29-072 (4) 30 ACREBROOK DR BP-2019-0255
GIS#: COMMONWEALTH OF MASSACHUSETTS
Man:Block: 29- 072 CITY OF NORTHAMPTON
Lot: -001
Permit: Buildino
Category; INSULATION BUILDING PERMIT
Permit# BP-2019-0255
Project# JS-2019-000410
Est.Cosi: $5356.00
Fee $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOSEPH GEORGE 99372
Lot Size(sa. ft.): 12632.40 Owner. SOUTHWICK PAMELA A&PETER C
zonin : Applicant. JOSEPH GEORGE
AT. 30 ACREBROOK DR
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774-3604 WC
GREENFIELDMA01301 ISSUED ON:812912018 0:00:00
TO PERFORM THE FOLLOWING WORK.,AI R SEAL ATTIC & BASEMENT; ADD 11" OF
CELLULOSE TO EXISTING 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 8/29/20180:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner
File#BP-2019-0255
APPLICANT'CONTACT PERSON JOSEPH GEORGE
ADDRESSTHONE 64 HAYWOOD ST GREENFIELD (413)774-3604
PROPERTY LOCATION 30 ACREBROOK DR
MAP 29 PARCEL 072 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TweedConstmction' AIR SEAL ATTIC&BASEMENT-ADD 1 P'OF CELLULOSE TO EXISTING 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
INFORMATION PRESENTED:
r_/ 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
_Demolition Delay
Signature of Building Official Dale
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.
R E E I V t_ Department use only
i>y of Northampton stows of Permit'.
uilding Department Curb CuVWveway Permit
-
AUG 2 7 2018 212 Main street SaoxnISeptic AvallawkLY
Room 100 WelerlWell AveflaD'Illiy
ND Hampton, MA 01060 Two Sets of Structural Plans
DFPr OF BUILDING INsFpftDO sM113 587-1240 Fax 413-587-1272 PlaUsite Plans
NORTHAMPTON.MN 1090 Other Specify
APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION t -SITE INFORMATION
This section to be completed by office
1.1 Property Address: ^ —7r�
o Aacyf�K Dive Map_ / ___ Lot / ! Una
florwe�/ r/TAA Zone d� Overlay District
0I,3 Elm St.Dismic cB District
SECTON 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
21 Owner of Record:
i6do SOI .w�CK 3�tIrIckf Irrole1mgolsNama(Pnot) } `,�aCtment Mailing A �7IIOSee 06'LteN TeleP encSignaNm2 2 Authorzed Agent
A ol3otName(Pd CuRentMaIFgA
Signalum Telephone
SECTION 3-ESTIMATED CANSTRIICTI Wi COSTS
Item Estimated Cost(Dollars)to be Official Use Only
campleted by pennit applicant
1. Building SAS SX (a)Building Permit Fee
2 Electrical (b)Estimated Total Coat Of
ConsVucoon from. 6
3. Plumbing Building Permit Fee �\
4. Mechanical(HVAC) L
5. Fire Protection
6. Total=(1 +2+3+4+5) 5,�� Check Number 4
This Sacfion For Ofacial Use On]
Building Permit Number: Date
Issued:
Signature:
Building Oommiwionad,a a wor Buildrzga
Data
SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition Replacement Windows Alterationts) 0 Roofing
Or00. O
Accessory Bldg. ❑ Demolition New Signs tOl Decks Siding[E31 Other[�p
� f,' I Inrv. on
Brief Desutption of Proposed ( �.lt (A bky@t/yt fldfl II pf tt��abk t(1 Cl1*1 ✓Muter
Work: / �1CG� J
Alteration of existing bedroom_Yes_No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basemen[_Yes _Np
Plans Attached Roll -Sheet
so-If New house and or addition to existing housing complete the followfna-
a- Use of building t Ona 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? 9mplawsor Wocdstoves Number of each_
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
Is construction within 100 R of warlords?_Yes _No. is constncfion 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 CONTRACTORAPPLIES FOR
BUILDING
y PERMIT
1, POtlf1 yy`�~t�\ as Owner of the subject
property <
hereby authorize 30�� yyVT�e
to act on my behalf,in all matters rel�a o work authorized by this building permit application.
See DS ba
Signature of O.vnar Date
I 3O5en1\ �QAr9Z as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and atxumte,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
_ Joseph GPpra�2
Print Name
Signature of marln[ Date
SECTION 6-CONSTRUCTION SERVICES
81 Licensed Consbuetion Suupervisor: ppr���� Not Applicable ❑
Name of License Holder. SOSQ� tSGVI'D�Q. CS319%31a
Cleanse Number
f4 HUywDDd syf:e\ GTeenf(cldi MA 0t3111 a-�)- 'mij
Adores Expimtiw Date
t (4i3)7�4-36�y
SIgnatuMQ Telephone
9.Registered Home Imorwament Connector Not Applicable ❑
If, Is w6
Company Name Registration Number
64 tiv'v,'agd\ 5}rezj (rree"RwIdl AP, .01301 7-)S-a0��
Address Expiration Date
Telephone 413 -77y-36p4
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M-G-1—c.152,§26C(6))
Workers Compensation Insurance afidavil must be wmplated and submitted with this re
this application.Failure to provide this affidp will sult
in the denial of the issuance of the building permit
Signed Atidivd Attached Ves....... ® No..— ❑
11. -Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-uccuoied Dwellings of on(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a foliose,Provided that the owner acts
as supervisor.CMR 79(L Sixth Emtian Section 1083AL
Definition of Homeowner:Person(s)who own a parcel of land on which hetshe resides or intends In reside,on which there
is,or is intended to be,a one or two family dwelling,attached w detacbed structures accessory to such use and/or farm
structures.A nsrsan who eDWITUCtis more than one home ia tworvear period shell 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 buildina Permit.
