25C-159 (7) 186 BRIDGE ST BP-2021-1146
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C- 159 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-2021-1146
Project# JS-2021-001923
Est.Cost: $2926.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOSEPH GEORGE 99372
Lot Size(so.ft.): 12414.60 Owner: HORAN MATTHEW
Zoning: URB(100)/ Applicant: JOSEPH GEORGE
AT: 186 BRIDGE ST
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774-3604 WC
GREENFIELDMA01301 ISSUED ON:4/9/2021 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 ' ' ,2 . 3-I'1 •
Certificate of Occupancy Signature
FeeType: Date Paid: Amount:
Building 4/9/2021 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
NI)
Department use only
City of Northampton, ,r-t; true of Permit:
Building Department 4,09 utii GuttDiiveway Permit
212 Main Street - 2 Sew- "eptic Availability
Room 100 T''. ,Water' ell Availability
(ii�.•. ° Two ets o:Structural Plans
Northampton, MA 0' �, . op
Structural
413-587-1240 Fax 413=58' '� ,7 PI-, Site Plans
��q p�CTjC` er Specify
��p S
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address: {0 6 11(.f'1„
a i"�( Map �` Lot f C Unit
I r3rAnliAphn, MA Zone Overlay District
0 I°0 Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
(V1u . uw kor(rn lit L1r14.
Name(Print) Current Mailing Address: 13) - ).a- 611
SO, kck@►C,\ \ Telephone
Signature
2.2 Authorized Agent:
SoS2 ( ecr 69 Hootwoo� S�, GreefAleggv\A oi391
Name(Print) I Current Mailing Address:
ri„ (kl3)-77'11.
-36o'k
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building P')•-lL,IS (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 IIIJJJ���
6. Total=(1 +2+3+4+5) a,�la.�,,`-j5 Check Number /}
This Section For Official Use Only
Q
Building Permit Number: '✓/7' OW �f (/ DIsated:
Signature: //7.1 . q-8-20Z.I
Building Commissioner/Inspector of Buildings Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House [] Addition ❑ Replacement Windows Alteration(s) I I Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [CI] Decks [M Siding[CI] Other[154
Inst.,tailor\
Brief Description of Proposed Svlr 4.6Als \Ai k �l)olost U��
Work: .11� (1rM 1
Alteration of existing bedroom Yes_ _ No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.If New house and or addition to existing housing, complete the following:
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e_ Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
MiNt‘►l,W \4oic ,as Owner of the subject
property L
hereby authorize arse�yl &-eoroK
to act on my behalf,in all matters relative ro work authorized by this building permit application.
See kl'tcnc\,e(11 0 4 109 J?-A al
Signature of Owner Date
3o 5€P\N creor , ,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.
UOS P\ Ciw,tivz.
Print Name
k 04 04 pal
Signature of 0 e gent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable El
Name of License Holder: aOSePl Geot t es31 ci 13^1
License Number
Address Expiration Date
J ' ) 413)TN-313A1.1
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
J. e• (y?ow fnntt 'tnt, 1Sb6S‘
Company Name Registration Number
1-10 4%j' d\ SIIM 6 l rf e 1e1 PAR 01301 7-2,S c�
Address \i"1/4/Vgitry� ll Expiration Date
�'�+ Telephone
.11;J-�7 -36oy
SECTION 10-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 l No 0
11. — Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780. Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,von may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
ti; , City of Northampton s. __:.
Massachusetts
i �y' DEPARTMENT OF BUILDING INSPECTIONS °f•i w S
sj �.. 212 Main Street • Municipal Building �s
-.t Northampton, M% 01060 � t`
Property Address: UN gr-tlke S .
