11C-001 (17) 92 FLORENCE ST BP-2018-1203
GIS#: COMMONWEALTH OF MASSACHUSETTS
MV.Block: I IC-001 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Gat g ry INSULATION BUILDING PERMIT
Permit# BP-2018-1203
Proiect 4 JS-2018-002150
Est Cost, $1965.00
Fee, $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: JOSEPH GEORGE 99372
Lot Size(sa.It.): 541886.40 Owner: GABLE VAGI I
Zoning,URAt1001/ Applicant: JOSEPH GEORGE
AT. 92 FLORENCE ST
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774-3604 WC
GREENFIELDMA01301 ISSUED ON:5/16/2018 0:00:00
TO PERFORM THE FOLLOWING WORK:AIR SEAL ATTIC AND BASEMENT. INSULATE
RIM JOIST WITH R-19 FIBERGLASS
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: 001• Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occuoancv Si¢nature:
FeeTvpe: Date Paid: Amount:
Building 5/16/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
r1tUtM—QCilr of Northampton Status of Pemdt;
Bui ling Department Curb CuVDivewsy Permit
MAY 14 M 2Main Street sawarrsapneAvaaabghy_
Room 100 WaterMell AvMlabilRy
orif impton,MA 01060 Twp sets of structural Plana
nrNT
0=nuLLDiNGIW{iJl6� "" 5 -1240 Fax 413587-1272 Plotfslte Plans
NORTHAMPTON, ""--"--
Other Specdy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO,,rr��FAMI(LIY DWELLING
SECTION I-SITE INFORMATION 13 /" a 1cYV /
1.1 Property Address: G'1 r This�section to be completed by office
Si
I Fbrence Lot Unit
LP�tl1j� MO Zona Overlay District _
Ploy i
FJm Sc Diepc[ CB district
SECTION 2.PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
irk! b7P ��' FJlPn0.' ��, �PP.�IL11�
Name(Pont) Current Malin9 Adtlress:
SEP, P'Aii0a1PA mapona (D R 1
Signatu2
2.2 Authorized Apeld:
3DSeo1 (s2oTL�t 0 HGywDa sI, crreeroitett vfq ollol
rvema(Pnnn Currert snare Andress:
Signature -- 13�-71'fi-46G't
Telephrnto
ON3-Its TED ONS CO TS
Item Estimated Cost(Dollars)to be Oftlsial Use Only
etad Poona tram
1. Builtling �� ')� (a)Building Permit Fee
2 Electrical (b)Estimated Total Cost or
Consvucllon tram(6)
3. Ptumtrirg Building Permit Fee
4. Medanical(HVAC) oa
5. Fire PRAOClion
B.
Total=(t +2+3+4+5 4 51
Check Number
This Section For Official Usa Onl
Bulding Pemrct Num Date
Issued:
Signa a:
&ilMps ntlS6ioae/lbiepectg0(auaafngs "
Date
SECTIONS DESCRIPTION OF PROPOSED WORK(check all sial,likablel
New House ❑ Addition ❑ Replacemem Windows Alteration(s) R-fing ❑
Or Doors ❑
Accessory Bldg. ❑ Oemolftion ❑ New Signa 101 Decks [❑ Slding LO1 O@rerj%
Indtnl on
Wier Description of Proposed Air Semi ot( b i. 7flJw I �.h Pi F /
Werk: A hMMPn � ' rIM W� IS�� PJJ
Alteraion of existing bedroom_Yes_No Adding new bedroomYes No
Attached Narrative Renovating unfinished basement _Yes _No
Plans Attached Roll -Sheat
Ba.If New house and or addition to existing housing complete the following:
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
E Method of heating? Fireplacesor Woodstoves Numberof each_
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
In. Type of construction
L Is consWct'ron wIIhin tOo tL of weWmfs?`Yes _No Is construction within 10D yr. lloodplam_Yes_No
iI. Depth of basement or cellar Floor below finished gratle
k. Will building conform to the Building and Zoning regulations? Yes_No.
