29-140 (2) 283 RYAN RD BP-2017-0606
GIS 4: _ COMMONWEALTH OF MASSACHUSETTS
B oete:29-140 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-2017-0606
Project# JS-2017-000963
Est.Cost:$3330.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const,Class: Contractor: License:
Use Group: JOSEPH GEORGE 99372 -
Lot Size(sq.ft.): 24567.84 Owner: EMERSON CHRISTIE D
Zoning: Applicant: JOSEPH GEORGE
AT: 283 RYAN RD
Applicant Address: Phone: Insurance:
64 HAYWOOD ST _ (413) 774-3604 WC
GREEN FI ELDMA01301 ISSUED ON:41/1/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:AIR SEAL ATTIC & BASEMENT, INSTALL 11" OF
CELLULOSE TO EXISTING INSULATION IN ATTIC
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector f 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 11/1/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0606
APPLICANT/CONTACT PERSON JOSEPH GEORGE
ADDRESS/PHONE 64 HAYWOOD ST GREENFIELD (413)774-3604
PROPERTY LOCATION 283 RYAN RD
MAP 29 PARCEL 140 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Sewd #66
Building Permit Filled out
Fee Paid
TvpeofConstruction:_AIR Ste.ATTIC 4 BASEMENT.INSTALL II"OF CELLULOSE TO EXISTING
INSUI,ATION IN ATTIC
New Construction
Non Structural int.rior ren.salons
Addition to Existing
Accessory Structure
Buildinc Pbns°luded:
Owner/Statements r 1 cense 99372
3 sets of Plans/Plot Plan
THE P yE01 OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INfFjn"v-1_C ATION PRESENTED:
Approved u 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
101.0.15
for
Si.. --.i e of Buildi e 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.
Department use only
City of Northampton status at Permit
'-1 Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability„ _
Room 100 WaterlWell Availability
_Y— 13-58North -1240, MFax
01060
13-5 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
°� (� p l This section to be completed by office
1.1 property Address:
_.! ,1 3 nY ti A Map Lot Unit
Ft3rencQ
() MA Zone Overlay District _
0 i "/�/r/ a Elm St.District CB District _
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
!
2.1 Owner of Record: '�— pp pp
CI\ OS\it [[[forst 93 I\�'ON 11a
Name{PdntCurrent Maing Address: Hisgu a-9See PianGIG``l.Ul Tephone
SI mature
22 Authorized Agent:
3oS.g. Gecat 64 HMywooch s3, GreenfleW,[irlp oilot
;tame(Print) _ t Currant Mailing Address:
\. l� ' , 4 `91{ (413)-774' -3Y3Li
Signatum $ Telephone
SECTI N 3-ESTIMATED CONSTRUCTION COSTS
Ilill 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
Millialni construction fmm.(6)
Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection �i
6, Totals/1 +2+3+4+5) 0, rj Check Number 466
( This Section For Official Use Only
Building Permit Number Date -_
Issued:_
__ _ ~—
Signature:
Building Commissioner/Inspector or Bui.Eings —_
Dare
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing E
gr Doors 0
Accessory Bldg. 0 Demolition ❑ New Signs [17] Decks (C Siding IC] Other Rftl]
Iniyx on
Brief Description of Proposed i (��� r•
Work: Psi iv" Alt Ou+dho• uA �I I� of ceib4ly t0 ie)kI NH)jM
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Sit.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 unitNumber 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. s construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes�TNo
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 CONTRACTORpAPPLIESn�rFOR BUILDING PERMIT
Gj1 11\(e E rrC Sot, ,as Owner of the subject
property
hereby authorize TOS€Py &eor..ql
e
to act on my behalf,in all manors relative To work authorized by this building permit application_
See f co'c\e.4\ I 0/a7(/6
signature of Owner Date
4.... close tb cre3T.t _�..... as OwnertAumodzed
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
end belief,
Signed under the pains and penalties of perjury.
