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37-035 (6)
306ROCKY HILL RD COMMONWEALTH OF MASSACHUSETTS BP-2021-1859 Map:Block:Lot:37-035-001 Permit: Alts Renovations CITY OF NORTHAMPTON Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1859 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est.Cost: 2890 JOSEPH GEORGE AND SON INC 099372 Const.Class: Exp.Date:02/11/2023 Use Group: Owner: COOKE PAUL HARVEY &ROSEMARY ROY Lot Size (sq.ft.) Zoning: SR Applicant: JOSEPH GEORGE AND SON INC Applicant Address Phone: Insurance: 64 HAYWOOD ST (413)774-3604 4220066477 GREENFIELD, MA 01301 ISSUED ON:09/13/2021 TO PERFORM THE FOLLOWING WORK: • INSULATION/WEATHERI ZATION 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: GviiitjA. - Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner r 1 ' : ) ' � -- l ',i Department use only • r_r) • - ---i S--s City of Northampton Status of Permit: -13 Suilding Department Curb Cut/Driveway Permit 1 M 212 Main Street Sewer/Septic Availability - Room 100 WaterJWell Availability o Northampton, MA 01060 Two Sets of Structural Plans IFLIpone 413-587-1240 Fax 413-587-1272 Plot/Site Plans tt Other Specify R TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING --, SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: 30(3 Rood 1.1i1) 4, . Map Lot Unit NY f I\t„olP}on, MA Zone Overlay District 0\00, Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2,1 Owner of Record: PAAPavki Cooly 3013 Rock,' Mill R Name(Print) Current Mailing Address: 9)3 )5� TT b 7 7(ru / See, pl,\\0 4 T _ Signature 2.2 Authorized*lent: Sose r,C 64 H 'p'000\ S., Greer�4��eh1,MA 0116v Name(Print) %i Current Mailing Mtn-ma.: ;) ! (13)-77i -3‘a1A Signature I. Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 1 1(6)0, 0 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee ' e 4 4. Mechanical(HVAC) l� 5.Fire Protection 6. Total=(1 +2+3+4+5) a, ll Check Number I I 3 This Section For Official Use Only Building Permit Numbe . 6 9"ei I » I g5'7 Date J//2 Issued: Signature: / / , / - U Zoz' Building Commissioner/Inspector of Buildings Date SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) I I Rooting ❑ Or Doors 0 Accessory Bldg. Q Demolition El New Signs [O] Decks (D Siding[0] Other[A tnS or. Brief Work Description of Proposed Air r C eu1 �,j,C n__ (, bGl m j$ Add t� of cavil*t9 IX13t GtheC n a 1 J t �"K� v 1 'M Cl1 Afferatiun rn`eAi 11i ti. Yes No Adding new bedroom Yes No jP5t4114 Attached Narrative Renovating unfinished basement Vasof 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 la-OWNER AUTHORIZATION-TO BE COMPLETED WHEN Z.V?t►LSRF AGEb&T.AR CONTRACCT_O/,R APPLIES FOR BUILDING PERMIT i, powAl cook ,as Overver of the subject Property hereby authorize .jvAitts � fd to act on my behalf,in all matters relative to work authorized by this building permit application. Set oA6,e()I 0(1/0610as\ Signature of Owner Date 1 'o s e 0N vorty, ,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. UOSen Gefg2 Print Name , OklAIC ©rw/0 id•O`i • Signature of OwnerfAgent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ( nt Not Applicable 0 Name of License Holder: '0Sep Geot (s3' License Number by Heywood s -tee.\ G•et,Al t4 I Not 0130\ a - a(z.i1 Address Expiration Data 413}T11 -3bo4 Signature Telephone 9.Reoistered Home Improvement Contractor: Not Applicable 0 J Q� &eore 944 Son,2nc, 1s6636 Company Name Registration Number fiiu vvoa 5}lee; (Treed\e ie, MA 3 J\ 7-1s. Address 1 Expiration Date �' Telephone1;,-774-3604 • SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) lPlcukers.Crtnraensation 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 108.35.1. 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.f1 person who constructs more Ulan one thyme his tWw"iesre et.i &'.xbaU the considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that hcdshe shell 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 eaM91Rtinnnf the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter i53 feiritt'ftiy t 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 - City of Northampton �. Massachusetts w. ;01. .. `-�1- 2'M DEPAR NT OF BUILDING INSPECTIONS •� p y I is s:.