I. Septic Tank_ City Sewer_ Private well_ City water Supply_
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT k-
I V I GA�� ,as Owner of the subject
property r ,,
hereby authoriza 50 � �7COrt}le
to act on my behalf,in all matters relative o Work authorized by this building Q r p�I fi
Set P&i, .4 J
Signature of Owner Data
305e01� as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and fi�accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
J0sp ' (I
Print Name
05 MAP)
si nmwe of Owrw Date
SECTION 8-CONSTRUCTION SERVICES
81 L'eansed Constmction Suoerv'sor: r� Not Applicabtle}.3
Name of License Holder: 30SP,� �r2Df1031IJ 1�'
i-imuse Number
a a oo ' SVtek 0130) a-1l-aoil
Address Fxpimaun Date
(413)7�'t-36�y
Signature 1,J N I Telephone
S.Reamtmd No,I t Countracte,, Not Applicable ❑
I ?, (Teerbe fW4 SDp, 'LM, 15664
Comparw Namej Registration Number
6V Hu�vvnOd\ Sllft &Tffr(X4, Ma 01301 7-)s -a015
Address `' 77 ?t� Expiration Data
Telephone C '71 1-36oy
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,y 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit Wit result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes.---._ ® No...... ❑
11. - Home Owner Exemption
The current exemption for"horreovners"was extended to include Owner-occuvied Dwelliaas of one(1) or 1vo(2)families
and to allow such homeowner to engage an individual forhire who does not possess a licem,orovidedlhat the owner acts
CMR780 Sixth Edition SectionIO8.33.1.
Definition of Homeowner:Person(s)who own a parcel ofland on which he/she resides or intends in reside,on which there
is,o is intended to be,a one pr two family dwelling,attached or detached structures accessory to such use andl or farm
structures.A Damon whostru ta mor.than hustle ia two-year period sh U not be considered a homeowner
Such"homeowner'shall submit to the Building Official,oa a form acceptable to the Building Official,that helshe shaU be
responsible for aU such wok performed under the building permit.
As acting Constructions Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)ofthe Massachusetts Garimil laws Amwtstarl,you Way be liable for person(s)
you hire w perform work for you under this permit
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ormoances,State and Local Zoning Laws and State ofMassachusens General Laws Annotated-
Homeowner
nnotatedHomeowner Signature
City of Northampton
h r Massachusetts
DSpARTMENT OF EULLOLNG LNSPSCTZONS
212 Hain Btreei • Mwueipal Building
f Northampton, MA 01060 (�
Property Address: ` hfeAcQ St , LLO edf MA ! ✓jS3
Contractor
Name: SoSeP� GeargC J.PohlZ w d S� Tnt.
Address: $Vr-e Oi
City, state: Greer4Mik, Mp o13Di
Phone:
Property Owner V��1G IYGIJ��
Name: 1
Address: IIS' f breAce St'
City. State: Leek, Mr, 01053
1, SoigP ( nj IP (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
Date
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 12 Nre" 11 �ePdJ�NQ A �D�DS3
The debris will be transported by:
The debris will be received by: Gr`^tf'2bOro ' Vh�l'
Building permit number:
Name of Permit Applicant ur'aeO &-gor z
Date Signature of Permit Applicant
1.
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» ar?:ars' Compenbation 3ns=.e-anee_tdaait. Su d'ersIContractorsTicc;ricians(Aumbers �I{
%,atr ieaset Liior anon Please.Print Leallah;
atT!;;Business,'Or�nimdoYirod'r[Fdnalj:d_P.George and Son;Inc-I Joseph George "
dd=�ss;6e Haywood atreet ..
Gtt�+r&tatc(Zip GreenSatdlMA(Oi301 Phone=:(413)474-3604 �!
Ase you an employer?C.hecltthe appropriate box: Type of project(required)- FYI
i.ffi i am a employer n'idt I am a general contractor and 1 S 17Nev;conszuction
amoloyees(%, [] and/or part-time)," have hired the sub-conL2cors
j 2. I xn e sole propdexor or partner_ haled an the atteChed Siteec 7_ 1L-modeling
ship and have no empioyaes these sub-cannaemrs have a. Demolition
vmoeing %or me m amp ce acin emPloyces and have•.vorkers' �
p y. []Building addition
C [_ ¢_� 141(...15"comp.issuancecomp.insurancer _ i !
eouired.j
j.. L Are are a coruotauon and its
10.[]Elactricat repairs or additions
ofncers have exercised chair llL Plumbin_re airs or addikio>L
J.!i ! am a hmneo,mer doing all x'or1: ❑ e p I�
right a`,exemption per i,4GL
' -yselE li�o rao�'<ers`comp- Q Rooirepairsinscrnncc t' uirce- c. 152 a 1(4),and we have non 7` - Odtar10sulallon
amployars.Z:�a':utters
Comp-insureice Rqulmd.]
a7lAFcatt Jwt tUtav imxPl �mrs[alsotauonr 'dZi,.md'P d wei.and,immme<wn.
