23A-123 (10) 20 MIDDLE ST BP-2019-0845
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map. -Block:23A- 123 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-2019-0845
Proiect# JS-2019-001397
Est.Cost: $2752.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOSEPH GEORGE 99372
Lot Size(sa. ft.): 13503.60 Owner. WYMAN GINA
Zoning: URB(100)/ Applicant. JOSEPH GEORGE
AT. 20 MIDDLE ST
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774-3604 WC
GREENFIELDMA01301 ISSUED ON:1/29/2019 0:00.00
TO PERFORM THE FOLLOWING WORK:DENSE PACK EXTERIOR WALLS WITH 4" OF
CELLULOSE
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: Qil: 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 1/29/2019 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
1��F -lq- f evb-
REC IVF=n I
0 artment use only
City of Northampton Status Of Pe
Building Department JAN 'q4rb2M* P Ty'rilt
. dQ
-'
212 Main Street Sevva-dSeptic Bab 11ty_
Room 100 lAt -ftAllabi
-
DEPT OF SUIL N G I Uc�
Northampton, MA 01 0 NORTHAMP 1�ctu Plans
phone 413-587-1240 Fax 413-587-1272 PlotfSita Plans
Other Spew.*
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
- 4-PLIF
SECTION I -SITE INFORMATION Iv T7 67
1.1 I'moopMAddrels. DMIA& This section to be completed by office,
map -48 4 Lot- ___j)nJt
hOrt"f4 t4A Zone Overlay District
010 0. Elm SL District ca District
SECTION2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2 Owner of Record:
(7.;00% 71man ;),P �•l'O(yAkj MA
Name(Print) Current Meiling Address: ( I; -a 37 -7N
Ste, AAM49 Telephone
Signature
2.2 Authorized Agent:
Name(Print) I Current—maling Address: A ol3r
L31- Hit A404
Signature Telephone
SECTION 3-ESTIMA D CONSTRUCTION COSTS
Item
O rRiji—r—
item
Estimated Cost(Dollars)to be Official Use Only
comoleted by narmit—ligont
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Costof
3. Plumbing Construction from.(6)
Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protectlon
6. T0tal=0 +2+3+4+5) 51.0 a
Check Number,
This Section For Official Use ril.,
Building Permit Number Date
Issued:
Signature: —------------------
Building Commissionedinspector of BuRdings
Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [oi Decks [Q Siding[C] Other[YA
�r►Sv► on
Brief Description of Proposed Detvu �at+( l�t' Q f Q I�pilo s4
Work: P k 'Q,��� I
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa.If New house and or addition to existing housing, complete the foll'owing:
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 R 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
v
1, &tft `N�M GR ,as Owner of the subject
property
hereby authorize SnS 6 &eOne
to act on my behalf,in all matters relative fo work authorized by this buildingpermit application.
Ste WfAco —1 4 ,�`►
Signature of Owner Date
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.
uoS x\ I&W 2
Print 4&Nlf-7&l o I lay
Signature of Owner/Agent N Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
��Se �2orae. cssl a`131PX
License Number
01301 a.-li-_poll
Address F.xpiratwn Date
-711-464
Signature A
Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
,M, �eory c-4 o\,-Tni, MW
Corn any Name Registration Number
C� $1v� H►oA slt"� &ree,\R 41 MR o1301
Address ("qqtrelephonA41;) Expiration Date
'77�'3 6
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 ElgMLi ion
The current exemption for"homeowners"was extended to include Ohyner-occupied Dwellibis 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 persony-vho constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Oficial,on a form acceptable to the Building_OfficiaL that he/she shall be
responsible for all such work performed under the bui'tdina 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
DEPARMUNT OF BUILDING INSPECTIONS e�
212 Main Street • Muni4 pal Building
< Northampton, MA 01060
Property Address: (dd�Q S rb I'AgjI MA
Contractor
Name: jj JgSeph CM2 I kl,P- (RON mtk Soni -1m,
Address: Strte$
City, State: �reta ;eld�, M 01301
Phone: biD-17q- 3G04
Property Owner Glia V1
Name: V on
Address: �10 it.
City, State: �o `Cl J , fl 10 67'•
I, Josefh ROM (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 01
LP /�
-------------
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: 0 O Nfle St.
The debris will be transported by: j,f, Geode o it4 Snn , 1/)
The debris will be received by: �rVA#1 ?baro .SCg
Building permit number:
Name of Permit ApplicantQS���, "�
0� a`f of
Date Signature of Permit Applicant
Tize Canznzonwealth of Massachusetts print Form s
_ Depwvlmeni ofbzdu 'Kral Accirleftis
-`,�jJICi? OJ �ftUPSLt�tFZt3F2s
1 Conp•ess sb—ee &-ate 100 1.
- OS13'1 ►�r� t 7 71 .'3017 1
. ,_-
ii231311?.�72L?SS_a Cl'lflttft
(Business.{Omani_adoitr7ndit-idu--[)_J_P_George and Son; Inc-1 Jossph George y
i{
ddycss:64 Haywood S-aeet {
Cli�iSic�elllp CreenTtela/ir11A/01307 = 1 _ t!
��a�e="--.(4-t3)-77A-a604.
