38B-066 (14) BP-2022-0164
251 SOUTH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-066-001 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-2022-0164 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION Contractor: License:
Est.Cost: 9967 JOSEPH GEORGE AND SON INC 099372
Const.Class: Exp.Date:02/11/2023
Use Group: Owner: MALINOWSKI, REBECCA S.
Lot Size (sq.ft.)
Zoning: URB Applicant: JOSEPH GEORGE AND SON INC
Applicant Address Phone: Insurance:
64 HAYWOOD ST (413)774-3604 4220(166477
GREENFI ELD, MA 01301
ISSUED ON:02/22/2022
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATH ERI ZATI ON
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:
Gas: Final: Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney;
Final: Oil: Insulation:
Smoke: Fina I:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
1I
: •. I' • 52 I'1 •
Fees Paid: $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
�__
-- AECFIVE ) i
l Department use only
1 COof Northampton Status of Permit:
F E B[ I2022
Building Department Curb Cut/Driveway Permit
12 Main Street Sewer/Septic Availability
Room 100 Water/Well Availabiiity
KEPT.OF BUILDING INSPECTION O(t ampton' MA 01060 Two Sets of Structural Plans
NpATHAMPTON,MA01060
Bu
ptrene 4137-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property( Address:[ / ( L This ction to be completed byoffice
f/Sou/h J1- Map �'� Lot 01... I/ Unit
,/ thOV^p//)L1,'�Ha. Zone Overlay District
/ f
`-�16(/,() Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Ownerne of Record:
fed;<'(cc( it1Ci/'W, / / dc/ •_)C1 i l/ St
Name(`(Print) Current tii)Ian d / �3 3
o, iMkolG141 one?Teleph
Signature
2.2 Authorized Agent:
SoSep C rlC 69 HoNti000N S , Gsee*et atkA 01101
Name(Print) 0 Current Mailing Address:
(k13)'77 —3(,nk
Signature a Telephone
SECTION 3-ESTIMATED CONSTRUCTION OSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building ` 9 (�7 3^ (a)S(/ uiiding Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) '(Ic5.Fire Protection
6. Total=(1 +2+3+4+5) 7, 9 7,31\ Check Number I I 7 7 7
2 This Section For Official Use Only
Building Permit Number: 01,91-/69
(f Date
Issued:
Signature: /r AL �, �t �,e' � �� rT
I
Building Commissioner/Inspector of Buildings
Cate
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House D Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [I:3] Decks [El Siding[CI] Other[154
InstA is}Son
Brief Description of Pr9pose / J
Work: air . ' I e /C �'_iv/t2^,- cr a�r]f CUTC( 5 / o'fr /J 1//JH
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.
1. 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
1 Keb e t(_./;ti (�'J G[ I I/10 Eo s Li ,as Owner of the subject
property
hereby authorize S)SeP ' °'ag
to act on my behalf,in all matters relative to work authorized by this building permit application.
See o.A% a a//:�/)-(2
Signature of Owner Date
1, 3.0 St ON (7420* ,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.
JOSQ k Geos e.
Print Name
• . '/i3/32
Signature of Owner/Ag t Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder
Sosgl. Geol. CS3I °1931 a
License Number
_ 4 H Pink #ood $ttt e. ee A'at ok t IVV\ 01301 _k, 3
Address\ Expiration Date
A*111-414 413)77i-3(pm
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
J. Q. (Teor e find+ S on, Zr t IS(At
Company Name Registration Number
vNI)A S+reed free 4te let AR 0130\ 7-as - Red3
Address Expiration Date
\ , , Telephone4,11)-77`1-3baN
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 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 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
City of Northampton
Y•
�a' Massachusetts
i , fit'' Z. W yy Z :i.
i J t�� �,^ v a ,,
6 •� '1 DEPARTMENT OF BUILDING INSPECTIONS % ''�N 1iz # �:
" 1.� 212 Main Street • Municipal Building -s
Northampton, MA 01060 %� ?'�`
e
Property Address: 6/ 5ofi S
7 .A 1,a• m /0`% / /A
Contractor
Name: 3QSep\ Georg /a,P Georqe tnnk So NIEnc.
Address: ' Hmywoo A . fret
City, State: (7 r ((il'a lA IAA O U 3O I
Phone: (t3)-7 t 4 ^ 3‘04
Property Owner
Name: 'f Lc L (-C( lila /hit) COS /
Address: 4).5 / So 6, ,cs Artilarri kti / "/C.t.
City, State: A r T iumii0 W /164
i, 56.e? (.rears 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 l have
provided the property owner with a copy of this affidavit.
