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17C-060 (10) BP1-2022-1493 183 CHESTNUT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-060-001 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-2022-1493 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 4222 J P GEORGE AND SON INC 099372 Const.Class: Exp.Date: 02/11/2023 Use Group: Owner: CAROLINA ARAGON, Lot Size (sq.ft.) Zoning: URA Applicant: J P GEORGE AND SON INC Applicant Address Phone: Insurance: 64 HAYWOOD ST (413)774-3604 4220066477 GREENFIELD, MA 01301 ISSUED ON: 11/16/2022 TO PERFORM THE FOLLOWING If 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 Department Driveway Final: Fireplace/Chimney: I Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ( Q el Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner . /'I ��� �' _'` 9 Z1 fi\17 The �: iv r 1 Comor re oft ama� is ding Revisions and atiltuil "As 8P lSt3 s BulTaig Code, );nt18 s: � as /I?/i nlnlr USE Building Permit Application To Coot,Rom,Ramat Or , s . °2d111 One-or T! -Pcor ily Dwelling ._.....___ This BettionPar Official Uae.Dnip BundingP miti Lumber: . I`'q, 1 Date*Beck ,Keu,/‘..) ` o2--- 1 - z B g ) . zp Z it. l . . : 1.1a Is this an.: ,* . stress ies no MapNumbesr Per tWaraber Us ing si€,g�s Lion: __ L. Property en ns: ZoningDistcict PtopasedUse LotArea(sgf) ProntagaOf) L.S BuStling Setbacks(ft) ProntYar4 SideYerds Rear Yard Required Provided Required 1 Provided , Required Provided L6 Water Supply;(W.G -c-40,§ 1.7 Blood Zone h n: LS Selvage Disposal < Public it Private Cl Zoom— Outside Flood Zone? uniemai ra on sitealma„ma1:1 Cheek ifyesCi SECTIUN2 PRCTIIRTY OfT4 QE • Vero\; c, s4 n NOrt k A (��I , 0 ��J 61 'Name( f� o Ca?,State,71CP \S)) CfNesirr \ j, .6 17 7s5 9615 0 No_and Street Telephone small Adstess SECTION 3;Dn- T. .sr °it i ICI OP PROPOSED VOW(shark all fbatapply) New Consfruclion 0 &bib:Paulding 0 Owner-Oc opied CI 1 Cs(c) II 1 Alteration(s) €l I ild&dou E3 Densoiitlon . C'i Accessory$kig.II Number of-Units t Other Clspiffy: BrierDescription csfProposed.Work'': At' ec01 & t Unii .� SECTION 41 PI Cons Item �d Cost: (Labor and M rials) • 1.Building $ LI )11 ,L►4 1. Bu din Per nitpee:$ Tnrlic WV i is n Btscstricsal E3 Standard Cltyi"fcrwn.Application Pee C3 Total Project Costs 6)x multiplier x 3.Plumbing 1 5 2. Otter Pees: $ &. chasdtical (tVAC) $ List 3.Mechanics. (Fire 81112PleSSIOTO6.Total Total All�' , j r f Pinged i-� �a� Cho esaklN.Ta.i 4 9U chock Amount: l� Cash nto �`1� Pa3s in,Pull aOutstanding Balance Due: 3 SECTION 5: CONSTRUCTION SERVICES q 5.1 Construction Supervisor License(CSL) LS CL O61 � 51? Q .-‘i.4.3 "Sosp 01 6€4,(1%e_. License Number Expiration Date Name of CSL Holder W� !� (D� 46.N\V D 1 Ifr�k List CSL Type(see below) ! No.and Street Q Type Description Gcee.vv eXd (ii4 130 1 U Unrestricted(Buildings up to 35,000 cu.ft.) f1 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 6113) 5311616 gK42-10y Aetst..COVA I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /����/ �� ?Q • o JDn HIC Registration Number Expiration Date HIC Co pant' me or HIC Re i tran ame 6 4 attatit iwacoh @owN°°rc olv) No. d Street Email address CT�ce�.wfk�.id,M a(SO I C' U1) S31107 6 City/Town,State,ZIP Telephone SECTION 6: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 lilt No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize V ose 1 Geo to act on my behalf,in all matters reli've to work authorized by this buil mg permit applica ion. C�ro1; A r� Se e U�i c,c \lfo 7 1?-0),4 Print Owner's Name(Electronic Sgnatu Date SECTION 7b: OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. 0-a3.ep�, gon 11107 1Ao).2. Print Owner's or Authorized Agent's Name(Ele onic ignatur Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage, finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" 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: lfc i Cie St The debris will be transported by: Ito, George Cwi The debris will be received by: 13 r`^ttle6 fro ti� U nN Building permit number: Name of Permit Applicant 3.0 (re e 0)7A°).4 PlitralV Date Signature of Permit Applicant City of Northampton :. vY--"' • ,., Massachusetts '` (67 &.