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