22D-118 (6) 20 AVIS CIR BP-2019-0997
GIS#: COMMONWEALTH OF MASSACHUSETTS
MV-Block:22D- 118 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Cateeoty: INSULATION BUILDING PERMIT
Permit# BP-2019-0997
Project JS-2019-001643
Est.Cost: $2164.00
Fee: $65.00 PERMISSIONIS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group JOSEPH GEORGE 99372
Lot Size(sa. It.): 18643.68 Owner: CATLJOGNO MARTHA E
Zoning: URA(100)/WSP(100)/ Applicant: JOSEPH GEORGE
AT. 20 AVIS CIR
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774-3604 WC
GREENFIELDMA01301 ISSUED ON.3113/2019 0:00.00
TO PERFORM THE FOLLOWING WORK.•AI R 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 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 3/13/20190:00:00 $65.00
213 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
City of Northam ton
_ Building Departn an
.� 212 Main Street
MAR 1 2 20'
Room 100
Northampton, MA Ill06
phone 413-587-1240 Fax1.13offiIr"Onl'
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTIONI -SITE INFORMATION INSULATION PERMIT
1.1 Property/AAddress: This section to be complQeted by office
ao , `vis ��rL1��- Map Lot ) / O Unit
n('(-'eMCt2y MI \ Zone Overlay District
O 166-
Elm SL Dbtrict CB bbbict
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
�2.1 Own f Record: /1 l /�
l C l�I��V�O �( r 1 novae
Name(Print) (\'� Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent, C 1 /� ,, ' t
JO - YI WCc-�T.13'(CeAAG(!A (VA kc,1361
Name(Print) Current Mailing dtlress:
13 3 10-76
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by Permit applicant
1. Building q t , , ` (a)Building Permit Fee
2. Electrical a �1 O (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee '�/�/ /
4. Mechanical(HVAC) zt'/ p C
5. Fire Protection CC��
fi. Total=(1 +2+3+4+5) • 'S Check Number
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature: 3' 13-�iQ
Building Cummissionedlnspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not ApGp'licable ❑
Name of Li,,,Holder: �1 v-�"� v` e s J l— p1 ln
3jjL
License Number
�yvS� C3ce�n�t�1d o �so� a- , i -aoa1
Address n , ' Expiration QDale! LfM�.LV . C4(3� S3/ 1076
Signature Telephone
S. Ist red Ho nvimunint Contrac in Not Applicable ❑
Com an Nal Registration Number
l� wcccclSl Cwe eM eke ckso i -7- �s--;019
Address Expiration Date
Telephuneyr3 531 /076
SECTION 5-WORKERS'COMPENSATION INSURANCE AFFIDANTT(M.G.L.C.152,g 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-.... ❑
Brief Description of Proposed Work NOTE: INSULATION ONLY
ANr5ec-\ A iL �,%asewte4
�Ad caw I()se �m eY-:kS,�Vi8
was '��sv\atm 1nGk��
as Owner/Authodzed
Agent hereby declare that the staLftents and informaWA on the foregoing application are tore and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of egury.
'�
VG. _f_o6 �
Print Name I
\1(A\ 3-�-r9
Signature IN Owner/Ageenn�7p`, ,/ �/t //�/� I} ,r/� Dale
1, 1 \�"r ' •'�` �S.:k 1 uG 11 U as Owner of the subject
property p(�1�/•\ CT��!
hereby authorize
to act on my behalf, in all matters relative tb work authorized by this building permit application.
See o��-�tier� 3-"i- 19
Signature of Omer Date
City of Northampton
Massachusetts
r
(' D&PARTl1fiNT OF HULLOING INSPECTIONS
212 Main rCr •
NoMu eipal Building
Nampton, NH 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR')regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owneroccupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:ljthe homeowner has contracted with a corporation or LLC,that entity must be registered.
Type of Work: - k���rrSV\0.�0� Est. Cost: pt 6q ' bs
Address of Work: do
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
—Job under$1,000.00
_Owner obtaining own permit(explain):
_Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBH.ITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
® City of Northampton
Massachusetts
x
DBPARTNNNT OF BUILDING INSPECTIONS �•' P^
212 Nain SUcaC Municipal Building 5�F` C9
NorUavpton, IA 01060 W 3`1
MANDATORY^!!FO/�R 1HO/USES BUILT BEFORE 1945
Property Address: O� V �5 `\'{L\�
Contractor T n ,_.,, S�iA1C•
Name: L7'�U Yv
Address: w ,�
City, State: 2�1 � \ f,^A V\ 666 1
Phone: 413 S7, I 10-7 6
Property Owner
Name: 'V�1, ^ _Jf, LI . a Vic)
�1�
Address: l, L L
City, State:
I, . 1Ct7V1 17Z� (contractor) attest and affirm that the building I intend to
insulate does not h ve 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
City of Northampton
/ Massachusetts
l DIM?AB1fffiiT OF BMWIBG INSPECTIONS
212 Main skrsst .lfitniciP 1 Bantling
Mortha tan, MA 01060
Debris 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.
