Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
24D-208 (5)
236 STATE ST BP-2017-1030 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:24D-208 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-2017-1030 Project# JS-2017-001774 Est.Cost: $1929.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOSEPH GEORGE 99372 Lot Size(sq.ft.): 3179.88 Owner: PELHAN STEPHEN Zoning: URC(100)/ Applicant: JOSEPH GEORGE AT: 236 STATE ST Applicant Address: Phone: Insurance: 64 HAYWOOD ST (413) 774-3604 WC GREENFIELDMA01301 ISSUED ON:3/16/20170:00:00 TO PERFORM THE FOLLOWING WORK:AIR SEAL ATTIC AND 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 sienature: FeeType: Date Paid: Amount: Building 3/16/2017 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck - Building Commissioner File#BP-2017-1030 APPLICANT/CONTACT PERSON JOSEPH GEORGE ADDRESS/PHONE 64 HAYWOOD ST GREENFIELD (413)774-3604 PROPERTY LOCATION 236 STATE ST MAP 24D PARCEL 208 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT r Bee Paid �� Building Permit Filled out Fee Paid TyoeofConstruction: AIR SEAL ATTIC AND 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 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 D-•': itioi relay ASO° . 3-/7- Signa • eof:wilding 8fficial 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. 4 Department use only C' City of Northampton Status of Penult: Building Department Curb CuttDriveway Permit 212 Main Street Sewer/Septic Availability_, Room 100 Water/Well Availability�,� Northampton, MA 01060 Two Sets of Structural Plans,_ phone 413-587-1240 Fax 413-587-1272 NoUSite 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 36 5 1.1 PrOPertv Address: ae U t Map LotUnit NDrtl+intAf ton, M ^ ` 1 `I Zone Overlay District_, 010Go Elm St.District , ca District ^_ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT ?y.1 Owner of Record: cte ehet, Pe ilogl ,3 36 Strtte s\-. Name(Print) _.. Current Mailing Address; (541) _409 -27{7 See p ka4Lh�t V Telephone Signature ?_z Authorized Anent /u t,� t, 3-0S e0, GD 7 eorAC _ iiol.,30 Y sk crreepiza,pkp, 013.71 Name(NM —J Current Mailing Address: eft le �, ( t3.77R 36a� Signature , r yTelephone _.. _ SECTION 3-ESTIMATED CONSTRUCTION COTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 't -f ft aclr Pt y (a)Building Permit Fee 2. Etaciricai '( (b)Estimated Total Cost of Gime/ruction from.(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) �^ 5.Fire.Protection 6. Total=(1 +2+3+4+5) 'r gaC1.ky Check Number gy3s . 465- This Section For Official Use Only Building Permit Number ,, Date Issued: Signature: _— Building Commissioner/inspector or Buildings Dae SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) I l Roofing ❑ Sr Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [CO Decks [0 Siding[o1 Other(A ±nivt[P}ton Brief Description of Proposedii,,y� p T tMex d7 w�i �1 Work: A- I) SPt7 � Mitt VA, QUG.'1"Pf�4 NM ami©�1{a WPp. Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _No Plans Attached Roll -Sheet Se.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? ,. Method of heating?! Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masacheck Energy Compliance form attached? h. Type of construction i. Ia construction.within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No I. 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 we6City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT . t}l,`-i"ntr ttft V _. as Owner of the subject property T to i /�,, hereby authorize 3bsepK &earniis to act on my behalf,in all matters relativefo work authorized by this building permit application. Ste in\ed - /19/17 si nature of Owner Date SOsepls, forty, as Ownet#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. U0SelAk GPATflie. .. Print Nameitika,"A' 3 f l°/� su.nature of Owned.nt ` Date SECTIONS•CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicabblle�r❑ Name oflicenae Heide SDSe?k Ge t CSS t3 to .— License Number (01 Hbiwooa scree; Gree€refdt, Ntq 013o\ a-tt• aDi� —.— Addles Expiration Date " ►,c .n Iv 4131-771I-3i)04 .ear►. Signature Telephone 9.Registered Home'imprpyement Contractor. Not Applicable 0 ["o S P. pise GAS Son 2nt, 156686 Companv Name Registration Number .e1 \t° v.ict S}reef Ureen(ieidd, PAN .oi3o\ 7—z-2.of5 Addros, Expiration Date � � Telephone413)-779-36°11 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MAIL,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 buildin. permit Signed Affidavit Attached Yes El No...... f3 1.1. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided*tat the owner acts issue.visor. ,_MR 7:0. S:: Et on *Hon 1083.5,1. 