38C-006 (2) 156 GROVE ST BP-2020-0912
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mak.Biock: 38C-006 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-2020-0912
Proiect# JS-2020-001552
Est.Cost:$5987.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOSEPH GEORGE 99372
Lot Size(sa.ft.): 16988.40 Owner: BAKER KRISTINE
Zoning:URB(100)/ Applicant. JOSEPH GEORGE
AT. 156 GROVE ST
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413)774-3604 WC
GREENFIELDMA01301 ISSUED ON:2/10/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-AIR SEAL ATTIC AND BASEMENT ADD
INSULATION TO ATTIC AND EX WALLS
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 Shmature:
FeeType: Date Paid: Amount:
Building 2/10/2020 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Dep
City of Northampton/
s� Building Department FFA
SULATION
212 Main Street
k? Room 100
Northampton, MA 01 OCQ;-, ,
"1
phone 413-587-1240 Fax 413- ���, ONLY
A�
07 CT/
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMIL_Y-pWEL ING ONLY
SECTION 1 -SITE INFORMATION INS ULA TION PERMIT
1.1 Property Address: lj b Grive This section to be compie by office
S i 00V
Map Lot `-� Unit
Zone Overlay District
o10
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address: �y�3) Ias 5.131
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by permit applicant
1. Building 1 i Z (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee 1/
4. Mechanical(HVAC)
5. Fire Protection
6. Total =0 +2+3 +4+5) 5,H b7 1'k Check Number
This Section For Official Use Only
Building Permit Number: �'� `�-- Date
Issued:
Signature: 7/20
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: :To'epl
License Number
Hu 1A MAI 03)1 �/I►I �1
Address NtWExpiration Date
Signature J Te phone
�.Registered Home Improvement Contractor: Not Applicable ❑
%1,P• (rid 30-. int 1166$6
ompanv Name Registration Number
61 V, ()Tfeipf;cls AAAj 01301 071g5A0A1
Address Expiration Date
` Telephone q 1&7 7 4 30
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....... CL No...... ❑
Brief Description of Proposed Work NOTE: INSULATION ONLY ,
Aif w(Aj ( t�Sc (,AJ SKA)CMel\i
uNt("-Lk VO- \w11) 1,NAK 4` cue I M►o3c
I, �Ipse C� Ueo[gt . as Owner/Authorized
Agent hereby declare that the statements 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.
J (*Ole
Print Name 131 119P
Signature of Owner/Agent Date
1, 1 f-, Af as Owner of the subject
property (� Q
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
QV—))�ao�-�
Signature of Owner Date
City of Northampton
Massachusetts
t�. DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 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 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: 1nsu)c,�ron Est. Cost: SA8 7*11
Address of Work: 5 b (Tm.Yt
Date of Permit Application: �)�3r IaOV3
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 the owner:
of �3r�a�a� �.e ��� w►d son, TIL. )AA
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
.` DEPARTMENT OF BUILDING INSPECTIONS a£
\ 212 Main Street •Municipal Building
\ .•*' Northampton, MA 01060 �; ;_• ���c
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:
156 (move 5�
(Please print house number and street name)
Is to be disposed of at:
)(,1V* 431yerng'N (Q. 914�41JlNoro, vl
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
0 1131110 1n
Signature of P Im
it A plicaht or' wner ate
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
A.. ;moi
11 S DEPARTMENT OF BUILDING INSPECTIONS
t 212 Main Street • Municipal Building
Northampton, MA 01060
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address: �56 Grove S�
Contractor
Name: 30SQ-, Ue'33Z
Address: 64 "LNI""oJ 5`
City, State: �Ffv flj; M A, X130►
Phone: ,113, 71 1"3b i
Property Owner
Name: kf;s��n� Nller
Address: 15 6 (y rove 5},
City, State: No(�6rkkon'MA) 0105
1, 30y0" (inIt (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.
h
Contractor signature
Date (N 31 �a0�0
AP
coln1nttrwealth o>fMrrss cusefts
be}�arttri,ent Of Indush id Accidents Pnrrt Torn.
Of tee-of'ruvesti .
ts
1 COWgt:ess Street,Suite 100
-80 M4 02114401
workerk;' CWhottfsation Insawww.utass.govldia
Iieout J.-A rance davit .$uil hers/Contraetors/EIeet
t 3tcfans/Pinr
n6(�usinesS/Orgmli-iionftndividutit):. Please Pr r ' '
�` �C.T
Address: l �a � -1
City/State/z.P.
