24A-044 (5) BP-2 022-1555
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-2022-1555 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION Contractor: License:
Est. Cost: 8215 J P GEORGE AND SON INC 099372
Const.Class: Exp.Date: 02/11/2023
Use Group: Owner: MCMULLAN WIENER, ELIZA C.&BRENDAN 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:12/05/2022
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:
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 VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
el • r )9 • 3:-Atii
Fees Paid: S65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
,I•; IROO 1- �. .. ....__-
The Commonwealth o£T Ias mats 1 NOV 2 3 Fit
S. The
ofBtdng Regu1s and 2O. liOtai�'
%v iviassar. s State Bullet%Code,la0 Cam.___ -
r)nt gl n __ Ts
vim"
BuildingPew Application To Construct,Repair,RenovateOr m �'a Mar 2011
One-or vo-FariyDweU, g
This Seotioniku OZzialUseO 1
BuildingPnftt ui er: 'A2,- 66 DV&ARAlect - ' . \
• i /
Bum 1(i'r3nt ame /�� 1 3D ZOZ2
=Mimi is METE IMAM At=ON
1.1 Fr'a 1.2 Assessors Map&Parcel Numbers
151 •- 77 asass Tar -6On 5 T r
Ma Is this anact; s yes no Ma914untber ParrceiNtentsnr
L3 Zoning ormafion: 1.4 !operty Dimensions:
Zoning District ProposedUse Lot Area(sgft) Frontage(11 I'
LS Building Setbacks(I)
FrantY'ard Side Muds Rear Mad
Required \ Provided Required 1 Provided , Required 1 Provided
11.6 Water SIMON 04.0.1.0.40,S54) L.7 Illood Zone oa: L.S Sewage Disposal$ A.
. Public II Private i7 Zia:.— Outside Flood Zone? Meal D on site&pout gam D
Check ifyes0
SECTION 2: PROPERTY O
I
2.1 °martofR osd:
Name(Plitt) _State,ZIT;
I V750Lck. r, .S4" A 7.Z brtndan frlc0)p I .Go PI
No and Street Telephone Email Aft*—,=
SECTION 3:pESCRIPTION OP PROPOSED WOW(+ee&.all that spy •
Nevi Construction Cl Waling Building ID 1 Owner-Occupied Cl 1 Repays} CI]Atteratinu(s) Cl 1 ./...riertion
Demolition • Cl Accessary Bldg.II NumberorUnits 1.Other IN Speciry: n`
Briefn .ts=.onooProposedWorlt: , � f cryi�u� i
l ' y ha,P/1) in' • P fir'/i5/ �.JG jr�.. _.__•__•-
SgeriON 4:ESTINAIED CONSIBRUCIION COSTS
Item I Estimated Costs:
(Labor and.M tale) `� :r''Tin Only
1.Building I $ ' /5 00 1. Bcu'Iciirig Permit Pee:$ indicate Is de6stmipa&
Ele rival S 0 Standard Cl irownApplicationFee
CI Total Project Costs 6)x multiplier x
3.Plumbing S () 2. Other Fees: $
4.Mechanical (Id.VAC} $ 6 Lists
5.Medrnirol, (lira
Suppressitm} S 0 Total All Fees:$
$ '� Cn CheclaTo.i'tl CheckAmou€�t:4 j6 Cash AMOUR
S.Total Profeet Cost: go` /J• CI Paid in Pull El Outstanding Balance Dan
t.
I
SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CSSLa9i 37? vqq - 1.4,3
• h OSe t &et)`oT_ License Number Expiration Date
Name of CSL Holder Wtr /��
/� (� 6edLNI
��01l4(Q.]- List CSL Type(see below) JJNo.and Street1 q G�..l Type Description
Gcef-vl eld M k o '30 I U Unrestricted(Buildings up to 354000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,S e,ZI' M Masonry
` 1 0\441,eitly RC Roofing Covering
WS Window and Siding ,
SF Solid Fuel Burning Appliances
(4I3) 531 Io-J to ameAsbw kkrt•CaW► I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
C�eor Son /56�86 -_.
;roc. HIC Registration Number Exp ration Date
HIC Co any me or HIC Re i tran ame
No.�d IS tE •a. a ___ ( _
lS� h�Aem 1 .1 • ''l i j S311076
076 Email address
City/Town,State,ZIP ,• ► ,(y' 4Telephone
SECTION 6: WO' 1 RS'CO iNSATION 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 lit 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 3Q�Qr 1 Ge.0
to act on my behalf, in all matters relative to work authorized by this buil mg permit applica ion.
i+ e ( / SeP G // 9.
Print Owr same(El�ronic Si ature) DateSECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the infonnatio
contained in this application is true an ccur to to es my knowledge and understanding.
JO$P1P ) orrI Oga!'
Print Ow is o�uthori Agent's Name( tropic ignature) 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"
F
The Commonwealth of M l&ssach se&ts
,�
e rl Department of In d °i' Accidents
-- 'rzs �r°eel,Mate00
tt
a on, A 02 4 20f 7
�' '�',.› www,mass.govidia
Workers'Hers' Compensation Insurance Affitidz' itt BuIldetrs1Contracto> t'1ectsieians/Plttmbers.
