36-061 BP-2023-0734
918 RYAN RD COMMONWEALTH OF IASSACHUSETTS
Map:Block:Lot:
35-061-001 CITY OF NORTH• MPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREG STERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUA- NTY FUND (MGL c.142A)
BUILDING ' ERMIT
Permit# BP-2023-0734 PERMISSIO IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
Est. Cost: 9500 J P GEORGE AND 'ON INC 099372
Const.Class: Exp.Date: 02/11/20 5
Use Group: Owner: R. SLOAN, SHARON
Lot Size (sq.ft.)
Zoning: WSP Applicant: J P GE I RGE AND SON INC
Applicant Address Phone: Insurance:
64 HAYWOOD ST (413)774-3604 4220066477
GREENFIELD, MA 01301
ISSUED ON: 06/06/2023
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATH ERIZATI 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 NO' THAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
,S Q ,I .
l
.
I • 1 . �Q • ' I
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commiss oner
4)11-7 ►q 56
The Commonwealth of Massachusetts FOR
Board of BuildingRegulations and Standards
{;il MUNICIPALITY
00 C,. „1, Massachusetts State Building Code, 780 CMR USE
--ice C _i
y c Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
v r M I One-or Two-Family Dwelling
Z D This Sectio For Official Use Only
I 7
o m 14-#1g Permit Number: / 0-,A .' -J 3 9 Date Applied:
z �.%' K era,-.N /Kp55 / ... ( 4- t-zoz3
a' Signature, Date
Build' g Official(Pont(Print Name) gn ,
t
l------- SECTION 1:SITE INFORMATION
1.1l
�l��opyye AcJ�r�ss:��y( 140 ��D� j 1.2 Assessors Map&Parcel Numbers
viq
1.1 a Is this an accepted street?yes - no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
$
aYOk SECTION 2: PROPERTYl/ OWNERSHIP'
z. r�S(64,1 fy� ion Ai
Name(Print) City,State,ZTP
m R-Liah / c-1 41757737
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other $ Specify: /h Sk 1a-41)r)Brief Description of Proposed Work'-: Add . /S Kid Ji ,, Q d A] Cell/A / 4 /j ,i"
Air- se4/ /,f7j1"C cf. &'.siete li t l J'YDp. V n , tott,iThers/b-1 2 iz,ktC riov-
atIors
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ Q I. Building Permit Fee:$ Indicate how fee is determined:
�� 0 Standard City/Town Application Fee
2.Electrical $ 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $ All Fe
es:$
Suppression) Total0 /srl, Check No. heck Amount: wCash Amount:
6.Total Project Cost: $ �X/�-' �a�
Z - 0Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
(,e,f MI 099 57? —%1-aS
'(Se#1 1 l_ License Number Expiration Date
Name of CSL Holder ` J ��
434
1 t u)OOd l �� List CSL Type(see below)
No.and Street rnJ`• MkType Description
rCee-n e1 a `301 U Unrestricted(Buildings up to 35,000 cu.ft.)
V ` , .7V J R Restricted 1&2 Family Dwelling
City/Town, • ate. IP M Masonry
,:4 1 RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
6410) 5311616 y1 Ads k•calm I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) S•• _�u� .(
. ( €.o( Son / 6 a�6 _[Expiration Date
HIC Company e or HIC Re i tran ame
No.,and Street /1 C� ,�/1 C4I3) rs� t o 7 6 Email address
City/Town, State,ZIP ,-1 W--Ill,, Telephone
SECTION 6:WO RS'CO ENSATION 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 3ase..O1n � e
to act on my behalf,in all matters elative to work authorizedo by this building permit applica ton.
Sharoh SiVl /co&kvccw1ee S i
ature /7
Print Owner's Name(Electronic i
€ ) Date
SECTION 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 information
contained in this application is true an .`curate to the st o 4; y knowledge and understanding.
S'QV_I 0 IN () e0)5e. , _.4 ‘ 4 • ' F .. .
# 5/a 7/2
Print Owner's l r Authorized Age(yi's ame 1•ctronic ignat re) 1 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"
r,,, The Commonwealth of Massachusetts
Department of Industrial Accidents
•` --; Office of Investigations
: S W. t Lafayette City Center
2 Avenue de Lafayette,Boston,MA 02111-1750
. www.m ass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): .,___) �e Cad[?cry, / S on vy s l—'
Address: 6:' HU..yLti0Oct S4
l At O1 Phone#: -
City/State/Zi :� �P_I'1 i�°. � � :�, "� � y13 T��`� �_ ny_
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with q 4• ❑ I am a genera)contractor and I 6. []New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity. employees and have workers'
insurance.: 9. El Building addition
co
[No workers'comp.insurance comp. 10.0Electrical repairs or additions
required.] 5. [] We are a corporation and its
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Numbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]f c. 152,§1(4),and we have no
employees.[No workers' 13.22 Other i r tf IC:1 iOf
comp.insurance required.]