Contractor signature A ,�� '/0 0 r '
Date A A
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: 2 /J i;.q/1 Ji4ai'ynr)
The debris will be transported by: If, Geor je ovidt, Son , Tn c
The debris will be received by: roll!&f ro -cl v.le
Building permit number:
Name of Permit Applicant O'er tre e
*Vi4 CliA56L5A.
Date (9 7/3Pd
Signature of Permit Applicant
-....... The Commonwealth of Massachusetts
..may l Department of industrial Accidents
=,% I Congress Streed,Suite 100
7� < ,Boston,tifA O2 14-2017
` --7"-.-`J, ur inv,mass govidh
Workers'Compensation insurance Affidavit:Builtsers/Contras`tors/E1ecteicii:tis1Phmibei s.
TO 2E FILED WITH THE FERM rf.I'iG AUTHORITY.
Aaligicant Iiz<ffrmatioit Please Print Legibly Name(Business/Organization/Individual):
Address: t� ( f 4-!-Coy‘i MIA C.
•
City/State/Zip: (C o, G% 414\ Phone#: (4 R) l C7 b
Are you an employer?Check th !appropriate bos: C V 30 Type of project(required):
t. I am aemployer with employees Ifatll,andlorpart-time). 7. ❑New construction
2.0 t am a sole proprietor or partnership and have no employees working for me in S. 0 Remodeling
any capacity.1No workers comp.insurance required.]
ID I am a homeowner doing all wok myself.[No workers'comp.insurance required.]i g Demolition
4.�t am a homeowner and will be hiring contractors to conduct all work on my property. I 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
s.D I am a general contractor and i have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.0 We are a corporation and its officers have exercised their right of exemption per AMGL c.
14.[1Other Ibt. 1 1OVi
152.;l(4),and we have no employees.JNo workers'comp.insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
I.Homeowners who submit this affidavit indicating they are doing afl work and then hire outside contractors must submit a new affidavit indicating such.
1C'ontrstctors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I ant era employer that is providing workers'compensation insurance for my employees. Belot is the policy and job site
information. I ,
Insurance Company Name: t �\‘e
Policy i±or Self-ins.Lie.#: 1794006` 4," 4 r 7 Expiration Dale: � I`'• as
Job Site Address J / N Si')• LET City/State/Zip J 1 r'' m 1-r A 0j 66
6
a.
fat...:. ._.copy ►a*e a*+aq ` + iz ton ge s otng e o i numn fzer •.. .rtefo dl to
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine 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 under the pains and, attics of per'ury t the information provided above is true and correct.
-t ` t n 1 ',22
Signarure:�,yJ�-SQpj� t-�c't>f° t ,f �01 ' Date: �T � 3
Phone#: t 1 3 l 74 3 6 okf
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#;
._ _ —__.......�. . —1
Commonwealth of Massachusetts
Construction Supervisor Specialty Division of Professional Licensure
} Board of Building Regulations and Standards
Restricted to: C.riL: c.'.3,- Pu-S/fr S.�
CSSL-IC-Insulation Contractor t.
CSSL-WS-Windows and Siding CSSL-099372 .- "" Edcppires.02/11/2023
JOSEPH P GEORGE § , ,,, 4.
�
64 HAYWOOED STREE'i_<.
GREENFIELD MA 01301 -1
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license. Commissioner �ja. a L7finu
For information about this license v
Call(617)727-3200 or visit www.mass.gov/dp!
Re
gistration
before the expirationrdate, If found return to:
Officeinividual use only
'9 itift MPO & hit ss r ion
of Consumer Affairs and Business Regulation HOME IMPROVEMENT CONTRACTOR
1000 Washington Street -Suite 710 TYPEi Corporation
Boston,MA 02118 Registration Expiration
156086;•_ 07/24/2023
. JP GEORGE• SON INC
j1 •
4.
Not valid itho t sig ture JOSEPH GEORGE
HAYWDODST
GREENFIELD,
1/40,4e(4/00/.lo/�•
MA Oi Q1 Undersecretary
DocuSign Envelope ID.FFF95ABD-17D9-4OFF-B2D0-ABA217B6A548
RISE
1"
ENGINEERING
OWNER AUTHORIZATION FORM
Rebecca Malinowski
(Owner's Name)
owner of the property located at:
251 South Street ,
(Property Address)
Northampton, MA 01060 ,
(Property Address)
hereby authorize ir I 1., EG; (,‘_v 01 SD;", ,
Subcontractor o 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 byNoma, 11)14Lit&owsLi
Own e?° `li 9'a'tliie
11/12/2021 I 5:05 PM EST
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335
www.RlSEengineering.com