22D-028 (3) 168 RYAN RD COMMONWEALTH OF MASSACHUSETTS BP-2021-1830
Map:Block:Lot:22D-028-
001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2021-1830 PERMISSIONIS HEREBY GRANTED TO:
Project# Contractor: License:
Est. Cost: 3630 JOSEPH GEORGE AND SON INC 099372
Const.Class: Exp.Date:02/11/2023
Use Group: Owner: DORHETY, OONAGH
Lot Size(sq.ft.)
Zoning: WSP Applicant: JOSEPH GEORGE AND SON INC
Applicant Address Phone: Insurance:
64 HAYWOOD ST (413)774-3604 4220066477
GREENFIELD, MA 01301
ISSUED ON:09/03/2021
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.
Signature: 0 3_,
I
Fees Paid: $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
Department use only
City of rtha f pton �I Status of Permit:
Buildi De•=rtmi9Cp (/ urb Cut/Driveway Permit
2 MaiR, treet / Septic Availability
R 1'„0 c9Q ater ell Availability
Northampton, 4, !•0 �� Two ets of Structural Plans
phone 413-5$7-1240 Fa IA, : 1272 PI Site Plans
•
q AFCi. er Specify
o7°5;9
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RE �VAiE O DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address: 1
KrA Map Lot Unit
F l0(`fn[,t)1/AP Zone Overlay District
,� 01 Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
(Don* t)a IQ( ‘.1(4)
Name(Print) Current Mailing Address: I y "�O 3 1
See, pt�� 042.� Telephone
Signature
2.2 Authorized Agent:
Sosepl, C�eor e, HO iaod\ s3, Gseeni;elt)13 .A o11(6
Name(Print) Current Mailing Address:
a, 19 -� N3)-77 t-36att
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
1:1 4. Mechanical(HVAC) L
5_Fire Protection 2
6. Total=(1 +2+3+4+5) 3I630'` I Check Number F 5M"
This Section For Official Use Only
Building Permit Number: 6g 1 oil / Date
Issued:
Signature: //7
9" 3-Z Z.
Building Commissioner/Inspector of Buildings Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House E] Addition ❑ Replacement Windows Alteration(s) 1 1 Roofing ❑
Or Doors 1]
Accessory Bldg. ❑ Demolition ❑ New Signs 101 Decks [p Siding[0] Other[gyp
Initn 1a}Son
.1
Brief Description of Proposed ( S 4 kic f__1 l3 hL.4 QUtiA IS of +cjj (4 I� ek(
Work: ) �� �"a 1, J t 1 S
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,,ri
,as Owner of the subject
property
hereby authorize 3' se tA\ &eOf le
to act on my behalf,in all matters relative to work authorized by this building permit appli tion.
See t‘kv ..,el D! 30 (A-I
Signature of Owner Date
I 3'O5 \\ c3eor e, ,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 GeSPO,e,
Print Name
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: ( � Not Applicable ❑
Name of License Holder: a'0Sq \ Geotc t CS31 01bl 13 mot l
License Number
(`t HUNT...owok Scree\ ree,o-Vlc\, lV 030\ a,-to- -43
Address Expiration Date
1\di1/4 413)TILHIPti
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
J. GforNt fnndk ofr,2rtti 156b36
Company Name Registration Number
IrtOTA,oA d\ S+rM (yreertf\e Id, Ma o1 0\ 7-2 `)4.3
Address 1 Expiration Date
tip , 61-y*t
TelephonAi1; '774-3b�y
al
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 ® 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,you 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
7..:
r.,...,.0City of Northampton s lict
p tMassachusetts
, ,t=J�iP`• DEPARTMENT OF BUILDING INSPECTIONS I l S
:. 212 Main Street • Municipal Building rs, �' ,i;
Northampton, MA 01060 ..
Property Address: (68' ( f ►`e
Contractor
Name: SOSC (T ory, /a,P. Geoice 04 Sim, Int.
jj ..
Address: b Homyw000k tree
City, State: Gryencl-eli , MA 01301
Phone: {1113)-TN-t ^ 3‘oi
Property Owner O�(Ash Doi,1
Name: I r G t�/T`�p '�,
Address: 1(A �y� ` .
City, State: Its tertei A P
I, 30StON {seorL f (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 ith a copy of this affidavit.
Contractor signature \ _1 $ ,
\kWit/Ai(11114
'
Date 0 6 0-G1 ?'°2%1
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: k rnn
The debris will be transported by: If', Georg
The debris will be received by: 8rrA ifte6ryo - ) e
Building permit number:
Name of Permit Applicant QSeFl,. bye orsie
OSI4I1401 \%\ylSulkkQqbAikrilt,
Date Signature of Permit Applicant
_ The Commonwealth of Massachusetts
'- '—'�!l. Department of Industrial Accidents
�.:�; I Congress Street,Suite 100
t teas. J Boston,MA 02114-2017
?yl - 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(BusinesslOrrganization/lndividuaf:
Address: t'z-C TCOft -k_cCi\4:CIA ,
City/State/Zip: bqlitiyacciA. Phone#: (4 t.. ) 31 i G7 6
Are you an employer?Check the appropriate box: 6`1-SD( Type of project(required):
i.11'.1 I am a employer with Li employees(fjttl.and/or part-time).* 7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. []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.)'
4.0 t am a homeowner and will be hiring contractors to conduct all work on my property. i will
10 Q Building addition
ensure that all contractors either have workers'compensation insurance or are sole 1 1.[]Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
5.0 I sm a general contractor and I have hired the sub-contractors listed on the anached sheet. 13.Q Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.[]W e are a corporation and its officers have exercised their right of exemption per MGL c.
14.(tjgOther �1/IVICL�"f0Vi
152.;1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box 4I 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. lithe sub-contractors have employees,they must provide their workers'comp.policy number.
i mu an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.Insurance Company Name: i\--(w\o,
Policy#or Self-ins.Lic.#p: n i Q'-�1� 06'O 4 77 Expiration Date: 1:33— 1.--3
Job Site Address: a 6 g 1� City/State/ ��enu) l 0 IO b 2
44 i ep3,w a wos4ers':.feom't> a> ! `4lA0 •
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 •de the ppin. d allies of perjury that the information provided abo e is true and correct.
Signature: � " ' ' 314
V t' Date: 0 g a� a°'`
Phone#: 413 1 t{ 3 o4
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#:
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construc ii •'t ' r Specialty
CSSL-099372 6cppires:02/11/2023
JOSEPH P GEORGE
64 HAY HOOD STREE1
GREENFIELD-MA 013Q1r •
'O
• `i)ISS7130v"
Commissioner djt K. Vit,,_ra
•
✓% Ycnb-izewe eaMe „/Gmy u40"f-:
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:PE:Corooration before the expiration date. if found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
156686^:± :` 07/24/2025 100n Washington Street -Suite 710
JP GEORGE&SON°INc Boston,MA 02118
JOSEPH GEORGE f Q� r'1,i
64 HAYINOOD ST ���,%f�?.,li✓/;«" l.c/�/"'� V"l
GREENFIELD,MA 01301 flat atid itho�t signature
Undersecretary
RISE
ENGINEERING`
OWNER AUTHORIZATION FORM
I Oonagh Doherty
(Owner's Name)
owner of the property located at:
168 Ryan Road
(Property Address)
Florence, MA 01062
(Property Address)
hereby authorize '�� Gto Je ov1vl Son, In( '
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.
:/764
Owner's Signa ure
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 Canton, MA 02021 339-502-6335
www.RISEengineering.com