11A-027 (4) BP- 022-0951
18 CHESTNUT AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
I I A-027-001 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-2022-0951 PERMISSIONIS HEREBY GRANTE 40 TO:
Project# INSULATION Contractor: License:
Est. Cost: 8181 JOSEPH GEORGE AND SON INC 099372
Const.Class: Exp.Date:02/1 1/2023
Use Group: Owner: STAMM KLEIN ALISA F& AMY D
•
Lot Size (sq.ft.)
Zoning: URA Applicant: JOSEPH GEORGE AND SON INC
Applicant Address Phone: Insurance:
64 HAYWOOD ST (413)774-3604 4220066477
GREENFIELD, MA 01301
ISSUED ON:08/10/2022
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL TION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
• )2 . TAR
Fees Paid: $65.00
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
f3UiLr I gob
Department use only
rr _ City of Northampton Status of Permit:
=- j `� Building Department Curb Cut/Driveway Permit
�'''— 212 Main Street Sewer/Septic Availability
Q(f G ROOM 100 WateriWell Availability
9 2022 Northampton, MA 01060 Two Sets of Structural Plans
• on 413-587-1240 Fax 413-587-1272 Plot/Site Plans
[rpr
of eini_r) r; Other Specify
P, 4MnT t"4 n T,p�. �aq�� ON3
_----APPtfGIQN TO ONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION _
This section to be completed by office
1.1 Property Address: Pf C(�le
n�� Qv� fyMap % l Lot 0 -2, Unit
Leeh r MA 10105 3 Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Arl
St PIIt c Sir, ' Oft
Name(Print) Current Mailing Address: u J 17 5 8 6 OW
St'k0f� A'
42d1 Telephone 1
Signature
2.2 Authorized Agent:
Jose►$ (r2.ot',,C 64 Hiny o4 s , GreeMleltII M 0MI
Name(Prin Current Mailing Address:
Vie 1
-0 I f ' ("yt .
Signature I Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed tly ermit applicant
1. Building ¢, l%I i 3 (a)Building Permit Fee
2_ Electrical (b)Estimated Total Cost of
Construction from.(6)
3. Plumbing Building Permit Fee
liffi4. Mechanical(HVAC)
5_Fire Protection
6. Total=(1 +2+3+4+5) tril,t Check Number i M 6 7
This Section For Official Use Only
Building Permit Number: f')-.. -QS 1 DateIssued:
Signature: �`71
8' le 20ZZ
Building Commissioner/Inspector of Buildings
Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House [l Addition 7 Replacement Windows Alteration(s) in Roofing Ei
Or Doors D
Accessory Bldg. U Demolition Li New Signs [p] Decks [C] Siding[D] Other[A
Brief Description of Proposed A•r ( ) c U t, Ada it" Of ce i!!H��,tn 1t1 I n9
UI ork: l Je I rn }I �11 f OS J
sv4s
Alteration of existing bedroom Yes No Adding new bedroom Yes No �.n [on In00
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ea. 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
I, AN StGrIP ,as Owner of the subject
property
hereby authorize SoSeo, &eordA .
to act on my behalf,in all matters relative work authorized by this building permit application.
See M cn6,e1 Q W!01 J 10a0-
Signature of Owner Date
1 5oseO\-\ C €t 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.
UOS 01 GeAM2
::::::
\A5,
01 fo
�^
Owne! ent �� Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder:
Uostpl. Georot. cS31 a 9l31').
License Number
H en'a',000\ 3 tt e.\ Gree k t ok, Mq 01301 a,-II
Address Expiration Date
• ' (40)77i-3iP4
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
) f' Geor�e &4'. �Dn Zr1c, 1566n
Company Name Registration Number
(4 tiCA w d\ s}«-6 Gre-en fte tit MA 01301 7—S -1O 1J
Address 117711
u Expiration Date
)...?1,6(4Telephone 411J"771'36°4
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
City of Northampton
3 t5 ' sic
(ir` ` � Massachusetts ��' }
t A,tt:
,7, !
�,..i. t.ry r' DEPARTMENT OF BUILDING INSPECTIONS G V �i
_S_^^-'ti.' .,ems•'
?1L °s'� 212 Main Street • Municipal Building vssF,.a ``
:ter Northampton, MA 01060 `�,� '
Property Address: Vi Ci)CSInknt okv t '
Contractor
Name: joseo, C3eoiy, /a,P George t,Atk soi\, lr\E,
Address: 0 'Hoi\owoci Stree3
City, State: &R'RiNCIltiths N'A 01301
Phone: t 1 3 -7 E Lt_ 3( °
Property Owner A Ml C J xr^
Name: l }}
Address: 1% C hnt14 0dQ
City, State: L.P/e,c‘ s / M A',0105 3
1, 3osgl. tsti015 4 (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 '),...).....Q.A.Q2e ,
Date 0(6 (ol I a,0).!),
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: I% C141114 SIC.
