36-134 (4) 327 BROOKSIDE CIR BP-2016-1443
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 36- 134 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-2016-1443
Project JS-2016-002487
Est.Cost: $3289.22
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use Grouo: JOSEPH GEORGE 99372
Lot Size(sq. ft.): 28183.32 Owner: BASILE NATALIE D&JOHN LEARY
Zon??'_no: Applicant: JOSEPH GEORGE
AT: 327 BROOKSIDE CIR
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413)774-3604 WC
G R E E N F I E L D MA01301 ISSUED ON::6/8/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:ATTIC AND BASEMENT INSULATION
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:
FeeTvpe: Date Paid: Amount:
Building 6/8/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1443
APPLICANT/CONTACT PERSON JOSEPH GEORGE
ADDRESS/PHONE 64 HAYWOOD ST GREENFIELD (413)774-3604
PROPERTY LOCATION 327 BROOKSIDE CIR
MAP 36 PARCEL 134 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT �,,t�(
Fee Paid Gb 17 $'{ 462
Building Permit Filled out
Fee Paid
Tyoeof Construction: ATTIC AND BASEMENT INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 99372
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR ION PRESENTED:
proved 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- olon Dlayy
ice 7/d
'fie of But • I cial 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 40K Contact Office of
Planning&Development for more.information.
Q_ Department use only
f
muof Pef:City of NDepampton
rtmenCurb CutlDrivewaY permit--.�—Building Department =ewer/Septic AvailabilitL�12 Main Street-1240oom lUO I Yauatpll s:Ayaibilly—Northampton, MA 01060 IaoSets of Strucluml Pla^sphone 413-587-1240 Fax 413587- 272 Plotlsite Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
• • _n,,y � This seWon to be completed by office
1.1 P p MAddress: 3a7 Bro9 cde dr( to Map Lot --Unit
Zone Overlay District
fbrtncei MP, o��6� Sm St.nfctrict CBDisMci
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
z, OtAiltec rd: UtDilie gos;It -7 DrooK I(* chat
(P ' r
Current Mailing Address:
S _a - t
Nam¢ ee y RG„`er�
See A{` Telephone
Signature ,1y�ft� 01301
22AuthorizedAg!M: G{QQp{�µr
7osep km-,e - 64 rya woodlsl,
Current Mailing Address:
Name(Print) ' I % , 13 -719--36c'
�i�1r1 , •1 - I Telephone
Signature I
S TIO 3- ' I i TED CONSTRUCTIO COSTS
Item EstimatedompletCost permit
plic be nt
Oficial Use Only
completed by applicant
I. Building ii.a p�A :a (a)Building Peunit Fee
2. Electrical d0-r (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAG)
5.Fire Protection l//
6. Total=(1 +2+3+4+5) 14(1. 22 Check Number 770p
q Ori
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Cdnmission&Inspector of auTaings Date
rSECTIQN 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
lew Nouse u I Addition L'] I Replacement Windows Alteration(s) El Roofing n
9r Doors D
Accessory Bldg. Lj I Demolition E I New Signs (DI Decks (Q Siding Kg] Other(IM]
t '
tithe Intent
Brief Descriptio pf Pro ea n p
Werk; Kir unit fn 1304form AAA 4„ of cCIluble AO eSkinnfti"it;>n .rn Vitt(•
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes �No I
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 moms in each family unit: ! Number of Bathrooms ,,, -„_
c. Is there a garage attached? ,
d. Proposed Square footage of new construction, Dimensions
e. Number of stoles?
t 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 Nu,
i. Septic Tank City Sewer Private well_ Citywater Supply
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR(py�( APPLIES FOR
ES( nFOR BUILDING PERMIT
RA
I, I •- `_`eI"A __ as Owner of the subject
property r
hereby authorize SnSe0, Creo?a,C I
to act on my behalf,in all matters relative fo work authorized by this building permit erotica•n.
See {1§tac\el _ 6/3/ 9/L
Signature of Owner Date
I, S°S'ep Crept-5Q, 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.
