17A-104 (6) 310 BRIDGE RD BP-2019-0970
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Map.-Block: 17A- 104 CITY OF NORTHAMPTON
Lot:-OQI PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2019-0970
Protect# JS-2019-001602
Est Cost, $3000.00
Fee: $65.00 PERMISSIONIS HEREBY GRANTED TO:
Const Class: Contractor: License:
Use Group: JAY BOLAND 101680
Lot Size(sq. ft.): 14461.92 Owner. DUSHAME LAURA L
Zoning,R1(100)/URALM Applicant: JAY BOLAND
AT: 310 BRIDGE RD
AppiicantAddress: Phone: Insurance:
233 COLLEGE HWY (413) 203-2454 O WC
SOUTHAMPTONMA01073 ISSUED ON.311112019 0:00.00
TO PERFORM THE FOLLOWING WORILBLOWN 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 ft 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 Sienature:
FeeType: Date Paid: Amount:
Building 3/11/2019 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
StreetCity of Northampton S�Of P�
212 Main
Room 100
- 01060
phone 413-587-1240 Fm 413-587-1272
APPLICATION TO CONSTRUCT,ALT* A ONE OR TWO FAMILY DVASIJNG
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Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54. i admowledge that as a condliion of the btrildltg
perms aB debris resin from the om#udion ac"governed by this&Aft Penna shall be disposed
of in a property Housed solid waste disposal facifty, as defined by MGL c 111,S 150A.
The debris from cortsfiadion work he"perbrned at
(Piesse print house rearmer and street name)
Is to bead d of at l
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v( masa pm name and wsion of
Or wN be disposed of in a dtmpster onsite reread or leased from:
(Company Name and Address)
SKpv* a of Permit Applicant or Owner Date
t,for any reason,the debris will not be disposed of as indicated,the Applicant or Owner shall no*the
Btd ft Depmtrnent as to the location where the debris wig be disposed.
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Office of Consumer Affairs and Business Regulation
1000 Washington Street-Suite 710
Boston, Massachusetts 02118
Home Improvement.Contractor Registration
- Type: Coq)amion
HOME ENERGY SOLUTIONS INC Regi183885
68 RUSSELLVILLE RDS 1v0�20n1
SOUTHAMPTON, MA 01073
Update Addrou rM Rstern C Wd.
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NOME IMPROVEMENT CONTRACTORpbNalbnv4bfor individualuN only
TYPE, H Caoarabf
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1000 WMin0211Strea[-SWb Tt0
HOME ENEROY&(YATfiGNB RIC Eos/JW{/n�JO,MA 02118
SHAWN MR
60 VILLERD
SWUTRAMPTON. 01073 rUntlereecrae—tery- _ /y��/!f//
Not jaUNuf kM1
SignStUM
uivision of rrotessionai ucensure
Board of Building Regulations and Standards
Construct i ki *5tr Specialty
CSSL-101880 �ires: 12/27/2020
JAY R BOL
12 PISGAHR
HUN'nNGTON
oz 3So�
Commissioner
Construction Supervisor Specialty
Restricted to:
CSSUC - Insulation Contractor
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For information about this license
Call (617) 727-3200 or visit www.mass.gov/dpi
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AFFIDAVIT
Hone I prevraewt Ciavitracter Law
Srppluhaeat to Permg App4nUea
The Office of Consu>mcr Affairs and Business Regulation("OCABR')regulates the registtadm of contractors and
subcunuacmts pedortttmg improvetB®ts or teaovati=on deched one to four family homes.Prior to
performing work m inch homes,a contractor msst be regasnaed as a Home Lt4mm anent Contactor("MC"),
NLG.L Chapter I12A requires that the"MUNIlxaloq alt cliff ,Mnovailck MPP modwnft A convwaion,
w p um w4 Mmowl damomort a catslmidbn of w adRion to any M-62do rg otwwatztpled&Adiv8 owdaidng
at issst one bit riot m bion fixv dwaft mfr.. to strtsrhass Mark are a4werd io sods residence orbu*W be
deme by reddayd comactam
NOW IfA*e Aea,arwm las ceabacred Wgk a MrpMII"X or LLC,dUdMMy Mona be PMU&Ned
Type ofWorin »Ct _
Address of Work:��� C) t �(O>',PiYI<1P
Date of Permit Application:
I hereby certify that:
Registabm is not tegakM for the following reason(s):
_Work excluded by law(at)lam):
_.fob vada SI,000.00
Ow obtammg own permit(explain):
_ au
Building not owacr-otied
_Otho(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNRBGWrERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME AfPROVE34ENT WORK ARE NOT
TT1GM RM AM DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.GL Ompter I42A.SUCH OWNERS ALSO ASSUME THE RSSSONSDMJM FOR ALL WORK
,,%VFOMM UrME t THE BUnXWgG PER-MT SEE NEXT PAGE FOR MORE EVORMATION.
Signed urKla the penalties of pajmy
I hereby apply for a building permit as the agent of the owner:
Sham W .he 0
Date Contractor Name IHC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the o�of the above properly
Date Owner Name and Sigoatote
D Sign Envebpe 10:aB2AFs9C-M"E?1AEE1C89a 1D51D"
RISE.
ENGINEERING
OWNER AUTHORIZATION FORM
I, Laura Dushame
(Owner's Name)
owner of the property located at:
310 Bridge Road
(Properly Addreas)
FlorenceMA 01062
(Property Address)
hereby authorize
(Subcontrador)
an authorized subcontractor for RISE Engineering,to act on my bow to obtain a building
permit and to perform work on my property.This form is only valid with a signed contract.
YC W-
Ownses Structure
12/10/2018 1 7:04 AM EST
Date
RISE Engineering,a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 1 Canton,MA 020211339-502-6335
www.RiSEenginmring.com
City of Northampton
5 «.
Massachusetts a �4
DEPARTMENT OF HUZLDZNs ZZNSPECTZONS 6r
212 Main street • M ici 2 6uiitlin
NartA t=, MA 01040
Property Address:
Contractor LT�—Y1
Name: 'Y� ) -�... (
Address: �, �_ '"
City, State:
Phone: i
Property Owner r.
Name: �ICA V1'i C
Address:
City, State: � iiY-,-,t
I, .� (contractor)attest and affirm that the building I intend to
ins ate 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 i affidavit.
r
Contractor signature
Date � ; � r