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11A-052 (2) BP-2024-0423 11 VILLONE DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 11A-052-001 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-2024-0423 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 9200 J P GEORGE AND SON INC 099372 Const.Class: Exp.Date: 02/11/2025 Use Group: Owner: PEEREBOOM WAYNE H Lot Size (sq.ft.) Zoning: URA Applicant: J P GEORGE AND SON INC Applicant Address Phone: Insurance: 64 HAYWOOD ST (413)774-3604 4220066477 GREENFIELD, MA 01301 ISSUED ON: 04/10/2024 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 NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 172- Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner / i ri-Jk6-4,-— .' ', "�.�u,L719yq ape i. The Commonwealth of Massachusetts 9 ,L02 'FOR id Board of Building Regulations and Standards- o MUNICIPALITY V..)' Massachusetts State Building Code,780 Che USE Building Permit Application To Construct,Repair,Renovate Or Teti a Revised Mar 2011 One-or Two Family Dwelling :��` s • This Section For Official Use Only -Building, rennitl+iun ir. . $17 '`�-e Y-- ,e.. f Date.Appiled: . ,. . Kcv ir-)/ )>5. if.Z. y-111;ZoZ Building Official(Print Name) ' . - Signature Data • . %" SE ON I:.SITE INFORMATION ' 1.1 Property Address:, A m 1.2 Assessors Map&Parcel Numbers // l///tins it 4. s ✓i�'/" 1.1a Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions; Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Requited Provided 1.6 Water Supplyt(MAL c.40,i54) 1.7 Flood Zone Information: " 1.8 Sewage Disposal System: Public CI Private D Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yeti:! . ,.SECTION 2: TY OWNS' . ZOwner'44 Record: �i¢ ru Pere x36ri tz-e/_S /0X 0 10 S3 . ame print) n City,State.ZIP // /i//� /) y,33 0 �/ 4/ rt//////A‘,/CAM No.and Street Telephone \ Email Address SECTION:3.DESCt TION OF PROPOSED WORICI(check ail that apply). - _ ` . • . y New Construction Cl Existing Building© Owner-Occupied CI Repairs(s) Cl Alteration(s) ❑ , Addition 0 Demolition CI Accessory Bldg.Ci Number of Unite Other lit Specify: ,n s 4/a T I0✓' Brief Descjption of Proposed\yorI 2 4,'r -teali' A -' al m n • ," . SECTION*ESTIMATEDCONSTRUCTION COSTS • • ' Estimated Costs: Item Metal$lee: - .. (Labor and Materials) , . . . . . " 1.Building $ 9/ 2 0 0 1:.Building"Permit Few$ . .. 'Indicate bow tee is 2.Electrical $ Ci Standard.Cityflown Application Pee• . 4114041 Project.tosts(Dam 6)r multiplier' ; x 3.Plumbing $ 2. Other.Fees• $ ; . • • 4.Mechanical (11VAC) $ Listr 5.Mechanical (Fire $ Total Alf Fees:Suppression) 004 . 6.Total Project Cost $ Check No.1)0'theck Amount: Cash Amotmt: ; ;' S !i a 0 0 CI Paid in Full Q Outstanding Babinec Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Cf 1 09q 3 7+1 GI..`t. 6" 54Se�4 Vet,f%e_._ License Number �` Expiration Date Name of CSL Holder ��► Vt u� (� O ! Ifr k. List CSL Type(see below) No.and Street Type Description /� ce t v €1�I U Unrestricted(Buildings up to 35.000 cu.ft.) LJ ��d! R Restricted 1&2 Family Dwelling City/Town,Sta ZIP M Masonry kl, j4411 ' RC Roofing Covering WS Window and Siding 41!.14) ` v SF Solid Fuel Burning Appliances 53I 1a16 : I -Insulation elephone Email address D Demolition 5.2 Registered Home Improvement Contractor(MC) //!!,,,, /S64 S6 J �• Ge0 for A.-Son t HIC Registration Number Expiration Date HIC Co any me or HIC Rc i tralthamtemrE No, nd Street Email address 'Ce�.vttitd f ' . 3• yt S I076 City/Town, State,ZIP • '• ►, 3t ( Telephone SECTION 6:WO'•.4 RS'CO NSATION 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 A No Cl SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES F`,4 OR, / BUILDING PERMIT I.as Owner of the subject property,hereby authorize "a 9 r L er,' to act on my behalf,in all matters relative to work authorized by this b it mg permit applica ton. G�Javnp a°.� da� S ��� / 1 Print Owtier s Name(Electronic St Lure) 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 and a curate to the b st of y knowledge and understanding. PrintJ/), k1/1/1 (Oft)rz. e , - . , ' Vs.d/ - Owm rs or Authorized A eg is N e(E 4 tronic, gna e) 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" ..�...�.""` De ailment of Industrii Ateidayi 1:14' Wee of Investigations '--� 6 Lafayette e City Center' 2 4ue e de.afar Boston,MA 0211M 75e wwwcanasagou/dia Workers'CottaipeRisatiOn Insurance. idavilt:BulldernICo iroeto o/1leet ddih.s/Pl mbers Amite S t Inform a-ton Mew Print Leaikiv Name(Business/Organization/Individual):JP George& Son Inc Address:64 Haywood St City/State/Zip:Greenfield, MA 01301 Phone#:423 774.3604 n p Are you an employer? Cheek the appropriate box: Type of project(required): 1.n I am a employer with 5 4. 