Are you an QTnptayer?Cheek the$ 0091 Phone#:
1.[� I am a employer with -PProliriate box: t �
employees - --- `l . I am a general contractor and I T3'Pe of project(required);
pro atict/orpatt_time)•* have hired the sub-contractors
T ip a sole proprietor or p listed on the attached sheet, 6. �New
construction
ship and have no arttier-
etnployees These sub-contractors have 7. Remodeling
working for me in any capacity, em to ees and have tivork$rs=
fNa'workers'.eo p Y 8- []Demolition
required.] insurance comp.insurance t 9-
3.0
_ [] Building addition
3.❑ I am a hotrteowner doing ail wont ❑ We are a yrs corporation and-its 1Q_
r�,r ❑Electrical repairs or additions
rriyseif.[NO workers' com exercised their l l.❑Plumbing repairs or additions
Insurance re p' right of exemption per MGL
. gaited.]- c. 1'�?, §
1.(4),and tvc have no 12-0 Roof repairs
employees�1�0 orkers' I3-® Other 1 Pl_5V(k_N�0'- Y apAlicant that cheeks hnxni m comp_ insuequired,]
usi also fill out
_the section t]elpW showing tlteir�eorkers'cotitpensaiipn ori
t FiOmeateneih who k toil this af7idavit indiradng they are doing-ail work.and then fiire ersl
'Contrtetorz lhat.check this hox must attached an additional sheet An the name of the sub- p tnf�nnaUan.
employers, if the sub-contractorshate de contraeto�s must suhmit a new affidavit inili
loyc >Bey must contrnctors -state Itether.or not Utace �ng auch.
I uitr art ear PTovidc.tl�cir workers'com)t:policy number. entities have
player tl:ai irprnvisluig WOO- rs'comperisatian insururrce for rrr
W jnrnxttinn. A
�� Jr enrpin}rees Beioat,is filePolicy and jab site
Insurance Compal,Name: �a
Policy 4 or Self-ins.Lic:#: L49X(�0 6 UA1 J
Job Site Address: 15b G r"'a Expiration Date:
Attach.a copy of the workers'com Git}'1St3te/Li Ofd ,M Q1o��
Failure to secure coverage as require under Sec�onyecfarafion page p' .-
FineP b {sanlviitg the.policy number and expiration date)-
fu ug to$1,500.00 and/or one-year imprisonment,as well as civil penalties in t
25A ofMCrL e. 152 can lead to number
of
of up to ZO.00 a day against the violator. Be advised that a copy of this statement criminal Penalties of i
Investigations of the DTt� he form of a STOP WORK ORDER and a Erne
for insurance covers a may forwarded to the Office of
I rta.drereh g verification. .
,a>retti under a Wins nrnd:
al a e ur tliat ilie
5i "formation Provided 7 v is true and.correct.
slurs:
Phone : J Jr- ( / a ---- Date
Uj}rrial yse only, ff
1'}n traf tyrife iri.tl�is area fo be completed by ciry vr tots►n n
City or Town: cial.-
I ing Authority Permit/License#
�.Btaard of fleaf:<fi 2.Building fleprar{n:eut 3.City/Tow>t C
�.Other fetft 4.ft leetrrcaf Inspector S.Plumbing 8 Ins PmWr
Phone M.
Office of Consumer Affairs 8,Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:Comoration Registration valid for individual use only
Registration Expiration before the expiration date, if found return to:
156686 = 07/2— 4/2021 Office of Consumer Affairs and Business Regulation
JP GEORGE&SON INC - 1000 Washington Street -Suite 710
Boston,MA 02118
JOSEPH GEORGE
64 HAYWOOD ST'
GREENFIELD,MA 01301 "� �'�` '°�
Undersecretary Not acid itho t signature
Commonwealth of
Massachusetts
Division
of Professional Licensure
Board of Building Regulations and Standards
Constructi
• f�r Specialty
CSS L-099372
9s ires:02/11/2021
JOSEPH P GEORGE ,
64'HAYWOODJSTREET,,a
GREENFIELD M4,01301 ~
�L
Comratssioner l/ -
DocuSign Envelo e ID:C5C8B52F-7628-4898-A4FE-5640C9B6E638
Permit Authorization
rTW" S61W Form
Site ID: 3353215 Customer: KRISTINE BAKER
Kristine M Baker
owner of the property located at:
(Owner's Name,printed)
156 Grove St Northampton, MA 01060
(Property Street Address) (City)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
cuSigned by:
Owner's Signature: 5�sfi,, h t5,kv
"-264250620EI 14D4
Date: 9/12/2019 19:20 AM PDT
s•••••••••••••••••••••••••••••••••••••••••••••••••••••••ems -- < • • -•
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
31
ry 6/
Participating Contractor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
Page 1 of 1 For Office Use Only
Rev. 102015