30B-091 (3) 66 FEDERAL ST BP-2019-0912
GIS#: COMMONWEALTH OF MASSACHUSETTS
M=Block:30B-091 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2019-0912
Project JS-2019-001530
Est.Cost:$6960.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOSEPH GEORGE 99372
Lot Size(sq.ft.): 23086.80 Owner: O'DONNELL GREG
Zoning:URB(II3)/WP(IO2) Applicant. JOSEPH GEORGE
AT. 66 FEDERAL ST
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774-3604 WC
GREENFIELDMA01301 ISSUED ON:2/22/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:AIR SEAL ATTIC AND BASEMENT ADD
CELLULOSE INSULATIONTO CAP AND SLOPES
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:
Feer e: Date Paid: Amount:
Building 2/22/20190:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
RECEIVED Ci IfNOrthampton StabaofPeaalL DepadmentuseaMy
Buil ling Department Curb CWDfiv yPermit_.
FEB 9 1 2019 z 12 Main SgaeC SmvedSep AyaAabN y
Room 100 WaW Neu pvallaMMy
om mpta , Ns401060 TxasetsafsaxuWPau
Dear oc rim ra:r,i , ,i 5 -1240 Pax 413587-1272 PlmlSits Plana
Other Spedty
APPLICATION TO CONSTRUCT,ALTER,REPAIR.RENOVATE OR DEMCIJS14 A ONE OR TWO FAMILY OWEWNG
SECTION 1 -SITE INFORMATION (i1_ q l'2L
1.1 ProoertyTA-ddMss: \ �This is�section to be completed by offices
c
f06 T L�CG.` Jk MUP_ ;�
, 153 _.•, tot_ /
„.1 q/___{.Mir
Zone Overlay District
Elm st OIWct Ga Diiebtt,
SECTION 2-PROPERTYOWNERatup t7T}iORtZED AGENT
Zt Owner of Rcecow.
NmM{PrcmYi � �'• 7`!O('PM IF. I�I t101oE
seg n��a�nea MedinvA 13� gay rag
Tmepbow
sgnabae
2.2 Author)ced Agog:
3a5e Geis, C6 FlUywood S3 GseeFileg'M 01101
Name(Pont ` Current M�a�@,n�g�A�a-drrelss: r is
Signature \Y
Telepbaw
SECTION 3-EETIMATEO CONSTRUCTiOn COMx
Item Estimated Cord(Dollars)to be Otfiow Use ONy
com Feted emlif a i ant
1. Building
(a)Budding Permit Fee
2. Elsctriwl (b)Esgmated Total Cost of
3. Plumbing Building lding Pution Goth 6
Permit Fee / /,�,�^' {'�
4. Mactem,,b(HVAC) 4K .� +Q t^y
5. FWD Protection
S. TOW= 1+2-3 i4+
' Check Number LP.
Thh;Ssetion For ORteial Use Onix
Building Permit Numbs Data
Wiled:
signature;
�-22Zd9
BUPdtrg ramintusknathsPor�wPfa ldings —"'J------
Dam
SECTION 5 DESCRIPTION OF PROPOSED WORK(check all li abi )
New House Addition ❑ Replacement Windows Alteration[.) Roofing
Or Doors ❑
Accessory Bmg. ❑ Demolition ❑ New Signs [a Decks [p Siding M Other[tip
Stn m
Brief escripti opos� W
V\ a
Alteration of existing bedroom—___Yes No Adding newbedmom Yes NO
Attached Narrative Renovating unfinished basement _Yes �No
Plans Attached Roll -Sheet
e..If New house and or addition to existing housing, connOlete 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. Mumsod of heating? Fireplaces Or Woodstoves Number of each_
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of constriction
I. Is conslmction within 100 R of wetlands?_Yea _No. Is corisbrucaon within 100 yr. floodplain Yes_No
j. Depth of basement or cellar floor below finished grade
k. Will building conform In the Building and Zoning regulations? Yes_No.
L Septic Tank_ City Sewer_ Private well_ City water Supply_
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR
PPLIIESFOR BUILDING PERMIT
1, e- V f h^-h as Owner of the sublet(
property q
hereby authorize 3A�6 �UTIe
m aU on my behalf,in all makers relative .ark authomced by this building Permit application.
Sce ��.edR �—l$-1`�
SigrrnWre of Oxvar Date
Jo5Cg1, (1kDtgf. .as OwnerlAmhGr@ed
Agent hereby daaam met the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belef.
Signed under the pans and penalties of perjury.