Uo°e.ti (sego&
Print Name
\esetani
1 �`M . jo Jaz //6
signature of Owner t nt Date ._
SECTION 8-CONSTRUCTION SERVICES
LI licensed Construction SupervisorNot Applicable C
9T
Name of License Holder: UOSe ft\ Gent*, cs31°1°131 a
f 1 License Number
b9 Hbv o\ sine; Gfetn ttieI MA 01301 a-a- 'aoit
Address Expiration Date
\ ► 1
.s>rc /P ' ' • 413)-7/1113W1
Signature v' Telephone
9.Registered Home Improvement Contractor' Not Applicable ❑
a. P. Gebre fnn4 Son,-Ent. IS 6(336
C4mpanv Name Registration Number
}15111r 11O Slreel f retncte idl MA .01 0} 7—az
-"9.915-
Address
• °15Address )ch_acjirtki) Erpiraion Date
?elephone�1 741236p4
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.t c.152,§25C(5)) 1
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 Ell 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.CMR780, Sixth Edition Section 108.35.1.
Definition of Hncneovnec 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 fano
structures.A person who constructs more than one home in a two-year period shall uol be considered a homeowner.
Such"homeowner'shall submit to the Building Official,on a form acceptable to the Building Official,that he/she}'hall be
re'•o b)• fora so hwork •erforme• un•-rtt• b 'di,._ •e.mit
As acting Construction Superyfsor 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 Amotated,you may be Kahl*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
s` Massachusetts
t . �(IP: DEPARTMENT OF buriDING INSPECTIONS r, '‘.;t71,5.�s ^J
212 Main Street a Municipal Building , ..,�
j ��(( p Northampton, !A 01060 n/� /�. t,,j/,
Property Address: (7 S3 1`ya`h 5Zd, loreAcel NIA , a(o"a'
Contractor t-
Name: / 3oS8ph GeorrSC J3,P, Geo�Q 4„.r}. Son aRt.
Address: 6t 4H' ovywoodi &tne% .
City, State: Greensieldt, MA 01301 �-
Phone: ('t13)-774^ 36o4
Property Owner
Name: act Address: Bt � g' Md
City, State: fi,,t_lsey AAA i o(J6a J_ _
i, 3ose (TP.orrf (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 \ II i 1l t, J
Date 1 °1X7ii1_
The Commonwealth of Massachusetts R'inf Folin f
Deparbnent ofzndtstial Accidents
--- Office of investigations
1 Congress Street,Suite 100 !'
Boston,IWA 03714-2O1
- mww;nass-govldia •I
Workers' Compensation Insurance Affidavit: Builders/Contractors(E1ectriciaas(P(:smbers :i
_olio:ntInformationPlease hintLegiblyII
(Same(Business!Oreanitario:uindividual)]J.P. George and Son. Inc./Joseph George Er
_ddress:dad Haywood Street 1
CityiState2ip:Greenfleiti/MAi01301 Phone# (413)-774-2604
Are you an employer?Check the appropriate hoz, Type of project(required):
(✓I t am a employer wth- _ _ 4. ❑ i am a general contractor and
general
t2 ❑Neweons-Unction
gull andtor pars time}.a have hired the subconactors
7.0 I am tante proprietor or partner-
Theseon the attached sheet ]. Remodeling 11
These sub-contractors have
ship and have no employees S. Q Demolition 'i
8p
employees and have workers' 4. [3 Building addition i+
working for me in any capacity. 3
[No workers`comp.Insurance comp. insurances
- II
required] S- ❑I We are a corporation and its 10.[]Electrical repairs or additions' ',
3.Li `em a homed.ner dolor all workofficers have exercised their l t-[] Plumbing repair or additions .j
myself, workers' richt ofax_mpiion per MGL I
Y [Nop- f 12.0 Roof repairs !,I
insurance required.] c. 15S§1(S),and we have no
q )> employees.No workers` 13.Q Gum-Insulation !!.
