43-100 75 PARK HILL RD BP-2017-0442
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:43 - 100 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-2017-0442
Project# JS-2017-000740
Est.Cost: $3229.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
UseGrouD: BRYAN HOBBS 83982
Lot Size(su. ft.): 58370.40 Owner: Laura Furlan&Lisa Abrams
Zoning: Applicant: BRYAN HOBBS
AT: 75 PARK HILL RD
Applicant Address: Phone: Insurance:
346 CONWAY ST (413) 775-9006 WC
GREEN FI ELDMA01301 ISSUED ON:10/7/2016 0:00:00
TO PERFORM THE FOLLOWING WORK AI R SEALING, INSULATING ATTIC
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:
FeeTvpe: Date Paid: Amount:
Building 10/7/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0442
APPLICANT/CONTACT PERSON BRYAN HOBBS
ADDRESS/PHONE 346 CONWAY ST GREENFIELD (413)775-9006
PROPERTY LOCATION 75 PARK HILL RD
MAP 43 PARCEL 100 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvoeof Construction: AIR SEALIN INSUC ING ATTIC
New Construction
Non Structural interior renovations
Addition to Existing_
Accessory Structure
Building Plans Included:
Owner/Statement or License 83982
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO AT1ON PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance'
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
D- oli '. elay
/0-6 d
Signature of Bui dig Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
"Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
Via'- Department use only
+ City of Northampton Status of Permit:
r 5�r Building Department Curb Cut/Driveway Permit
S' 4. LTi, 212 Main Street Sewer/Septic Availability
�� 1 Room 100 WaterNVell Availability
01°�3,ejoa Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PbUSite Plans
Other Spedfy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address'. This section to be completed by office
A Map Lot _..,_Unit
IA Zone Overlay District
Tti/edI ' HA owtoa -.t- Elm Sc District CB Distrip_
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
3.1 Owner of Record:
41-c - —Hrte. J �S .PAric, 14t1 i? J )7(U✓er+ca
Nam nnt) Current M.il'n•Addre-C:>.
- QL fk Aitu`t2. to C'v✓x.ti.fTelephone
Sig re
3.2 Authorized Agent:
` 6NAn h ttck>ial 5Votocp4,0 KJ i (wedi 1J
Name(Print) Current Mailing Address:
__
IK-Th UIQ e 7606
Sign re 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
4. Mechanical(HVAC) �— 1��j
5.Fire Protection R LLQ' i13
6 Total=(1 +2+3+4*5) J- (CQ9, ii Check Number 8,358
This Section For Official Use Only
Date
Building Permit Number Issued
Signature: _
Building Commissioner/nspeetor of Buildings Date
Section 4. ZONING All Information Must Be Completed Permit Can Be Denied Due To Incomplete information
Existing Proposed Required by Zoning
Thu column m be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R,
Rear
Building Height
•
Bldg. Square Footage
Opcn Space Footage °lo
(Lot area i nus bldg&paved
parking)
rf of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW at YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO p DONT KNOW 61 YES Q
IF YES: enter Book Page and/or Document d
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO SO
IF YES, describe size, type and location:
E. Will the construction activity disturb(d aring,grading, excavation, or filling)over 1 acre or is it part of a common plan
that wilt disturb overt acrev YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S-DESCRIPTION OF PROPOSED WORK fchecK all applicable)
New House 0 Addition [] Replacement Windows Alteration(s) J Roofing
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C7 Siding[l7] other[xs
Brief Description of Proposed,[,
Work: /nv 5 (ea U fc r Inl,,jc 'r< At{
Alteration of existing bedroom__Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Se. 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?
e. 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 farm attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes_TNo
7. 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, f.( Q CCL t 'au _,.,, ,as Owner of the subject
property
hereby authorizeirdeiii /606,0 jedPitAcat t.Ait-\
to act on my behalf in all matters relative to work authorized by this building permit application.
1 , 9 /71" /t
Signature {caner Date
4
I, ° ha ,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.
gift//GV,bb_S
Pnnl Name
Signal - • , er/Agent Date
SECTION 8-CONSTRUCTION SERVICES
fit Licensed Construction SuRervieor: �/ / Not Applicable El
Nome of License Holder r (- /iciJ5 Cs -0 rp j L q
A7?_,
License Number
i C4.7,,ljG,vi �'. ,.en.� iJv`�r`d�jl (,�S�o9-/ ,vl
Address / Expiration Date
77S-70)
Signatu Telephone
p.Rephtered klome Improvement Contractor�y Not Applicable ❑
MAn C.- Jdt.hh� S u M x� l7 / ?
