11C-069 (4) 81 FLORENCE ST BP-2019-0011
GIs 9: COMMONWEALTH OF MASSACHUSETTS
a :Bl ck: t 1C-069 CITY OF NORTHAMPTON
Lot'-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2019-0011
Proiect# JS-2019-000015
Est Cost$2000.00
Fee' $65 00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAY BOLAND 101880
Lot Size(sp. ft.): 19994.04 Owner: BUROUE RICHARD C&LINDA L
Zoning*URA(100v Applicant: JAY BOLAND
AT: 81 FLORENCE ST
Applicant Address: Phone: Insurance:
12 PISGAH RD (413) 203-2454 O WC
HUNTINGTONMA01050 ISSUED ON:7/3/2018 0:00:00
TO PERFORM THE FOLLOWING WORAMLOWN IN INSULATION AND AIR SEALING
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 4 Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: OM 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 7/3/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
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SECTION 5-DESGBF7 N OF PROPOSED WORK telwdr all aoaiFabM1
New Nowa ❑ Addition p aRepla "W. AReratlon(s) ❑ Roofing ❑
Acwacey SWg. ❑ Demolition ❑ New Mg. )p] Docks [0 Skft= Otiwr(�
&pt of
wod� au"PmposetlInSrlo },.v� a;f Seal;nr
AMe,abon of wig bedroom_Yes_No Adding new bedroom Yes No
ASWred Narmfi a Rem oveffig uh@nWM besemerd Yes No
Marrs Attached ROB -Sheat
Ba:U MWJ1r Weand-0Ia1ddlbjmtp musbamhll6Ds1ALL camel aft Utefollowim
a. the of bWkWq:One Fsedy Two Fandy 00W
b. Number of morns in each family nmtt Number of Bathrooms
G Is Vwe a gemage attached?
d. Proposed Spmm totege of new man. Dbnormiorm
e. Number of sbmies?
f. Method of heaano? Fvaplam or Woodstoves Number of each
g. EneW Corwervatian Compllence. Masscheck Energy Compdanoe form aaaOwd?
h. Type or WnWurbon
i. is cornbuction wMin 100 R of wetlaWs?,Yes _No. Is co whiction Within 100 yr. fioodpleln_Yes_No
J. Do*of besemad or cellar floor below%*had grade
k. WNWkMgcadormtothaBMdmgwWZordrgregulatb-? Yes_No.
i. Septic Tank_ Cldy Sewer_ Pnvatawall Cdywater SUPPtY
SECTION Ta-00111EItAUR10RWATIOM-TO BE COMPLETED WN91
OVMM MS AGEl f.OR CONFRACTORAPPLES FOR BUILDING PHtMT
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Agent hereby dacha ttat Me 8}81erm,ehd8 aM in(arrbon on the foregorng application ars bus and ameats,mare best of mY lowx7edga
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Signed weer Ne paste and perms of .
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SECTX*8-CONSTRUCTION SERVX=
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Are you as employs?Chark the appropriasa bozo Type of preleet(rMeh):
1. I am a employer with 19- 4. ❑ lam a general contractor and l b. QNewconstrwtioo
employees(fA aod/apatH®a)L' have hired O as actors,
2p 1 sur a sale papdabrorpartner tiasedon>heatraedredabeet.t 7. ❑Rammialing
sly andhsve an employees Thew bave 8. 0 Demob ion
woddog forms in my wacky. wodtas'cou-insamuct. 9. [1Bmldmg addi =
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reepucd.l officershave eaercaed&w 10.❑&kehicel repairs or adddion
3.0 Iamahomeovmerdomgallwmir xi&ofeaempimperM(E, 11.0 Phmb®g repass oradd:pcm
Myself No waters,camp, a. 152,§I(4)�and we bawoo 12.pRoofrepMM-
immumocerequired.]t employees.[Nowoskas' 13,®pdw IA'V 1 ian
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Iosmmce Company Name:tAfl �c em-ei :(15urGH(r Gafpm,c
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rmeup10$,.SW an&m.no yes,impaiamem,asvmuascivilpemttiesin>ffifromofaSTOPWORKORDERandafine
3fnpm5250.00adry erg 1 ftviolaoo<. Be advsedthata copyoft &amrementmay be forwardedm the Office of
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Office of Consumer Affairs and Business Regulation
41 10 Park Plaza-Suite 5170
Boston, M usette 02118
Home Impr tractor Registration
Type Corporation
ratIM: 106724
Hoare Energy Solutions Inc i- ExWWon: ovausote
88 Russellville rd
Southampton, MA 01073 --
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7iwry'' License: CSSL-101860
Construction Supervisor Specialty
JAYRBOLAND
12 PIGGAH RC
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NUNTINOTINOTON MA 07060
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Debris Disposal Affidavit
In accordance of the provisions of MGL c 40,554, I adoowfedge that as a condition of the building
permit all debris resritng from the oorlshucton ach*governed by this Building Penni shall be disposed
of in a properly haersed solid waste disposal facility,as defined by MGL c 111, S 150A.
The dad's from construction work being performed at
S 1 '�Iorerir'e S4.
(Please pint house number and sheat name)
Is to be disposed of at )
�Inu�gww. j I-4n- 'eJ �4 M
(bra nwnaam Wattion of reduryw
Or wit be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of Parma Applicant or Owner Date
If,for any reason,the debris will not be disposed of as indicated,the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
City of Northampton
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212 Baia Strant • Iboicipal Building sc'
Auethnaptoa, an 01060
AFFIDAVIT
Home Iaaproveaaeat Costractm Law
Supplement to Permit AppReadon
The Office of Consumer Affairs and Busmess Regulation("OCABR")regulates the regishatim of contractors and
subcontractors performing improvements or renovations on detached one m four family homes.Prior to
performing work on such homes,a conttacmr must be registered as a Home Improvement Contractor("MC").
M.G.L.Chapter 142A requ eree that the"rBcorBtruc6on,amrsden renovallon,repay nwde"Amwaa,co varslon,
kvmvemw4 rmaovat dernoWon.-oonstrualon of an addNon b nary pm-eWS&V agar-occrpiad bukWV conswang
at low one bort not mara Men kurdalBrtrgmb..-or to sbuctreaer aatlR:a area4scard to awri restboas orIxAbWbe
done by r conoacema.
Noge.IJMekoarnearrser las cBabacidd with a csrponedos or LL r-dw emffynAw Pe registered
Type of Work 1C(G1'Q�(1'n �^ ) Pat Cost 0
Address of Work () I �j//�C){?',h C P c')4 Lek
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Date of Permit Appheatiom G /i1'Li ' I y
I hereby certify that
Registration is nM required for the following reason(s):
_Work excluded by law(explain):
_Job amdw 57,000.00
_Owner obtaining own permit(explain):
_Bttilding not owner-occupied
_Other(specify):
OWNERS OBTAINING TEMM OWN P&RbUT OR ENTERING INTO CONTRACTS WITH UNREGMTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
FIG UFORAND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FOND
UNDER M.G.L.Ciapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBUJTES FOR ALL WORK
PERFORMED UNDER THB BUHX4NGPERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of pointy:
1 hereby apply for a building permit as the agent of the owner.
OLVA MQc6II
Date Contactor Name HIC Regia ration No.
OR
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property-
Date
ropertyDate Owner Name and Signature
i.
71-7
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