36-026 (9) 28 DEERFIELD DR COMMONWEALTH OF MASSACHUSETTS BP-2021-1829
Map:Block:Lot:36-026-001
Permit: Alts Renovations CITY OF NORTHAMPTON
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2021-1829 PERMISSIONISHEREBYGRANTED TO:
Project# Contractor: License:
Est.Cost: 5608 JOSEPH GEORGE AND SON INC 099372
Const.Class: Exp.Date:02/11/2023
Use Group: Owner: MANNHERZ BRIAN J
Lot Size(sq.ft.)
Zoning: WSP Applicant: JOSEPH GEORGE AND SON INC
Applicant Address Phone: Insurance:
64 HAYWOOD ST (413)774-3604 4220066477
GREENFIELD, MA 01301
ISSUED ON:09/03/2021
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATH ERI ZATI 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:
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.
Signature: I Q Ti
Fees Paid: $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
/ IN?'
Department use only
/ CI City of Northampton Status of Permit:
sep f/k. Building Department Curb Cut/Driveway Permit
/ I) V 12 Main Street Sewer/Septic Availability
far Oom 100 Water/Well Availability°v°ltie���o� `�0�/ No ampton, MA 01060 Two Sets of Structural Plans_
ifh(N, pho e 41 87-1240 Fax 413-587-1272 Plot/Site Plans
°• , 'so6, Other Specify
APPLICA s N'TO C NSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
-
This section to be completed by office
1.1 Property Address: aN/ Dp�f�I ./) p(N t
1 v Map Lot Unit
Flo
aft,
Zone Overlay District
O 1 J b 1 Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: �� Deep f It ()Olt
grk/NT\ f V\vvv 1 1
Name(Print) Current Mailing Address: GI 16 L(� I�0 0
See, A�$(I aNg Telephone 1
Signature
2.2 Authorized Agent:
Sosep Creoi'.t C 69 Hfniwood\ S . Crreeni;eg,M.A Oi3'J1
Name(Print) Current Mailing Address:
q615)Fig ( 13)-77 t -36a
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from.(6)
3. Plumbing Building Permit Fee
li
4. Mechanical(HVAC) (e0-
5.Fire Protection
6. Total=(1 +2+3+4+5) S6'QZICIs( Check Number I I
�/Tfhis Section For Official Use Only
Building Permit Number: 10—07�i`faV'/ Date
7 issued:
Z___Signature: 3"20z
Building Commissioner/Inspector or Buildings Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs ID] Decks [0 Skiing[DJ Other[tt]
InSt r�
}n Jaiio
Brief Work Description of Proposed INv' Q,'c}, i ivo.t1) NA,IfI� (if 1,41,)Q aotd 9" o 4b ce II 1 9 ‘-x J
lJ1i
Alteration of existing bedroom _Yes No Adding new bedroom Yes No
iNulfrlt')n 1� Pt�t.
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
Bri i'r -t
I, ,as Owner of the subject
property hereby authorize Snse Pkl Creorle.
to act on my behalf,in all matters relative o work authorized by this building permit application.
See Mcrnc\,e1 or(v1
Signature of Owner Date
3oseo, Cr Ot . ,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 ergs Z.
Print Name
Ogle (WO
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: � Not Applicable
0
Name of License Holder: ao3e?, G2orte. CS31 't° 1
License Number
HWilev0001 3 ttee\ C-ree(Nit1 l MI\ 013°1 a.-11- a�17
Address Expiration Date
(413)771¢-3(Pw
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
a. Q. ()forte rnndk ¶on,2nt, IS663(1
Company Name Registration Number
VICA V.03q SIrei6 6-rPer\f\e id,' AN o1300 7.- ti),o(5
Address Expiration Date
Telephone ]J' 1`7711-360
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 1083.5.1.
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 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: ?S Duff-Jo nr
The debris will be transported by: Ir. Georje 7VJ, S, , Tn c
The debris will be received by: Bru#Ieboro So►Ivtie
Building permit number:
Name of Permit Applicant U0Se0 (Ye ore.