*Any applicant that checks box N I must also fill out the section below showing their workers'compensation policy information.
i 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. If the sub-contractors have employees,they must provide their workers'comp.policy number.
r
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Aro°e,t i Cti
�t �/ -T ^
Policy#or Self-ins.Lie.#: a )Op / '7 Expiration Date: /j,
Job Site Address: qi0kkh k-,1 City/State/Zip OI Ji(, Y1 .414 o I clog-
Attach a copy of the wor/ers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify unde to airs and penalties of perjury that the information provided above is true and correct.
Signature: .9 6 '\ ' Date: -�/a7%d
I h
Phone#: tT 13-77• - 3 I l
4-1
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(check one):
1DBoard of Health 20 Building Department 30City/Town Clerk 4.DElectrkxl Inspector 5EIumbing
Inspector 6.DOther
Contact Person: Phone#: I
*
" S 1
COMMONWEALTH OF MASSACHUSETTS
DEBRIS DISPOSAL AFFIDAVIT
Town ofAr % lOn, Massachusetts
IN ACCORDANCE WITH THE PROVISIONS OF MGL Chapter 40, Section 54,
A CONDITION OF BUILDING PERMIT NUMBER
IS THAT THE DEBRIS RESULTING FROM THIS WORK SHALL BE DISPOSED OF
IN A PROPERLY LICENSED SOLID WASTE DISPOSAL FACILITY AS DEFINED
BY MGL Chapter 111, Section 150A.
6iii-1,14,Saluatle Y5k'Jk, SJ &tftQbOco IT
DISPOSAL/DUMPSTER FIRM
N/ Ctil kJ i 646 IUD` 141
a kn 0-
1
CONSTRU TION SITE ADDRESS
ot'614 I's.
SI NATURE OF PERMIT APPLICANT
5127/,23
DATE
Commonwealth of Massachusetts
Construction Supervisor Specialty Division of Occupational Licensure
Restricted to: Board of Building Regulations and Standards
Constructs . &---.4�• ' Spec;:. _
CSSL-IC-Insulation Contractor .,� y
CSSL-WS-Windows and Siding CSSL 099372 Pires:02111/202:
JOSEPH P GORGE p
64 HAYWOOU STREET
GREENFIELl j47A 01304 '
45
t.
Failure to possess a current edition of the Massachusetts �/
State Building Code is cause for revocation of this license. Commissioner h�. Ei�imcla-
For information about this license
Call(617)727-3200 or visit www.mass.gov/dp!
Registration valid for individual use only - .�....._ .�._ ram
before the expiration date. If found return to: tHc��dl��fPROV'EMEN&f eS6s TTORion
Office of Consumer Affairs and Business Re HOME IMPROVEMENT CONTRACTOR
1000 Washington Street -Suite 710 gulation TYPE:Corporation
Registration Expiration
Boston,MA 02118
156686 . 07/24/2023
6 ' W--?0,41_, ,
Not valid ithotit sig tune ' ` JOSEPH GEORGE
64 HAYWOOD ST f�,7feft.�% (�,e '
GREENFIELD,MA 01301 Undersecretary
Permit Authorization
mass save Form
Site ID: 4707676 Customer: SHARON SLOAN
Sharon Sloan
I, ,owner of the property located at
(Owner's Name,printed)
918 Ryan Rd 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: Skarou arm
Date: 05/ 17/2023
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
9/9 / a c&04-14Ca 5A7/9 3
Parti mating Contractor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
Page 1 of 1 For Cffice Use Orb/
Document Ref:VSDAD-DNBZ8-UF2S-WXMUM
Page 9 of 19
City of Northampton
10 '- " 5� 'cr
' '' Massachusetts El, 4 t*.
\ t.�. J + ;1 DEPARTMENT OF BUILDING INSPECTIONS 9 s�
y�' y�i+,w-, r' 212 Main Street faMunicipal Building ,�,- O,�
\ Northampton, MA 01060 V 3''311
Property Address: CH U 1N' 0314 U
Contractor 'j', G-
Address: �1(3,t( kl9CatH9S.\-1
City, State: cAc - (1/4i\INO \3 0
Phone: (40 77 it %6 4
Property Owner S A a�rO' nS{ OkSA
( Vl v\ 1
Address: 1,1? .Q\ 26 '
City, State: lq)(e-A/Ve i tl\f' O i O6D-
1, �Qs rAL -€01 ccy (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 \V N\c.,, , (..,k,26_,_v___T4 ,
\ _27_,
Date -5--` 1 a-3