30B-110 90 MILTON ST BP-2017-0070
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block:30B- 110 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGLLcc.1144/2�A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-0070
Project ti JS-2017-000129
Est.Cost:$2615.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOSEPH GEORGE 99372
Lot Size(sq. ft.): 10018.80 Owner: GORDON BRIAN K
Zoning: URB(100)/ Applicant: JOSEPH GEORGE
AT: 90 MILTON ST
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774-3604 WC
GREEN FI ELDMA01301 ISSUED ON7/21/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL ATTIC & 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:
FeeType: Date Paid: Amount:
Building 7/21/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File/I BP-2017-0070
APPLICANT/CONTACT PERSON JOSEPH GEORGE
ADDRESS/PHONE 64 HAYWOOD ST GREENFIELD01301 (413)774-3604
PROPERTY LOCATION 90 MILTON ST
MAP 30B PARCEL 110 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT ,�/�
Fee Paid 727& 7Y
Building Permit Filled out
Fee Paid
T .eofC.nstruction: INS ALL ATTIC&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
INFO ATION PRESENTED:
.4 pproved 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
Demalit . Delads
y��
Signature of Building Official 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.
�'j_—T'm,y :- . Department use only
Ci of Northampton Status of Permit
201 .0
16 uil Ing Department
Curb Cut/DrivewayPetmd_,_„
2 MainStreet
Room 100
Sewer/Septic Availability
,n„e waterPNaitAvaiMdbiiky
o ;' pton, MA 01060 Two Sets of Stmctural Plans
phone 413-557-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPUCATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Pr4Aerty Address: G/� ((}Nil, c2A J1 MapLot _Unit
Zone Overlay District
_ Elm st.District _ Ca District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record- u
Br{un Gordy MO ltiii-oo M .
Name(print) Current
f, - GLCurrentent Mailing Address: 0ii) 5,3 o - /y0 7
See. PM al(APeU\ Telephone U
Signature
2.2 Authorized Agent:
3-osep• (ieortt 69 itmy ..o0d' St G-ctenf'sfldl[w9 ailc3
Name(Flint) Current Mailing Address:
`AlR - :- A cYt. (%4-71i#-36at1(
Signattire _ Tdephnna
SECTION 3-E.STIMCONSTRUCTION COSTS ATED
Hem Fslimated Cost(Dollars)to be Ofgliai UseI
Wed co . Jte+db .-rmit at..icant TJnly
1. 0uilding 1 0 5 0 0 (a)Building Permit Fee
2- Electrical
(b)Estimated Total Cost of
Construction from 6
3. Plumbing Balding Permit Fee
4. Mechanical(HVAC) 111 1
5. Fire protection
6. Total=(1+2+3+4+5) f t rfOa
Check Number 7274 > CS j
This Section For Official Use Onl
Building Permit Number: Date
Issued:
--
signature:
` 6uilwng Commissioner/bopaGmr of geldings I
.�.. „ Dem
1
•
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Ft Roofing n
1 Or Doors C
Accessory Bldg. ❑ Demolition ❑ New Signs j0] Decks (1] Siding[0I _Other[�
TARA). on
Brief DescriptionA�pp%Proposed /f ai(, (M fi� Q d I lte 04 (ellhJe t gXhti.
Work: /lir Seq( /IT BoWImo' /J I In J u o
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 folibwinq:
a Use of building:One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
a 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 I
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
I r P� wfP� ,as Owner of the subject
property ` !�y rt
hereby authorize 5tS€Q &eor;le
to ad on my behalf,in all matters relative b work authorized by this building pe - application.
f e
Ice tc\e$ /I7a/!l
Signature of Owner Date
I, 3ose,ti ...NE, ,as OwnerlAuthorized
Agent hereby declare that the statements and information on the foregoing application are true and aunt al%to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
00S• .ti C cat I
Print Name 0 A , '� 7/11/16
Signature of Owner 4 Date 1
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Suupervisor: pNot Applicable ❑
Name of License Holder__ 3o5e.P1\ Ue01-Ct , C511 016111
License Number
b°l H01011e000 Sate,\ (Treerft4e, Mol 01301 ti-3Q11
Ptldmss \ /P a Expiration Date
lt 1 /1/11(1(p(p(Q�� �4i3)-779-1601i
Signature l Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
S. Q. Genrgt rAAdk Son, 2nr, 156656
Company Name Registration Number
y
�
64 i`w`IwODd\ Street (rreenf\eiel MR \ 7-75 =ao11
Address \ 1 Expiration Date
'vm 0 ' _ Telephone;1.77r-36�
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(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 acts
as supervisor-CMR 780. Sixth Edition Section 10835.1.
