31A-115 (5) 38 VERNON ST BP-2018-1088
CIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A- 115 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv: INSULATION BUILDING PERMIT
Permit# BP-2018-1088
Project# JS-2018-001960
Est.Cost: $2777.00
Fee: S65. 0 PERMISSION IS HEREBY GRANTED TO.-
Const.
O.Const Class: Contractor: License:
Use Group: BRYAN HOBBS 83982
Lot Size(sg.ft.): 10628.64 Owner: COFFEY KELLY A&RICHARD WEIS
zonm& URB(1001/ Applicant. BRYAN HOBBS
AT. 38 VERNON ST
Applicant Address: Phone: Insurance:
346 CONWAY ST (413) 775-9006 WC
GREENFIELDMA01301 ISSUED ON:4/25/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.ATTIC FLAT & KNEEWALL INSULATION,
VENTILATION, AIR SEALING, INSULATE RIM JOISTS, 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.
Certificate of Occupancy signature:
FeeType: Date Paid: Amount:
Building 4/25/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
- — log C
Ate 2 Department use only
City of ortampton Status of Permit:.De rtment Curb CWDriveway Permit
'^212"#alis [feet Sevier/Septic Availability
Room 100 Watet/Well AvaAabilily
Northampton, MA 01060 Toro Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Ogler Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO
.FAM
�IL�IY DWELLING
SECTION 1 -SITE INFORMATION �n-s-wo-1I(�7
1.1 Property Atltlr
This section to be completed by office
Address r
3gVQfy�ovtV-s, I -g ` ICG- Map ✓IA Lot_ 15 _Unit
Zone Overlay District
DIC)U
Elm St.Dil CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Ir�gll , �'rf to J �R f�eC�n�� ISS l� �lmr I� $hQ 1 �tDn
Name(Pdnt�� Cur ent Mailing Address O I up
';',f0 f iA)L" 6 T .rjrl"\ Telephone
Signature
2.2 Authorized Apart,
f s omrrlo�law SLC P/1a� 15J'S rcecfiold mq iame Pnn[) Current Mailing Address'.
ql3 775 . 9iX L
n re Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building _1 .-�-I-I )g- (a)Building Permit Fee
2. Electrical lY (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee Lf
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) :,177. 19' Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued'
Signature:
Building Commi nerllnspector of Buildings Date
Info I bmav) hGhtns @
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
this column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L R: L R'
Rear
Building Height
Bldg Square Footage
Open Space Footage
t],oi arca minus bldg&paved
parking)
#of Parking Spaces
Fill:
�amme&wwuon)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW ® YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW ® YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Gr DONT KNOW 0 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 O NO 0
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 Q
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0) Decks [p Siding[0] Oth r '
Brief D criptio of Propose
Work:'
Alteration of existing bedroom_Yes_�_No Adding new bedroom Yes No�
Attached Narrative Renovating unfinished basement Yes R No
Plans Attached Roll -Sheet
sa.If New house and of addition to existina housing- complete the followina:
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 constmetion. Dimensions
e. Number of stories?
L Method of heating? Fireplaces or Woodsloves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance farm attached?
h. Type of construction
L 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 O/R�CONTRACTOR APPLIES FOR BUILDING PERMIT
I, a,� l 4)1'�Q 4�( as Owner of the subject
property
hereby authorize
au� �)1C �au� h[�olinr LU_
to act on my behalf;in a matters rela(t,ive to work authorized b is building permit application.
534.( ��)M(V ylj9(jsr
S'gnature of Owner
lI n( Date
I, AC�,VI (17)0 C P�f,VI'1O(?�➢.�( 1R u-(. ,as Owner/Authorize)
Agent h eby tleclare that the statements and rmation on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
B(T1Gu1 N71hilirs
Print Name
N)19 j�,
,trVaturb of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: /� Not Applicablee/❑
Name of License Holder: Krl'aR PO Bos 1535 bPA b a
HOb lireennela,NIA U IT UL License Number
x(413)775-9006 �)A'y
Address Expiration Dam
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable D
IM15�q
Company Name H011 Greenfield, DIA 01302 Registration Number
(413)775-9006 1 W A
Address Ezpirati n Dam
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.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....... x No...... ❑
<%1! III :I Gas
of i1vtISS3CFlUSt lCS 60 Shawmut Road, Unit 2 Canton, MA 02021
A MSu..ComOeny
OWNER AUTHORIZATION FORM
I, Kelly Coffey
(Owner's Name)
owner of the property located at:
38 Vernon Street 1 FI
(Street)
Northampton, MA 01060
(Town, State, Zip)
j Boz 1535
H
� ob�GrCreenfield,MA 01302
hereby authorize � (413)775-9006
(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.