Innr-ottners u'i�p sohmii Nis amdavMwiadv%Neyare dGagno\:'on and Nen aimamidemmmclommusl=bmitanev nnda+ieindiodti sue
enlrnc:os 01-10dad`,this horc mastauxhW an a4fiional sFsassbovin¢Um name orWc5b�,ndl MMa
dStat[tC11cII1Cr Or nordcCraitia bme1
.ity' FIII.Sabrdvmdaa Sitaa:'e emdantf tibymUSipro"idetlur uwi:< comppolicenunbr,-
7nnlanen}PlAyer lh2 i5J}raY}dtng rVarker5'Ca}nDelY$Q;/OUI}}S}OaNC2�01'£>}I'e}H)}IDj+C@6 Belom6ibepoije),nlldfOb51}B
rinrnMtio}c
insurnce Company Nam :Arbeelllla
Policy--or Self-ins.iiiyc_4> t 1 ( � 9 1 �y Expiration Dffic.'�' »(r�0� _jq �j j}� '
_ab Site Admass: is t feff4Q $�'' Ci'cswa-zip: J f"tbOJOU
ac;;'e copy o;rhe tvori:ers' compensation policy declaration nags{xnoning ffie policy number and e.vDiratlnn date)- y
ailuro m secure coverage as required under Saran 25.:of MGL a 152 can iced ro the imposition of trminai penalties ora 5
flna up to S1,s00.00 and%or one-year imprlsonmenL ase+ell as civil penalties in the forth ur a STOP IWORK ORDER.end a fine d
ai ap r,USO-00 a day against lite i o,lator. Be advised thee,a copy of this statement may be iaiwarded come Office of i
inaaStigaiipoS of Cha DiA car insdranCa rovenee v.ri ncac[on. ,
Cu t:erebn cenif+under rbc pammcmdd npe�altier fpad lir thra the irzfarnxt¢ian gra f(tett above Is Flat and Carrect.
Be
ai. ..a-_i-76)-TT4-3605 0
II vOfj`imi use ont r- Do no:rwlte in Uric crap,to be comnlared by 1117:11'1-1-IfTdaL
i'iR'or 2owas �_„J„_PermiVLicense et
asvwg A.thnrixy{ofrela ane)=
I. Boa rd of Health 2.13u11dilg Departmear 3,Ci}drown Clerk —4 Electrical inspector S.Plumbing inspector
i.Gth ar
if COgi2C%2°fSD1: ?Lone.'•'.-:
Massachusetts Department of Public Safety
Board of Building Regulations and Eta dards
License. CSSL-099372
C nn sG'uC..cr. Supar;l>or Spr_ialt;,
JOSEPNE
B4 NAYN/OOD GGD STREET
GREENFIELD MA 01901
commissioner 02/11/2019
— CMiat(`. Regulation
`�--x
HOME
IMPROVEMENT
CONTRACTOR before
noepiratfor Individual Itfoundretur
L L- TYPE:CatwE04 before the expiration date. a found return e
841 W86 F.ffi4/2019 10 Park f Cal admer Attain and euainess RegulaHwt
_ 156896 W/242019 10 Palk Plaza-gage 3170
JF GEORGE&SON INC Boston,MA 02116
1
JOSEPH GEORGE
64 HAYWOOD ST
GREENFIELD,MA 01301 Undersecretary Not valid etu10
RISE60 Shawmut Road, Unit 2 Canton, MA 02021
ENGINEERING"
OWNER AUTHORIZATION FORM
I, Vicki Gable
(Owner's Name)
owner of the property located at:
92 Florence Street
(Street)
Leeds, MA 01053
(Town, State, Zip) - -
hereby authorize _ 3 , f, Gej(ge 4 SDS/1Af -_--_ -
(Subcontractor) I
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property. This form is only valid with a signed contract.
The Permit will be secured by the insulation contractor, at no additional cost. It is the homeowner's
responsibility to close out this permit by contacting their municipality at the completion of thiswor .
-Customer Signature
-Sign Date
02/16/2018