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10D-023 (4) 39 FLORENCE ST BP-2019-0273 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 1013-023 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:INSULATION BUILDING PERMIT Permit# BP-2019-0273 Project# JS-2019-000450 Est. Cost:$3838.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const,Class: Contractor: License: !Ise Group: JOSEPH GEORGE 99372 Lot Size(sq.ft.): 26353.80 Owner. Rebecca Duggan Zoning:URA(100)/ Applicant: JOSEPH GEORGE AT. 39 FLORENCE ST Applicant Address: Phone: Insurance: 64 HAYWOOD ST (413)774-3604 WC GREENFIELDMA01301 ISSUED ON:10/12/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-AIR SEAL ATTIC AND BASEMENT, ADD 14" OF CELLULOSE TO ATTIC FLAT 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: Oil: 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 Occupancy Signature: FeeType: Date Paid: , Amount: Building 10/12/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner N6665 KNO15 —1 i4ibF A MbWT -PFrFIVFDt AuSf, r'V:1LT' oaoo)i Department use only y of Northampton Status of Permit: FF� C it cvv SEP 4 2018 ilding Department Curb Cut(Ddveway Permit - -0 212 Main Street Sewer/Septic Availability_ Room 100 WatedWell.Availability_ DEPT OF BUILDING INSPECTIONS NORTHAMPTON, A 01060 N. ham MIpton', MA 01060 Two Sets of Structural Plans one -587-1240 Fax 413-587-1272 Plot/Site Plans IOther Specify_ APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I-SITE INFORMATION I &9_10-.2 -73 1.1 EMParty Address This section to be completed by office Map Lot -Unit If Zone Overlay District Elm St.District CS District_ SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: R�-' CCCI" dame-(Print) Current Mailing Address: SQ, Telephone 3 1 rN 1Y y Signature 2.2 Authorized Agenj: 'Tos e W 64 HWY%WqOVs &Tfeftj;egI" 01301 Name(Print) Current Mailing Address: Signature (4131-77q A,04 ignature Telephone SECTION 3-ESTIMATED Item Estimated Cost(Dollars)to be Official Use Only 1. Building cam leted by permit applicant 3 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of 3. Plumbing Construction ft-om. 6 Building Pen-nit Fee 4. Mechanical(HVAC) 4f 5-Fire Protection 6- Total=0 +2+3+4+5) 3 Check Number This section fior Official Use Ont Building Permit Number: Date Issued: Signature. Building-COMmissioner/inspector&Buildings Date 746f, A V Cr SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House F7Addition Replacement Windows Alteration(s) Roofing ❑ Or Doors L_I Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding[E7] Other[C Q Brief �)�� I }. 1�nStn on Wok Description of Proposed Air r Seo) A*t 0%4 [L'x L'1�• jJa 14 1 of Ce'�1(Jk' I O Jql( F44 Alteration of existing bedroom/� Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.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? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 IL of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ( V�A as Owner of the subject property hereby authorize Sn�eQ� mor;ie to act on my behalf,in all matters relative fo work authorized by this building permit application. SCP. �M(Ac�.e� - o'9 44 Signature of Owner Date 1 3'05$ 2or�f. as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. uoS h Ge„r-e. Print Name 1 y y aff Signature of Owner/Agen X Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction SUperyisor: Not Applicable ❑ 5 Name of License Holder o5e . �2oro ?, cS31 otll3'la License Number ('i HoNwo4 5�n0ee(\iW-4l M� 01301 a,-►i- ani Address Expiration Date Signature T lephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 3- Q, Rof 4t (n4 SOf\,1-ntISW(i Company Name Registration Number Ell "Olprwzi ON S+te-6 Gre-erste 1d i AN 01301 7-)s Address Expiration Date Telephone 41;)-774'3604 SECTION 10-WORKERS'COMPENSATION 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....... ® No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780. Sixth Edition Section 10835.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-vear period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official.that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the wort: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)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS �"` i ' 212 Main Street • Municipal Buildingy s Northampton, MA 01060_ Property Address: Jq Floffin(e- Jl, Contractor Name: JIDSe?1 (TeDMt ! ��'�' (ROK &Auk Soh, int. Address: City, State: G rR�(4-4d 1 N1 A .01301 Phone: ( 113)'774^ 304 Property Name: Owner �Q�e CCAh� C�n Address: 39 FV!)rtug sv City, State: Lea, m 1 01355 1, �o�P� GkO25 4P (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 1 have provided the property owner with a copy of this affidavit. Contractor signature \41V�q*rck�� Date Sr !j 1911 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: 39 Flo(tn tt Si . Leek, A , o 1,53 The debris will be transported by: Georig S�j The debris will be received by: f��t tie6f)ro V4 1e Building permit number: Name of Permit Applicant �- o�8 0' ®gWho , Date Signature of Permit Applicant Prim Form j' TIze Co.