06 IJ.41 Ido? ► )1y4k°1r1P14
Signature of Permit Applicant
City of Northampton
.`tT. ,rjk °�� - . sic.
( i Massachusetts ,4,
f s- _,!I il
DEPARTMENT OF BUILDING INSPECTIONS s I;gr -,'
'•'''c _•� 212 Main Street . Municipal Building `.��';,z-7,�;�.
-�` Northampton, MA 01060 ?••
Property Address: ;D Diet'E rtlJ D riW t
Contractor
Name: SoSeo, (TQoc /a,P. George r,Atk Sal\, 3m.
Address: �i Hmywao[A . rte
City, State: Gree 2IJ► fNA 01301
Phone: C 113' 774^ 3‘04
Property Owner Br i�) M iv-2,Name:
Address: rg Detr{i t(d Br.
City, State: f f ec) /A
I, 3os0 Rorf 2 (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 \ •i W CkhA-V.,V,
'�
il
Date 06 IX-Cio -e-1
The Commonwealth of Massachusetts
x` i ' •% Department of Industrial Accidents
unr ,.a I Congress Street,Suite 100
• \ t e'�, Boston,MA 02114-2017
www.ilmass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organimtion/individual):
Address: t--< Q iA I C
City/State/Zip: f AMdj Phone#: (4 R ) C 3 167 6
Are you an employer?Check the appropriate box: 'VSC Type of project(required):
1.11 am a employer with Li employees[Lkaandior part-time).* 7. Q New Construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. [l Remodeling
any capacity.[No workers'comp.insurance required.)
9. Q Demolition
3.EI I am a homeowner doing all work myself: No workers'comp.insurance required]
10❑Building addition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or arc sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
5.0 t am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs
These subcontractors have employees and have workers'comp.insurance.: t i�'
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other bit v 1 j Z
152,§I(4).and we have no employees.]No workers'comp.insurance required.]
*Any applicant that checks box#1 must also till out the section below showing their workers compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire 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: kw\ek..
Policy#or Self-ins.Lic.#: U1 O 0 G 477 Expiration Date: —
Job Site Address: au De eff it Id D �f 1v City/State/Zip ` �'t '�
�o(�11c,�j \0
0-
. ... . .p th Lv c a+ �elsr � a tg� e ' ►um�er And expir lion 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.
I do hereby certify und- t e pa'rs ' td mollies ofperjury that the information provided above is true and correct.
Signature: Date: O 8'1ci I
Phone#:
yI3 79 ' 60
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#:
Commonwealth of Massachusetts
Division of Professional Licensure
Q Board of Building Regulations and Standards
Construct W k i Specialty
CSSL-099372 `. • `, kacpires:0211112023
JOSEPH P GEORGE +fir; . f IIII
64 HAYWOOERSTREEt.
GREENFIELD.)A 0130'f.,'.;f �'
— 0
41.
Commissioner di,A. K. `i&i bA_.
..�% Yanrrnevievece(l�o/.(Kee,w(c tJe/h
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:
Registration Expiration - Office of Consumer Affairs and Business Regulation
156686 - ` 07/24/2023 100E Washington Street -Suite 710
JP GEORGE&SON-INC' Boston,MA 02118
l t
JOSEPH GEORGE =_- .` �l�llsd 4 ; �,r t
64 HAYWOOD Si <-:. wr.�'CL t �1� V"�
GREENFIELD,MA O'1301 Not acid itho t signature
Undersecretary .
DocuSign Envelope ID:532B5951-42EA-4C5B-9C8C-78804E8A9BF8
RISES
ENGINEERING'
OWNER AUTHORIZATION FORM
Brian Mannherz
(Owner's Name)
owner of the property located at:
28 Deerfield Drive
(Property Address)
Florence, MA 01062
(Property Address)
hereby authorize , , enr e fMc� 5On1-InC
Subcontractor(to be fill in by office)
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 subcontractor, 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.
/—DocuSibbed by
alrn Itta , .x4)
O ne ' Kat re
8/10/2021 I 12:44 PM EDT
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335
www.RlSEengineering.com