31B-115 8 EDWARDS SQ MBP-2018-00137
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot 31B-115-001 CITY OF NORTHAMPTON
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# MBP-2018-00137
Project# 8 EDWARDS SQ
Est.Cost: 2684
Fee:65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOSEPH GEORGE
Lot Size(sq. ft.): Owner: MCGUIRE EDWARD L &DEBORAH M.
Zoning: Applicant: MCGUIRE EDWARD L&DEBORAH M.
AT: 8 EDWARDS SQ
Applicant Address: Phone: Insurance:
32 PENNYMEADOWS RD
SUDBURY, MA 01776 ISSUED ON: 08/07/2017
TO PERFORM THE FOLLOWING WORK: Air Seal attic and basement, add 10" cellulose to
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: Check Number:
Insulation 08/07/2017 65 8751
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
,.,
_., Department use only
City of Northampton Status of Permit:
‘ \
\ ; 0 Building Department Curb Cut/Driveway 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 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION /17 OP— 71— /3 7
This section to be completed by office
1.1 Property Address: ge EdmArk sct ,
Map 316 Lot //5 Unit
AOrtiNalt411)61? NIA 01060
f Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
IM lor4 /14 c)(Aire S' t4G1-ii S
Name(Print) Current Mailing Address:c
11—ill 7c)7-37A
S€e, AM g Telephone
Signature
2.2 Authorized Agent:
jOS W Cert 69 HorNood\ s)'. CrreerkiatJMA 013(3k
Name(Print) I Current Mailing Address:
\ • 1 i o h.C\telpits (413)-779- -3cyouc
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit_applicant
1. Building 'a, 6 Pf,0 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction trom.(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) 4, 68'W Check Number 39c/ iracc
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: "_.__..__ /4......4L....e. et-17Z/t.0--ri-ed_--
1
Building Commissioner/Inspector of Buildings
Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House 0 Addition Replacement Windows Alteration(s) n Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C7 Siding[p] Other 03
r to la}ion
Brief Description of Proposed /
Work: f/ leeI bo)L'I'1211i 011 CQ if ce f i(4[9)e to Q����I^� j1}UI„ � iO crti c,
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.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. Will building conform to the Building and Zoning regulations? Yes No.
1. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Dek k
lA1 rf ,as Owner of the subject
property
hereby authorize 50Se ek\ &WOW.
to act on my behalf,in all matters relative "1:)work authorized by this building permit application
See \ coc\,e� 811,/17
Signature of Owner Date
Jose \ t reOrt, ,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.
U0SeCeAr
Print Name f�
-OVIArk. 7
Signature of Owner/Agent Date
___---------'—'m"....................... .
il
!I
i Print Form i il
_-.--.
;.. The Commonwealth of Massachusetts
Deparbnent of Indzestial Accidents
-• ....--=.;, _,...-=:, ::•-•- Office of investiga-ii. cms
- II
:1 • -----:;•,.. c roizoress Street,Suite.700 li
-
Boston VA 02114-2017 . 1!
,. —------. .
II
www..mass_goviciia :1
Workers' Compensator.TriViraRee Affidavit: Builders/CoutractorgElectriciansfeliambers 11
II4
„........„_,..,-.._ _e ,. _LF nioao:w,
?lease Print Lezibly
I
Name(BusincFlOraaniaationilndividu.l):IP_George and Son, Inc_/Joseph George II
_
21,ddress:94 Haywood Street iI
Cii-y/StatetZip:Greentield/MA/01301 Phone fr-:(413)-774-3604 1;
Are you an employer? Check the appropriate box:
Type of project(required):
1.1./1 I am a employer with 4 4_ 0 1 ern a general contractor and i1
G.
n New const-uction
employees(full andior part-time).* have hired the sub-contractors
\Il
listed on the attached sheet_ 7_ 0 R.emodelinz i•
2.0 I am a sole proprietor or partner-
These sub-contractors have
ship and have no employees S. 0 Demolition
working for me in any capacity. employees and have workers
. 9_ 0 Building addition
[No workers' comp.insurance comp. insurance.- 11
i•equired.] -7 ri We are a corporation and its
..,_ 10_0 Electrical repairs or additions
3.El I ani a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions 11
t,
right of exemption per MGL ll
myself. No-viol-I:arscmp.
= o12.0 Roof repairs
insurance -t,ciu.red..3.t c. 152, 1(4)ployees. [,and we have no
11
13,0 otherInSUlatiOn
emNo workers=
comp.insurance required.] 11
'Ally nppi icant that checks box g I muse also fill our the section below showins their workers'compensation policy worm/ion, ,
H orncownzrs who submit this ollidevit Indic-aline they are doinE all war and then hire outside coniraciors must submit a new c.ffidevit indicating such.
i;
:Contractors that check this box must attached an additional sheet showiatt the name of the sub-contractois and state whaler or not those entities have ,
employees. if the sub-contractors have employees,they must provide their workerscomp_policy number.
lam an employer that is providing workers'C.01-402171011017 inSIMIlle2501'My 2n2ployees_ Below is the policy and fah Sire
h!fornzation.