_-^r e 1 ou an emp)oyer? Cherli the appropriate box: Type of project(required): 1
ii✓i I
an-z 2 atnplOyt:r ti�=ith 4- L- I asci a general con,.ac'ror and I
t 6_ ID ev constructionemployees(;ull and/or par tuna)_ ttav a hired the Sul
Z Q i Wn a sole p;opt ie-.or or par,`,ier- listed on:he at t:chee shee_ 7. lC]R modeling
snip and have no ez-rinlo,eas These sub-co_itr cross have g_ II Demolition%=.=orlting ror ine in ant,capacity-
�mpiol ees aril have�vorlcers= q_ Q Building addition
RO Vrorkerf comp_insurance comp-insurance
~aei:irec j =_ ( I V 7e arc a cornoraaon avid i�u I Q_Q Electrical repairs or additions
1 am a hoinco�':ner doing all t.'oili o max;Ita12 exercised CIiBlr I I-Cf Plumbing repairs or ad ii-noons
NIS611_�LNo rvorz'ers'contp_ I'!=alit of e_:ernption pe-LViCT I?
I�'?-
and c. i s t ! _ -,v--hay:e no
--Q tZou_rapairs
ins�t3tlCz_$Llt!Lt�C..l'
empioyees. [Wo=-vorkers- Othet4nsulaiion
coup_insurance requited_]
it.=:?Ducats,that tiiec.z ho, -h ttlust also tt�l am the section baiowshorins Ji-ir,trori cal compensation noun ituot;n ion.
Hatnco-ter tvito submit alis asidavIL indimcnie dtev m coin°-all v.aik and!hen hireoulside contractors mustseb;nit a n--%r a ndavit indicating suob_ l!'jIl
ontracru3 that cheel:chis box must attached an additional en=t sho Lv iaa tit_name o uic sub-canin._ctois and smc ttlicuicrornot!Mise trioti"&Iia%°
employe-eL LF die sub-conimmois have unplctvees,liter-mustprovide their. war---.s conn policy num6cr- H
G
1 anz an e111ptn]ter tltctr is proviclinj ivorksrs'c0172.0et sin?on i7sltr[1121-=2 for;.iii 2211 yeer_ BdJOIV is t&e pOliCT!I1?[I JOh s e h
a1b171zation. 'i
`.t
Lisul ce Company'-Name:Arbella qgX66L' 6 �77
�I1Cy=t Lir Self-in-e-Self-in-e->riC__: rxpi3.2aOn l7aiC_ C✓- � ;
lob Sitc-Ad-dress: a o AiA St. Cidlsta azip_ Xi
•z_i;?crit c Ct3py of�PiC'I�Orli2r5- compensation polis_,d2CI81'2�iOD _ =c-(sho-wing foe policy number and expiration dfli'e)_
aile=ra m secure coverage as required rode°-Section a of iGFGL c_ 152 can IeaciLo tlae imposition of cr;minal penatxies of a
=�>ie
up to S1,500.00 and/or one-year imprisonmenE.ss-well as civ=il penalties in the form of a STOP WORK ORDM and a fine a
oif up a 2250.00 a daly against the violator— Eke advised the a cop,of this smm em-ent Titan•be forwarded m the OrZee o
iiiVesd2srions Of the DIA tor insurance cove:aga vat i icncio t.
K
iso!hereby cer c'=ailliei•'tie oarsd e1lal ies of�erJscn-tlrc�=hz informtzrioll provllled above IS Aire rind corracl,
Da01 ��
Rhone g-.(413)-7—Td-3604
i
GfjWlat rSSe 12111-}: Do not 10)*2111 t11i$itFM to be compJared DN&1.3;07 MILAN n}ficiaL j
h Cry or To1Trii: r
P e=�tiJlicense- `
ArsuingAuthorit-1r(eirc?e one)-
r .Bos=.�o€i ieali�► y_i3lsildi!-l;�epartmW 3-CiLvl'ozin Cler4 Eiectricai insoecror s-Plumbing.insnector
Colica Fenopr
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Reg ulaLLt,,IIico,,��ns,,and Standards
Constructiob � Specialty
CSSL-099372 ' apires: 02111/2021
JOSEPH P G. RGE
ti4 HAYWOO TO
GREENFIELD1013 L���1.
IST(
Commissioner
-U'/ie.�anr�riutruaea�l�i a�'C�.Y��irvlaG�usell ° _ .. ,
Office of Consumer Affairs&Business Regulation
HOME 1MPROVEMENTZONTRACTOR` ' Registration-valid for individual use only
TYPE:tomaratfon hefore.the expiration date. If found return to:
eaistration Expiration Office of Consumer Affairs and Busimess Regulation..
_256F •_.
07124t2019 10 Park Plaza-Suite 5170
JP G15ORGE& Boston,MA 02116
' r _
JCISEPH GEORGE
64 HA,YWOOD Sr � Not vabdwkhout Signature
GREENFIELD,MA 01301' Undersecretary
Docuftn Envelope 10:FBA34132-EBBE-4C78-A300-661R.8f)E5sOF2
RISE
ENGINEERING
OWNER AUTHORIZATION FORM
I, Gina Wyman ,
(Owner's Name)
owner of the property located at:
20 Middle Street ,
(Property Address)
Florence, MA 01062 ,
. (Property Addr#,rs )
hereby authorize 0'e` age 04 son,
[.
(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.
Oocusigmd uy:
B8J4i06iA6
Owner's Signature
12/10/7.018 1 10:51 AIN EST
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 1 Canton,MA 020211339-502-6335
www.RISEengineering.com