24A-044 (4) BP 2022-1238
159 JACKSON ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24A-044-001 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-2022-1238 PERMISSIONISHEREBYGRANTEI TO:
Project# 2022 159 JACKSON RENO Contractor: License:
Est. Cost: 4766.24 J P GEORGE AND SON INC 099372
Const.Class: Exp.Date:02/11/2023
Use Group: Owner: MCMULLAN WIENER, ELIZA C.& B' ENDAN T
Lot Size (sq.ft.)
Zoning: URB Applicant: J P GEORGE AND SON INC
Applicant Address Phone: Insurance:
64 HAYWOOD ST (413)774-3604 4220066477
GREENFIELD, MA 01301
ISSUED ON:09/30/2022
TO PERFORM THE FOLLOWING WORK:
ATTIC -AIR SEAL& ADD INSULATION
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 Depa rtment Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
111:1A/41 y2 . 3-1„ .
I
Fees Paid: $65.00
212Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
OIL-r. 1goo
Department use only
on City of Northampt n Status of Permit:
rn ';
-° Building Departm nt Curb Cut/Driveway Permit
ry L' 212 Main Stree Sewer/Septic Availability _
co l,—a Room 100 Water/Well Availability
r" 1, Northampton, MA 0 060 Two Sets of Structural Plans
ry _ hone 413-587-1240 Fax 13-587-1272 Plot/Site Plans
Other Specify_
i
APPLICATION TO CONSTRUCT,ALTER,RE AIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
r This section
VA/section to be completedl by office
1.1 Property Address:
I 7� �6CKS c1r\ Map Z qi t Lot 0 Unit 0 1
N°rfkaretPil) Zone U/1 e Overlay District
WOOElm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: r,'1_,� Wow, 010 t9
15'i TE Kso„ Si. N1Dr'il,Gr(IOA,w i
Name(Print) 1 Current Mailing Address:t�/ O) $a 47 a L
See AAk014e Telephone L b
Signature
2.2 Authorized Agent.
Sosepl, G-euti 69 HoT.,40 \ s't, Green{z1ip,MA ono'
Name(Print) 1 Current Mailing Address:
(413)'77 —36Ckc
Signature Telephone
SECTION 3-ESTIMATED ONSTRUCTION COSTS
Item Estimated Cos-(Dollars)to be Official Use Only
completed by permit applicant
'I. Building 4,7 6 h :).4
(a)Building Permit Fee
2_ Electrical (b)Estimated Total Cost of
Construction from L6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) _ t�
5.Fire Protection Si -
6. Total=(1 +2+3+4+5) 1()L ,19 Check Number
pis Section For Official Use Only
Building Permit Number: 5/9 2022- —/.. 3 g Date
Issued:
Signature: /Z.-
9- 0-ZOzz
Building Commissionedlnspect r of Buildings
Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House [l Addition n Replacement Windows Alteration(s) i l Roofing
Or Doors D
1 �
Accessory Bldg. U Demolition U New Signs tO] De Its [1:::7 Siding[Q] Other[70
$nStn laiion
Brief Description of Proposed I-\ ( Ste' � �`
Work: I (�'t Ot t�l'U1e entni G1 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.
!. 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
l El,z o, W,e_Ae as Owner of the subject
property
hereby authorize Sale? , UeOrt\e
to act on my behalf,in all matters relative?o work authorized by this building permi:application.
gce N 6.e.t1l Mk a2
Signature of Owner Date
+ 3.OSQtp;\ C3 orcy.. ,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.
OOSe ftN Co-
Print Name
KNA pq fry �ao )�
Signature of Own Ag t Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:� g Not Applicable 0
Name of License Holder: aose. koro1� (S3) 1&13 1 r)'
1 License Number
(,9 Hc' 'oo St-re; f iee,(M.4, 013°) a.-i8 - , °..J ��vz3
Address Expiration Date
Signature )&,� Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
3 " &reara,e fnnr� S or\, ' r ' 15 6(3n
Company Name v RegistratigQ Number
6 CA�woA dti 5fr e re�n�ce lit Ma .0130� x ram" 2_02-3
Address Expiration Date
Telephone 1 \ 774 36°4
1
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 U 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/br 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 Iiable 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 Cod',City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated_
Homeowner Signature
Tat City of Northampton
•
10 Massachusetts '^w
` DEPARTMENT OF BT)ILDING INSPECTIONS 1'4 E
212 Main Street • Municipal Building
Northampton, MA 01060 ?'
Property Address: 1561 Sat C0O0 - NOrfiIV'ri ft01 MA 01° (a
Contractor I
Name: JOSetAN &ecne /a,P. Geoty 0.4 S,oi\, ar c.
