36-169 (9) BP-2023-1456
747 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
36-169-001 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-2023-1456 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
Est. Cost: 5000 J P GEORGE AND SON INC 099372
Const.Class: Exp.Date:02/11/2025
Use Group: Owner: SAUTHI PEPIN DANIEL &
Lot Size (sq.ft.)
Zoning: SR/WSP Applicant: .J P GEORGE AND SON INC
Applicant Address Phone: Insurance:
64 HAYWOOD ST (413)774-3604 4220066477
GREENFIELD, MA 01301
ISSUED ON:10/18/2023
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 VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
• A - CP1 •
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
, LT I9i, : COVED
The Commonwealth of Massac :etts F t R
Board of Building Regulations and S : ,: ,: 7 7023 PALITY
\ A, Massachusetts State Building Code,7:O C R 'C1 U E
Building Permit Application To Construct,Repair, ' ,o - , 0 e.-,+" ' ' i • yced •ar 2011
DEPT.OF C�UILDINfi fNSPEGTt• S
One-or Two Family Dwelli � gMpTON.MA 010eo
I . This Section For(dial U i ft '
P Mimbet: ..c'�'• ?I' •/ci i r Date.APPlied: - '
. •/(kvii,..) ii?0,3• '.- /17 .
Official=(PrintI le) ! Signature Date. ..
faCTION is SITE INFORMATION
1.1 Property Address: t �/� 1.2 Assessors Map&Parcel Numbers
74" Nlnrt., 12(1 ✓k r[4,0,r i-Nv H y
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(it)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required T Provided Requited Provided
1.6 Water Supply:(MAL c.40,$54) 1.7 flood Zone Information: 1.8 Sewage Disposal System:
Public D Private❑ Zone: ,,,_„, Outside Flood Zone? Municipal❑ On site disposal system 0
Cheek ifyesi3
..SECTION 2: PROPTY OWNERSHIP' '
2.1 Owne Record: 1
Panie.1 rPoIn NoilivonrlOr, M' jdlo�
aine(Print), 1 City,State,ZIP
No.and Street" Telephone �i Email Adlffei
swat*3:DESCRIPTION OP PROPOSED.WORK;(check all that apply) ' • • .
New Construction D Existing Building U Owner-Occupied Cl Repairs(s) D Alterations) ❑ Addition Cl
Demolition ❑ Accessory Bldg.Cl Number of Units Other ® Specify: /'AI'(t/c),a n
Brief rip on of Pmpofed Workt: ,�ji r- ./l h ri;c 6y C'If4 4.29"' c46.b b�
('s,//APa ¢f'r'(- Pia
. SECTION 4e ESTIMATED CONSTRUCTION C
Item Estimated Costs: tidal Vie.Only
(Labor and Materials) , .
1.Building $ 5 o o o J. Building Pezinit Feee:.S • ,'Indicate haw lbo is detain**
2.Electricalr LU Sta tid:id City/Towr:Applicatit+n Fee-
r•U Total Pzgiec ;C Mani 6)trim/tiger x
3.Plumbing $ '2. Other.Fees: $
4.Mechanical (IIV•AC) $ Lire
5.Mechanical (Fire $ ,
Suppression) Total Alae .�,S. :
' Check Na �y�,,,,_Check Amount:id 1 h Amo.
6.Total Project Cost: $ 5 00 O ,.CI Paid in 1u aOutstanding l glance D __
_,, ;
SECTION 5: CONSTRUCTION SERVICES �f i
5.1 Construction Supervisor License(CSL) f�'�'` d�9 57 v'<<�a'S
—3-4Seih (yet,(Q� License Number Expiration Date
Name of CSL Holder J WS���
Ve j 4ONPO°1d �k List CSL Type(see below)
No.and Street 1 O
Type Description
Cyce .n€e d M 610tU Unrestricted(Buildings up to 35,000 cu.ft.)
/ ` 1 R Restricted 1&2 Family Dwelling
City/Town,S te,Z e M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
60 531lb% inAes N t' I Insulation
Telephone �— Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ls�b�6 -Nits�5
' "' o c* �h IZ- -• HIC Registration Number Expiration Date
HIC Cotl►pany a or HIl.