Contractor
Name: JOSetAN Creor/5e, /a,P. Geode 0.4 Son, 3m,
Address: t9. Hmywoo(A ,treei
City, State: G��2 f\ ;e 1O,, (vi A o 1301
Phone: ( tt3)-7 P ti. 304
Property Owner
Name: pie he,,,, ‘{or&n
Address: \S' • &'&3t 5\'
City, State: 1 c'r\p\or J'M 10I06°
I, 3os-ON (orb-e (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 i
Date 0q 109 ` 3-)
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste 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.
Address of the work: iA 13rrcy �r
The debris will be transported by: Tr, GeArle avn4, Soo , Tn
The debris will be received by: ("ot6foo Sc,f U e
Building permit number:
Name of Permit Applicant j" ePh. 6-eorr
ai 109 ja-0).‘
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston, MA 02114-2017
V'� l�anf.wmass.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: ga C-l EEC -? t-<01A L` _City/State/Zip: o 0.1(.(Jt 61 RtialkitA Phone#: `/
'it t ) 1 I6/
Are you an employer?Check the appropriate box: 1.--SL' Type of project(required):
1.54 I am a employer with 171 employees(Ipiland/or pan-time).* 7. New construction
201 ant a sole proprietor or partnership and have no employees working for me in $. El Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.0 I am a homeowner doing all work myself[No workers'comp.'insurance required.]'
10 0 Building addition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will
ensure that all contractors either have workers'compensation insurance or arc sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5. I am a general contractor and t have hired the sub-contractors listed on the attached sheet.
13.0 Roof repairs �.,
These sub-contractors have employees and have workers'comp.insurance.: r�G.n 0i
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. l4.�,Other IV) `v ]
152.*1(4).and we have no employees.]No workers'comp.insurance required.]
*Any applicant that cheeks box#1 must also fill out the section below showing their workers'compensation policy information.
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.
l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. 1\--cloake"..
Insurance Company Name: ^� {
Policy#or Self-ins.Lie.#: Lt c6 G 477 Expiration Date:
Job Site Address \0) RNA R St City/State/Zip �O1�horAplol�r MA l O'o‘°
AttAc t t copy ###s l!ql rs�`aeanapea 4to t p9 Icy lgclsratttunap b9 ► 4.11** a *104 ei>7100:7n 44)
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify u r the airs n n ies of perjury that the information provided above is true and correct.
n Y`
j 041°9/a0al
Signature: Date:
' �' Date:
Phone#: -11i I - 3(lo (I
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.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
- -r -
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constructyop c Jt r;Specialty
CSSL-099372 a pires:02/1112023
• •
JOSEPH P GEORGE ,, 5,
64 HAYWOOl STR ap
GREENFIELD-OA 01301 ____________1
,* O
•
f)/ss~laC1
Commissioner Q�`C7"` /,. 8'&Mt. .
✓ate rnrnrnu.•erzi i 61,t�<GY,,weirI)E7/i
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:
Reaistration Expiration Office of Consumer Affairs and Business Regulation •
156686= 07/2412021 1000 Washington Street -Suite 710
JP GEORGE&SON-INC = Boston,MA 02118
‘)).4
JOSEPH GEORGE /2 t
64 HAYWOOD ST leer wf�./•.✓.f }; r
GREENFIELD,MA 01301 Undersecretary , •Not acid itho t signature
0
DocuSign Envelope ID:FB546E92-0B9F-4166-8978-4CCOCOA96BOF
RISE
ENGINEERING"
OWNER AUTHORIZATION FORM
Matthew Horan
(Owner's Name)
owner of the property located at:
186 Bridge Street
(Property Address)
Northampton, MA 01060
(Property Address)
hereby authorize P} GeoE Son, 2a' .
Subcontractor(to be filled in by office)
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.
The permit will be secured by the subcontractor, at no additional cost.
It is the homeowner's responsibility to close out this permit by contacting their municipality at
the completion of this work.
—DocuSigned by:
Itt attt ..w (ker'ain,
OwnaP'hTIPatui-e
1/21/2021 1 1:44 PM PST
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335
www.RISEengineering.com