JOS- rh Cseotgt
Pnnt Name j i 1i 1, ilk. 6 3 2.016
Signature of OwnerIAgi I Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: I Not Applicable
«1❑
same of License Helder' OStP1'r &otgt. CZ) � Y •
License Number
, 'Ot woof Slti'eet Gteenfreidr MA o130) a-i(- 'aC11
• ..: Emiration bate
\ " I 7. 413 flit-hoM
Renato, � Teehwe
Q.Reale-tared Home Improvement Contractor. Not Applicable ❑
3. f. &Porti& ovul+ Sop.,trn 156686
Company Name Registration Number
69 tibia/agGl Stree-t 6-cetnfseId, MA oi301 7-a3-aol5
Address `\ U{{��.r�f�\�\1Qg 'y-0�(�,t�tyt�'..,,Vy�,�',((tt Expiration Date
Telephonet'�131-774-36�
V
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.BL e.152,§25C(0))
Workers Compensation insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit wiII result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes )d No 0 •
11. -Home Owner Exemption
The current exemption for"homeowners"'was extended to include Owner-occupied Dwellings of one(I) 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 alts
as supervisor.CMR 780. Sixth Edition Section 10833.1.
Definition of Homeowner:Person(s)who own a parcel of/and 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 net be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a fora acceptable to the Building Official that bdshe shall hr
responsilie for ail such work performed under the hnilding permit:
As acting on. .in a.- i ryour presence on thejob site will be required fromdme to time,duriog 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 inhales not resulting in Death)of the Mnsachusets General Iaws Annotated,von may be liable for person(s)
you hire to perform work for you tinder 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 ofMaswchusetts General Laws Annotate&
Homeowner Signature
City of Northampton
Massachusetts „y
�$
DEBUILDINGN
212 $ain Street Municipal Buil fling
Northampton, MA 01060 i I ct?>
Property Address: -1)17 Brside
-
f�
Circle fiorence1 MA 01962
Contractor
Name: 5nse'6 62o =C J,P, Geo • ' and, S..m, lot.
+ddress: u+ He wood Stree}
City, State: ureenc,sl& MA 01301
Phone: `tI3)-774- 3GO4
Nameerty: Owner lie 11040t
Address: 7 BrooKside ci rtjc
City, State: IoreAcC/ it o 6
1, Joseph Ge.orrc (contractor)attest and affirm that the building I intend to li
•.-suiate does not nave 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 \, t e \ gtal yyl
Date 6/3heab
sa Commonwealth ofMiassachaefts I
;tint Paan ( II,
:mar tment of latizzsaal Accidents III
--_ = %ce of Investigations III
- :oaan's Street,Suite 100
- .. - Ostonn. VA 02114_2017 ' III
www.,mnss_govitiin ill
II—Mr—kers' Compensation Insurance Affidavit B tipders1Coniractors/EleciriiciansfP3u:,.bens III
Applicant Information Please Print Le_Srblie
Name(6usincs-/Oreanimdomindblduat):J I.P.George and Son• Ink./Joseph George ill
__athx-ea5:64 Haywood Street _
• '
Cin'/State%Lip:Greenlield/MA/013
301 _ Phone-:(413)-774804
' Are you an employer?Check the appropriate box: Type of project(required):
4 = 0 f am a.general and : 1
1.17 1 a gem la3mr.et
employees{toil and/or part-ime). d- Nem consauctian
x have hina3 the sub-contractors
listed on dna attached sheet_ 7. 0 Remodeling
2.0 r an a sole proprietor or panne:-
ship and have no employees Thew Sub-contractors have S. [] Demolition
.vorlcin for me in any a achy employees and have workers'
gP s 4_ 0 Building addition
[No workers comp.ifsura to comp.insuxance.-
reeuired.J 5- 0 We are a corporation and is 10.0 Electrical repairs or additions
officers have exercised their
;.Li ' am a homeowner doing an Rork I LQ Plumbing repairs or additions
myself. Fo workers' com . right of exemption per MOL Roof ,i
Y P 12.0 repairs
instuancetegtsed.)s c. 152,§I(4),and we have no
eMplo?ax-(No workers'
t3.E�OthuittSu4H@Ott
I_ comp.insurance required.] 1
env applicant thei checks box Ill fust also till out diesection',non-showier their endcr compensation policy information.
a I.lameo'vners tvilo submit this affidavit indicating theyare doing all were and men hitt outside contactors munsubmit n nsr adavit indicating-soh.
