24A-046 113 BARRETT ST BP-2017-0724
GIS a: COMMONWEALTH OF MASSACHUSETTS
flk:ock:24A-046 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-2017-0724
Project# JS-2017-001195
Est.Cost: $5770.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Sonst CI�54. Contractor: License:
Use Group_ JOSEPH GEORGE 99372
Lot Size(sq. ft.): 27225.00 Owner: GUYETTE BRUCE H& LAURA B
Zomn : RB(1001 Applicant: JOSEPH GEORGE
AT: 113 BARRETT ST
Applicant Address: Phone: Insurance:
64 FIAYWOOD ST (413)774-3604 WC
GREENFIELDMA01301 ISSUED ON:II/29/2016 0:00:00
TO PERFORM THE FOLLOWING WORK AIR SEAL ATTIC & BASEMENT, ADD 8" OF
EXISTING INSULATION IN ATTIC
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 11/29/20160:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587.1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0724
APPLICANT/CONTACT PERSON JOSEPH GEORGE
ADDRESS/PHONE 64 HAYWOOD ST GREENFIELD (413)774-3604
PROPERTY LOCATION 113 BARRETT ST
MAP24A PARCEL 046 001 ZONE URB{l00)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
LOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee
Fee Paid ('7
Building eermit tilled out
Fee Paid
TyoeofConstruc on: AIR SEAL ATTIC&BASEMEN ADD S O EX . PING INSULATION IN ATTIC
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
INFOV4ATION PRESENTED:
_ pproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:g
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
Demolition Del.
Si. . ure o tuildmg Ilhircial 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 MGI.,40A. Contact Office of
Planning&Development for more information.
l-
T, Department use only
City of Northampton Status of Permit:
N `-% Building Department Curb Gut/Driveway Permit_„
212 Main Street SewerlSeptic Availability
j . Room 100 Water/Well Availability .,
Northampton, MA 01060 Two Sets of Structure)Plans
`ti )-- phone 413-587-1240 Fax 413-587-1272 Plot/Site Plansu-_,_
/� Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
1 SECTION 1 -SITE INFORMATION
1.1 Property Address: 413 Oddi S\ I This section to be completed by office
�A Map Lotunit
NOt� 4n10❑p 8r ntA Zone Overlay District
y^
_ "`"J V Elm St.District CB District _...
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT I _-
2.1 Owner of Recent:
Bruce 61Ayekg — 113 13wre% b},
Name(Print) (�)} \ r� Current Mailing Address:� n) .. s - 03K
See, A\ l3Llle"* Telephone ``1I )) Jo0 V`a
Signature _
12.2 Authorized Agent:
3-osepl, CTe4T&t 69 Hrnyi+ood\ s3, Crreeni(clad A ()not
--
Name(Print Current Mating Address:
i1. t c 2 -3t'1. (413)-779 -36ck
Signature ti
Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Nem Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Budding (a)Budding Permit Fee
2. Electrical
(b) TotalCost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
S. Total=(1 +2+3+4+5) {7'1 71I ,on Check Number 4,17'7.9 14
This Section For Official Use Only
Building Permit Number: Date
-- Issued:
signature:
Building Cammissoner@specter of Buildings
Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Ej Addition ❑ Replacement Windows Alteration(s) n Roofing C
Or Doors O
Accessory Bldg. 0 Demolition U New Signs 101 Decks ICI Siding t1] Other[I*
trim Uttar)
Brief Description of Proposed A,l L p_��,� : All pt• _„yk,l t L, tla� iliSulo6On in
Work: r ��1 ()omens
AAA D W 7 IV '
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 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Wll building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private welt City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 131-ute G' eA\t
property t (�,. as Owner of the subject
hereby authorize 30se p4. &for%
to act on my behalf,in alljmatters relative o work authorized by this building permit applicati{jrl,
Sce Q o4Pj\ II 5/16
Signature of Owner Date
3osep' George
as best o my knowlezed
dge
hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my
and belief.
Signed under the pains and penalties of perjury.
OOSep1, George.
Print Name
Signatureaf Owner/ACM-St Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:TtGG�st (Rome
Not Applicable El
Name of License Holder: Uoseph CSS) q I) 1�
license Number
19 Haywood, Scree; 111-efn{(tiat MPL 01301 a-a- aoit
Address Expiration Date
\ ItRqPit (413)-774-3b°4
signature \ Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
s. f. (leant 0. 4A Son, TM 156686
Company Name Registration Number
64 iiuYwnA it S+ref\ fn$eldl AN okIol 7- -2.01
Address qui
7` t1 L Expiration Date
�• Telephone(91SJ-77f-360M
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 0
11. -Home Owner Exemption
The current exemption for"homed ners'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 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
City of Northampton
y*
Massachusetts �
0 l�l�[F_ A �[ 'I
DEPARTMENT •
212Ma OF HDLLDING INSPECTIOPScaf_
212 Main Street • Municipal Building
Northampton, MA 01060 <� y,j:t
Property Address: II3 *Arrelt S},
Contractor
Name: Joseph (reor5C /J.P, Leone cMd $,oh, ant.
Address: b't Ho" wont, $tr€ft
City, State: Green4,eW, MA 01301
Phone: (-C-77q- 304
Property Owner
Name: Brt4te- Gtnyekte
u y�
Address: !!rr (I3 j3cnrre}\ S}.