Registration Name Number
CicincjcH 4. Griping-D y/ /.uta
Address Expiration Date
Telephone 1 /: f(IJ(6
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L C.152,§25C(8))
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-eecupied Uwe lines of one(i) 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
ps supervisor.CMR 780, Sixth Edition Section 108 8.5.1i
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 Sweet, 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: OS / 11;1( �7c4 p
The debris will be transported by: Circa k Thnybc Q
The debris will be received by: Conic( 4L �l�s� �.� �1
Building permit number:
Name of Permit Applicant rvi,P
9�z� lG Ti'Z1�.
Date S' /ature of Permit Applicant
City of Northampton
/:I":ti
; Massechusetts rte (
It� i , , DEPARTMENT OF BUILDING INSPECTIONS y 4
212 Mein Street • municipal Building 'r ,e0
Northampton, MT 01060 p yJ
Property Address: 1,S iIWL. Ill f I Kz(U
Contractor
Name: .1�6u1(k(\ (a- IUnd cia(rQf (IA\
Address: -77-1(b Gin.A. nil ,�+-
City, State: CflI2 -CL14.0 /f=1A
Phone: �I A .. 7-) S - tf U-1(J
Property Owner
Name: L, QrAr— 73:r)
Address: i c PAWIlr(7 KI
City, State: 'cid P U' rtcl Cl Un C,? - l))- I
6"1 /1611i (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 7 /t 7- 7/9.°
C The Commonwealth ofMosenchusens
- Department of Industrial Accidents
Office of Investigations
_Ire= 600 Washington Street
ane
Boston,MA 07111
www.massgov/dict
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electrician$/Plunibers
Applicant Information Please Print Legibly
Name(Budnna'Orpnizationandividual): Bryan G. Hobbs Remodeling
346 Conway St.
Address: Greenfield, MA 01301
City/State/Zip: Phone#: f`(I 7 p7?S —t( 090 sL:
Are�you an employer?Check the the appropriate box: Type of protea(required):
fg
1. a I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New eonsvocdon
employees(full and/or part-time).* have hired Me sub-contractors 7, 0 Remodeling
2.❑ I am a sole proprietor or partner- listed on the attached sheet 1
ship and have no employees These sub-contractors have 8. ❑ Demolition
westing for me in any ninety. workers' comp.insurance. 9. ❑ Budding addition
[No workers'comp.insurance 5. ❑ We arc a corporation and its 10.0 Electrical repairs or additions
wired.) offices have exercised their
3.❑ i am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself [No workers' cone. c. 152,41(4),and we have no 12.0 Roof repairs
Lance req®esi1 t comp. [No kers' 13.[}f Orher ab•--!0-1J 121/' e
mp. required.] • I qw !_Ha.
•Any applied that Sacks box M1 nun So fill out the',aim below showing then writer'runsoatiao policy fufonmtioa'
t Nomeowms who ashoit this affidavit indicating they us doing all work and then bit<Side contracts man sumrdt a new affidavit Skating such
+Cone an l*t disk tbu bot roues atadd a additional that showing the nos orate mbcowwemn and the winks'cos.Folic/information
I am an employer that br providing workers'compensation brwranrefor my employees Below is the polity andJob site
Informant"
insurance Company Name: A , n C,L)t K wart F'rY itj
Policy p at Self-ins.Lie. M: I2_ l t.!la.fa f ('�5 1 h s Expiration Dare: I L'li-01
lob Site Address: City/State2ip:
Attack a copy of the workers' compensation policy declaration page(showing the policy number ted expiration date)-
Patine to gime coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the Caron of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statcmeut may be forwarded to the Office of
investigations of the DIA for insurance coverage verification.
I do hereby cert&sutler th��e palm and penalties of perjury that the information provided above b due and correct
5i®atmc: Jam)/rDate: 71) 21442
phone.: f] 5 — 0f7
Official use only. Do am melte in this area,to be completed by city or town officiaL
City or Town: PermwLdcxase 0
lasting Authority(circle one)
1.Board of Ileatth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone M:
• BERKSHIRE HATHAWAY Worker's Compensation and Employer's liability Policy
- AmGUARD Insurance Company A Stock Company
V
tM�+ GUARD INSURANCE
COMPANIES Policy Number R2WC648612
Renewal of R2WC513915
NCCI No. [218731
Policy informationPage (AR)
[IlNamed Insured and Mailing Address Agency
Bryan G Hobbs A. H. RIST INSURANCE AGENCY INC.