:ronlnerars dial dumb this box must attached an additom_t taint ening um name of Om cob-conta0ar9 and srnc whether or not Nose entities have
emmtoves. ifthe sub-conlCnctors iMnte miibycc,titer must provide tat"Ir uftrui roam.policy numb,
I ma an employer tear is providing workers'con;pE11SW0n insu:uacefm•nog employees Below it the policy and job she
!q/h;-ntatiOIL Ilii
Insurance Company Name:Artella II'
Policy 4 or Self-ins.Lit_-:: �r 9 13-9-fir
-
, 1 1 >IC) Expiration Date:4/29/20i6 •tp (p /'�
Soh Site Address / '^ ( . �ro4SS'de Cifcl _ City/Stare/Z7p- 'i0(ea(el NI A/ 006a II
.d.:tact:a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure m secure coveraae as required under Secunn RSA.of MGL ELM M oan lead to the imposinon of u:winal penalties of a
fine up to ShitROO and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up:o 6250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
I oVOStiE8Oon5 of the Dia Thr insurance Covn',e verifcatiun_
J ac inrrebv ce1Yff_i,under the pains and penalties of perjury that the itrj'ormorion provided above t5 true and correct }
S(snatura: +' I 1 4 �..`7YL Date: 6/3d 6 I
3)
phone 4:(4 -774-3604\ UU
IOfficial use only. Do not write in this area,to be complered int do;or fawn official
Ii City or Town: Permit/License-
II 1v-uing Authority Cairo-hi ane): ^—
ng Department i City/':ono Clerk 4.Electrical inspector 3.PIumbing Inspector
I i. Bnzl'e of Keane 3 Suddi De rtimen` '
1 n
I Loner Person: Phone:
:' Massachusetts -Department of public Safety -
..ard of Ending Reguiat ons and
tc, oft
n_-,se. a'SSL-0993721 }a.. Y.
ASEPH P GEOR5E atilt
-4 HAYWOOD STREET
GREENFIELD MA 01301
T oiraiion
Commissioner 0211L2017
_-. ri,,,,,,,,,,,,,,,,,bA c1r./ir,::.,r/..,o.
__. Office of Consumer Affairs&Business Re ulabon License or registration valid for individul use only
==HOME IMPROVEMENT CONTRACTOR before the expiration date_ If found return to:
=Registration: 156685 Type: Office of Consumer Affairs and Business Regulation
—,..=Expinbon: 7/25/2011 Private Corporation 10 Park Plaza-Suite 5170
Boston,MA 02116
GEORGE&SON INC 11
JOSEPH GEORGE \
64 HAYWOOD ST {\:1v \1\ )12/ 1-J tS-vrL-
GREENFIELD,MA 01301
Undersecretary NoYvalid without signature
Permit Authorization
mass save Form 1 4�o.
PAIMOPI
--,te ID: 50191345 Customer: Natalie Basile
1. Natalie Basile •owner of the property located at:
iOw'ner's Name,printed)
327 Brookside Or Florence
(properly Street Address) MeV,
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 andfor weatherization
work on my property. ((z7�� 7l%�
Owner's Signature:D7/;taJj , j�J g&Its
Date:0 5-9 g,
P90ei.00JN9sGv39i99000RR10G94GG4R4P900 ida49BSal 4Gin044049h990G80000 AaO
FOR CSG OFFICE USE ONLY
Conservation Services Group has assigned the following Mass Save Home Energy Services Participating
Contractor to the above referenced project:
•
I '
aiP.1 GEDrge t . 06) friar)/
Participating Contractor Date
Eita
Pot_Were User.Mq
Conservation Services Group • 50 Wauhingmn Street,Suite 3000 • Westborough.MA 01381 • 18004800.7472
Rev.06201S -