17C-316 (11) 48 HILLCREST DR BP-2020-0864
GIS#: COMMONWEALTH OF MASSACHUSETTS
MU-Block: 17C-316 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-2020-0864
Proiect# JS-2020-001482
Est.Cost: $5436.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group: JOSEPH GEORGE 99372
Lot Size(sa.ft.): 31973.04 Owner: MILLER NAOMI J TRUSTEE
Zoning: URA(100)/ Applicant. JOSEPH GEORGE
AT. 48 HILLCREST DR
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774-3604 WC
GREEN FIELDMA01301 ISSUED ON.1/29/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-ATTIC AND BASEMENT INSULATION AND AIR
SEALING THROUGHOUT
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 1/29/2020 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Dep
' City of Northampton
Building Department
212 Main Street
t A s Room 100 A'
IMSIJA 6A
�,�
;4.
Northampton, M
p A 01060
phone 413-587-1240 Fax 413-587-1272
ONLY
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTION 1 -SITE INFORMATION INSULA TION PERMIT
1.1 Property Address: This section to be completed by office
—7 /
Map / C- Lot �G Unit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Pant) � j�10
Current Mailing Address.
f-� CLIli) • 53z-S3�,1
Signature Telephone
2.2 Authorized Agent:
Name(Print) pppJ`.Yl�!1 �vJ � by
1/� ^ Current Mailing Address: �{
Signature V (� 4 1 3) 7 7 1 t7 I
Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be
completed b permit applicant
Official Use Only
1. Building
(a) Building Permit Fee
2. Electrical
(b) Estimated Total Cost of
3. Plumbing Construction from 6
Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2 + 3+4+ 5) f t♦�� N(, Check Number O
This Section For Official Use Onl
Building Permit Number: / Date
Issued:
Signature: J 29 �ZO
Building Commissioner/Inspector of Buildings
Date
l�
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: ,� Not Applicable
e -❑1
Name of License Holder: 3-3o� I,y" nrit 9" 3 11
License Number
S�. GfQen¢►e Jd 3�1 2/11/foal
Address Expiration Date
Signature Telephone
8.Registered Home Improvement Contractor: Not Applicable ❑
J,P, "r�T rnd SOA, Inc. I fiu b
Company Name Registration Number
0130) 07l34dOdl
Address Expiration Date
Telephone
L1li -771-316,-q
SECTION 5-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...... ❑
Brief Description of Proposed Work NOTE: INSULATION ONLY
Air Seo G\h iL W) ►fnseMN
hAJ 14" of ce livlle ,b ajs' jmj jnju l&41Jn !n u�}`fiIC
I
I, 3'OL�P4 (reprqf as Owner/Authorized
Agent hereby declare that the statemerfts 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.
Jcuo\ G to fit
Print Name
Signature of Owner/Agent Date
as Owner of the subject
property j I
hereby authorize S�S�Qh G�or �
to act on my behalf, in all matters relative to work authorized by this building permit application.
Set WCAChN 01 dab 11,3no
Signature of Owner Date
City of Northampton
Massachusetts ,S�s
• DEPARTMENT OF BUILDING INSPECTIONS 7
212 Main Street • Municipal Building
b
Northampton, MA 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCA-BR")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 owner-occupied 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:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: 'JAJAI G�JD 1
Est. Cost:
Address of Work: g M;�lcrel� psi Je NYACei MA , 0100.
Date of Permit Application:_ 01 4611,0)n
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 RESPONSIBILITES 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 h wn r:
of a mlo) 1,11 &boe GJ i) Int. IS bb�b
Date Contractor Nank 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 "
A. DEPARTMENT OF BUILDING INSPECTIONS 7
\ 212 Main Street •Municipal Building SJtb
Northampton, 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:
48 H11CRJ) nrW
(Please print house number and street name)
Is to be disposed of at:
1Cbnro Sc Mole IyefA,,n P Rr4leboyo , T
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Comp y Name and Addr s)
�I/�6lao�o
Signature of Permit Applicant or 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.
�- City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS yy
k ' 212 Main Street • Municipal Building
Northampton, MA olo6o d ��3
MANDA TORY FOR HOUSES BUILT BEFO
RE 1945
Property Address: K Ivey D riv F 10 renal MA 1000
Contractor
Name: Gfo e MP SOA A • Jose
Address:
City, State: 6-re1J, AAA,A , r)1?,))
Phone: ��� _ 774-3 604
Property Owner
Name: _ ��10M1 IAd iff
Address: u"s1ICrm br,
City, State: _ F 10(en(Pj A 0 I1 b�k
pk insulate ds not ha7e--a�nyt �o en (contractor) attest and affirm that the building I intend to
p 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 ++ ++
i
h:.
c�
he C01111r7onveattth o: .
b assae.us .
ieat a f'Cttt#-Form...
