16D-021 147 NORTH MAIN ST BP-2017-0968
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 16D-021 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-2017-0968
Project ft JS-2017-001671
Est.Cost: $3285.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOSEPH GEORGE 99372
Lot Size(sq.ft.): 24262.92 Owner: BLAIR DANIEL E&DEBRA A
Zoning: URB(100)/ Applicant: JOSEPH GEORGE
AT: 147 NORTH MAIN ST
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774-3604 WC
GREENFI ELDMA01301 ISSUED ON::2/24/2017 0:00:00
TO PERFORM THE FOLLOWING WORK AIR SEAL ATTIC AND BASEMENT ADD 10" OF
CELLULOSE TO 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 ti 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 2/24/2017 0:00:00 $65.00
212 Main Street. Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File 0 BP-2017-0968
APPLICANT/CONTACT PERSON JOSEPH GEORGE
ADDRESS/PHONE 64 HAYWOOD ST GREENFIELD (413)7743604
PROPERTY LOCATION 147 NORTH MAN ST
MAP I6D PARCEL 021 001 ZONE URB(I00)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Pail}
TypedConstruction: AIR SEAL,ATTIC AND HAS ' ADD 10"OF CELLULOSE TO EXISTING
INSULATION IN ATTIC
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
BuildingPlans Included:
(awned Statement or License 99372
3 sets of Plans 1 Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON '1'1115 APPLICATION BASED ON
INFQRMATION 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
Demolitlo. `clay
S mature of Building to !dal 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
�p U .\
City of Northampton Status of Pere&
�\ �SY Building Department Curb CuUDriveway Permit
\\....(,-.:::"1-:
- >_ r 212 Main Street Sewer/Septic Availability
\. '` l� Room 100 WaterlNeg Availability
‘.-->>---'
Northampton, MA 01060 Two sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Piousite Plans
Other Specify
—
APPLICATION 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 Property Address:
X47 N moo st.
A Map Lot Unit
Foregce j r •/��/ i Zone OverlayDisfrct ..._-_.
0)0 6). einSt.oistrrct CS Mudd
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: fi�� t
Uo'(Vc1. idk r- 1i7 frorth Mir;nSt. fforttnce,MAt_
Name(print) p y Current Mailing }Address:. (- 0IOW,
See ft'hNGhe�v _ Tdeplume 1'fl - J -573
Signature
2.2Authod ed Agent:
\Mse0, Genrlt, 64 h000‘ Sq, Cyr CelTkt1y ai3Ol
Name WWI Cement Mailing Address:
\ 1d,. f• flive (�y1}� 7? 36o
Signature t Telephone
ve
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)fo he Official Use Only
completed by permit applicant
1. Building ,1p5 (a)Building Permit Fee
2. Electrical �d (b)Estimated Total Cost of
Consimclion Iron(6)
3. Plumbing "—Building Permit Fee
I
1 4- Mechanical(HVAC)
5. Eire Protection
6. Total=(1 +2+3+4+5) s 5,2Q Check Number 5T/ (lt6
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings
Date
SECTIONS-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Aiteration(s) ❑ Roofing ❑
0r Doors C7 ,
Accessory Bldg. ❑ Demolition ❑ New Signs [[ii Decks [O Siding[ D] Other[
.._. tn_DAI tory
edef DasMddrio cif Cx\F n]kit�on ig G�'�IC
Wie
f*�,r3ecil +rv- d (kneel foci � ' of cOlobre }D
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Rob -Sheet
6a.If New house and or addition to existing housing, complete the following:
a Use of building:One Family Two Family Other
O. 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
o. 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 No.
I. Septic Tank City SewerPrivate well City water Supply
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1. DwIeI )3I��)
I?^Is as Owner of the subject
Property c t rr� --
herebyauthortze 3bE 11 & vrgc
to act on my behalf,in all matters relatNeto work authorized by this building permit application.
Set {N EA el WI)7/17
Signature of Owner Date
•
305e9h GeDr5t ,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.
Jose? GeAfOi .
Print Name
) sa�IWaerOwner„ .""�� �` � = Date ��fl7�t?
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of L,lyensa Hgftler:
003 \ (gorge, — 01101013111
License Number
6ti Hoiwoodt 3\rees Greens(EIdl, N1A 01301 a-a- aoi7
Andre Expiration Date
Signature t Telephone
9.Registered Home Improvement Contractor Not Applicable 0
S. P. Geor�t mcK Son, tnt, }5668f,
Company Name Registration Number
Gui 1'la`tWxrdl S+reef Gfeenf-tell. MA o130\ 7-23-aofS
Address ( Expiration bate
(_ _...}r7rfl(y Telephone 4li)1)1-774f-3604
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(I LG.L c.152,§25C$8))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavitwill result
in the denial of the issuance of the building permit
Signed Affidavit Attached Yes M No ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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 10845.1.