As acting Construction SuoeMsor you presence on theist,site will be required from time to time,during and upon
completion ofthe work for which this pemrit is issued.
Also be advised that with reference m Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)ofthe Massachusetts General Laws Annotated,yob may be liable for person(s)
You hire ro perform work for you under this permit-
The undersigned•'homeowner'certifies and maracas responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State ofMassachusets General Laws Annotated-
Homeowner
nnotatedHomeowner Signature
City of Northampton
V
-� Massachusetts u
a ARMW OF RVILDWG INSFSCTIONS
K� 212 Hain scce•! • efunicipal Buildlvg ` „�J
s.� Northampton, M 01060
Property Address: 30 Fleren% MA, 010 da
Contractor
Name: SoSep1 (real jl / . P Geo( aid Sion Inc.
Address: b� {-{mywoof� STT'PQ7
City, State: Grrao�;tlA MA o9ol
Phone: (N)-174- 304
Property Owner I
Name: PrnrelG SO �VJiiI\
Address: 37 kcE or k Dr'
City, State: F6(enit MA 090
I, 7o&ep Wr9 @ (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
U � ttT
Date
City of Northampton 212 Main Street,Northampton,MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 3o Rcft'br-)( Dim IfID(" e)MA
The debris will be transported by: �jf, Geor9e OAA SO/' In
The debris will be received by: Cj v'Je
Building permit number:
Name of Permit Applicant JoSefh r�2
o1la2/2WjT
Date Signature of Permit Applicant
Print Form
'S7ze Counnon we allIt Of Massachusetts
-_LL. .r�epm•+3ne:xi of ldus`r:.alAccidents
Cazgt'assStreetsSuite 700
071 i4-201
- ' iniplU.�dSs.e O"J�dia
'df iden/cortrae#u'rs let 'ici��s 'i• iiess 14
` "It Tzfolmazion Lease trios;_,e.�bly �%
\2412 iGusiness?Oreaaizadonlndioicu=_i):•I-P.Gso(o2 2nd Snn= ir=c.t Josiah George _,�„ {i
I
Address:�4+ia}^nopd Street
Cit1'JSFaTetL-Ipcareeniield/PftAt4i30i �hoae sc{<53}-i7PI-360x- �`
i ..=se you an empiOyerY Jteek The appropriate box: ` T}•1)e ofproject(required)= '
1 am c ECneral COmtraC'i0r 2nd I s
1 s here cored+ha sub-contrac:Grs
enAloyee;(full and/or par':ime}
j 2.� 5 am aso{e propriem<ar parva tisieu on rhe a.':ached shee_ �- []RemodaCm3 �'
i Th:12 SL'b-CO?1Y2Cr0r5 hat2
shin end have no enrployaes S. [� DemoliEon
ampiorces and have wwleers' I
vrondng Far me in any capacity- 4- j,�Building addPGOn E
[:io+.voslss`cam&fasufaace c0n_insurznm: J
eeuird. 5. ❑ :lze xza coraorzhon and it< ]d.[]ElecMicai repairs or additior's f
;ens a hmma.rnerdoins all c;ork off s hacc exe-rcised their 1 j ` Flumbin�Npain or addition;
.� ,ysali
Massachusetts Department of Public Safety
Board of Building Regulations and Sta-wards
License'. CSSL-099372
_�rstruc:r Supermsor5oeclai*v T("'��
JOSEPHOOD SIRE
86 SEPP GE STREET
GREENFIELD MA 01301 ell
Expiration'
Commissioner 0W111Y2oig
Masai Cansumer Asid.&Bueineea Reguletian
- - HOME IMPROVEMENT COWRACTOR Registration valid for lrWividual use only
1, TYPE:Corporation before the expiration date. N found return to:
• Reoiatration Esaination Office of Consumer Affairs and Business Regulation
156666 07124/2019 10Park Plaza-Sulte5170
JP GEORGE&SON INC Boston,MA 02116
JOSEPH GEORGE
64 HAYWOOD ST J Not�without illynature
GREENFIELD,MA 01301 Undersecretary
Columb"ia Gas
Of MaSSkhUSMS 60 Shawmut Road, Unit 2 Canton, MA 02021
A MIS..Company
OWNER AUTHORIZATION FORM
i, Pamela Southwick
(Owners Name).
owner of the property located at:
30 Acrebrook Drive
(Street)
Florence, MA 01062
_
(Town, State, Zip) _
hereby authorize &eO')t fMJ S011y 2pt.
(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 th� owner's
responsibility to close out this permit by contacting their municipality at the completion of this work.
-Custom rSignature
_ >
-Sign Cat Dat
311 212 0 1 8