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15-014 (3) BP-2023-1415 356 CHESTERFIELD RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 15-014-001 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-2023-1415 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 3900 JOSEPH GEORGE 099372 Const.Class: Exp.Date:02/I11/2025 Use Group: Owner: ELLIOT EZCURRA Lot Size (sq.ft.) Zoning: RR Applicant: J P GEORGE AND SON INC Applicant Address Phone: Insurance: 64 HAYWOOD ST (413)774-3604 GREENFIELD, MA 01301 ISSUED ON: 10/12/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERI ZATION 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: 3-11 . 0 • , • y9 • Fees Paid: $65.00 212 Main Street,Phone(413)587-12,40,Fax: (413)587-1272 Office of the Building Commissioner aillt_i- 1968 Ili x, The Commonwealth of Massachusetts FOR t'.i Itt ; Board of Building Regulations and Standardsrn MUNICIPALITY ,780 CMR USE cn 3-11° l - Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 o One-or Two-Family Dwelling o z — This Section For Official Use Only • q n o cMemba_r M I'1 i'IJ- . }Date.Apphcd: ` . • •,, re . o� l��i 5� � ' ' :It) /2'7OZ3 z - ,C oat Pnut•Name) • •Signature - • 1)at45 En - " ., SECTION 1:SITE 1143ORMATION 1.1 Property`Address: I 1.2 Assessors Map&Parcel Numbers ,�tt,r if.� J i d - 1.1 a Is this an ac - -d attract?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions; Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided i 1.6 Water Supply:(M.Q.L c.40.i54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public O Private© Zone: — Outside Flood Zane? Municipal D On site disposal system 0 Check ifyest i - • ,, .SECTION 2; OPERTf•OWNlimp1. . , •- ' 24 Pvaarl oCRecord: / t. i s f &1 c c1 raa �(.�irf 1 hjz1 44 ())4.c 2 Name! *r/?e/1 t) City,State.Z1P ` , ( 2.� eArzs.a rYGc e�Jpla)1, C d'1 No.and :rest Telephone Email Adds • - .- . SECTION 3:DESCRIPTION UF'PROBED WOW.(cbeck all that apply) • New Construction Cl Existing Building Owner-Occupied$ Repairs(s) 0_ Alterations) Cl Addition Cl Demolition 0 Accessory Bldg.CI Number of Units 4 Other la Specify: lo,S Gt G 1 ;,7t7 Brief Description?FProposfd W r r i O , • , , rre�/C,e t&� � ' cz ,•C • L,Jp�: c•s v I f' a f c G)'r�Q P'S . SEA TION,4'ESTIMATED aCONi m ix-n*0N COSTS. - Item Estimated Costs: :Tsie;t3itiiy (Labor and Materials) , " • • 1.Building $ , ti () I' TA-#1 ing Pere nit Fee::$ .'Indicate hero il;e is d Z.Electrical e CI Standard City/roamApplication Pee •Dl Total Pr ieot:Cosls{I+aomr 6)ii n uttipiler x 3.Plumbing $ 2. Ot "Fe ca: $ __; _ - - 4.Mechanical (HVAC) $ 5.Mechanical (Fire Suppression) $ •Total Ali Feu$.".•� ,, • 6.Total Project Cost $ < ~ Check No.j',?-'1) hek Amount*I J 7• Cash rem mt: - • 3)Id 0 :0 Paid in Full Cl Outstanding Balance Duet ,,,. . i. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor&e,License(CSL) `�,c�d ei r37+. 01-% $ .tO5eiki1 f License Number Q� -Expiration Date Name of CSL Holder 64 wood gf List CSL Type(see below) WS No.and Street Type Description U Unrestricted(Buildings up to 35,000 Cu.ft.) �� d R Restricted 1&2 Family Dwelling City/Town, te, IP \ M Masonry 3K. RC Roofing Covering WS Window and Siding (� SF Solid Fuel Burning Appliances i Ila r al1AQ00401.••tlli I Insulation Telephone Email address _ D Demolition 5.2 Registered Home Improvement Contractor(HIC) c LQ` 04 5 • Geocog. ..Soh imix. HIC Registration Number Expiration Date HIC Co any me or HIC Rd i tran a n No.6c.10S2trjhreet f{e c v A 0 , ( S"31 t 0 7 6 Email address City/Town,State.ZIP Z114. Telephone SECTION 6:WO RS' OENSATION INSURANCE AkEIDAVIT(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 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 5(Spll 1 Ge to act on my behalf,in all mattee. rs r ative to work authorized by this buil mg permit applica ton. F.