comp. insurance required) — U
'1e amilica;n rI r cbecia box iii must also till aurrim section Sults showinn SSs vorscompensation poli,'information
om,mmersnim snbmil this affidavit indieming they ere doing an work and then hire outside conwanoxs mastsubmit a nss:Mdsit lndtaiintsuoh.
teas! t b Sack SU box mus:spoiled iled an additional a :t showing,am name of Inc 30brnmc
-cotnrs and stale whci er orno t0Se enc hies!lave
employees. lithe subconvaaars Svc crnpiocecv,time mum provide their makes'comp.policy mmmbcrii
-
ii
I am mi employer foot is providing workers'km0E1150001,fnulium ee for am employees- Below is the policy and job she
iaiinbnation.
Insurance Company Name.,Aiwa L i �,��7�}Tt� _
Poliy or Self-ins.Liie.p=: i9f Iao0V- i " l I_3_ Expiration DatedE29!20i7 ._...^,f/,_ i� r
rob Site Address: (7-83 Rin Rd _ City/Stara/Zip: flomIcel ?v IP i Ot:•)W.
.Attach a copy of the worriers' compensation pulley declaration page Dim-wing the policy number and expiration date).
Failure to secure coverage as required under Section 29A of MOL c 152 can iced to the imposition of criminal penalties of a
rine up to 51,500.00 andfor one-year imprisonment:as well as civil penalties in the form ofa STOP WORK ORDER and a fine
of up to 5250,00 a dayagainst the violator_ Be advisedibat a copy of this statement may be fnnvarded to the Office of I'
Investigations of the DIA for insurance cova.-ge verifindnn.
ata hereby certify under the
painsQunit penalties j peckay mat:he information provided above is true and corral.
•
s Pinata!e '1fJ'^'y Vt%. Date-.._._ i�l"Z�I I
Phone g.;(413]-774-3604 L
11
iii
Official ase oiib- Ao nu:unite in this arra,to be completed he ef0;or to,vn officiaL
il
C'.tv or Town:
PermitLteense it
llIssuing Authority(circle one):
ii 1. Board of Health 2'3cilding Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing lnsn for
5.Other
l' ' Oi!iBCi Pe; snn: _ Phone :
Massachusetts -Department of Public Safety
..
RoamJt 3L•.:G:^�^y YCy::l.^.tiC^.5 ononC St�:a^3i.:'..'a
lippuilitiJri tiIcCi.lit'
_.cense CSSL-099372 'kj4
JOSEMP GROR E a
64 HAYWOOD STREET
GREENFIELD MA 01301
CommIsslor.er
02111=7
->L,- i4,m,.r..,o.rrd/l.7 /foi;rer!,,,dG
Office of Consumer Affairs&Busiotss Regulation License or registration valid for individul use only
'.HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
yp `Registration: 155509 Type: Office of Consumer Affairs and Business Regulation
/ma Expiration: 7/25/2017 Pnvale Corporation 10 Park Plaza-Suitt 5170
Boston,MA 02116
JP GEORGE&SON INC
JOSEPH GEORGOODSI LLr",9 ;L
64 HAYWOOp SI' V J Jy
GREENFIELD, MA 01301 - — ------—
Undersecretary N valid without signature
n
RISE wamx+I334-50244135
wantateenghwertigaren
Elfider.cf Ene:p¢?.
OWNER AUTHORIZATION FORM
C rr; £tAp igyCl
-
(Ownele Name)
owner of the property tested at
�IS Cyt° .
I
nw - cL
herebyartnorae Q, Vf>fn Gr Son lnc.
(Subcontracted
an authorized subcudracter for RISE Engineering,to act on my behalf to obtain a building
permit and b perbm work on my property.This form Is only valid with a signed contract
�wfa SIWrWra
Date ��