Address: b171 HQ woo(1 . rt2k
City, State: Gt'$2nc'2i(h� MA 013o1
Phone: ( tl3'\ 77Lt . 3(,O
Property Owner E1;zName: \inej
Address: tJ�1 J'GGtSo.
City, State: I a h >
JoseQ6rif (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
Date
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: `561 cKSDn S\
The debris will be transported by: I f, Geo r je.
The debris will be received by: r►^11-1e6 ro Sc,) U e
Building permit number:
Name of Permit Applicant aoserl'. (re r7e
fl i):1401,1hill 47-
Date Signature of Permit Applicant
` Commonwealth of Massachusetts
Construction Supervisor Specialty V` Division of Professional Licensure
Board of Building Re ,"pulations and Standards
Restricted to: �do:fal e�t1; r4o4 �.S'�•
CSSL-IC-Insulation Contractor t.
CSSL-WS-Windows and Siding CSSL-099372 fires:02/11/2023
JOSEPH P GEORGE , 1
64 HAYWOOD_STREET ti
GREENFIELD MA 01301
Ls
'1401`S'S!1:10`
Failure to possess a current edition of the Massachusetts ,�/
State Building Code is cause for revocation of this license. Commissioner eala iJ�mc �
For information about this license
Call(617)727-3200 or visit www.mass.gov/dp!
Registration valid for individual use only •Ag&ggftergUii`2 Il�ratjg& I+ afdtion
before the expiration date. If found return to: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
JP GEORGE&SON INC .
• Wis)Ovedt '31i,
JOSEPH
4 HAYW
r. Not valid ithout sig ture 6AYV OOD 5T i GEORGE .. e(( /„r/ '`A
64
GREENFIELD,MA 01301 Undersecretary
;` The CON118Bo272We 1t o,`Messcuig€i*tisea`
Deportment oil In s ri c l Accident
1 Coagrez Street,Thdte 100
a � 3o ton,NA 021 4 2l7
Workers'Compensation BlIstardce Affidavit:3ildersiContr actor,/Electriclsns1P1umbers.
O DE MU SD wrim THE PlialbliTTING AUTHORITY.
EIT'.
kp lice nt information Pjle_use Print L etObly
Name(Business/Organiaationllndividual):
Address: , ;L.LD$c'.;...._ $, ,... e ,
City/State/Zip: i.tt;3'* 144aiki Phone#: k."1 13V 1 167 b
re you au employer?Check the appropriate bout L'V i1 Type of project(required):
1.0•I am a employ*.with ' employees f f ikandise pan-thnc).' 7. ❑New construction
2.0 I ant a sole prokuietor or partnership and have no employees working for mein 8. 0 Remodeling
any capacity.[No workers'comp.insurance required.]
3.0 I am a horneowner doing n11 work myself']No workers'comp,insurance required.]'
9. Q Demolition
10 0 Building addition
.1.0 t am a homeowner and will be hiving contractors to conduct ail work on my property. I will
ensure dun all contractors either have workers'compensation insurance or arc sole 11.[]Electrical repairs or additions
proprietors with no employees,
12.C]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-contntctors have employees and have workers'comp.insurance.* 13.0 Roof repairs (�
6.0 We am a corporation and its officers have exercised their right of exemption pet MGL c. 14. OtherJ e 3�
I a3.fi 1I4),and we have no employees.IN*workers'camp.insurance required.]
"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
1 Homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such.
*Contractors that check:this box must attached an additional sh tel 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.
>' •--1 ; .tom- .
I am an employer that is providing workers'compensation insarance for my employees. MOW is the policy and job site
information. �� ����
Insurance Company Name: t ` p.) _
Policy#orSeif ins.Lic.#; '� �-' t 1 Expiration Date: ) 1 GADA3
Job Site Address: 1- , t,J fin. 5\ City/State/Zip 0 r th C'P1 ADA hi 0 IOC°
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a line 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 t. $250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for nsurance
coverage verification.
I do hereby certifjy wr er the pains and penalties of pointy that the information provided above is true end COT'
Signature: Date: 01/). /9).oaa
Phone#: 4i3 7 1 36
�r
�;,ir7eiaft use only. Lla not write in this area,to be completed 6y cis_;?or town official
CEng,or Town: Vie« .it/Lieense to i1
IsstntawsAtmhority(circle one):
I.Board of Health 2.1 uilding Department 3,City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Cotltnct Pn_rsom Phone#:
�..._._._ - f
Permit Authorization
mass save Form
Site ID: 4560585 Customer: ELIZA WIENER
Eliza Wiener , owner of the property located at:
(Owner's Name,printed)
159 Jackson St Northampton, MA 01060
(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 weatherizati•n
work on my property.
Owner's Signature:64 - Win /FR
Date: 08/ 18 ...
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
U" • Ge-Ory, 5,0 11-4C. 09 id,00),)
Participating Contractor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
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