24C-154 (9) 55 ARLINGTON ST BP-2019-0702
GIs#: COMMONWEALTH OF MASSACHUSETTS
Man:Block:24C- 154 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-2019-0702
Proiect# JS-2019-001144
Est.Cost: $2344.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO.-
Const.
O.Const.Class: Contractor: License:
Use Group: JOSEPH GEORGE 99372
Lot Size(sa.ft.): 10236.60 Owner: SCHRADER ROBERT W&CAREN M WE
Zoning:URB(100)/ Applicant. JOSEPH GEORGE
AT. 55 ARLINGTON ST
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774-3604 Liability
GREENFIELDMA01301 ISSUED ON:12/17/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-AIR SEAL ATTIC AND BASEMENT
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 De®artment 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 12/17/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
City of Northampton Status of Permit- Department use orgy
EC 2018
Buil i ling Department Curb Cut(Drivevay Permit
D 1 0
2 2 Main Street Sewer/Septic Availability
I Room 100 water/Well-Avallability.
r)PPT OF:r:URmti(,INSPFCTIrth mpton, MA 01060 Two Sets of Structural Plans
I I
NORI HAMPTON,NKA"0413-5 -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 I-SITE INFORMATION --7 08-
1.1 Property Address This section to be completed by office
Atli(, hn Map ?"—I C" Lot -Unit
Zone Overlay District
0100 Elm St.District ca District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner gj agpord-.
Name(Print) Current Mailing Address: 0110-7 - 190h
Ste, AM064 Telephone
Signature
2.2 Authorized Agent:
lose'w kju4t 64 H(AxIWODr S3', Crteefti;CIIM. 01301
Name(Print)
Current Mailing Address:
(4131-77q-A-alk
Signature Telephone
SECTION 3-ESTiMAT1rD CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
I. Building co ant
(a)Building Permit Fee
2. Electrical
(b)Estimated Total Cost of
3. Plumbing Construction from,6
Building Permit Fee
4. Mechanical(HVAC)
6. Total + 3+4+5) 3' 4,
Check Number.
This Section For Official Use Ong
Building Permit Number. Date
Issued:
Signature:
ridIng C'mmissbnedinspector of 13tillding, --------
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House [] Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [17] Decks [Q Siding[0] Other[CQ
.tnStn on
Brief Wok escription of Proposed R i r ('e&n� 0A `C � �tlj mtn� �JA 1,0" Df Ct I t�XTJ11 n3 !n1ti c�})pA
AJ In o�}4i(.
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 C1O0NTLRACTOR APPLIES FOR BUILDING PERMIT
I, t\Qt7.r1 g0.Cr ,as Owner of the subject
property r�
hereby authorize S��e�l� tTzOffe
to act on my behalf,in all matters relative ro work authorized by this building permit a plication.
@ ��
se %ey-1 1I7D
Signature of Owner Date
1, Sas-eps (Te3rax 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.
Print Name
�- 05 an
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
T0X6 (2ot4 CS31 offl I l
Ucense Number
H!h4%-Ooa 5�tft� Green tlL Mit 01301 a-iI
Address "�, 4/� - Expiration Date
413)T1i-3W
Signature Tel hone
9.Registered Home Improvement Contractor: Not Applicable ❑
J- Q, Row mn Sol\,Int, }56686
Company Name Registration Number
�j "c- \rAA 6 S11P-A &O-e4 e 4 i MR o1301 7-2.'S=ao f S
Address l Expiration Date
Telephone �{��'�7�-3�oy
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...... ❑
11. -Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwells=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 ueriod shall not be considered a homeowner.
Such"bomeownet"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 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
City of Northampton -_
Massachusetts
DEPARTMMT OF BUILDING INSPECTIONS
212 Main Street • Municipal Sui.lLb ng
Northampton, MA 01060 5 �`
,r thamp `'�.'..
Property Address: Ariif�jlon
Contractor
Name: JoSeP�, CTe���C I���� �i20 a 6,fti, S�R� �ttC•
Address: b �rnywoorll S}1 e�
City, State: G ffe(4.m j AAA 01301
Phone: 1,3�'� I , 304
Property Owner
Name: Ro�ef� Sc1�r�d��
Address: AA {�rilr�tlon 5�
City, State: Ir°�fi�Ur�DFo��I'�l�l 0100
1, JoseLh (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 1 have
provided the property owner with a copy of this affidavit
Contractor signature
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:
The debris will be transported by: Geor je O'A'4 Sin , Zn
The debris will be received by: Bru#160ro SC, M UI' t'
Building permit number:
Name of Permit Applicanto��Ph. "
Date Signature of Permit Applicant
i
Faze Canzmonwealth of1!rassachursetts I�ir►L Form �
oAidersDeparb2 i fat
Bice aj fzvestigaiiofr7s }
-S�,zee,SUPLe 100 1'
-_ -
Boston,IM10,31.114-2017
- ii2W2t.F12CSS-gt?vfd is ,
^vz' LsrS' i3 c�E?Saii4l i.3�= 'i ±edavit:B�:i Gee f�.Oq��G iD S dE+r as /I
�i=e�z_ Fo�•�►2==0� Please j--z- z
Name George and Son. Inc-!Josaph Georgi; !
d(:jc35:o<Haywood Streit (�
{{i
C-ItViSii_ielLip_Green►izld/MA/01301 Phone:=_(`13)=r7 36504
an employer?Check the appropriate box:
Type of project(required):
i i.i✓f i an a elnploN. r Jt icb"_ -`_ [� I am aden:raJ contactor and 1 1
- 6. ID tiely=consu-'Cdo.