Prim Name
sanawre of OwnwfAaent Dam
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Consbuc8on Supandjor: Not Applicable ❑
Name of Limine Holder:
License Number
i � woD S�Ycei gen{.recd 01301 a-a-aDi�
Address Ex aafton Data
ru' (413 74-3604
Signature TelaMosis
9 RerdataMdH linpromamentC tract Not Applicable ❑
11f, 156686
Company Name Registration Number
64 11a- rvo-a A S}reel &FeZNR Idr MR -01301 7-2s`ao IS
Address Expiration Date
�' Telephone 413 -774-3604
SECTION 10-WORKERS COMPENSATION INSURANCE AFFIDAVIT(M.G.L a.152.4 25C(S))
Workers Comp amnion Insurance affidavit must be completed and submitted With this applicawn.Failure to provide Lids aftava wol'.Wft
in the denial of the issuance of the building perimit.
Signed Affidavit Attached Yes....... ® No...... ❑
11. -Home Owner Exemption
The current exemption for"homeowners"was extended m include Owaer-occunlcd Dwellblbs of one(1) or two(2)fandlies
andto allow such homeownerm engage an individual forhire who does nmpossess a license,provided tbatthe owner acts
as sunerv)sor.CMR 7Sk Stith Edition Section 1083.5.1.
Definition of Homeowner:Person(s)who own a peal of land on Web he/she resides ur intends in residq on which there
is,or is intended to be,a one or two family dwelling,attached in detached structures accessory m such use Mdl or farm
structures A name whosbwcts more than out house in a twoaemr period shall not be considered a homed n .
Such"homeowner'shall submit to the Building Official,on a form acceptable to the Building.Official,that kabbe shall be
responsible for all such work Performed ander the building permit.
As acting Construction Supervisor your presence on thejob site will be required from time to time,during and upon
mmpkdon of the work for which this permit is issued-
Man
ssuedAlan be advised that with reference m Chapter 152(Workers'Compensation) and Chapter,153(Liability ofEmployersm
Employees for injuries nm resulting in Death)of the Massachuseua Gaac al Laws Annotated,von may be Sable for persons)
you etre to perform work foryoa under this pyran
The undersigned"homeowner"cordfies and assumes responshibty for compliance with the Stare Building Code,sty of
Northampton Ordinances,State and Local Zoning Laws and State ofMatsechusetrs General laws Animated-
Homeowner Signature
City of Northampton
rc Massachusetts
212 tl Street Bonding 4
Nortbam ., M 01060
Property Address:
Contractor
Name:
Address: U'� �mYwood �trY4{
City, state: Groer4,mx MA onol
Phone: ti31 174- 3604
Property Owner
Name:
Address:
City, State:
I, JoSgP W!)8 (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`cotp�y of this affidavit
Contractor signature �-�,
Date �j
tkini t-urm
The Conmzonweaitiz of wassackusays
Departs,a o}?ndzntva7Accldenzr
_- - Ojice o}Inven`igatians
}:_y"+`• 1 Congress Qtrze:.Kazin 100
3osiok,3114 031 f 017
lonnv-,-.a-gov/dia
i 'ar ears' Co�pe�s2Goa _s sa seAact3iC � acorscrcal- tbe.s
wm sdl .
-lcar' on-,ai'o;s Pteaser.'rJ:e.x.elc
\e0.'e(ausims:!Qr=ari�do:vina:•idaal)_�-B-
George.and Son; Inn t.loseoh George
*ddroes:ai Haywood Street
C;i?°lSiaie/lap:G;aennelolPJIAl0530i ?hone-(=�3)77�-360e
,I re;'oe an emp33per? r-necYz the appropriate hod: Type of projeer.(requiredl): 1if
{am z�reral con racmr and 1
i-4d1 ianaemp{oyarwizth"= `• C] d. Qcnrceasuuction fl
employees(mll and/or oar.-timo).'* ha:,e�rsdtheme.00 zcton I
1.Q icnase{e proprie or os pacmer lima on the auached shee> 7- QRemodeliu�
Am and have no amployees Thes~sub-canfracmts have L Q Demolition
?,crldng For rile in any achy- em➢IO}'CCS and llat•C WDSkeiS'
c-a - 4. ❑Building addition
i re o a'otkers'comp,insurance comp.a.cornee-
� ;zquiied-j I;- Qt %U=_xrz x coraorxtion&zd its 70-0 l:lecvirl repairs or additions
am a homcowne[doing all work o�c�h2ve ese_mised Their I 1-Q Plumbing repair or additions
rl tef:3np`.wn as-M(r'T
mysak.to::•oroars'comp. 72.Q Roo,`,repairs
incemace_equa-ed-i+ c.e5 -fit L- andw�ers. no 9 (15Ulaton
1 zmnla.�.s.7ro::orlcars' 13- Other;
corr,u.insurmce required-]
^hm•aplicua dlxt chew W';=!must elm 4d1 au;dee s.iioe urtua-smriaguusir w•vt.;er:eamPemauon Oatin•idra�marian.