The debris will be transported by: 1r, (merle 0/14 Spr, Inc
The debris will be received by: rs^ t'P L. rp
Building permit number:
Name of Permit Applicant 3.0�eF1'. (-e e.
0101 %001kgizActe..44 ,
Date Signature of Permit Applicant
(�r1\
The Co ammf wflefth ofMassachusetts
u,
j.
1 Coi rep, met,Smite 100
. e oac,1�2 6'®211 - 7
��Q>^,T• r.-+` 3;E")m mass.gov/Aik
c';rori ess' Cornpensetion linsura3ice Affidavit:Ottilders&Contr actors/Electr€cifansnhciinbers.
TO DE FEUD WITH a 4 use.PT'S Fa irraP.G AUTHORITY.
F.:unlietnt Tinfori 'o L9e se lit: 'V ,M,,
Name(BusinassiOrganization/Individual):
Address: Gc4
-Al,? L,
City/State/Zip: O liriW .,,,;� �t 1 n Phone#: (4 t") S ! I CI 6
%re you au employer?Cheat the appropriate boat C`i Si,;: Type of project(required):
1..5..I um a employer with_____q employees(a,and/or part-timcl.` 7. 0 New construction
2.0 t am a sole proprietor or partnership and have no employees working thr me in $. Q Remodeling
any capacity.[No workers'comp.insurance required
9.
3.0 I am a homeowner doing all work myself.[No workers'camp.insurance required.]' Q Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
l0 0 Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.[J Electrical repairs or additions
proprietors with no employees, 12.❑Plumbing repairs or additions
5.0 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. l3.fl Roof repairs
These sub•contrectots have employees and have workers'camp.insurmce: ,�}
5. We are a corporation and its officers have exercised their right of exemption 14. Other ,'* * 1 t n�s
❑ �+ g pri per A4tiL c.
152,OM,and we have no employees.[No workers'comp.insurance required.]
t
'Any applicant that cheeks box#1 must also fill out the section below showing Their workers'commmsatioa 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 subcontractors have employees,they must provide their workers'comp.policy number.
T am art employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.n. A
Insurance Company Name: � i i'-+., __.._.—
Policy it or Self-ins.Lic.#::r 't ` '6y (n H 7.7 Expiration Date: I 03 _
So'-..b++xxSiteAddres�se O C`b�iSjf1t�` aye, City/StatelZip, LeeSI An 0I053
,Jit4{t A p 2@ 'iS4i . yam -*ik , �3yp*� _.. < �t .. #t.oltii]_ :tiji*f.��'y}`,� � . ,��p{y��y
jriY .i�D[3A'.Jt.'_T�fr...,w ...�,.�.r�� � -V .- ��"1G.`.���. �I ��3.�V�,YAHWM.e47.w4.�'T+�. i f 1 . 1 I F ..r�^.:!'.
Failure to secure coverage as required under NGL c.152,ti25A 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.
p tie;fie eby certify t er the pains and wallies of perjury that the information provided above Ls true end correct
Signature: �� , C Date: O i 107/Xo a7
Phone#: 413 77t 36O
official age duly. Do not wria"L't'rs this area,to be completed bl'city or town off i al.
ICity or Town: Permit/License# II
'issuing Author ky(circle one):
E.2oard of Health 2.Building Deportment 3.City/Town Clerk 4.Electrical inspector 5.Plumbing inspector
GI.Other
Contact Parson; Phone ii:
L — ..e.i
Commonwealth of Massachusetts
Construction Supervisor Specialty ` 7r�'k Division of Professional Licensure
Board of Building Regulations and Standards
Restricted to: i i +,rr. _ - .. _ ,
CSSL-IC-Insulation Contractor
CSSL-WS-Windows and Siding CSSL-099372 crp►res:02/11/2023
JOSEPH P GEORGE . A tr-'
64 HAYWOOD STREET X.
GREENFIELDMA 01301 *!
Failure to possess a current edition of the Massachusetts b/
State Building Code is cause for revocation of this license. Commissioner >✓i'. I7Fa�t�ca�
For information about this license
Call(617)727-3200 or visit www.mass.gov/dp!
Registration valid for individual use only _.__,___. .._. _._
before the expiration date. If found return to: Oeftfir & ion
Office of Consumer Affairs and Business Regulation HOME IMPROVEMENT CONTRACTOR
1000 Washington Street -Suite 710 TYPEi Corporation
Boston,MA 02118 Registration Expiration
156686 07/24/2023
1 I 1 DO JP GEORGE&SONINC
Not valid ithowt sig ture JOSEPH GEORGE
64 HAYWOOD ST f�4.,:.<<fC•j
GREENFIELD,MA 01301 Undersecretary 4.
RISES
ENGINEERING'
OWNER AUTHORIZATION FORM
I, Amy Stamm
(Owner's Name)
owner of the property located at:
18 Chestnut Avenue
(Property Address)
Leeds, MA 01053
(Property Address)
hereby authorize J .Pw G eo r5t o'er A Son In C
(Subcontractor)
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.
Owner's..§ nature
(2o22-
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335
www.RlSEengineering.com