Definition of Homeowner:Person(s)who own a parcel of land on which hefshe 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 andt or farm
structures. k person who constructs more than one home in a two-veer period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Oficial,on a form acceptable to the Building Ofcial that he/she Shap 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,von easy be liable for person(st
you hire to pm form 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 ,_
i
The Commonwealth of Massachusetts Print.Form
Department of izdustrialAceiderts
::÷r.:,- --- 1!'tehri Office oj'i.zvestigaizmzs
Z Congress Street,Suite 100
Boston.1trr4 02114-2017 . 1i
:muw..nass.gov/dia
11
Workers' Compensation 3_ns*.iraace Affidavit: zB,nidersJCoitractorslElectricians/P lumbers
ar;deant"Information Please Print Legibly ��
Name(8usincsJOraniaadowledividneq:J?. George and Son, tric_I Joseph George
11
P,ddress:64 Haywood Street 'I
11
Cii'r Srare/Lip Greerniald/MA/Oi301 Phone:5:(413)-77444-3604 J i
Are you an employer? Check the appropriate box: W Type of project(required):
i."[ i am a emotoyer with 4 '- ❑ I tin a general contractor and 1
b- =
h • nsTtlGionhae hired the sub-contactors(fug and/or pan-time).*
2.❑ I am a sole proprietor or partner- listed on the attached sheet /. 0 Remodeling
ship and have no employees I hese sub-contractors have S. 0 Demolition ill
11
working for me in any capaci employees and have workers'
.co workers'camp.insurance comp.insuaance.=
P4. 0 Building addition
reouired.j
5. 11 We ere a corporation end it: 1a.[(Electrical repairs ea-additions
A
officers have exercised their
3.Li I am e homeowner dolma all work I L[] Plumbing repairs or additions Il
myself o workers'tom right of exemption per MCI.. I;
ib' p- r I yv s t12-0 Roof repairs
insurance required.) ("),and we have no II
employes.[No workers' az 6iherinSt1I860n
comp.insurance required.] '
l
applicant the cheat ups=l must alio lin ant Jm section below showing,their trout compensation policy inrnrmnion.
'il 'Iomeon et rim submit Offs affidavitindicatingila they am doing all w work and then hireic son
-c convertors munsubmi n nosnoidIOSt lnlftiioavucit SII
Conuactssft cited-this box mumYa:ached an additional sheer sbowire we name oft0e spPconrrelote and mat nhN¢rornot 11105C eillitie5 have
hosto'ees ittet`ud1YNNPamors havc angloaets,Cody mIUtprovide;Mi•'women Come-poky number.
I tin an employer that Is providing workers-c074DERStrri017 IDSA:timefor npi employees. Below is the policy and job she
ii jimnarlon. lit
Insurance Company Name,:Arhena q
ttf� t 7
Poticy=or Settling.Lic-_tnt''�9 (a 61 9 t. Expiration Dare:4129/20 % Oa?
lob Site Address: 147 NortL Nnhn fl. City/State/Zip: FIOren V,MAPI0
A Eich a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as.cyuired under Section 25A of MGL c. 152 can teed to the imposition of criminal penalties ora
fine up to S1,500.00 and%or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine V
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
i nvesSgations of the DIA far insurance covet-ogle uarii ashen.
tows . oer--------- t
aI rto herebn Certify ander the pains anti p»rzaiies ofperjury that the iry'armarian prtvirlEd abope i5 true and correct.
>
)41, A GAA 7/17 einem: Ii. o
Tirana=^413)-774,3604 '
d
'I Official use only. Do no:woe in Uris area to be comnlered by cio or to nor
If
City or Town: Permit/License?
t 'rgu fog.4u horizy(circle one): f
;
ii 1. Board of Health 3.Building Department 3. Cityliown Clerk A.Electrical inspector 3.Plumbing inspector I
Il Other
li
II Conttact Person.: — Phone H-:
City of Northampton
4 44-:4'i %
;112.7;:,
Massachusettsfk �f '.,\
)
\ DEPARTMENT BUILDING INBuilding_- j 212 Main Street • Municipal. Building
Northampton, MA 01060 `'+_..2
Property Address: 117 North Nodn 3 E , Fbrent.ee Aim jDJgba
Contractor
Name: JOSen &eoctje /a,?, Georg A Son,
d an(.
Address: Cli Hv"?wooA, ctreei
City, State: Greeni,eld,, MA oU3o1
Phone: (`#)3 -774- 36o4
Property Owner N
Name: (Anje( rnir
Address: ItIt DA J o i^/iN b1 St,
City, State: I torfnfeiMA ,oho 6a
1, 3oS£oi r9/2 (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 )11)411/46\‘161V-5114
Date
® Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License'. CSSL-099372
72
t u -, snr
cisnS
- sp_ca;,
PGEORGE
64
HAYWOOD STREET
GREENFIELD MA 01301 30
1
Expiration:
Commissioner 02/11/2019
Office ofConsumerAffairs&Business Regulation License or registration valid for individul use only
-- —'NOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
a? Registration: 156666 Type: Office of Consumer Affairs and Business Regulation
Expiration: 1/25/2017 Private Corporation 10 Park Plaza-Suite 5170
Boston,MA 02116
JP GEORGE 8 SON INC
JOSEPH GEORGE r
GREENWOOD ST � � ` -�,
GREENFIELD,MA 01301 'r—
Undersecretary NoYvalid without signature
`Lim,.
RISE ` 60 Shatinnut Road,Unit 21 Canton,MA 02021 1339502-6335
ENGINEERING wnwRlSEengineering.com
"cl rnegPed
OWNER AUTHORIZATION FORM
Ark F
(Owner's Name)
owner of the property located at
(Property Address)
(Property Address)
hereby authorize P, Gere ariA 50n) 111(.
(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.
The Permit will be severed 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
Owner's - ignature
1%—t ' l7
Date
62016