` 212 Main street • Municipal Building f, "x,-.+' �? 1 Northampton, MA 01060 '' Property Address: 30(3 R(Xi l IA it I Ra. Contractor Name: r 3oSe Gent /J.P. Gene �d Sin, 3f\C Address: bLf Hoofwoot Stree} City, State: Gri'enftidki M A o 1301 Phone: ( t13 774- 3604 Property Owner Name: P(A'"i (,O Address: 30 l 0 LP! 11 City, State: f\br&krhpkon, Mo i olok) i, 1oSefh (Orr$ (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 \ 1, ° \A) .Cteitl li\ Date 0 01 f 0 6 ja,l, City o -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: 3°6 Rock? The debris will be transported by: If, ()bile rp The debris will be received by: fir'^ 100oro Sc, U�,�� Building permit number: Name of Permit Applicant Cie on)e 0(1I06 IP))-1 \ 1111 Date Signature of Permit Applicant The Commonwealth of Massachusetts jr, Department of Industrial Accidents Ti,iaL s, 1 Congress Street,Suite 100 '__":`C. a Boston,MA 02114-2017 www niass.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: (`• ( 4-5C•C i(1 }I L City/State Zip: 66.644404Phone#: (4 c 3) S31 j 67£ Are you an employer?Check the te.hsx. C t' y '�°tn""�' Type of project(required): 1.511 am a employer with 1 employees I fS111•and/or pan-time)« 7. ID New construction 2.0 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.] 4. ❑Demolition 3.0 tam a homeowner doing all work myself[No workers'comp.insurance required.] 10❑Building addition 4.0 tam 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 are sole 11.0 Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.0 i am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: 13.0 Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.atOther 1yl��'�� d� 152.gl(4),and WC have no employees.iNo workers'comp.insurance required.! *Any applicant that checks 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. lithe sub-contractors have employees.they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: kw\o, Policy#or Self-ins.Lic.#: 1-144°Ct)� 477 Expiration Date: i " Job Site Ad4ress: 6 1`0CI` • I IV1l' Ctty/Statel2tp Or /010ba : te �� s ._ _ umber end eagiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500.00 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 under th•pains and penalti of perjury that the information provided above is true and correct Signature: 1 , Date:TQ4 D"ioA'o 6 i�a1 Phone#: ��131 454 5417 Official use oni;t Do not write in this area,to be completed by city or town official. I City or Town: Permit/License# Issuing Authority(circle one): I.Board of Wahl. L.. it 'bt p rtrrrnent':City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector b.Other Contact Person: Phone#: Commonwealth of Massachusetts Division of Professional Licensure '' Board of Building Regulations and Standards Constructrikr Specialty CSSL-099372 c scpires:02/11/2023 JOSEPH P GEORGE w 1 64 HAYWOOO S - Ern GREENF1ELD- AA 0130' y C Commissioner c • 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&SON74INC---7-ffL Boston,MA 02118 JOSEPH GEORGE /� • 64 HAYWOOD ST -__,-. i 4,a. ,✓,find" V \ ` GREENFIELD,MA 01301" Undersecretary Not alit# itho signature • i. DocuSign Envelope ID:2613A026-A568-4EA5-9EF6-C8BODBA672D9 Permit Authorization .4frit mass save Form Site ID: 4232098 Customer: PAUL COOKE Paul Cooke I, , owner of the property located at: (Owner's Name,printed) 306 Rocky Hill Rd Northampton, MA 01062 (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. --DocuSigned by: Owner's Signature: eta (A' — `—tSh tl,`Jt541 hLbJ41 U. 5/6/2021 Date: FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: IP ' Geo IQ 0,r SonZ O�jIQ64 0'1 Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 F_r Cffi:e _;_e Crly Rev. 102015