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16B-038 116 FERN ST BP-2020-0886 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16B 038 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-2020-0886 Proiect# JS-2020-001510 Est.Cost: $3308.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JOSEPH GEORGE 99372 Lot Size(sg.A.): 6229.08 Owner: MCGRATH DAVID H Zoning: URB(100) Applicant: JOSEPH GEORGE AT: 116 FERN ST Applicant Address: Phone: Insurance: 64 HAYWOOD ST (413) 774-3604 WC GREEN FIELDMA01301 ISSUED ON:2/4/2020 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 2/4/2020 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner offCity of Northampton Dep Building Department 212 Main Street INSULATION Room 100 Northampton, MA 01060 ,y phone 413-587-1240 Fax 413-587-1272 ONLY APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION --] INS ULA TION PERMIT 1.1 Property Address: T12hi section to be compleetted office S�. Map Lot ✓ y Unit rr� �-trn Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �)aNj �6 ma�ozw Name(Print) �,j_ Current Mailin Adds:r s4��-� ��1�3� 5157-7 OD�- SQL .11 Telephone Signature 2.2 Authorized Agent: 35+ � -:::�K-0SeP\A (760f��-- (04 q�j WOO - (��Mt6- N40�361 Name(Print) NJ Current Mailin Addr ss: \14W. ( )4. 0 S31 /b7� Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number d 70d Q This Section For Official Use Only Building Permit Number: ou — 0 Date Issued: Signature: 6&Lk., VU 3 �(J Building Commissionedlnspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction'Supervisor: Not Applicable ❑ - 1 Name of License Holder: �.1 C J `� f�S S L Cq 1 Q > 1 7 P" License Number 7.�t , U t-it _A4 W 00A S�. , _e/ V& Address Expiration Date (4 Signature 0 Telephone L9.Registered Home Improvement Contractor: Not Applicable ❑ zt h CSS(o $�ompany Name Registration Number 144o�OOd��• �r1�-e-e"�1 �� 301 7--a-`t -011 Address Expiration Date Telephone&3 5311676 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....... i� No...... ❑ Brief Description of Proposed Work LNOTIE: INSULATION ONLY AM NA ID"f ce tw b&e- �ui �ose— e-Y�A8�(' ,c-,-�-(s A 0 as Owner/Authorized Agent hereby declare that the tatements 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. Print Name Signature of Owner/Agent Date I, � , as owner of the subject property e /�`f P hereby authorize �� f v ` to act on my behalf, in matters rejgive t authorjzed by this building permit application. -! ((fJ - O `/leri j- 30-40 Signature of Owner Date City of Northampton Massachusetts ` DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �' ... .+ Northampton, MA 01060 Jy `�JC 4w rvy 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 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 mu ee registered. Type of Work: 1 �Jy I� dyi Est. Cos : J ' Address of Work: TVlf v 1 S+• Date of Permit Application: — 1 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 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 5s _ DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Northampton, MA 01060 Jsyj� �t� 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: 116 + , (Please print house number and street name) Is to be disposed of at: Please print name and location of facility) J Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) N�W kl" (-30-40 Signature of Wrmit Applica t or Pwner 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 :, be 212 Main Street • Municipal Building Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 116 �(vl J-' Contractor Name: V Address: wood,S� City, State: U �---eJA4A Phone: C1 1 �� Property Owner m_A \I�1 LGIA ,� Name: �l I v \ v ` Address: /6S City, State: q90 (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 The.Col"117- "Wealth"Of Afassachusetts- bepa'tine�t d f dr s#ricrl E=-=F Accidetat� Ofte Of Inv28figadolrs I Congress Sheet;Suite. tQQ Workers' Conzponsation jnsnrance cla WWW-ftza s gavAd#a I;pant Information B it kers/Contractor"s/E)e,tl i,ans/1Plub,rg Name{li_usin'ess(Orgatii�atiunfittdividt►tit}:_ . f Please bri nit L Address: 6� Sa (,� G-en City/Staeaip- Are.you anQrnptoyer?Check thea Q130�Phone#: (41,1-3 1 { T am a employer with PPropriate box:. employees — ¢ I am a general contractor and I Type.of Project(required): 2 (�li and/orpart-throe).