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25A-061 (8) 390 BRIDGE ST BP-2021-0934 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25A-061 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-2021-0934 Project# JS-2021-001597 Est.Cost: $9312.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JOSEPH GEORGE 99372 Lot Size(sq. ft.): 5662.80 Owner: CHANDLER JOSEPH Zoning: URB(100)/ Applicant: JOSEPH GEORGE AT: 390 BRIDGE ST Applicant Address: Phone: Insurance: 64 HAYWOOD ST (413) 774-3604 WC GREENFIELDMA01301 ISSUED ON:2/23/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATION/WEATHERIZATION 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. I Certificate of Occupancy Signature 4 ' I - 15-� 1l FeeType: Date l'aid: Amount: Building 2/23/20210:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ° ak City Northampton r Building Departmen , tee ,„ - x �'( L 212 Main Street, �' '� -. 1 Room 100 ',�-)°�� ��'0 :-..! ---22 ' , „il,____ . _ , . ,' , , , •--, `:'•_ E :. Northampton, MA 0106@`'4��`),, ,,--iji'',',V ' phone 587-1240 p ne41 7,1 Fax 413-587='t l�AF i - �4 ; s 4, APPLICATION FOR INSULATION FORA ONE OR TWO FAMILY DWELLING ONLY 'n i a SECTION 1 -SITE INFORMATION INSULATION PER 1.1 Prooertv Address: MIT Q r ih� s This section to be completed by office Map____;7_61E__ 14°r}�(A�I Pb^i AN / O 1D� Lot i Uni Zone Overlay District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Elm St District CB District 2.1 Owner of Record: Name(Print) 300 �).�F'�,����aa A .Ice Current Mailing Address Signature G Gl�r y�y Telephone 2.2 Authorized Aaent• Name(Print) via 'wo od S -. (Tree:, ietl MA Olio) Current Mailing A dress: Signature ) 77 _ i Telephone ) b SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be ' completed b •ermit a..licant Official Use Only 1. Building //��' i "I/31A.1X0 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) #0() 5. Fire Protection 6. Total=(1 +2+3+4+5) et30,ac, Check Number This Section For Official Use Ont Building Permit Number. X /4" 94. Date AO" Issued: Signature: _/ 7- 22—ZL Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES l 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: 3 (YeOrY 1 1G3761 License Number £y Nu1W:)DD .S G�e1CiAA,MA r 01301 'Qa/11�a4)3 Address 1 Expiration Date Signature 1 \4..c2NC(111013 \ -774-3e�y 0 Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 f' ()fay c 4 S© n., in,. I SbbAL Company Name Registration Number Ltk Nf^iwmk st. &(`e d cId, NO {Sot O7/i /20)! Addres Expiration Date gitiVirik Telephone 0I3' "714-3t oa 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 lkf No 0 /E Brief Description of Proposed Work NOTE:GTC : INS ULA TION ONLY Ai( ; ►1 G ikt 6,4 5oo rol NJ \0 (-04)z to Ci n 1,w \core ;n cn►c. I, NO, (Rol , 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. Joseph Geode Print Name 4 °VI6 ate' Signature of Owner/Agent Date i Df),1/4As ovwl - , as Owner of the subject property hereby authorize 3-03e h v� , 2 to act on my behalf, in all matters relative to work ahorized by this building permit application. See U cA� ; o/i 6 f a° i Signature of Owner Date City of Northampton a row 5 st {47,0 Massachusetts a � DEPARTMENT OF BUILDING INSPECTIONS ZIT 2,1 ?y. 212 Main Street • Municipal Building s 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: 1/1SAWiry; Est. Cost: g 1i31)..P Address of Work: 300 Qr01/4�1�.' St Date of Permit Application: 0)-( b 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: Mitt pa)) 3��; Gear, ov+.,, soy, iri .J • (s��V Date Contractor Name IC 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 aj„nMPF,. City of Northampton ._ Massachusetts M` ........ 