The debris from
construction work being performed at:
(Please print house number and street name)
Is to be disposed of at:
(Please print name and localion �cillty)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address) p y
Signature of Penjit Applicant 6r OwNer Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
Prini�-0rfil
_ The Commonwealth ofMrtssaclzuse(ts I
_ .+. _Departneri a} ndrs6%aI�ceirEexir I.
irzvesiigafior-29
4 ."^
- _- lz:orzpas 3}hest'Suite 7p0 (:
Bosion `777.4-207% I'..
r___ i
' cutotv.r�css_aov/u¢ -
,o-iwirs' Comneeasatiol:: srzranceSs„davr;: 8ers/ .o isa�brs/E2eetsis<.,a�ss/PYa-v he;5
pleased R.Ledbh°
\aroa(BusincsgO,, r adoaimdivieuefl:J-?-
George and Son, Ine-1 Jowl George
Add:css:64 Haywood Street •I
Citi°r'Ste1De/Lip-Greendeld/MN01301 Phone 9—'_W3)-774-3604
re yon an empioyer?Chertt the appropriate bac Type of project(required):
1.112 1 am a employer midi? ?- 0 I am a genelzl contractor and i
:anplo}res(toll andlor oars-time).' have hired the sub-conrzcrors
6, ONev:conshcodon
2. 1 am...I.proprietor or parser- listed mt the attached sheet 7. 0 R.-nod-.ling
stip and have no employees Thee sub-conte actors ha•.+e S. Q Demolition
wovIdne for me in any capacity- empioyees and have workers' 9. Building addidpn
(Noviorkerf comd.insurance comp-innnancev
j :eouimd.] 5. Are art a corporation and im 70.0 Electrical repairs or additions
i am a homeowner doin__a]I mord oo—_+-rss Parr exercised their 11.0 Plumbing rapair or additions
mysal:.[N'o rra2>srs'eomp. ri�n:o`-_'nrrPumper NtGi t�
sf ,O Roo:repairs
inaWBnCe refill{see] 1 y ('),and ws have no
amplcy—s_\-o workers, 13-Q Otherinsulation
Comm.insurance requited.]
-- 'n•�plic,wlr rh.t�ahamd' f.el must also GII aurdiesetiw Ion-nim+i+¢thenhii,... campemation pdim'iniommtion.
'iiartuw.xr,ngro submit Nisamdavlttndfw'rng dyer zre¢ashes all{iatnnd Nen h3reoenide romnoors mnmsebmhn -v:Fndn+•irindiw[ina such-
ealoiwm d+er chcl:xhts ho<museauahed an mldi3omi�•_^{nho..ined+�n-.mL alp+c sue-wntrcrors and riotCMmNccarnotNoce endtfg anve
JlIDalT2i LiNC 911b-Ca1110eya1S pal•2 nnplayKS'd`I$n1LL5[pfal'ItiL iM1'J-:icOdhS romp.oanermm�ov, p
t rwr an emp(o}'art/zar lsprov±r!>oworkers'com¢ensa7on(n5¢PNrC2jar::xP $elmvis:IkepaGet+mrrljou site G
irjbrmado&
I
Indmim—ce Company NinuaArbella _ f
Policy E or self-ird Lica__ Q I �)0__L `/.� 4 7 7 Eari
�pion Dat,_
job Silo Address: a() Ayif Drives CljCE WziP: F(orf/lret MA , 0/00
.=_ aLfl a cant'o;rhe WO,-kers'eomaansation policy declaration page(sbotsing the policy number and aspiration did)_
Failux in secu'e coverage as raaeired and ,Section 354 ofivtGL c lit can teed m the imms5on of criminal penallies of,a
Fine up m 51,500.00 artd(or ane year tmprisdnm_eni,as Well as civil penalties in the mon ora STOP WORK ORDER and a an: S
o:up ro S250.00 a day against-ie violator, Be advised hes a copy of this statement may he;forwarded m he Office of
tin'C dilad0as Ofthe DIA far insurance covcage�'armc+con.
da lterebt+cerY
Ti,rmder:be prdas and penaWas hlr&'s(ae injormndon prov(r(er(¢bone is fine and comer.
s mature: 4j$ n m-
Phone 9-_(`%l 3)-T74-3604'
i
Cfc(a(use mr7+. Do net Mile br drlr amq to be CORLDIetad bn cry ar rm n e�ciol.
�i.,�or Totivn: ?arm"rJLicense=
1 .r.uin&=+uth o;•iy(CirL?e one).
J. Board of Health 3.Balling Department .i..CiVlrown Cleric -t,Electrical inspector 3.Plumbing Inspector
I &Other
I
AlidCt?23SOD: Phone 9:
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Ree'gl�iations and Standards
Constructi`ooC§fWbfiapr Specialty
CSSL-099372 �arires:02/11/2021
Yl _
JOSEPH P GEORGE "
64 HAYWOODVRE
GREENFIELD M�D730 J�
i�r115�4d1'�
Commissioner C4
14,
D61ce tConsumer Atfaim&auMneea Regulation :
HOME IMPROVEMENT CONTRACTOR" Registrationnalld for Individual use only
TYPE:bDr00ra11Cn heforothe expiration dete. If found realm to:
Rmistratwn Esoind on OMm of Consumer Affairs and Business Regulation..
15_6686 07/24/2019 10 Park Plaza-Suite 5170
JP GEORGE&SON7NC _ * Boston,MA 02116
JOSEPH 64 OOD ST
GREENFIELD MA 01301 _ Undersecretary Not va d without signature
RISE
ENGINEERING
OWNER AUTHORIZATION FORM
I, Martha CatUogno ,
(Owner's Name)
owner of the property located at:
20 Avis Drive
(Property Address)
Florence, MA 01062
(Property Address)
hereby authorize 3,P, cd' ie end
(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 ignature
ateCrete
RISE Engineering,a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 1 Canton, MA 020211339-502-6335
www.RISEengi n eenng.com