* have hired the sub-contractors Tam a sole proprietor or partner- listed on the attached sheet 6 Idety construction ship and have no employees worktna These sub-contractors-ltave �- Remodeling a far me in any capacity. employees and have-« [No workers, comp. ' orkers' $. ❑Demolition P insurance required.] comP-insurance= 4_ Building addition 5. ❑ We are a 3.❑ I am a homeOWner doing corporation and-its 1t)[]Electrical repairs or additions a all tt=orlc officers have exercised their myself. e r workers' comp. right of exemption per MGL l l Plumbing repairs or additions insurance required:] c. 152, §1.(4),and'kve have no 1�❑ Roof repairs cmptoyees. [No workers' I3.® Other is fl-5V(a4i3OiA �Any aPpliM�tt ecks hnx rl mast alsq fist out.ihe section t low�o�Ynsirmu���cI�e��Comc�8amcaxnchmit this affidavit iRdic86119 they arc doing-till}vorli and then hire outsidem 4ntrrctors ihat.eheck this hox mustattached an additional she l showing the name of the sub Compensation u.qt s bmittnaiirn. employees. if the sub-contractors hate contractors mustsubmit a netir�davit:indi a►nployceS,they must piovidr.their workers'eo contracln�antis n 4ciheror not Utoce cog wch. I arta an enipluyer that it �-policy number. �"�� in Pmvtdutg tuojke"s'compensation insurance far my etrrployees. Belo��is thepvlicy and'o .in�'a:az'ion. Insurance Company Name: ���C 1 bsite �a Policy 4 or Self-ins.Lic.g: Job-Site Address: /6 -2,ry� JJ Exption Date: 1� Attach a coPY of the workers'corn e GitylStatefZig; Fc)( 6E 4 Failure to secure coverage as rcequired under Section 25A of MGL C. 152 sl4owiit� CYAeclaration page E d the.poi<icy number and expiration date)_ fine up to 1,500.00 and/or one-year imprisonment;as well as civil pcan enalties in to the_imposition of OfLIP to$ 50:0©a day against the violator. Be advised that a co of entnlnal penalties of a Investigations of the DTA for insurance coverage verification. the . ml of a STOP WORK OR-DER and a hue PY this statement may be fan;,arded to the Office of I do lrerehp serf. attde ze runs acrd. o e u tlzat the iufarinadon prop' 51 attire: ided rrbnve is true und.correct Phone 4: j J'�j I Q Date _✓�'1 - Offieial nese only. dao�rnt'krrite City or Town: ut.iliis area,io be cotnpletecl6y ciFV or-town official. Issuing-Autharity(circle one): fern WLicense# t L Board of Health 2, l3uildin I}e t ti.Other g Purtment 3.Oity/Town Clerk 4.ElecoicQl.Itzspaetor S.Plumbing Ins etor Contact Person: Pc I - Phone 4: ------ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Corporation Registration valid for individual use only Registration E-Piration before the expiration date. if found return to: 156686..: 07/24/2021 Office Of Consumer Affairs and Business Regulatioj JP GEORGE&SON INC - 1000 Washington Street -Suite 710 Boston,MA 02118 JOSEPH GEORGE 64 HAYINOOD ST ��� �. GREENFIELD,MA 01301 Undersecretary Not alid itho t signature 1; p. Commonwealth of Massachusetts W\ Division of Professional Licensure Board of Building Regulations and Standards Constructio�irr Specialty CSSL-099372 1!�pires;02/11/2021 JOSEPH P G6bRGE � ; 64'HAYWOObrSTREET., , GREENFIELD"— .0130 1 1 �L A. Cornr+issioner tom— RISE ENGINEERING- OWNER AUTHORIZATION FORM I, David Mcgrath (Owner's Name) owner of the property located at: 116 Fern Street (Property Address) Florence, MA 01062 (Property Address) 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. Owner's Signature Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 ( Canton, MA 020211339-502-6335 www.RISEengineering.com