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 ceosidered 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 percents)
you hire ro perronu mark 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
The Commonwealth aj`M-asstrckuseits
L RindFonf
"�. Deparbnanf ofiminsir'ial Accidents
Office of invesrigaiions
I Congress-Street,Suite 100
3nsro7, — 02114-2017 •
wlpt.mass.govidia
Workers' Compersatioii.insurai-ce Aft-davit:t: B•udders/Contractors/Electriciarislt IlmberS
�(easrt information
?Iease Priet Legibly
Name(13usineslOreanizxuovindividuall IR George and Son, Inc./Joseph George „4
_ddrdsmeM Haywood Street ^.
Chv(StStelZip:e nfieid/MA/01301 Phone#:(4'13)-774-3604 �_
r.
Are you an employer?Check the appropriate ham Type of project(regtdred):
I� i am a emtoyer p ith q =- El am a general coon-actor and I
ib. [1 New construction 1
i employees(full and/or pan-ame).k have hired the sub-contactor,
listed on the aiYached sheet. 7. [7 Remodeling
2.0 I am a sate proprietor or partner-
shin and have no employees These sub-contracmrs have S. 0 Demolition
working for me in any ca actin'. employees and have workers'
p - 9. 0 Building addition
[,tip workers' Cpm[!.Insurance WeComo.insurance.‘
equired j 5. 0 We area corporation and its 10.0 Lleehieal repairs or additions
3.Li ' am a homeownerdoing all Work officers have exercised their ILO Plumbing.rpair or additions
right of exemption per MOL
myself. [No workers' comp. • 12,0 Roof repair
C.. i3-$t(4),and we have no
insurance requited.]` 1321 Otherlflstllailofi
employees.No workers]
comp.insurance required.]
sAils anlicnt That checks bas 21 must Pisa lin oat Uu sermon uNowsirov:iiu their wont:comomsaion policy infbnnaiion.
alnrnzownen who submit cis affidavit inUicatins they are doing all‘von:and men hire outside mammon mustsnbmiv a new ufirdatrio indicating sutii.
:caJ IrxcPR pmt the l this boa must auadied an additional Cpm shod..-we name otitic sun-cpntmemrs MO mac Mstlty or pet Lime entities have
enlpiaeets. trills Nit-cpnVagnR have uaployRF tipy most Pm:•itit tFer wa2xr'ramp_policy numuei
—t am an employer that is providing workers'compensation insurance rep errIaloyeest Below is Mepolicy andJob Site
mf0nnatiOli.
Insurance Company Nalne;Arbella
Policy-or Self-ins.Liiee.. �M jyz..i-�(1110 1 e 1 1J _ Expiration Dace:3/�/2146 _ (�
;n6 Site Address: vt t"Il lOh Jt City/Sia:e/Gip: �D ItGrIr/�'�gl Mil /31060 fi
tacit s copy of the workers'compensation policy declaration page(showing the policy number and ex, Wotan date}
Failure to secure covmras..re as required under Section 25A of MGL e, 152 can lead eo the imposition Diu;wino!penalties of a tl1['I
fine up to S1,500A0 and/or one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER_and a fine
of up E0 S250.00 a day against the violator. Be advised that a copy of this statement may he forwarder(to the Office of j
Invest; aro/ oftheDSA :filc insurance ..narace nannaan=.,-
I to hereby certify ander the paths van p diles 1 parfait that rhe i furrnarion provider(above is tnfe Alin correct,
4 is
r-_,uur : pate:
;I:ane _.413)-774360,. ..
i Official use only. Do not woe in this area,to be roomier-ad br dry or town anklet
•
II City or Town: Permit/License# '
•1 issuing Authority
I_ rd
(circle ane):
11 Bouof Health 2-Building Depot uuent 3.Ctrtflinvn Clerk Eleccnrei inspector i.Plumbing Inspector
J S. Other
I `Lani2CL 'B13011: Phoneth
City of Northampton
3 Massachusetts t ' 't
{Y;} DEPARTMENT OP BUILDING INSPECTIONS
:pr./ 212 Hain Street • Manicipal Building
Northampton, MA 01060•
Property Address: go milt,„ 3k
Contractor
Name: JoSepl (reoco /J,P• Geon 4 SQn,
Address: ft Hmywooq Street
City, State: Greer4;e1th, mix O1301
Phone: et)3)-77,1- 3G04
Property Owner BrionGader
Name: /,,� }WI
Address: °1D Ayton lton Si.
City, State: NDrU‘NM I10D. NIA OJQ613
3oSeet\ Mor 2 (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 \ -A 14 (\tap
Date 77/3 I
RISE60 Shawmut Road, Unit 2 I Canton,MA 02021 1330-6024335
ENGINEERING www.RlSEengineoring.com
OWNER AUTHORIZATION FORM
( ers Name)
owner of the property located at
% iii, 1 Wk. 5I
(Property Address) (�/�,p- /�
(Property Address) { ' `11 6 ' V loC)
hereby authorize DT'` ' GC)IE (NIA Son; DX- ,
(Subcontractor)
an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building Mpg serD
permit and to perform work on my property. This font is only valid with a signed ,�
e/a ,i
Owners Sign re f
k >° — '.V