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Address: l L_
eityfStte/Zip:
Are,you.an esn '10 ,e
Y Check the a Qty Phone#:
1• I ant a employer with PPro>priate box:. t L
,) oemployees(full an 4- 111 am a general con T
f am a sole ' Pari time)-� have hired the sub-contractors l 6.3'Pe of Protect(required):
shipProprietor or partner-
and have no listed on die attached sheet ❑Ne"'construction
working �Ployees
for rite in my capacity. Tbese sub-contractors have 7' ❑ Remodeling
(No Workers,comp-insurance employees and have workers'
required.] $. ❑Demolition
3.❑ I am a comp-insurance:* 9- ❑Buildin
holneowncr doing all nr $ ❑ We are a corporation and-its g addition
arIc officers have exercised their 1(L❑Eleetncal re
myself[No workers' comp. Pairs or additions
insurance required.] right of exemption I 1•❑Plutnbin
• c. 152 e Per MGL g repairs or additions
I(�),and Ive have no 12-❑ Rnof-re
cmployces. No pairs
.Y applicant that checks �z workers' I3.0 Other �jAS,1��- -j`
.Homeowners tvho sulsmit tthi.a t coin insurance re O W
mast also Fitt out the section tn:)rnv shawin required]-Cilmractors.lhat.check this hoz -&Vit indicatin■ 5(heir%orkers` p
employees, irthe su must tittaehed, they arc doing-all work and the cam ensation petit
b contractors hacc �d'nbnal sh�wt showin n hire outside contractors } 1d�OrtltBLnn.
c'nIrioyccs,th - the name of the tractors mu'stsubmit a neCv
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an,an enr 1 cY mustprovidc.tEicir t<orlters' sub-con whc ati`rdavit irtdi
F nyer rllat is eomp.,potic3=numBer and-state thMor not those entitiesve
nr'n:afian. �YfJLllt7f2g 1U01 jseYS�COI11�1L7tsa11DF!Iflall!`QnCE'fOY 1!!
Insurance Narne: Y emPlc gees Uelo;�,is the
policp andjob site
Policy 9 or Self-ins_Lic_i=: L4,
job Site Address: Ili �i���rf� �r JJ
Expiration Date:
Attach a coPY ofTtheo
1 ailure to.secure covers ricers campeusation PofieY declarafion a� Gity/State/Zip:��jren f �,�I
lime u to 1 - gess required under.Section 25A ofMGL Page
/ u.(
P '500:00 and/or one-year b.the.policy number and exgira ion trate).
Of up to$250*00 a da Q - Y ar lmpriscnmen lead to the.imposition of
Investiy aoamst the violator as well as civil penalties in
gallons of tltc
DTA Be advised that a the form of a STOP WORK
penalties of a
far insurance coy=erage verihca�on.c0PY of this state
I do heT ment may be fonvarded to�t1le�RDER and a fine
ehy ietli larder the Office of
s arnd: el:rrt
Si at;tre: n e ur "'at the info anon provided.ubove is true unrt correct
Phone : 'J 3 1 o b Date f�) 6._ Qao
t3�ieral use only. i3o
rrnt mute in.11iis area, n
be carnpleted by c*tt,.Or tort n n�civl..
CRY ar Town:
using Author, circle one): permittLicense tY
I-Board Of F3ealth
w
&Other 2• ilding DePartmcut 3.Cityr own
CIC
rIt 4, ElectrfetlCortzfit arsonlnspozfnr plumbing Inspector
Phone#;
lZmJd¢ u-1e/�J
Office of Consumer Affairs$Business Regulation
HOME IMPROVEMENT CONTRACTOR
eTYPE:Corporation Registration valid for individual use only
6686.`n Ex i ion before the expiration date. if found return to:
07/24/2021 Office of Consumer Affairs and Business Regulation
JP GEORGE&SON'INC = - 1000 Washington Street
- Boston,MA 02118 Suite 710
JOSEPH GEORGE l
64 HAYWOOD ST' -'
GREENFIELD,MA 01301 `°"`��'� `� �,{
Undersecretary �e t
Not alid itho t signature
r Commonwealth of Massachusetts
Division Of Profes
Board of Buildin sional Licensure
g Regulations and Standards
Constructi`o"i r Specialty
CSSL-099372 �•
f fpires: 02/11/2027
GE-rp RGE
84'HAYWOO
GREENFIELD MA
01301 Zt'"
Cornrnissioner
i
I
RISE
ENGINEERING'
OWNER AUTHORIZATION FORM
I, Naomi Miller
(Owner's Name)
owner of the property located at:
48 Hillcrest Drive
(Property Address)
Florence, MA 01062
(Property Address)
hereby authorize I 1 , lQO Cqe C11AA SD
(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 Signature
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 1 Canton, MA 020211339-502-6335
www.RISEengineering.com