ari i�
employees(Lull and/or p -Lime)* bai�e ntr4d the sub-con�crors
} ?_ I arm�sole proprietor or partner_ listed ora a atiachee sliee_ '_ Rcmodeting
ship and have no employees These sub-conttractors have
S. � Demolifiion (S
V-. rlcine forme in ani•capacity- empioa-ees and have--vorkers- 9_ a Building addition 1
! (leo.vorkerf camp-Insurance comp_insurance= 1
j taeuired_j 55- 1 i ;'re are P.corporation and its I0-0 Electrical repairs or additions
i anti a nomea�=:Her doinga all t,�ai p=iece have etercised their I I. 1 Plumbing repair or additions
! TztiJsei%tL O worl:C rs'COi?ip_ t'lgii e i e 2n2pii(Sit ler iviGL 12.0 t�poi repair
li!5L=r~CIC:�etlC j t c- 151% 1 -'.);and:�have no
employees.(No=_vorlkers I--Over• Otherinsulaiion
camp.insurance tzquired_I
'=nx•.pnl iCmtr that cheda box rI must also fill our d,::section briowshox in_their%vor'rcal comaensation poIicr iniottnation.
s lamcotettrcS teito submit tt,is a►Yidavit inciicatitt_they we Boit 2i!t:it=:ant then hili outsitla contractors rmstsubma a nz%-,Mda.is indicadnz sucit. l
Zenlncmz3 l,aI Check this I,O\-:Host attached an rddition?i sh=t S1tou inc the num--o=tete sub-contt alCiois cant!S'wc whahcr or not.those entities lenge
=td-ot ePS_ I Fthe sub-contmetor3 halt tn.A =ces,thea:i urt provide their:rOc'n�=S cOnp_pellet-number_ Ii
it
rt)t an empliger tha_r is provicting workers`con2Del sation RS1171112e=2 fo)=; ll 2)uDjoyees- Below is_12e polka.aivl job site T
i1 jorniatir121.
insurance Cotnpary Name-ArballdLa�i_
Policy-' or Self i
ns.>,ic_ U 7 23%piration Datr-
— _
_obSiteAddress: ,5 ndq,) SF CitylSzaielLlD: i+I00 C'1Mnhn.n, 0 10 0
-T-
=iich a cony Qi the war kers-- cOmpensa'don rloliCv declara-ion Dage{st30tiZSi�lite p01iC�•number and expiration date)_ 4
ure to secure co,,feraae aS raatti3•ed t?aer-r -ee-.ion SA a;ivfGL c_ 152 can Iead to tine imno51l7on of cr urinal penaiiies o-,,a y
ine up to S1,500.00 aadlor one year imm isortm_esZi_aS t1:ei1 as 6.61 penalties in the fiDnn a►a STOp'utrORK ORDER.and a ane a
a"up_o S250.00 a day zi inst elle violator_ 3e adt i=_ed L'naL a cop,of phis statarr_ent nay be;orivarded n ibe O�c-a0: g
iiy sdearions ojf the OIA nor iitsurance covera_ga van--teavort_ r
r ero her ebt.cer @ tr hailer the pcuris and pmnral les of"yerf_cr1-tlrC_Le irtforazarion Provide((abov f rMe fl33(l COTTECF=
hail-rLu-C: t �2`�' •4 05 o
,:-1 S)-7-1411-3604
�'i:cnz�:(-i •
' v^f�icial use n1�i}. Do 1701 W ke in dlis arza,to be compered oP am:or tows n11iciaL {
mains=or To'.11 : - Ps.�nWLicense= I
irsui i Authority{C2rC:P one)-
( . hoard of ftealth Building Depa- neni 3_C itvr_btivn ylerl4 %Electrical immector 3-Plumbing In peaor
t 5.Other
'1 •
1 -
�4 coli icn=.CL;'ei'sp��; ?hone=`;
Massachusetts Department of Public safety
Board of Building Regulations and Sta-idards
License: CSSL.099372
Constructor, Supervisor Specialty
JOSEPH P GEORGE
64 HAYWOOD STREET
GREENFIELD MA 01301
Expiration:
Commissioner 02/11/2019
—4�h� Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
TYPE:Corporation before the expiration date. If found return to:
ftistration EzRiration
Office of Consumer Affairs and Business Regulation
156686 07/24/2019 10 Park Plaza-Suite 5170
jiiGEORGE&SON INC Boston,MA 02116
JOSEPH GEORGE
64 HAYWOOD ST
GREENFIELD,MA 01301 Undersecretary J 'hfOt Vabd W pout signature
RISE
ENGINEERING"
OWNER AUTHORIZATION FORM
I, Robert Schrader
(Owner's Name)
owner of the property located at:
55 Arlington Street ,
(Property Address)
Northampton, MA 01060 ,
(Property Address)
hereby authorize �� C 1 w U SO n,
(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.
Owner's LSignature
6 - P,, S; -- I '-�
Date
RISE Engineering,a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 1 Canton, MA 020211339-502-6335
www.RISEengineering.com
City of Northampton
, Massachusetts
DEPAR21ENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
Property Address:
Contractor . a'
Name: .
Address:
City, State:
Phone:
Property Owner g €
Name:
Address. T �
City, State.
(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
Date '