346 Conway Street 159 Avenue A
Greenfield, MA 01301 PO Box 391
`urners Falls, MA 01376
Agency Code, MARIST111
1 i
Federal Employer's ID 01-3527850 Insured is IndividWai
Risk ID Number 842909
Additional Names of Insured
(N2) Bryan G Hobbs Remodeling Contractor
Locations on Policy
(L2) 171 Wells Street, Greenhela, FIA 3i301
(10/20/2015 - 10/20/20161
•
[23 Policy Period
From October 20, 2015 to Oc1obei 20, 2016, 12:01 AM, standard time ac thy^ insured's :mailing address.
[33 Coverage
•
A. Workers' Compensation lnsw ante - Part One of chis policy appthes to the Workers' Compensation
Law of the following states. Massachusetts
B. Employe'r's I,ia0lhty Irisuraliie - Part Two of u(u Piiicy oppiie :u Poop a, Poi r, 01' the states listed
in Item [33A. The hrn is of our liability under Part TWO are:
Bodily Injury by Accident - each accdent $500,000
1 Bodily Injury by Disease each employee $500,000
Bodily Injury by Disease - ooflcy limit 5500,000
c. Refer to Residual Market Limitee Other States Insurance Endorsement-WC200305$
0. This policy induces these endorsements and schedules:
See extension of Information Page - Schedule of Forms
(4] Premium
The Premium Basis and, therefore, the premium till, be determined by our Manual of Rules,
Classifications, Rates, and Rating Plans. All required information is subject to verification and change by
audit. (Continued on another page)
Total Estimated Policy Premium $ 10,916
Total Surcharges/Assessments $ 599.00
Total Estimated Cost $ 11,515.00
NTERNAL U$E OR Papa - : 1 nrnrrnannn Page
.AWT .R2WCSIO012
)me ne/25/2015 WC 6nppp;A
4ANOTE
Issuing office: P.O. Box A•M, 16 S. River Street, Wilkes-Sarre, PA 18703.0020 . www.guard.com
•
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS4383982
BRYAN G HOBBS
346 CONWAY STREET
GREENFIELD MA//01301
C
�✓.i. ,. . Expiration'.
Commissioner 05/02)2016
ctit/e YtOretaxonrd/erre o.</717tr iirrc/,rfjel/j
Office of Consumer Affairs and Business Regulation
4 ' ` 10 Park PIaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration! 139584
Type: DEA
Expiration: 7/23/2017 Trd 267354
BRYAN G. HOBBS REMODELING
BRYAN HOBBS
346 CONWAY ST
GREENFIELD, MA 01301
Update Address and return card.Mark reason for change.
71
:cai n 20M-05.11 Address 71i Renewal EJ Employment 71 Lost Card
-'AA, r,,,,,,,,,,,,,,d//y -//,,,,,,,/,,.,/c
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
::y2fBOME IMPROVEMENT CONTRACTOR before the expiration date, if found return to:
fatm8an: 1345e4 Type: Office of Consumer Affairs and Business Regulation
".'Expiration: 7/23/2017 OBA 10 Park Plaza-Suite 5110
Boston,MA 02116
BRYAN G.HOD9S REMODELING
BRYAN HOBBS
146 CONWAY ST
3REENFIE&D,MA 01301
Undersecretary Not valid without signature
DocuSign Envelope la ADDBA768-8330-4929-9853-283A48A69605
ir-der
mases save CONTRACTOR
Samos nergyell<enc-,
PERMIT AUTHORIZATION FORM
I, Laura Furl an ,owner of the property located at:
(owners Name,printed)
75 park Hill Road Florence
(Property Street Address) (City)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
rcusiened by:
01 342 B
9/20/2016 I 14:35 EDT
Date
FOR CSG OFFICE USE ONLY
Conservation Services Group has assigned the following Mass Save Home Energy Services Participating
Contractor to the above referenced project:
Participating Contractor Date
For Office Use only
Rev. 12132011