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06-006 (11) BP-2021-2267 502HAYDENVILLE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 06-006-001 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-2021-2267 PERMISSION'S HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 8247 JOSEPH GEORGE AND SON INC 099372 Const.Class: Exp.Date:02/11/2023 Use Group: Owner: FLINKER PETER A&STEPHANIE J Lot Size (sq.ft.) Zoning: RR Applicant: JOSEPH GEORGE AND SON INC Applicant Address Phone: Insurance: 64 HAYWOOD ST (413)774-3604 4220066477 GREENFIELD, MA 01301 ISSUED ON:12/07/2021 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: Q ) • (NT Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ! Department use only ( r — i --.__Cit of Northampton status of Per it: -�,'_.. Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability DEC - 6 2021iiRoom 100 Water/Well Availability orthampton, MA 01060 Two Sets of Structural Plans C�aT of r>iti�nin.� hone 4 3-58'1-1240 Fax 413-587-1272 PIoUSite Plans ___ _ Nor?rN.,,,,r inigr°TloN,s Other Specify APPLICATION TZON3TRUCT,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: 501 Hcyativiitt P.d f� Map 6; Lot 111 Unit N (*Or\► IAA Zone Overlay District ©'0 5 3 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner ot Recent: Pet Er F1;lkr S')Z Nuiakylviii (VI Name(Print) ` Current Mailing Address: I G 7 3 jl6p4 See, A 0t(,ti ke \ Telephone 0 Signature 2.2 Authorized Agent: SOS eA-, ( earrt 69 He i.sood\ S)-, Crreen{;etdibk(\ Ot3ot Name(Print) t Current Mailing Address: (413 711f --36C k Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building D(•ay 7, b Z( (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) it e� 5.Fire Protection '9 6. Total=(1 +2+3+4+5) 8 29 It/ Check Number ii 06 /J )) This Section For Official Use Only Building Permit Numb r. 6 e-A i re:7 01Q 7 Date issued: signature: /Z C-Zi2/ Building Commissioner/inapector of Buildings Date SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House E] Addition ❑ Replacement Alteration(s) ❑ Roofing Or Doors [1:1 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks r Siding[DJ Other ''] Brief Description of Proposed A Jeo ir ( 'ocerr Add 15" of cef lone tL fI6f Work: t l I 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 Pt ter F br ,as Owner of the subject property hereby authorize Sole fk‘ CTt?Ortti to act on my behalf,in all matters relative fo work authorized by this building permit application. See mcctc.\,6 _ \1/3 o fan I Signature of Owner Date 1 Soseo, rty, ,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. Print Name 30 a4 1) Signature of Owner! nt Date SECTION 8-CONSTRUCTION SERVICES 8,1 Licensed Construction Supervisor: G�r,, ,,��,,pp Not ApplicableG 0 Name of License Holder: 30JL '. eOt cs3) q 13 11. License Number ( t HOIrkiCtOdk s rte GreeniCtie IVA 01301 a711 Address Expiration Date (413)77 i-31)04 Signature ephone 9.Registered Home Improvement Contractor: Not Applicable 0 J• Q" &Pore Cnnd+ Sor',Ink jSV3S6 Company Name Registration Number tiOlVq d� 5}ref (rretnfie Id, MA o13O\ 7-33 Addres- ++ Expiration Date ‘' , / • Telephane��t jj J)'774'3 b 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, Sixtb_Edition Section 10835.1. 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 netted 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 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: 502- NotriaiV llt Rd . The debris will be transported by: I r. Geoie aw , Sor}z Tn c The debris will be received by: rr^tt1e6nro �� Ule Building permit number: Name of Permit Applicant UoSe0. 6-e or e U(3°i�, \�. ) ° ►\/\ 46/A—Allt Date Signature of Permit Applicant �S%7 .._.sH-P-p. City of Northampton -r Massachusetts ;mow s� )1. DEPARTMENT OF BUILDING INSPECTIONS y I 1 "1ry 212 Main Street • Municipal Building �s .�' `••K, F Northampton, MA 01060 y . Property Address: J°of )Ioya v i lle (( • Contractor Name: jj SoSe0, Gor5C /I P-- Genf w,Ek Sion, Inc. Address: b`1 tim Inn:ma Street City, State: GriLenctiolk, AAA 01301 Phone: ( t 3)-77't 304 Property Owner 1 Name: Pets, F1 i^Ke Address: SO 1 i 6IldieMiiltk 1'J• City, State: NICAVrThA 1 MA I, 3oseti‘ Ceori v (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 10\1\ 10 i IA , • Date \1 (i0 ;Lb \ The Commonwealth of Massachusetts F+.141,C11111161 Department of industrial Accidents 1 Congress Street,Suite 100 *,=` _ x: Boston,14l,4 02114-2017 e,r www mass.gov/dta Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Anuilcant inffrlpation Please Print Legibly Name(Business'Organization/Individual): Address: City/State/Zip: C,C �tktell A Phone#: t ICI 6 Are you an employer?Check the appropriate box: C Type of project(required) am a employer with ' employees(fLandtor part-time).* 7. New construction 2.0 I am a sole proprietor or partnership and have no etnpioyees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9.3_0 I am a homeowner doing all work myself:[No workers'comp.insurance required.]* a Demolition 4. I am a homeowner and will be hiringcontractors to conduct all work on my 10�]Building addition Q property. l will ensure that all contractors either have workers'compensation insurance or are sole 11. j Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I ant 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.❑Roof repairs 6.0 We are a corporation and iu officers have exercised their right of exemption 14. Other ik�SLf '- �#w1 $ pi per MGl c, 152.A 1(4),and we have no employees.[No workers'camp.insurance required.] *Any applicant that checks 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. k'antractors 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ��, Insurance Company Name: ��t j e r Policy#or Self-ins.Lie.#: liar/ 06'O 77 Expiration Date: Job Site Address: 56 H� f lAV 1kk RE), N�1t On t 5i City/State/Zip: fNt1 Q' � Attar ► py oft�leworker? r'. _don to7lcy tl d t+on sbo g tb( i cy ► bet*s I irat€on date 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 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 coverage verification. I do hereby certify under the pans allies of that the information provided above s true and correct. Signature:t�l t t-\ Date: 11 30(ko ,1 Phone#: i 13 7 7 3 6 0 Iu Official use only. Do not write Or 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#: • f• Afflc6"SfttfritUitrefl faffs/&eutiirie5slieguliition 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 07/24/2023 1000 Washington Street -Suite 710 JP GEORGE&SON INC Boston,MA 02118 JOSEPH GEORGE ,) ►�f �V\ /f 64 HAYWOOD ST jCi (\ 1 r` GREENFIELD,MA 01301 Not valid Witho t si tore Undersecretary 9 • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructlj `j Specialty CSSL-099372 �1 • tres:02/11/2023 JOSEPH P G ORGE r' 64 HAYWOOEFSTREET GREENFIELDJytA 01301 ,. �± ` C fi()/S 1:01 Commissioner d,� �? 41041ii- Permit Authorization mass save Form imarovalftellaaev Site ID: 4292538 Customer: PETER A FLINKER Peter Flinker , owner of the property located at: (Owner's Name,printed) 502 Haydenville Rd Northampton, MA 01053 (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. Owner's Signature: f'der F k& Date: 1l / ?7 / 2021 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: (re,ory c,ild se fe ff,(. 11130 al Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 Fcr Cffi:e Use'Orly Document Ref:UPQS8-THPRQ-NG46T-RXBQJ Page 6 of 8