--i).''r: .!::', Flf , t ` : DEPARTMENT OF BUILDING INSPECTIONS ' • i•+j j,; .:v 212 Main Street • Municipal Building Northampton, MA 01060 Property Address: l U ; ClC S1110 S\ , Norfi wr'\pton, MA , 010 6z Contractor Name: JoSeo, George /J,P. Geory {,,A Son, JTnc, Address: 0 Ho►ywooiA tree City, State: GrRef\ci'Idd, MA o13o1 Phone: ( tI3)-7711.% 3604 Property Owner CGro\In�► ArQ9on Name: 1. Address: 13 Ce r I\ '4fi 3t. City, State: NCrt C/rh * n MA / 010() )- I, JO € \ Ron)42 (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 �i 1111/1:41 .01), • The Coreae;1Oen aleh of Massachusetts Deportment ci ecat o��>r2d�. °i'e Acckie1a = o 1 C re Saver,,asi e 100 r�' .2osgo.�a, A 021,�J-2017 �� f 'Yrt1'�r�.:aCess.govIdia Workers'Compensation 1t.staraace A d it:BulidersiCoutractorsf 3ect>rifiaasJPhimbers. TO 1Y F L D M'1 H THE E PRi.11'I r1b1C A€T5'IO:21TY. Applicant information ?lease Print Legibly Name(Business!Orgatuaationllndit'iduttl); Address: (` C-- a O t, i &, City/State/Zip: 'tCitt . t itPi4 �/4\ Phone#: 6I ) S i 6I 6 ire you au employer?Cheek qapprolrr4ate host t1 y of project(required): l I am employer with employees es f T,;p]).andlarpart-tune).* 7. El New construction 2.0 l am a sok proprietor or partnership and have no employees working for me in 8. C(Remodeling any capacity.[No workers comp.insurance required.] • 5.01 ant a homeowner doing all[Lurk myself.[No workers'comp,insurance required.]' 9. ©Demolition 4.0 t tuna homeowner and will be hiring contractors to conduct all work on my proparty. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or arc sole 11.0 Electrical repairs or additions proptiixors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-conuactots listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insunmcr,: 14.igOther 1Vk ii C0-:Y10�%. G.❑t`e area corporation and its aftershave exercised their right of exemption per A4GL c. . 152.ti it4),and we have no employees.[No workers'comp.insurance required.] ''Any applicant that checks box#1 must also fin out the section below showing their workers'compensation policy information. 1.Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. [toms e.tors 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 w:r an employer that is providing workers'compensation Insurance for iny employees. Below is the policy and job site information. • insurance Company Blame: i \I) _—— Policy#or Self-ices.Lie.#; 9-3.00 ‘ 6 Expiration Date: '-)-- I'` d•Da3_ Job Site Address: tS 3 `i1hl` Str tAt5 t' C}}l StateZY �or G�trt � n1Mfli 0 o k i � }� r i V * a � 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 tine 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'cerdt;�i'under the pains and penult//es of perjury that the infonnalion provided above l true and correct. Signature: Date: I+ fOl/202 tl Phone#: ` i 3 tvittf Official:use only. Do not write€is this area,to be completed by city or town official. City or Town: Permit/License# j Issuing Authority(circle one): E.aoard of"Zenith. 2.Building 1pepnr extent 3.City/Town Clerk 4.Electt'icnl inspector 5.Plumbing inspector G.Other et:t^et P rsonl_ phone#: Commonwealth of Massachusetts 11). Division of Professional Licensure Board of Building Regulations and Standard Construction Supervisor Specialty s Restricted to: `'.Ora:i 4 i r Sg lai ,- CSSL-IC-Insulation Contractor !. CSSL-WS-Windows and Siding CSSL-09937271ras:02/1112023 s JOSEPH P GEORGE 4 ` , 64 HAYW00D STREET..<;' ,^, GREENFIELD MA 01301 .." c Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner (AA ��vnr 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: l�ffid�'di Cf U > ENT C NTRACTo1'ion Office of Consumer Affairs and Business Regulation HOME IMPROVEMENT CONTRACTOR 1000 Washington Street -Suite 710 TYPEi Corporation Boston,MA 02118 Registration Exairafion 156686 07/24/2023 JP GEORGE&SON INC A� �Y f , I d12 ', -.374, Not valid itho .t sig•ture JOSEPH GEORGE /J 64 HAYWOOD ST ,/r<r=%f�.('a/�cti� GREENFIELD,MA 01301 Undersecretary Permit Authorization mass save Form Site ID: 4512131 Customer: CAROLINA ARAGON Carolina Aragon I, , owner of the property located at: (owner's Name,printed) 183 Chestnut St 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. Owner's Signature: CaIbt�CGtGI 4pgyou Date: 06 / 19 / 2022 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Pi Georele Unci soA, anc. u/o7/9,cu Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Ciffi:e Use Only