07-054 (5) BP-2023-1784
430 NORTH FARMS RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
07-054-001 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-2023-1784 PERMISSION IS HEREBY GRANTED TO:
Project# insulation 2023 Contractor: License:
Est.Cost: 3889 J P GEORGE AND SON INC 099372
Const.Class: Exp.Date:02/11/2025
Use Group: Owner: VOLLINGER GRACE F
Lot Size(sq.ft.)
Zoning: WSP Applicant: J P GEORGE AND SON INC
Applicant Address Phone: Insurance:
64 HAYWOOD ST (413)774-3604 4220066477
GREENFIELD,MA 01301
ISSUED ON: 12/26/2023
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: Ilouse# Foundation:
Final: Final: Final: Rough Frame:
Gas: Fire Department Drip ew 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
tIA s -
W:./65,11
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts FOR
F-'ci F; Board of Building Regulations and Standards
o o •t Massachusetts State Building Code, 780 CMR MUNICIPALITY
IY USE
LYTY
DGI Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
�, One-or Two-Family Dwelling
�: This Section For Official Use Only
.�-12
o °ag P rut Number:. .,,n,t 3-/7f 41 (Date Appli d:
a ti �
i ?t3WCN‘kti1/4k, ' � ` ter 1.24%42.3Oo, Building Official(Print.Neme) Signature
--- ,a SECTION 1:SITE INFORMATION ,
1.1 Pro a dd1ss: 1.2 Assessors Map&Parcel Numbers
ti:3t . t 3
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 0 Zone: Outside Flood Zone?
— Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 ( �G< 1Vl�ei I, OA A Oft.). .)-
Name(Print) ` r e,Th City,State,ZIP
Lt3o !�i , -CW1S k<d (413 S/i
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building, Owner-Occupied Y Repairs(s) ❑ AIteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units 1 , Other 0 Specify:
Brief Description of Proposed orle: _
iiiD 'M\C 14Jg1)L-YID q" c idLV(, 'Pt
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only .
(Labor and Materials)
1.Building $ 1. Building Permit Fee:$ - Indicate hew fee is determined:
2.Electrical $ 0Standard City/Town Application Fee
t -.0 Total Project Costs(Item 6)x multiplier ; • x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
11
Suppression) $ Total Alt Fees: , g
C C Check No. I`d Check Amount: Cash Amount:
6.Total Project Cost $ y , .-� 0 Paid•in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES 4
5.1 Construction Supervisor License(CSL) tin699 579. a''1-a'S
(} � &€€ ` _ License Number Expiration Date
Name of CSL HoldersJ
/�_4 614*.y3eXA
� �k. List CSL Type(see below) WS!�No.and Stree1tt ^ Type Description
C1ee, .n' e.�d U Unrestricted(Buildings up to 35,000 Cu.ft.)
`R'' �i7d R Restricted 1&2 Family Dwelling
City/Town, e,1;20 M Masonry
cid
�� ' RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
(uA) 531 1017 41tiviteheow.Astivta-ovA410K.•awl I Insulation
Telephone Email address D Demolition
5.2 Registered Home. p Improvementt Contractor(HIC) /S•�/ �� wit..?.5UT. G .O( '_J n j L HIC Registraattiion Number Expiration Date
HIC Company e or HIC Regi tranlame
vof
No. nd Street t ,'v J Email address
ee..�e�te.1d, e t 1 c4t 5'3110 7 6
City/Town, State,ZIP d( ? - . Telephone
SECTION 6:WORS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c. 152. 25C(6))
LE
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 A No .0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR FOR BUILDING PERMIT
I.as Owner of the subject property.hereby authorize o -91 1 O
to act on my behalf,in all matters xti%leto
work authorized by this buil tug permit applica ton.
Sele_ o\k\-.-0.&.e
Print Owner's Name(Electronic Signature) 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
containe—d— c
inn thiss applic andation is true dd acccura to a best of y wledge and understanding.
— - , ..rpt,6
Print Owner's or Authorized Agent's Name(El ctron c 'gnature) 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
94.•,
---. Office of Investigations
Lafayette City Center
p2 Avenue de Lafayette, Boston,MA 02111-1750
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 g
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. 0 Demolition
working for me in any capacity. employees and have workers' 9 Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5• 0 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 INSULATION
employees. [No workers' l 3.0 Other
comp. insurance required.]
,......--
*Any 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: 3bMWI\ - C\ • City/State/Zip: iOc k _ ' `
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.f 1�' r�3
Signature: y Date: /b
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 51:3P'lumbing
Inspector 6.0Other
Contact Person: Phone#:
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THE COMMONWEALTH OF MASSACHUSETTS
o
Office of Consumer Affairs and Business Regulation , I®
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor� nn Registration
,-t tkril `„„ 46'4"A Type: Corporation s
JP GEORGE&SON INC Registration: 156686 s
Expiration: 07/24/2025
64 HAYWOOD ST F� c
GREENFIELD, MA 01301 ` *. 4. c in '
.. �' o c o to
'D s. 41 t0 ,
�,.„,.., Update Address and Return Card. V c2 o
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G 6 UfT4°N i
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THE COMMONWEALTH OF MASSACHUSETTS V w§ y O o
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Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the p
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: a.C> p,
TYPE:Corporation Office of Consumer Affairs and Business Regulation $;r v tj
Registration Expiration 1000 Washington Street -Suite 710 ▪N N o
156686:-.". 07/24/2025 Boston,MA 02118 m V V 'R 0
y
JP GEORGE&SON INC .,
JOSEPH P.GEORGE \11\ c
�pA
64 HAYWOOD ST ilp �`
GREENFIELD,MA 01301 •,, ... '„
Undersecretary Not vali with ut signature
401 Permit Authorization
mass save Form
Site ID: 4948923 Customer: JOSHUA CARON
Joshua caron , owner of the property located at:
(Owner's Name,printed)
22 BACON ST WESTMINSTER, MA 01473
(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: JOVHA4 COON
Date: 12 / 01 / 2023
ikests ►+ + megoommos4► ►oe ►si+ a ik.•w+r•••.•r+assmsmmoseom•••••••••
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
rTh
Participating Contractor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
Page 1 of 1 For Offi:e Use Cr ly
Document Ref:XFE8Y-OAOE9-UVQTZ-6OPUV Page 9 of 21
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1. .
i
COMMONWEALTH OF MASSACHUSETTS
DEBRIS DISPOSAL AFFIDAVIT
Town of , 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
Ufa , 1\--000WtS .
CONST CT ON SIT A RESS
) NiuM2-1vi .
SIGNATUR OF PERMIT APPLICANT
/: g3
DATE