 'UN, MA U1060
—' APPLICATION TO Co ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: �'1 This section to be completed by office
tv Map Lot Unit
o }on, MR Q I��EO
Zone Overlay District
Elm St. District CB District
SECTION 2'- PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: C 319c. / 4� '- S), fio Z�1f j }thrp>r(,' 1 'Wf 6y �� I O
•`I Ml(:0S00'4f Street ���f}�e /N O 1'D
Name (Print) Current Mailing Addres$:
, 4teT Telephone
Signature
2.2 Aut • ized A • ent:
S�� e p eo��Z t4 H wocc{ S' \-reel (I-reenf �, , Mt ct3� �
Name ( int) Current Mailing Address:
dt► , ..�. I (41 3) 7 �
t —3 t�
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)
5. Fire Protection ��
6. Total = (1 + 2 + 3 + 4 + 5) •3 »i r 6 Check Number � 5:3"--
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Date
Building Commissioner /Inspector of Buildings
File # BP- 2013 -0271
APPLICANT /CONTACT PERSON JOSEPH GEORGE
ADDRESS/PHONE 64 HAYWOOD ST GREENFIELD (413) 774 -3604
PROPERTY LOCATION 54 MASSASOIT ST
MAP 24C PARCEL 072 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST _ /�'
ENCLOSED REQUIRED DATE (�
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 4/
Typeof Construction: ADD ATTIC INSULATION & AIR SEAL ATTIC & BASEMENT 0
New Construction
Non Structural interior renovations \
Addition to Existing
Accessory Structure ! J
Building Plans Included:
Owner/ Statement or License 99372
3 sets of Plans / Plot Plan
THE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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
D-. -• io De .y
o ir
Signature • S ui ding • fficial 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.
54 MASSASOIT ST BP- 2013 -0271
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C - 072 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- 2013 -0271
Project # JS- 2013- 000438
Est. Cost: $3254.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOSEPH GEORGE 99372
Lot Size(sq. ft.): 15855.84 Owner: FERRARA JAMES J
Zoning: URB(100)/ Applicant: JOSEPH GEORGE
AT: 54 MASSASOIT ST
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774 -3604 WC
GREENFIELDMA01301 ISSUED ON:9/13/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD ATTIC INSULATION & AIR SEAL ATTIC &
BASEMENT - IN PROGRESS INSPECTION REQUIRED
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 9/13/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner