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25C-141 (8) 47 ORCHARD ST BP-2022-0137 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C- 141 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WIT I UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2022-0137 Project# JS-2022-000243 Est.Cost: $11654.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JOSEPH GEORGE 99372 Lot Size(sq. ft.): 10018.80 Owner: EATON BARBARA Zoning: URB(99)/ Applicant: JOSEPH GEORGE AT: 47 ORCHARD ST Applicant Address: Phone: Insurance: 64 HAYWOOD ST (413) 774-3604 WC GREENFI ELDMA01301 ISSUED ON:8/9/2021 0:00:00 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: 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. I , 3:),D7 Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 8/9/2021 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ECE/` , Department use only City of Northa pto 1� ' Building Depa me Cu ' t• Driv= ay Permit 212 Main reet "uG - 4 2/��Stewer/-eptic 'vailability Room 00p 0 late ell •tenability Northampton, ' U`I'v• a Two •ets of Structural Plans phone 413-587-1240 Fax 4 '8+4'V inisa - • -ite P ins N•MAo6 *Sp° ify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOL A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map A6-C,�/Lot iCti Unit NottivAn) ton, MA Zone Overlay District 0100 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Malpftt 5o115 I1 Orc il A. Name(Print) Current Mailing Address: 913 127 am I See A`k koGVA Telephone Signature 2.2 Authorized Agent: 3-+Sew Carat _ 64 1-irn,fkqood\ S . Green{zIJt3/VJ\ 011,3i Name(Print) t Current Mailing Address: 11 ° 4.14... ° -ll'ti . i3)-779--3604 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS 7 Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building III bS � , (a)Building Permit Fee 2. Electrical I (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee �� . - 0 4. Mechanical(HVAC) 6 5.Fire Protection 6. Total=(1 +2+3+4+5) l I/ bi y, 12, Check Number I riggi This Section For Official Use Only Building Permit Number: 6,(2n.. ) . .. ,i -7 Date Issued: Signature: _,/_, . g- q-ZOZI Building Commissioner/inspector of Buildings Date ti 5 p 3c( 1 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) I I Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [0 Siding[0] Other(IX InStnk on Brief Description of Proposed b2nSt; Work: ekic cell tA��5 e 1� e , w i S �.1, 1 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 ft.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, M(f(4y/rfz.! 301tS ,as Owner of the subject property hereby authorize SDse GeOrtr, to act on my behalf,in all matters relativeo work authorized by this building permit a licati n. gee , �c.�.e� 07730 ao}.1 Signature of Owner Date 3oSe?I\ G Q QOtt , ,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. >3OS 2Af'e1 .. Print Name 07130(a01-1 Signature o f Owner/Agent �, Date f . • • • SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable�❑ Name of License Holder: 3-03q\, Ge0t9t (S3) °I93 ft a License Number 1j -10),wood S trec c &i-eenilt.� 1 /VA 013°1 a-I - aoll Address Expiration Date Nt 1qtAtcrot• 413)77i-3boti Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 Q, (reolt v.r4 Sots,-IN., 1 S 6b3‘ Company Name Registration Number V1CNI q 5+tee (yree$eIdI MA o\30\ 7-15 - 1oi5 Address Expiration Date X04\4461-kult- Telephone��1;}J-77t-3 6°4 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 0 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-year 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 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)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 - r err' — 1 , Massachusetts __tir; DP"''PARTMENT OF BUILDING INSPECTIONS e, .'.sC� ��'l 212 Main Street • Municipal Buildingv'r ' •` rs Northampton, MA 01060 s` Property Address: 4 .7 0 Oqp f d S� Contractor Name: ScSeON George /L,P. Geode dt Son, Irv., Address: b Hat wooAA Stre2$ City, State: &rR n f;$'i, M A 01301 Phone: Ct13'-7 t 4, 3()0t Property Owner Name: gUObOr(t LQAon Address: `l 1 Qr c n,(A St • City, State: N o,NPt°n , Mqi i 0100 I, 3o6e k' (Seams. (contractor)attest and affirm that the building I intend to insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature )yic,JR4. 41,Afts,0. Date 0-7 30 b. .),.) City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: `l 7 O rcv4 S� The debris will be transported by: If Lbile The debris will be received by: 81 v�tfil��, ro _GI i vie Building permit number: Name of Permit Applicant . .c)\-6r$ 0fe oft) o7 30 1 OV1, 1.( e,,atuyvis Date Signature of Permit Applicant The Commonwealth of Massachusetts 6;1t Department of Industrial Accidents =j � 1 Congress Street,Suite 100 ""'f' Boston,MA 02114-2017 www ntass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: &bc > '}IAL. City/State/Zip: b 1yj1d .() cteielii Phone#: C 3� 3 \ I C7 Are you an employer?Check the appropriate boa: \' l Type of project(required): l.[ I am a employer with Li employees(gg ltandior pan-time).* 7. ❑New construction 2.0 t am a sole proprietor or partnership and have no employees working for me in g. Remodeling any capacity.[No workers'comp.insurance required.) 3.0 I am a homeowner doing all work myself:[No workers'comp.insurance required.]' 4. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.E Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[ Other WI l L' CIb1 152, i 1(4),and we have no employees.[No workers'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 him:outside contractors must submit a new affidavit indicating such. :Contractors 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: t l Policy#or Self ins.Lic.#: lia'- . T G6 tr p L(77 Expiration Date: ~ Job Site Address: 1 0«'[tl4 S t Ct /State/Zt ((©r f G n, M fl ,J 106 0 444e S Pi`, t ►4 Vitt' aoam m?q ng + i +ntilmb±er and ea>p}*+ n date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pain ad 'enal 'es o er' ry that the informati on provided above is true and correct. 17 Signature: , Y J1',' Date: fao I � Phone#: 913 779 3 60 1 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ' Contact Person: Phone#: A Commonwealth of Massachusetts i. l Division of Professional Licensure `' Board of Building Regulations and Standards constructiet4to }Specialty f. CSSL-099372 ::= empires:02/11/2023 JOSEPH P GEORGE l 64 HAYWOOEI S .. .. GREENF1ELDyIA 0130. : j' i. O Commissioner ama. K. Id(&Ii O . 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: Reaistri tion Expiration Office of Consumer Affairs and Business Regulation • 156686= =' 07/24/2021 1060 Washington Street -Suite 710 JP GEORGE&SON'Il iG =-� Boston,MA 02118 JOSEPH GEORGE�_-___ , 64 HAYWOOD ST -:7_-,. �r/.w,- al.. .>„4 GREENFIELO,MA 01301" Undersecretary Not slid itho t signature t RISE ENGINEERING' OWNER AUTHORIZATION FORM ci, Barbara Eaton (Owner's Name) owner of the property located at: 47 Orchard Street (Properly Address) Northampton, MA 01060 , (Property Address) hereby authorize J' P, Geo rye CA4 SW n 1 a (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. • 54/. z,,,,,t_.. ‘,,t--,A,, L. Owner's ignature ( A tile IL 2( Date RISE Engineering,a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com