0 I am a general contractor and I employees(full and/or part-titre)! have hired the sub-contractors 6. New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. Reluodelifig 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.insu ance.t required.] 5. Q 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.O Plumbing repairs or additions myself. No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.)t 0. 152,§1(4),and we have n0 INSULATION employees. [No workers' l3. Other comp.insurance required.] t'Any applicant that checks box#1 crust also fill out the section below showing their workers'compensation policy information. P Homeowners who submit this affidavit indicatingthey are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContrcotors 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 waiters'comp.policy number. .. I ma an employer that is providing workers'compensation insurance for ray employees. elow is the policy and job site information. Insurance Company Name:Arbolie Policy#or Self ins. Lie.#:4220086477 Expiration Date:8-1-2025 Job Site Address: J/ ,J/dii,c City/State/Zip: l P 41 ) 610 S 3 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 'Failure to sect a coverage as required under Section 25A of MGL e. 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 tine 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 a and penalties of perjury that the Information provided above Is true and correct. • 1 ' ae: to a;: Phone#: 413-774-3604 Official use only. Do not write in this area,to be completed by city or town official cial City or Town: Permit/License# Issuing Authority(chec one): lDBoard of Health 2il Bulldiing Department 3 f clty/Town Clerk 4.0 Electrical Inspector 5 'twanhing Inspector 6.DOther Contact Person: Phone it: f r • Q EDHICCMWE LTH Ott" HASS il4+il7l ll.Unvl,Cc IIT0' DEBRIS DRSPOSAL AFFRIDAVET Tovnt of s 9 Niasszchusetts 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 05SP SAL/DUMi/; TER FIRM CO STRUCT%SITE ADDRESS ),),,,y, ��6�,,1TURE OF WIMAI 'APPLiCANT 3f30 f� DATE 404k mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM I, Wayne Peereboom owner of the property located at: (Owner's Name) 11 Villone Drive Leeds (Property Street Address) (City) hereby authorize the Mass Save® Home Energy Services Program assigned Participating Contractor to act on my behalf and obtain a building permit to perform insulation and/or weatherization 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. OMslSi ideff rear"14 02-29-2024 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Jo1i1J_J4 , 3/51r. Participating Co. ractor Date Document Ref:U7FAT-PGGNT-UEDX5-ZWJBD Page 1 of 5 g.4- uw c- .. P , . iwc . _. .•.p.„;.%,, -... - ,. -,_ la •',:. go.'...15..;'',,,-.-_ ' t 8 B I.:. livlbro,No , §. i t,;c1' - 4')0,,, .. tu4 t3 i,?' - .-. n 5i ob :4- 6 E 41-1-3 • t-'f? ,,, , 011„3 . w 0 cn ,,i == ;'•3. 4.1igag c Poa•rs 0 1... .0. .. 1 1. . . . . - to ,git, 0 cr ct5 THE COMMONWEALTH OF MASSACHUSETTS top Office of Consumer Affairt and Business Regulation ‘ , 1 1000 WashingtOnareet-Suite 710 BostoryAlassachusetts'..02118 Home Improvemept.Confraciorfiegistration , 1, .1;',":7-..?'''''-‘...”:";,..-...;:::::_s!„,,,,-74--•, .. Ic.r.e.n-,..7-1--, 51,:z ,-zzz......F.;:i1J.I.it - tt,%1,,"-t-:•':' Si ,,...---,...4. ,. ,., :..vt•-•1,4 ,; .:, . ,. Type: Corporation i::,:f 'ij... .: =.1:?,,i5:71- t.4.5.:,:f1,,,ttegi8ttation: 156686 I •3 °B. - .. JP GEORGE&SON INC 12.-,'„; -.;,ti,..,7;:t4-.:-:....":',7•:':`,-;,:i Expiration: 07/24/2025 64 HAYWOOD ST 't,!. GREENFIELD,MA 01301 ...:„:.,::,i,:t.„,, t-, .,... ,0 ,...,==„ , ,.., i.:, e.o•-:,=-., 4- -'-', 14 -'1.-:: . :• 4------- - '''V '`,;-;71-,::;,..-r.n.•:.,4:-:,•-...-:,',1' .: 0%.A C1=1.?.•'•,:3T"1'...1.1"..-H:.:1'.4 ":: 14.4.1 Iii 1 I in4-I l'; ric-‘ CI 5 P 0 t 1:1 to i E.io 1 f § t ;: • Update Address and Return Card. 'E 10 41 44:423 I ' V:, 0 10 M 4,4 ra cal C.I to S eq 1 5 1 . .3. .01, qteop. I ! -73 = .R = c , t , . ... _.. . 1 C THE COMMONWEALTH OF MASSACHUSETTs . ad fn Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the a -:... • co .1 c cc - ...... 1 . it HOME IMPROVEMENT,CONTRACTOR expiration date. If found return to: ti t,.1 3 TYPE:CoMoratIon Office of Consumer Affairs and Business Regulation i.3 3 a)ca co •i 4 Registration Expiration 1000 Washington Street -Suite 710 fil t.3 0 1 f 1.50388-: ., .,07.4141425 Boston,MA 02118 re it.it; i i GEORGE&SON INC ' . ''''i•t--.1-:'•-:17-.14;:';:.j...;-,.,- --. , -- \, ' 1 1CAtCP ;EPH P.GEORGE ,..", '.:E. •-'-- /2 lit% • . , IAYWDOO ST : sbox6/4./Ce4" , , ii, . EENFIELD,MA 01301 - undersecretary Not valit uvittout s g•Pvature