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 he/she shag be responsible for all such work performed under the buiidintpermit. As acting Construction Supervisor your presence on the job site will be required from time to dine,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 maybe Gable 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 _4.3077)--=‘, -�* Massachusetts r '.,\ DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building tt�� ! NortharBtOn, DA 01060 `t Property Address: P-3 i Stoye �t Contractor Name: JoSeph Genn t /J,Pi Geot le 04 Sion, inc. Address: (D'I H{ ' wood Street City, State: Greenceldt, Mp. o33oi Phone: (1113)-774- 35o4 Property Owner Name: Step^ (t lvQA PeIw>A Address: `d.36 StG4 nr Sh City, State: I ortbri(t9 MA ,0)0 bo I, 3osep (yearly (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 `10'..\A-1 Date o 3 /19/1 I I Faint Form The Commonweakh of,M9assackusetts I I tieParb'nate`of Industrial Accidents -- —_ Office of investigadons I Congress Street,Suite 100 Baton, 4,14 0214-2017 1 tuww.mc•ss_gov/dig Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Please print Lesib1c• II ��i=CdTit Epap£ a.eoF 1 Name (nesinessOrsaeizadowieeividUaIt JP. George and Son, Inn./Joseph George 11 4.4dod55:84 Haywood Street City/State/Zip:Greeniield/MA/01301 Phone#_(413)-774-36oa A;-e you an employer?Check the appropriate box: Type of project(required): ,I I.(_I I am a employer with 4 _`. Q I em a general coatractor and! HMI/Ogees flitI andtrn'part-time).5 have hired:he sub-contractors b. �l New ' 'rtion '_.❑ I am c sok proprietor or partner- listed on the attached sheer i_ 0 Remodeling II ship and have no employees Tike sub-contractors have S. 0 Demolition Ili n•orlcin2 for me in any capacity. employees and have workers' i -. 9. ❑ Building addition no It o. ers'comp.iusunsice comp.insurance.= required 1 5- 1 I We area corporation and its ISO Elechical repairs or additions 3.u ! am a homeowner doing all work officers have exercised their I in plumbing repairs or additions salt o workers' right o;exemption per MGL LII Y [1" camp. 12.0 Roofrepairs insurance revised.] li?, ten.,and we have no '. employees.[No workers' 13.�✓ p lrasuldtl0n I ei compinsurance required] annliczm Sri cheat.box HI n usi also fill our dm section Mow slum-Ina emir workers'compensmion policy informetioa ^,dnmmunerd who submit this armdm•it Maiming Sao era doing all wart and then hitt outside contemners munsnbmk it dem'affidavit indiauingsuch. di-animators:hat Sued[bis bad mast attached an additional mart skowine We name of Mc sub-tonunaWFS and State labeller or am those entities have 1 unioya lithe Sob-conga{MS lick emplovta,(kr must provide their tivr.."ef romp-oaticv'nrnbcn t =I urn mtemployer that is providing workers'compenSarla;t instfrl112o2f•nzI employees. Reim,'is;hepaticp runt job site inravnation. l) Insurance Company Name:Arballa 'k I �{ t7 Poiicv=or Selz"-iris.Liie.a: lag, 7 G t `.3 Expiration Date:t4/ / 2901 / 'II _e /,, Job Site.Address: "a3() �hkte 51 • City/State/Zip- 11°4 catt tl MA 10IQV� ii Affnch a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). y Failure to secure coverage as required under Section 2SA of MGL c. 352 esn lead to the imposition of w Tuinal penalties of a rine up to SL500.00 and/or one-year nfprisonmenL as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investioafipns of the DIA for insurance coverage t+eeinention 1 �/do hereby certify under flee pains and penalties ofperjury that the irifomtatif+.n provided above Is true and correct, I • Dots: 3/to/ 17 _ Iri;onp a:(413)-7774-3604 ii official use only. Do not write in this area,to be completeed he city ortannt offrciaL llj City or :own: Permli((..icenSe= suing Authcrire(circle one} Hoard of Health 2.SuildingDepartment I City/Town Oak 4.Eiectricai inspector 3.PIumbing Inspector d.Other ,. 1 11 1I Ol't2Ci Person: Plaine kit 1 Massachusetts Department of Public Safety Board of Building Regulations and Standards 'cense: CSSL-099372 Mnstruz:Elon Su - t. JOSEPH HEYP GEORGE JOSEPWH GE STREET GREENFIELD MA 01301 - ---v.-- Expiration Commissioner 02/11/2019 Office of Consumer Affairs&BusinessRegulation License or registration valid for individul use only IMPROVEMENT CONTRACTOR before the expiration date- If found return to: Registration: 156686 Type: Office of Consumer Affairs and Business Regulation c--Expiration: 7/25/2017 Private Corporation 10 Park Playa-Suite 5170 Boston,MA 02116 JP GEORGE&SON INC JOSEPH GEORGE 64 HAYWOOD ST n GREENFIELD, MA 01301 Undersecretary No valid without signature RISE60 Shawmut Road, Unit 2 I Canton, MA 02021 1339-502-6335 ENGINEERING www.RlSEengineering.com OWNER AUTHORIZATION FORM Si?I ?F‘ifn (Owner's Name) owner of the property located at: 2 3C- 5 52721-1 / (Property Address) (Propierty Address) hereby authorize JI P, ceor y one 5on1 in (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 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. oleprALA 4, Owners Signature Date 6-2016