1{`, ,.r G• T �ni ig rik! W •' 1;i DEPARTMENT OF BUILDING INSPECTIONS I\ 70.ey: 212 Main Street ea nicipal Building 'N `4y�'b' Nor MA 0 lit Sr, MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 14o af13 st Contractor Name: .3 c1, GeeV I 'It (try,Gtry, uMd son, Inc• Address: 64 kw/vrood A City, State: G-TeeiNT milli I AN, ()13°► Phone: ( 13)- 71 4 'VI Property Owner b `6A�\C Name: OM Address: t'10 DPi )e S\ City, State: o('t\C trpp°'\. 'AA , 0100 I, Jok[* (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. 1... .N Contractor signature \ !i / I pi • Date 4 Iblap11 City of Northampton oaT��Pro ' ytS + -F Massachusetts o}ly :� !r, DEPARTMENT OF BUILDING INSPECTIONS tw o z. 4 � y 212 Main Street •Municipal Building '2 ,.'a Northampton, III 01060 ;71 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: 360 Drid21l (Please print house number and street name) Is to be disposed of at: Di Nora S61v t 431 \kJno,, rc ebora, JT (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) tr /l Signature of '-rmit Appli nt ,'r O ner Date lf, 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. Q : 1 1* The Commonwealth of Massachusetts 1 krl Department of Industrial Accidents ?ea sir 1 Congress Street,Suite 100 iii i t>.r ff, Boston,MA 02114-2017 Vdr ''��� www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/individual): Address: t� -("rtc > -cp�l MA L. City/State/Zip: �1 i( . �j 11-1% Phone#: 61 t3) 1 IC76 Are you an employer?Check the appropriate box: t V-S l Type of project(required): ill am a employer with_ ti _employees(I:gland/or pan-time).* 7. D New construction 1 am a sole proprietor or partnership and have no employees working for me in '-�❑ 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 1 am a homeowner doing all work myself(No workers'comp.insurance required.) 9. Q Demolition 4.0 I ant a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.: t t t�`�Q6.❑We area corporation and its officers have exercised their right of exemption per MGL c. 14. Other 'het�ti �'( Vi 152.a 1(4),and we have no employees.I No workers'comp.insurance required.) *Any applicant that cheeks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I an:an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: IV'0 8\et Policy#or Self-ins.Lic.#: li °6 G 477 Expiration Date: i .--()-(Al Job Site Address 300 B_ 5 Ciy/Slate/Zi)1 „Ala-qv/onto!),N1A i 91060 ��P3�.� .. n►3!� ._: .*pP...� ?�B� $�*s�pg !4,p numbex end=gagir0ron date} Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$I,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance covet-age verification. I do hereby certify under the pains and pe allies of perjury that the information provided above is true and correct. Signature: `i' I ��y Date: 02/i 6'a0 ' Phone#: 013) '11 t4• 1601 Official use only. Do not write in this area,to be completed by city or town official . City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Budding Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Commonwealth of Massachusetts 111 Division of Professional Licensure Board of Building Regulations and Standards Constructikae8Vkii4K Specialty CSSL-099372 .ti - 6cpires:02/11/2023 JOSEPH P GEORGE _ • y 64 HAYWOOD S • GREENFIELD CIA 013f, ', i . Commissioner do f. t3&n • Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR _ Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation • 156686_= = 07/24/2021 1000 Washington Street -Suite 710 JP GEORGE&SON<INC Boston,MA 02118 ‘,) '#\/\,( JOSEPH GEORGE ;•r /, ; V''i 64 HAYWOOD ST <;._ �;_, ju„uQfa.( ✓.fso! GREENFIELD,MA 01301 •Not alid itho t signature Undersecretary DocuSign Envelope ID:43000BE9-1EA2-4145-86AC-B840738A5AE2 RISES ENGINEERING OWNER AUTHORIZATION FORM I, Davis Chandler , (Owner's Name) owner of the property located at: 390 Bridge Street , (Property Address) Northampton, MA 01060 , (Property Address) hereby authorize a'- I" • 64331 1 Son, IA( (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. DocuSigned by: V&A C,IA.atn.eit t.r agAg ture 6/15/2020 I 10:30 AM EDT Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com