S atraril e
b�( . pip •_
No. d Street /f CM` , Pp,
�a(�t) S31 107 6 �`Q—� Email address
City/Town,State,ZIP f ' �. Telephone
SECTION 6:WO' RS'C MPENSATION 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 : O.Se I Geoff_
to act on my behalf,in all afters relative to.work author' ed by this buil�`mg permit applicn.
jh S��lJ\ ii��bona ap/(023
Print Owner's Nai fe(Elec nic Signature) / Date
SECTION 7b: OWNERt 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 tru .,t ac :t;to t of my knowledge and understanding.
asepA (Fear i 7•K /4//3/93
Print Owners or Authorized en s Nam• lectronic Si atu ) '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"
The Commonwealth of Massachusetts
Department of Industrial Accidents
1= �� Office of Investigations
=is
Lafayette City Center
C
11Lafayette,2 Avenue de Boston,MA 02111-1750
'_"`� ,Qr
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):JP George & Son Inc
Address:64 Haywood St
City/State/Zip:Greenfeld, MA 01301 Phone#:423-774-3604
Are you an employer? Check the appropriate box: Type of project(required):
I.0 I am a employer with 5 4. 0 I am a general contractor and 1 6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
listed on the attached sheet. 7. 0 Remodeling
2.❑ i am a sole proprietor or partner-
ship ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9 ❑ Building addition
[No workers' comp. insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.]t c. 152, §1(4),and we have no INSULATION
employees. [No workers' 13.11 Other
comp. insurance required.]
*My applicant that checks box#1 must also fill out the section below showing their workers'compensation 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.
tContractors 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 an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:Arbella _
Policy#or Self-ins. Lic. #:4220066477 Expiration Date:8-1-2025
Job Site Address: 77 7 / !Oren Ce /(0` City/State/ZipArikiny)4t, 11 A --
Attach a copy of the workers' 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 under t ai and penalties of perjuty that the information provided above is true and correct.
Signature: Date: /4 //3/>-3
Phone#; 413-774-3604
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):
10Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 5ralumbing
Inspector 6.QOther
Contact Person: Phone#:
cit-
*,.:n
s.
COMMONWEALTH OF MASSACHUSETTS
DEBRIS DISPOSAL AFFIDAVIT
Town of`torflramdd0 , 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.
Brattleboro Salvage 437 Vernon St. Brattleboro, VT
DISPOSAL/DUMPSTER FIRM
7Y7 i/)1wice /d Mr/ tir‘n '4 4r126)-
CONSTRUCTION SITE ADDRESS
0 r
y)Trt'
S NATUR F PERMIT APPLICANT
fi//3 /3
DATE
411/1011/11i- Permit Authorization
mass save Form
Site ID: 4888825 Customer: DANIEL R PEPIN
Daniel Pepin , owner of the property located at:
(Owner's Name,printed)
747 FLORENCE 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.
Daniel, Pew
Owner's Signature:
Date: 09 / 29 ...
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
- f
or o. VI �-N<< lv// %3
Particting Contractor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
Page 1 of 1 For Office Use Only
Document Ref:2FPPK-15VT3-QWTZB-4MMCD Page 1 of 1
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THE COMMONWEALTH OF MASSACHUSETTS ° u u
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Office of Consumer Affairs and Business Regulation
1000 Washington>Street- Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration ,
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�" •. Registration: 156686 I `� i
JP GEORGE&SON iNC E 1.: � r oi
Ex ration: 07/24/202564 HAYWOOD ST ,.. , 'k ''� '°� Pi
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GREENFIELD,MA 01301 '1', `G .; 4R .�. 1
Update Address and Return Card. `
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THE COMMONWEALTH OF MASSACHUSETTS I§ ��m `'
1
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the o '
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HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: �s c� ors i
TYPE:'Corporation Office of Consumer Affairs and Business Regulation Lo 4n c m
Registration Expiration 1000 Washington Street -Suite 710 It
156688 - 07/24/2025 Boston,MA 02118 goo CC Lt.H !
JP GEORGE&SON INC
•
JOSEPH P.GEORGE I ` `•.I I\,\
64 HAYWOOD ST /i3O,x,{� �ai..":
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toce-V'�•
GREENFIELD,MA 01301
Undersecretary Not val w t signature