City, State: Iiorfi1`afnPfoh, MA
I, Joseph (reorrQ (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 oofftthiss affidavit
Contractor signature p\) it\�\� ) �p/ m�
Date 11 J(°('6 Y`� \Qy`
i
The Commonwealth of Massachusetts R151t Form1
il
•_ Department-of industrial Accidents
Office of Investigations I
1 Congress Street,Suite 100 lI
SOSiOit,M 03114-2 0 7 7 ii
:now.mobs-govJdin �?
Workers' Cotszpensat on insurance Affidavit: Builders(ContractorstElectriciauslpla-anthers I
3»':?cant Enior apo,. tett. lease Print ,edihh
J.P. George and Son, Inc./Joseph George ,,
Name(Baslw:s5(Orgam>a'io>vIn -i6�})_ 9 9
+ddress:64 Haywood Street II
t
i
l:i r/Sra2C/L1p 6leenflald/MA10130i Phone 19-0(473)-774-36040a „_ '.,
i Are you an employer?Check the appropriate box: Type of project(required): iii
i.✓3 i am a employer q§rh 4 4. L I am a general contactor and I l
etnployees(iu41 aodior par-time).• have hired the sub-contractors
6. 0 New construction
'- Ism a sole proprietor or partner-
Thi dub-contractors fisted on the attached sheet 7. 0 Remodeltne
11
have ,
ship and have no employees - S. 0 Demolition
working for me in any capacipc employees and have workers'
Como.insurance.= 9. 0 Building addition
[ 0 workers'Comp,Insurance _
required.' 3. 0 We area corporation end is 10.0 Electrical repairs or additions
�I
officers have exercised their
3.:__H-1 ! am a homeowner doing all work11.0 Plumbing repairs or additions
myself. [No workers'Com right of es:envotion per MOL 2I
Y p- I_.0 Roof repairs
insurance required.)t G 52, I(4').and have ave no
employees.[.4o workers' 13.0✓ Od,erinSniaHnn
coma insurance required.] )
onphcanr hal checks bnx.'I must also till out at Section heta•'simhrin_tiernrofxts compvmsatan policy information5
�9nmmoners who submit this amUaeil indica/lad they are dolma all nark and then hit:outside conmmrs affidavit omostsubmit a naw davit iodic:nine own
:Cowen-arshat Omsk tins box mus:attached an addiaonei shu[sho"mc w_name of ilia sub-contractors and state whether Oros these makes have aemployees. !f die sub-contractors have ernployces,they Must provide Their nil d'e¢"wind policy number j
lam an emplover that is providing workers'commensal-ion JOsain):C2frr ntjl employees. Be/mw is the policy aid job Site
fit/biathlon.
rthlon. u
1
insurance Company Name:Arbeh2 _ __ q
Policy Et or Sel;ins.Lice.4: 9 1C7-'-r 0 1 1 Expiration base:`"- i'
9'20 /�}
ii
Joh Site Address: 113Bowie\t A- Ciy)State/Gip: 1\11144k,rn�°a/ MA / OO
nch a cony of the workers' compensation policydotharation page(showing the polity number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition ofcnminal penalties of a
foe up to 31E00.00 and/or one-year imprisomnenC as well as civil pantiles in the form ofa STOP WORK ORDER and a tine F,
of up to 5250.00 e day against the violator. Be advised that a copy of this statement may be forwarded to the Once of
Investigations of the DIA for insurance coverage vmPrrinatZon. •
I do hereby cosily under the pains and penalties ofperjury that the information provider!above lS tore aid correct
?=nature: —.... '[ ��C. i ft • 'Date: ('/�'"J 4
2scne 4:(413)-774-3604
_tett.
li I
Official use only: Do not write in this arse,to be completed by rill:or town ofcial-
li 11 City or Town: Permit/License`
'Issuing Authority(circle one):
I. Board of Health Z.Building Department 3.City/Town Clerk 4.Electrical inspector S.Plumbing Inspector
o.C:-aher�
I
II Contact Person: Phone::__
!
I
t Massachusetts -Department of Public Safety ',
=Massachusetts
of Betiding _ tions anc Sianaaras
r
arm 931 .--.
,sense CSSL-090372
JOSEPH P GEORSs'EC�
64 HAYWOOD STREET
GREENFIELD IvfA 01301
Ja_ _t� a =.Cita:iCn
Commissioner 02111/2017
/,C t(/i)".,,.rr,/7/ /^/G,ar..u4,,. ,,
Office of ConsumerAffairs&Business Regulation License or registration valid for individul use only
—HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration 156686 Type: Office of Consumer Affairs and Business Regulation
Expiration: 7/25/2017 Private Corporation 10 Park Plaza-Suite 5170
JP GEORGE 8 SON INC Boston,MA 02116
JOSEPH GEORGE
64 HAYWOOD ST
�� 2`14 \PL.
GREENFIELD,MA 01301 4o4.5 —
Undersecretary N valid without signature
RIS60 Shawmut Road, Unit 2 I Canton,MA 02021 i 339-5024335
ENGINEERING- www.RlSEengineering.com
OWNER AUTHORIZATION FORM
I, "l,) W &"tr&7
(Owners Name)
owner of the property located at:
// 13R ai s p
(Property Address)
NOA1Efi9T"> i
U Address)
/IA . r660
(Property
hereby authorize L c. front 04 Sn n I 1(1C.
(Subcontractor)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property. This form is only valid with a signed contract.
Ther Permit will be secured by the insulation contractor, at no additional cost. It is the homeowner's
responsibility to close out this permit by contacting their municipality at the completion of this work.
„„de
?s Signature O'
10(2-A/f6e. G V
Date
6_2416