'!lona,roam=rs+rnos�bmnrHuemdx.�nlnU,cari+v S�ev are doh�All�:6:aM ihn hittauuick wrumvors mans.:bmuonsv--.ft:'ca�rtindir�tinssucn.
- onamcmvthm chad;:hic6r¢mmeansbM m.eddiaonm saytatw.�ix¢ur_cems orwc xo-wauana¢mul sane sehcWcrorrwlihuseelailitt Ml'a
endo�aae. L Ne maU<anirdmaa nave vrul'oyas,uary four;prr.•ivaaiar.ra7�•�canp-yoficy-mmbr.. !';
I RHI rat eFnplal'af fit6 lSpraVi(filio tvOSkarS'Cnrs]OQTSarlfll)IJ)Sl+i+nlC2jDP:9?P�rnj)ID},ePS Baia'.is_ltopo le),arlI job Site
hjdrrtwtiat -'ll
tnstnmoa Company Name:Arbel12 _ r
-aµ1 (� /` 1 i ']
°olin f pr Sehias Liu. :! 1 a��f�"\ L 4 7 j =spiraflon Dam
Ieb 5¢e Addrasr. 'Q'a �"�`^•� ` City/S'.aRlLip: "�•l�d(�-� C I b3
�;nd;a cnoy o;the workers'compeasaaon policy declaration page(sko:ring me policy number and espirarfdn date)-
Faitura to sawn:coverage as required uad-rSeeuon til-or`MGL c 152 cxn Sead m dxe imno9don oYci'oi lipal psa{ties uta ly
ane up to s1,500.00 sadlor one-year imprisonment as well as C'M,l penalties in fie lbrm ofa STOP WORK ORDER.end afire - a
of up to 5250.00 a day against the violator. Be adviseclthe,a copy oftItis statement maybe forwarded to fie Ogee of
uiee;_dga[ion5 of rhe DIA for insurance co.re,aya
7 do t;erebr carr nrtJertlze pairss qnE eual5es%pep"/pm�t_&{.,yr("_lee ii jorm¢rion provided n60ne7s fr[±e RAd COTIECl
'�4t a? i' � A O2h• �—� �—I�
Cimne 9-(413)--/74-36D4 y
I
G,L-Feia!use nzzi0; Do no:wrrze firs deir area,tq be comm an cnu m•rnrvn gf7claL
07y or?-own! Permir/Lirense=
:saving A-thGein-(eirera one):
I.Boerd oMealM Z.3isilding Depart meni 3-Cityl 'ewn Gar4 !-LSectric2l inspec[or 4-Plnmbia�inspeccbr
I LWwC"{7Ql5nO(i:
Commonweatth of Massachusetts
Division of Professional Licensure
Boats of RuOding Regulations and Standards
Ccnstructiort+SlWMs9r Specialty
CSSL-099372Lajccpiras: 0271112621
s�
i
JOSEPH Owmw
64 HAYWOOp'-STRE �.
tutEENP1ELO M74,0130 1`
'btJiR7i0y�10
commissioner `
C�l s�muwrouureo�!><`,��ZRaw rlros,Y� -
Wice of Consumer Affairs&Business Anulaaan
HOME IMPROVEMENTSONTRACTORfor kMlviduW use anty
TYPE:'Corowwon- betom.the expiration date. If found rOWm to:
Reoistrat'an Emindan OMoe at Consumer Affairs and Business RegWation..
-_tsssw 07rAW19 tOPWkPtaza-SWte5170
*,—GzCRGE&SONIMC: - Boston,MA 02116
JOSEPH GEORGE \R.G('Jc C� 'Q' QJWy '
64HAYWOODST U Not validw out si nature
GREENFIELD,MA 01301' Undersecretary 9
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: U � eCC�` q.
The debris will be transported by: If- Genrle V A4 Snn , lA t '
The debris will be received by: B r't*6oro .Sc,Iy je
Building permit number:
Name of Permit Applicant �oSePh �"e o q�2
a-18-19 �Qp1� gin.
Date Signature of Permit Applicant
RISC 60 Shawmut Road, Unit 2 Canton, MA 02021
ENGINEERING"
OWNER AUTHORIZATION FORM
i. Gregory O donnell
(Owner's Name)
owner of the property located at:
66 Federal Street
(Street)
Florence, MA 01062
(Town, State, Zip)
hereby authorize ,
(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 additiona cost. rI a homeowner's
responsibility to close out this permit by contacting their nicipalit 4he cgmpletibn o this work.
-Customer - --- -
Sign Date
10/3/2017