-fnrzonwealfiz of Massacliziseffs 0i'l *o _:r!Dqparl�,-zeizz RaRSM. Offlice 0_F Ir -Tpwns lizves, a slifte.100 Bosion.Atlea' 0_7174-2017 tr VII-Orkerg' Camoenmratior_t 11-asiuraRice z,',=Mda-vtt:31:6-1-derslComn -act-OrS11.1-. riC1a mbers Kease Piiat Legibl-v. mTo duRD-J-P-George and Son.. Inc-I Joseph Georae -0 1 9 Z`gMle(Gusinus_, o..1jJfld1.j . - - ,I I Addrcss:84 Haywood Street ii Phone=".(A13)-774_S604 C!LY _Greentlald/MA/01 301 A re you an empioyer? Cher-It the appropriate box- Type of project(required): laurn a general coritracWr and I am P_employer Leith A. 4 — - I , i 0- ev; construction el-liployees(fibil and/or pari time)_* navehireed fhee sub-cont.actors tisted an the attached sheet. Remodr emg 1 an-;-L sate proprietor or parEner, 1 !1 ship and have no employees These sub-contractors have S. F-1 Demolition ovorlding Eor me in an,,,capaci-c emp1myees and bave worlcers COMI).ihSL'rance�- 9- D Buildina addition [moo 1,1.10rkC5�COMD_insurance T-1 -,,kfe are a corporation and its I O-El Electrical repairs or additions officer have exercised their 11_E1 Plumbing'L�i i am a horneowner doing all work Ing repai sor addinions righ".crFe:,:etnpVo-n per\MGL I) NLo r-forkers'comp- I t C. 1 no I and we have emplayeas.LNNo wmikers- 13-Df 0-,herinsulalon CORM insurance required-] diat clie&E box--i niust also nill out iie section balowsitiox%ina emir voemre compensation poliev information. !ail Aari;aTd'diln hire outside conlmcTors. nllslsL-b.-nitnn--�i-,-fidnvirindicatinzsu6ii. ni ZConic,or.s that check-this box must attached an addalonai shcei:showiing L11=name ofilic.sub-rariJrm:!orS and Slate 7 xylictlicr or noLdiose entities Batt -em If die sub-mninictors hay es. c r plvve t7iiLmuszpro,,,idethztl--IV014,-;!.—�-COMDpolicL•nuinbc,-- M �, _-- iTill(M eillphiver tha-r 75provilling JSOrA-zTS- COIL DERSIU1017 hJS11;'11!2V2fDY Mil 22)1DJD ees- Below is thapolicy andjob Ske finsumance Com-panA,Name-Arballp D of 6 Police-=i-or Sel'-in-IL- - - 6 477 2xpiratzon Darc____O1&L_aO_1T sob Site:Address: Citvlstate/zio: Lee d fz f'11V Of? I. a cony of the Workers, compensa-don policy declaration nacre-(showfng the policy number and expiration date). �Olure Zo sacure coverage as required under Section 25=o-.?vfGL c. 152 can lead to tl-it imDC&1ion of ahminal penalties of a d/or one unpr7sonm_eni�as vv LIP LO 3 1.500.00 ari 'Orm.O'r':a STOP WORK ORDE-R and a ane ell as civil penalties the;arm .zt uprO S250.00 a day againsttlie violator- Be advised that a copy ofthis stvi-ement,may be j%r,.Yarded to the 0-iffice ei i i vesci aad o ns ori 7 e DIA for insurance cove.a-cre vaa-i r[o h e,, -ebi.C-01 11 Tj,ander L'lz a pains and penal ofperjazy trip[the h!fo rnzarfan pro virlerl above is trill;(111CI Co) 72C1, i2n"Iture: Data- LA otle g:(41 3)-774-3604 � lCity or To-wil -PArrnftd-license one)-- 53,oanf Offienitt '71.BuildingrDepzYbment 3-Ciryf-lown Clerk -, :,,;1ectrC211n=aCtOr .5.Plumbing inspector li tell 6 Phone 9.. Massachusetts Department of Public Safety Board of Building Regulations and Sta^:dards License: CSSL-099372 Construct:_-% Supervisor5pecialty JOSEPH P GEORGE ` 64 HAYWOOD STREET GREENFIELD MA 01301 Expiration: Commissioner 02/11/2019 '//e �(%r ii�iinic•nrt�/,���''lltr;.:rr�Irc1e// Office of Consumer Affairs&Business Regulation -' HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: r Rggistration Expiration Office of Consumer Affairs and Business Regulation 156M 07/24/2019 10 Park Plaza-Suite 5170 JP GEORGE&SON INC Boston,MA 02116 VC JOSEPH GEORGE �.E CG � ` �� VCS 64 HAYWOOD ST Not Va Id W hOut signature GREENFIELD,MA 01301 Undersecretary Columbia Gas of MassachuSCtts 60 Shawmut Road, Unit 2 Canton, MA 02021 A NlSourea Company OWNER AUTHORIZATION FORM 1, Rebecca Duggan (Owner's Name) owner of the property located at: 39 Florence Street (Street) Leeds, MA 01053 (Town, State,Zip) hereby authorize �� �' N^J Son, lnt (Subcontractor) 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 this work. -Customer Signat e r -Sign Date 5/1/2018 - City of Northampton Massachusetts - DEPARTMENT OF BUILDING INSPECTIONS � a :-:e• =� 212 Main street • Municipal Building fes% c -� Northampton, MA 01060 Flormct S� ��{'d s M D I0 3 3 Property Address: � j Contractor r Name: Address: t q Ho%m Wood SiceB$ City, State: G�'��� ;���1, M A Phone: 304 Property Owner p Name: Pt bail U V41, lin Address: �� F <e s} City, State: MA I, 3osefh (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