24A-067 (4) 61 RIDGEWOOD TER BP-2017-0502
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:24A-067 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Campers: INSULATION BUILDING PERMIT
Permit# BP-2017-0502
Projects JS-2017-000824
Est. Cost: $4527.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOSEPH GEORGE 99372
Lot Size(sn. It.): 8363.52 Owner: WOOD JASHUA
Zoning: URB(100)/ Applicant: JOSEPH GEORGE
AT: 61 RIDGEWOOD TER
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774-3604 WC
GREE NFI ELDMA01301 ISSUED ON:10/17/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:AIR SEALING BASEMENT, WEATHERSTRIP EXT
DOORS, DENSEPACK EXT WALLS WITH CELLULOSE
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/4 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 10/17/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240. Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0502
APPLICANT/CONTACT PERSON JOSEPH GEORGE
ADDRESS/PHONE 64 HAYWOOD ST GREENFIELD (413)774-3604
PROPERTY LOCATION 61 RIDGEWOOD TER
MAP 24A PARCEL 067 001 ZONE URB(100)(
MIS SECTION FOR OFFICIAL USF ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILI;£D OUT
Fee Paid 'I,�r`06
Building Permit filled out
Fee Paid
Tvneof Construction: AIR SEA. NG B• : MEET. WEATHERSTRIP EXT DOORS.DENSEPACK EXT
WALLS WITH CELLULOSE
New construction
Non StructuraaJnterior renovations
Addition to Existing
Accessory StruVRae
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
INFORMATION 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
lay
nature 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.
7
pry�,� Department use only
\r1� City of Northampton Permit:
�c\ i Building Department curbII
sratus s of of veway Permit
/ 212 Main Street Sewer/Septic Availability
//- Room 100 Water/Well Availability
gyRd`e Northampton; MA 01060 Two Sets of structural Plans_„
phone 413-587-1240 fax 413-587-1272 Piot/Site Plansi_•
Other Specify,
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION I
1.1 Property Address: z n �1 't' This section to be completed by office
CJt�I' I�INOeV�r+}M� 1�.rr&' e
Map _ Lot ,_—Unit_
Nohko vi-6A, MA Zone Overlay District
010 6 0 Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
)o4uin woos) 61 gi(i)ewmal Terra(e
' Name(Print)
PASS
Current Mailing Address: c7),1 _'t N7- pr,t.1
See, pM@c 2'�} Telephone r ) l P f-'Di
Signature
2.2 Authorized Agent:
YOsep , (seaTmt _ 69 Haywood S}, Green{TW,MA °131:3‘
Name(Pent) 11, Current Mailing Address:
N. :�. 4,4 ' ` IU - (1-113)-77't -36a't
Signature f Telephone
SECTION 3-ESTIMATED CONSTRUCTIQN COSTS
Item Estimated Cost(Dollars)to be Official Use Onfy
completed by permit applicant _
1_ Building Ly 5.17,4o (a)Building Permit Fee
2- Electrical (b)Estimated Total Cost of
ConStwetion from-(S)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Are PrOteC(ron pp n� r 66—
"y
,apt
6. Total=(1+2+3+4+5) y,5n. 00 I Check Number OO7
This Section For Official Use Only
Building Permit Number: Date
"""' Issued:
Signature:
Building Commissioner/Inspector of Buildings
Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition ❑ Replacement Windows Alteration(s) n Roofing D
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [CO Decks [p Siding[p] Other[IX
Sn.]IAMIN.
Brief Descdpuon of Prpp osetl
Work: fill' Seel PrTti,, t pip PtN \i‘r"Nill{p -GO. G'IXNJ. _Cen)epiAcK ek' Wull] wit)
(eIhsIue
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ga.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 It 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
i
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
vJO\j1UU wood
` t�,. ,as Owner of the subject
property
hereby authorize $Olepk ore
to act on my behalf, in all matters relative o work authorized by this building permit application_
p\
Ste `N6,el Iok7/16
Signature of Owner
p Date
li 3OSeph GQnrI3 . ,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.
JoSeph GeoPat
Print Name
" I. 1,kgli,T4 .
10/0 7/J6
Signature of Owner/Age ii Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: (�'rr���� ,,gy,�pp Not Applicable 0
I Name of License Holder: aoSePh Geo rcit
eg31 q�131 a
License Number
( Hthyv�d 3treei ket4(tt t, 01301 a-11-.a0i7
Address Expiration nate
R. N3)174-3W
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
S f• &forte &4 Son, 2rlt, IS 6686
Company Name Registration Number
64 k 'iw nd\ Skref\ free,flele, MA olio 7-73 -2,017
Address \ '♦l ,' ` /( , 'l ii ( Expiration Date
fl"flil//J/''la Telephoned))-77(-36°4
-
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a 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 El No 0
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellinus 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 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 heishe 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
City of Northampton
.a
IT t .7 i' Massachusetts =,
Si tit iti;Iii
it iiIi Tyiti II
i DEPARIZENT OF BASbDZNS INSPECTIONSis °
` 212 Main Street 0 Municipal Building t
Northampton, MA 01060 „�i `:,.--�
Property Address: 61 f nd)ewooi iCTtucf NO' ttSUNi on, ivA , 01060
Contractor
Name: _..._ U0SeQ /t &gory, 1 a,q. G2orgg 4 SON, lttt
pp ._
Address: U'� HrIwooa Streei
City, State: Greenb(eid,, Mp 0130
Phone: ( 131-77tt- 3601
Property Owner ee
Name: q tit&n WOO)
Address: 6) gbAeyim) Terri-Kt
City, State: i\JOPtiVAPIFhh, MA . i 010 be)
I,, Joseph Rawl Q (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 \ , I ' m
C AA./
Date 1° i07/1
...