TC 2,S PLUM MTN THE P ;ArrINO AUTHORITY..
fare t I for. • none !letse 'sat Lib ,
Name(Business/Organi2alion/Individual):
Address: (:',. C 4; `-<0 I e e,.
di: !Sate/Zi rs t"' 'Ut 1Ckel t 3 i i Ci d b
' S' P� l Phone#: 6 -�
Are you an employee'Check tit appropriate box: C c1 D1
Type of project(required):
l. ;�, 1 am a employer with employees(lfi ,and/or partaitne).0 7. 0 New construction
2.0 t am a sole proprietor or partnership and have no employees working for me in 8. Q Remodeling
any capacity.[No workers'comp.insurance equired.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.)'
9. CI Demolition
10 Q Building addition
4.0 i am a homeowner and will be hiring contractors to conduct all work Olt my proptay, i will
ensure that all contractors either have workers'compensation insurance or are sole 11.E1 Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
5.0 i am a general coniramor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs
These subcontractors have employees and have workers'comp.insurance.: 9
6.0We are a corporation and its officers have exercised their right of exemption14.53iOther ��ail`0.. O
ors• g pti per MGL c.
152.310),and we have no employees.INo workers'camp.insurance required.]
'+Any applicant that checks box#1 must also fill out the section below showing their workers'conq.o..sation policy infonnation.
r Honteownars who submit this affidavit indicating they are doing ail work and then hire outside contractors must submit a new affidavit indicating such.
-tContmctots 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 en employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
Information. t
Insurance Company Name: v 't �.:t `.„
I Policy#or Self-ins.Li: #: y 'J�o Li i J Expiration Date: '`` ' O3_
Job Site Address: J(O? s..S \y' City/State/Zip 0 �.t,w� ) �l���
Failure to secure coverage as required under IvIGL c. 152,ti25A is a criminal Violation punishable by a line up to S1,500.00
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.
a
I do hereby certify under the paine and •aifles of ry orate Information provided above Is true and correct.
'�" I J (�ignaturt:: `�o�b ��01� `,1 � •
��• Date: j l�;� a�0��
Phone#: ` 13 774 36 111
, - _.,.... .. ..., __... .... .
1 Of.leiact nr only. Do not write irr flak area,to be completed by city or ton'n official.
ill
l
! air Or Town:t'c: ?ex ntt/Lieense it •3
Issuing Authority(circle one): I
1.' oamcl of i,wealth 2.wilding Department 3.City/Town Cleric 4.Electrical inspector 5,Plumbing inspector
6.Other
Contact Person: Phone IV: 1
Commonwealth of Massachusetts
Construction Supervisor Specialty VI Division of Professional Licensure
Board of Building Regulations and Standards
Restricted to: OriB$rtt �� `s)3ECfaii.y
CSSL-IC-Insulation Contractor
CSSL-WS-Windows and Siding CSSL-099372 pko*:02/11/2023
JOSEPH P GEORGE ,
64 HAYWOOD STREET
GREENFIELD MA 01301
Failure to possess a current edition of the Massachusetts Q ,'�
State Building Code is cause for revocation of this licerise. Commissioner K. "en;
For information about this license
Call(617)727-3200 or visit www.mass.gov/dp!
stration valid
individual use
ob tre the expirationrdate. If found returnto: MIff�� � � � hut'ion
{' `atWeines€
Office of Consumer Affairs and Business Regulation HOME IMPROVEMENT CONTRACTOR
1000 Washington Street -Suite 710 TYPE:Corporation
Boston,MA 02118 Re15668 ation
156686 07/24/2023
\A^ JP GEORGE&SON INC _
Jl i2
Not Valid itho It si JOSEPH GEORGE° ;j' 4.g ture 64 HAYWOOD ST f,,'",,-:efl(:✓�'P
GREENFIELD,MA 01301 Undersecretary
City of Northampton
17,A hq A A. ! ++rklr,
//t , • Massachusetts �� z._ (i
st
0 `` DEPARTMENT OF BUILDING INSPECTIONS
i"+ f 212 Main Street • Municipal Building yV`R Yarn
Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: bica't lb orb SlOar ' (f37 Vernor SL 13at.EUô a V+
The debris will be transported by:
Name of Hauler: Pa 2 i
Signature of Applicant: 3'tQpk\ (-Nit( Date: f /jett 9a
DocuSign Envelope ID:F4FFFFB8-0CB5-4B4C-8F85-09738BCF52EE
RISE
ENGINEERING'
OWNER AUTHORIZATION FORM
Eliza Wiener
(Owner's Name)
owner of the property located at:
167 Jackson Street
(Property Address)
Northampton, MA 01060
(Property Address)
hereby authorize jreOro, d�
(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.
—DocuSigned by:
•(,i,ya Wit,I4A-r
O`wr�'Pertme re
9/28/2022 1 1:25 PM EDT
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 I Canton, MA 02021 339-502-6335
www.RlSEengineering.com
City of Northampton
Massachusetts ,� f.
f (. - l
r.
-' " ! Jae DEPARTMENT OF BUILDING INSPECTIONS '� t 1P .z
•Pea •� 212 Main Street • Municipal Building ss."• ^:
Northampton, MA 01060
Property Address: /' ,, 7 L AirASdri j f
Contractor
Name: 5oSeel% CTeorq, /a,P. Georle l dk Sr',o J.>1C,
Address: 4 ),j i' oo(A !tree g
City, State: &r$€c c Ids M� 0i301
Phone: (j t3'-TN' 3604
Property Owner E /. } , o
Name: / ?.Q y(/�
Address: /67 t7a SOvi St
City, State: ,,/Vbt/L m,O�ON /144 DAV.
I, 3ostON Karl Q (contractor)attest and affirm that the building I inten to
insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and teat I have
provided the property owner with a copy of this affidavit.
Contractor signature
Date 1 /fei, aa