//d TZcar�� A /0/5/�2 Print Owner's Name(Electronic Si ature) 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 c te to bemy knowledge and understanding. 13 P,04 ��r�� 7t/5/;t ized A etit's ame ft )qMsL41. Date Prntt Ot�nets or Au hon g (E 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 ford 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 9—_-1„,-. 1-----it.ivr Office of Investigations Lafayette City Center - 2 Avenue de Lafayette, Boston, MA 02111-175D t 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:Greenfield, MA 01301 Phone #:423-774-3604 Are you an employer? Check the appropriate box: 4. i am a general contractor and I Type of project(required): 5 1.0 I am a employer with 0 employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 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 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp. insurance.: 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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.111 other INSULATION employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 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. 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: j'5C asZiAti A City/State/Zip4)y h4 /4- 4j,16? 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 perjury that the information provided above is true and correct. Signature: I ' OW' Date: /�/5 d3 f�rL l / 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 31:City/Town Clerk 4.0 Electrical Inspector 51:Plumbing Inspector 6.0Other Contact Person: Phone#: i.444,, COMMONWEALTH OF MASSACHUSETTS DEBRIS DISPOSAL AFFIDAVIT Town of/Por /n,OA)I' , 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 3 5Z/ 5/ir4e// ,o/ Ahc/Ac, 471 CONSTRUCTION�� ?? SITE ADDRESS ,y/, ..7 qt, SIGNATURE OF P MIT APPLICANT 7O/5/23 DATE 1 .. I • & t higA t a CA 'Stk., - ,r e 11 tat li G. u p = u. 1 di _ �gn E THE COMMONWEALTH OF MASSACHUSETTS 1 U Office of Consumer Affairs and Business Regulation i 1000 Washington Street- Suite 710 Boston,Massachusetts -#J2118 Horne Improvement Contract. Istration k r Type: Corporation s j JP GEORGE&SON INC 1 ` ti on: 156686 64 HAYWOOD ST t E>t T'ration: 07/24/2025 k° GREENFIELD, MA 01301 :�; ili sin I. i: `'• .'f <, Dal rob C fig • 1! Update Address and Return Card. v al to o THE COMMONWEALTH OF MASSACHUSETTS V = r �I-,3 liSk as Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the .:' n a d HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: i «R. =-� i TYPE Corporation Office of Consumer Affairs and Business RegulationIri.1 v-�-► i a Registration Expiration 1000 Washington Street -Suite 710ii ai m 15608E 07/24/2025 Boston,MA 02118 U v JP GEORGE&SON INC i . . \I\ • JOSEPH P.GEORGE ` \ 64 HAYWOOD STr4! tict-Tt• GREENFIELD,MA 01301 Undersecretary 111 Not veil wit ut signature Permit Authorization mass save Form Site ID: 4840010 Customer: ELLIOT EZCURRA I, Elliot Ezcurra , owner of the property located at: (Owner's Name,printed) 356 Chesterfield Rd Northampton, MA 01053 (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. aiwt/-Eeet rYa Owner's Signature: Date: 08 / 12 / 2023 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: 1-f) ( or�a ,�-. C��% L; P3 Participating Contractor / Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Orly Document Ref:XQ9C7-KQBOR-G6Y40-ECKCN Page 6 of 16