i/
r
Customer Si nature
-Sfgn Date 1
4/2/2018
�\ The Commonwealth ofMassaehusetts
Department of IndustrialAccidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
A licant Information Please Print Legibly
y PO Box 1535
Business/Organization Name: Greenfield, MA 01107
atm(413)775-9006
Address:
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box: Business Type(required):
1.M I am a employer with_—employees(full and/ 5. ❑Retail
orpart-time).* 6. ❑Resmurant/Bar/Eating Establishment
2.❑ 1 am a sale proprietor or partnership and have no 7. ❑Office and/or Sales Qncl.real estate, auto,etc.)
employees working for me in any capacity.
[No workers' comp, insurance required] % ❑ Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152,§1(4),and we have to.[-] Manufacturing
no employees. [No workers' comp, insurance required]*
4.❑ We are a non-profit organization,staffed by volunteers, I I.[] Health Care s
with no employees.[No workers'comp.insurance req.] 12.aOthur
*Any applicant that checks box 41 must also fill out the section below showing their waders'compensation policy intvesio on.
'9fthe corporate ufftcars have exempted themselves,but ac cotporaaon has oth,,evhployac,,a workers'vw,e ua,.n policy is required and such an
orguaizatlon should check has 41.
I am an employer that is prow mg workers'compensation insurance for my employees. Below is the policy information.
Insurance Company(Name: (i p 4 ��ill l ' A HILL'
Insurer's Address: 1'b bre LM
City/State/Zip: _�rdtnf�nsj i (�r
Policy#or Self-ins.Lic.# A)CAD-M-M Expiration Date: /�1�r�0�(�
Attach a copy of the workers'compensation policy declaration page(showing the policy would expi
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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
ofup to$250.00 a day against the violator. Be advised that a copy ofthis statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify, under the pains and penalties oirperjury that the information provided above is true and correct.
Signature 60 11 y5l&L Date'
Ph # `1L'>-775-96C&
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):
1.Board of Health 2.Building Department 3.Citylrown Clerk 4.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www m s:sov1dia
City of Northampton
5
Massachusetts
a
DEPABTlE:NT OF BUILDING INSPECTIONS
212 Main Stroat •Municipal Building 5JF V CD
Northampton, MA 01060
Debris 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.
The debris from construction work being performed at:
�i IfOC[� �sI- icni—
(Please print house number and street name)
Is to be disposed of at:
700 (M Cu-Y1
�n�e&Lu lin _ ' u 'L 1��Iak -""' 0"""
(Please print name" location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
rrat 6hhS i V.yYIMO( t fc, LCC x1.535
,yy (Company Name and Address) I 1�d MA CI�,�a
1�14�1�
nal re of Permit Applicant or Owner Da
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
®/ Massed husetts De pa rim ant of public Safety
Board of Building Regulations and Standards
License', CS-083982
Construction Supervisor
BRYAN O HOBBS
3"CONWAY STRAIT
ORBENFIELD MA/01301.
ZM & — Ex pi retion
Cohimissioner 09/0212012 -
✓' �/✓'AO//Jd P'Ad/dr✓'✓dli'J 6'✓ ��'P'CQ7.1�(Ir!%IIIJP.�r.{
Zn
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: Indivlduel
BRYAN HOBBS Reglatrdon: 139884
D/B/A BRYAN HOBBS REMODELING Expiration: 07/22/2019
346CONWAYST
GREENFIELD,MA 01301
Update Address and radurnoMd. Mark n
' n A.!dxaa r3.6anaMml C1.BwplBym
_—_ Office of Consumer maim A Buein9s Rapuhtien
HOME IMPROVEMENT CONTRACTOR RsWatraean valid for Individual WeoMy
"a TYPE IntlMtlual be rethempiratlendete. ebundrWlmtM
809M1r9t106 E2011 Office of Consumer Adslrs and Bushel Regal
139384 07/22/2019 10 Park Plan.Butts 3170
BRYAN HOBBS Boston,MA 02118
D/B/A BRYAN HOBBS REMODELING
BRYAN G.HOBBS
348 CONWAY ST
GREENFIELD,MA 01301 Undareeoretary Not valid Without signature
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OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(II),AUTHORIZED
RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
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