II
Print Form
• The Commonwealth of.Messaclzuseitt
_ Department of Industrial_Accidents i
Office of investigations
1 Congress Street,Suite 100 ,I
Bostpse, 444 02114-2017 - l!
www.inass.g0v/a a Ili
Workers' Compensation insurance sartfidavit BuCders/C-ontractors/Eleciriciausf.??iumbers it
Aaoiieent Information - Please print Legible
Name(Busines/Orzanim[ioMndividuall:J-E- George and Son• Inc.I Joseph GeUrye
ii
_ddreas:8e Haywood Street
Cit'/State/Zip:Greenfield/MA/01301 phone-:(413)-7743604
Are you an employer? Check the appropriate boxType of project(required):
i,117 i am a employer with 4 ' 7 I am a general contactor and! S- 0 New consn'aeviar.
employees Gill and/orparntime).* have hired the sub-contactors
2.0 I am x sole proprietor or partner-
I!on the attached sheet. i. 0 Rcmodeline II
ship and have no employees hsa sub-contractors have S. 0 Demolition
!
working forma in any capacity, employees and have workers' II
oma.insurance' '3- ❑Building addition
(NU%vori ers'camp.insurance
reeuired.j 5- 0 We area corporation sod iw 100 Electrical repairs or additions
I-I3. ' am a homeowner doing all won( othc i-s have exercised[heir
:J I I_❑ Plumbing repairs or additions
myself oworlazs'am right of exemption per VIOL III
[� p- 12.0 Roof repairs
iesumnCc requseti}" c. 152,61(-i,and ca have no II
employees.[Not',rottera= 1?.�CltharEns[ilaiiOn q
comp.insurance required.]
?.ny applicant dua checks box St!mustalso till our dor section belov.uho.:in_Amir worker compensation policy information.
`iaomcmthers who submit this anidarit indicating they are doing all WOR and then him outside contractors mustsubmh n rr_.,affidavit.indkcrtine-such.
•outmc3-s the;dwth this box must attached an additional sage shoa'ino the name or the NPwntmcip6 and$me whether or not ibose whirs have
amplowes.5r=.be suleccaniarkors haw employers limy mus provide;hair mike&mon mew wringer,
I ane an employer that is providing workers'compensation fosurmmeG Pror; 'employees. Below i5 the policy andjob site
liformalion.
Insurance Company Name:Arbella L j
Policy 4 or Self-ins.Lie.:sr p(9 13-96 `-r9 IC) Expiration Dare:4129/2017 �/tnn /� .
.lob Site Address: oI Rid)9 vvoG,4 1err ce Ciiv/State/Zipr_IVOrf/nl''nfkO't lelif 'OPo 60
.act.a cony of the workers' compensation policy declaration page(showing the policy number and expiration dare). i
Failure to secure coverage as required under gentian 25A ofMGL c 152 gen lead to the imposition or criminal penalties of a
fine up to S1,500.00 and/or one-year imprisonment:as well as civil penalties in the Form ofa STOP WORK ORDER and a fine 'I
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be fnvarded to the Office of
Investigations of the DIA Mr insurance coverage..erraoaamn_
I do herenv certify under the pains and
,► p nal les J perjary that the it fannatian provided above is true(inti Cortin
1 l
s7: et e: �..... - l Deter 10/07//6
I
prone T3)-774-360o,
II Official use only. Do not write in this urea,so be completed by dal,or mien official.
II
City or Town: ,Permit/License=
'sing Harbin-in-(circle one):
Iii _ w. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
5.Otne:
i
1 `uOlfCt.; I'Sdnl: ?hones
to dassachusetts -Department of Public Safety
4'j
':Oa:C of tl4iiC:^y RCgWa.:C.^.5 '0..d Jmnvm ar i
_,ru.L u61ou Super ti+nr Sj.uci.iia ��
-.cense: CSSL-099372 {a_.�„
JOSEPH P GEORR'E a.
64 HAYWOOD STREET _ '..
GREENFIELD DFA 01301
`5�. Expi,'aticn
Commissioner
02/11/2017
Office of Consumer.4t1'sirs&Basi ess Regulation / License or registration valid for individul use only
NOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
'Ig Registration: 156686 Type: Office of Consumer Affairs and Business Regulation
:Expiration: 7/2512017 Private Corporation ID Park Plaza-Suite 5170
JP GEORGE 8,SON INC Boston,MA 02116
JOSEPH GEORGE
CT')
\ /�
64 HAYWOOD ST � _ (\may�[JL P\l` ICJ` ��u_ jV -
GREENFIELO,MA 01301 ! I _"l nat 'I
Undersecretary N valid without signature
RISE - NIA 020711330-5024336
ENGINEERING ewesttrawainewlegeani
Mdcr.a.^.e: '.
OWNER AUTHORIZATION FORM
1, -- ]ar5S) — ()3000)
(Owner's Name)
owner of the property located at
b [ Ste" �-xc cat ,
' . ; '` " ._..,1 mit,- o LOQ
hereby aubnodze .
(
an authorized subcontractor for RISE Engineering,b act on my behalf to obtain a building
permit and to perform sort on my musty.This is only valid with a'toed contract.
......44
Owner's Signature
55- l - 14-,
Date