Insurance Company Name:Arbella
Policy 4 or Self-ins.Lie_-.4: 0 •
CI t 1 g-
., , - 8 0 Expiration Date:41-29/a01 2
Job Site Address: LdWfAreli ScIAA re
1 t'l City/State/Zip: N r %oftip I")) M 4 /0060
Attach a cony of the workers' compensation policy declaration page(showing the policy number and axotraton date). li
Fail LIV2 to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of%A it.uinal penalties of a 11
fine up to S1,500.00 andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a fine
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 .,
t.
Investigations of the DIA for insurance coverage veriirecAt;on. !!
I do her.eirr certOr under the pains and penalties ofperjwy that the information provided above Ts trlie-1117d correct,
g/1/17
Signature: Date:
?bone •;.:(41:3)-774-3604
Official use only. Do not write in this area, to be conwiered hi'dry or 103a11 oftkiaL
1
i
city or Town: Permit/License#
• 1
issu inc.:A_uth oriry(circle one):
I. F3o 1:4 I'd Of Health 7—Building Deparb-nent I City/Town Clerk 4.Electrical inspector 5_Plumbing Inspector
5.Other
.:.,..ontact Person: Phone g:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
�oseoIN GQOtOtt cssl '131
Name of License Holder: ,
License Number
Hot' ood 3 tt e\ , N'i o13O) >
Address Expiration Date
413)77q-3boti
Signature .14)-11 �e
S.Registered Home Improvement Contractor: Not Applicable 0
George Son,
Company Name Registration Number
tioN w A d\ S+re-6 6-re-enf‘e 1d, PAR 0130\ 7-2s --)015
Address ‘, . ,t,...Qq6ice.iltoi__
lExpiration Date
Telephone 775-3604
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"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 that the owner acts
as supervisor.CMR 780. Sixth Edition Section 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 shall be
responsible for ail 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
t1 -, City of Northampton .
`�! <\°57.7 car
• =' Massachusetts (
,i ,.J,(I, tt av _
fir; DEPARTMENT OF BUILDING INSPECTIONS r , , ..
.-c•. -- .. 212 Main Street • Municipal Building ` .ts..`_/,-
.:,r Northampton, MA 01060 %'r
1 Eowdr4 f
Property Address: '
Contractor f,,
Name: JOSC & or�, j L,P. karate osi.tA son, 1(1Z.
Address: Hmywooa StrePi
City, State: G r e r\flt ifx AAA 01341
Phone: (`1'3)'77' - 304
Property Owner Del l 9a$ MC3�i,
Name: re
p V
Address: p E 0y wUrd; Si "
City, State: r� �M�i}n M r i�1D 6 0
I, 3ostON Gorr(3 (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 ‘ / . 0 , , 0 /
SA-41k
Date ri 1717
•
..• ,
gig, Massachusetts Department of Public Safety
V Board of Building Regulations and Sta-,dards
License: CSSL-099372
Supervisor ","ccialw
JOSEPH P GEORGE
64 HAYWOOD STREET
GREENFIELD MA 01301 400'
. ,
. .
-. •
Expiration:
Commissioner 02/11/2019
77, t-,(,,,,,/‘,,iii/ r/ 747 ,,ir/h',;,#,
Office of Consumer Affairs&Business Regulation
711--:ilf. ,- HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration date. If found return to:
..,.5---=:: ,.
- Registration Expiration Office of Consumer Affairs and Business Regulation
-7,.--7:'
156686 07/24/2019 10 Park Plaza-Suite 5170
„..,
JPGEORGE&SON INC Boston,MA 02116
N (---- '
_Cel_Sci----:‘---1L.
JOSEPH GEORGE ,.. .Q.-Cc.-C,--1,----
64 HAYWOOD ST u Undersecretary
GREENFIELD,MA 01301 i Not valid w newt signature
Permit Authorization'
mass SISV ' V Form PARlICIPATING
-Savings gs thimusWantfrgy,efiidonty'
CONTRACTOR
Site ID: 50288954 Customer: Deborah Mcguire
I, Deborah Mcguire ,owner of the property located at:
(Owner's Name,printed)
8 Edwards Sq Northampton
(Property Street Address) (City)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain:a building permit to perform insulation and/or weatherization
work on my property.
Owner's Signature: 5Y?1V)
Date: a./G i T_
•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
FOR CLEAResult OFFICE USE ONLY
CLEAResult has assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project: V
if, Gble 01,1 500, Ia:. M/47
.Participating Contractor Date
CLEAResult • 50 Washington Street,Suite 3000 • Westborough,MA 01581 • 1800480-7472 Q y
For Office Use Only
Rev.102015