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31A-046 253 CRESCENT ST BP-2019-0722 GIs#: COMMONWEALTH OF MASSACHUSETTS MQ Block: 3 1 A-046 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv: INSULATION BUILDING PERMIT Permit# BP-2019-0722 Proiect# JS-2019-001181 Est. Cost:$2139.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BRYAN HOBBS 83982 Lot Size(sq. ft.): 6969.60 Owner. AUGARTEN MARK S&ELLEN M Zoning:URB(100)/ Applicant: BRYAN HOBBS AT. 253 CRESCENT ST Applicant Address: Phone: Insurance: PO BOX 1535 (413) 775-9006 WC GREEN FIELDMA01301 ISSUED ON.12/18/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-KNEE WALL INSULATION 2 INCH FOAMBOARD, GABLE VENT, AIR SEALING 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 Deaartment 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 12/18/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Plowlt, . Building Department Curb Cut/Ddv"eyPemtit f 212 Main Street SewerJseoll `I + f �( Room 100 Wate ►efl Northampton, MA 01060 TWO Sots,ofs . ansa . phone 413-587-1240 Fax 413-587-1272 PlotlSite Plata APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION ids ULi4ri0 1.1 Property Address: This section to be completed by office a53CQ j, '. Map 3 1A Lot C�rOUnit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: rl-I�a4ipv c n FO Name(Print) r C rr@nt Mallin A d ess: d 1 l l� Co - la t LU Cumlof(cahj&vi Telephone Signature 2.2 Authorized Aclent: Rld XA aaaj Name(Pri t) Current Mailing Address: N13) `7-75 - 9601 � jie4 Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building i 2(�, (a)Building Permit Fee 2. Electrical J t (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee J 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) lCheck Number oZ This Section For Official Use Only Building Permit Number: Date Issued: Signature: )Z-17-1g Building Commissioner/Inspector of Buildings Date t 1 .� t b cert o t0 L�S @ Y"CIA . w wl 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 (Lot area minus bldg&paved parking) #of Parking Spaces - Fill: _ I volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW a YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW YES IF YES: enter Book Page, and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained © , Date Issued: C. Do any signs exist on the property? YES Q NO Qy IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 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 Q NO a 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 D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[O] Otger[ Brief D scription of Pro o ed 1 (� - L Work: Y1Q�L arc I �,� 1[; ,�TTI�[,iV1�(��1'�� fi 1��.1,'lA (mil, 0 Alteration of existing bedroom Yes_X_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 ach family unit: Number of Bathrooms c. Is there a garage attached. d. Proposed Square footage of new con ction. Dimen ' s e. Number of stories? f. Method of heating? F' places or Woodstoves Number of each g. Energy Conservation Compliance. Ma heck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetla Yes No. Is construct within 100 yr. floodplain Yes No j. Depth of basement or cellar fl r below finished grade k. Will building conform he 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, 19011 �' a 1 1 T A 1:kVN as Owner of the subject property hereby authorize L to act on my behalf,tff all nibitters relative to work authorized by this building rmit application. 2 Q _ (Aow i S CW P o. �l ,�-f an 1'WL 1'�)1) '� J Signature of Owner Date I, AtMIA qlbC 81)1O riQl l c_ LI, L ,as Owner/Authorized Agent hereby declare that the statements and informatiorODn the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. 1 n 0_�k S—, WAC— Print Im hg Si re of caner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not/A'�pplicable �❑ Name of License Holder: V V)9 d a License Number ya PJ Box 1535 �� WX . I afield,ARA M?M d Address It�> - r(q 13)775-9006 Expiration Date Signature Telephone 9.Reallstsred Home Improvement Coihtractor: Not Applicable ❑ I ng 1A Company Name P�Box 1535 Registration Number y ',%h Greenfield,MA 01302 —]I Q a' l- Address ( )775-9OU0 Expiratio Date Telephone 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...... ❑ RISE ENGINEERING' OWNER AUTHORIZATION FORM 1, Mark Augarten (Owner's Name) owner of the property located at: 253 Crescent Street (Property Address) Northampton, MA 01060 , (Property Address) hereby authorize JAS contractor) 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. Own rs Signature Date RISE Engineering,a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 1 Canton, MA 020211339-502-6335 www.RISEengineering.com 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: Q53 CrQ<,u-o - S1-5--q k�- The debris will be transported by: L�Obv\& L)'c 7 The debris will be received by: Building permit number: Name of Permit Applicant6)ublLL 71 M UAA- 1 Date Signature of Permit Applicant ' \ The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aaalicant Information Please Print Lezibly Name (Business/Organization/Individual): Bryan Hobbs Remodeling LLC Address: PO Box 1535 City/State/Zip: Greenfield, MA 01302 Phone#: 413-775-9006 Are you an employer?Check the appropriate box: Type of project(required): I.E]I am a employer with 7 employees(full and/or part-time).* 7. []New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.a I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E]Building addition 4.❑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 are sole I L❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.DOther weatherization 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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 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. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Selective Insurance Co. Policy#or Self-ins.Lic.#: W(Ct9057270 " � �A- Expiration Date: 10/20/2019 �/� (� Job Site Address: a5' Lu ,`U� &A—- City/State/Zip: &o ('' i�v Attach a copy of the workers' compensation policy declaration page(showing the policy number and expira on date). O 1510 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 pains and penalties of perjury that the information provided above is true and correct. Signature: a4A 0.0 1 Date: Phone#: 413 5-9006 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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACORO0 DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 07/25/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Adina Edgett Webber&Grinnell PHONE MI 00,Ext (413)586-0111 arc,No: (413)586-6481 8 North King Street r-MAIL s: aedgett@webberandgrinnell.com INSURER(S)AFFORDING COVERAGE NAIC N Northampton MA 01060 INSURER A: Selective Ins CO Of S Carolina INSURED INSURER B: Selective Ins Co Of America 12572 Bryan Hobbs Remodeling,LLC INSURER C: Selective Ins Co of Southeast 39926 346 Conway Street INSURER D: INSURER E; Greenfield MA 01301-1516 INSURER I: COVERAGES CERTIFICATE NUMBER: Exp 08/19 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSR TYPE OF INSURANCE INSD POLICY NUMBER MM/DD EFF MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 15,000 A S2289042 08/04/2018 08/04/2019 PERSONALS ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑JECT LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ B OWNEDX SCHEDULED AUTOS ONLY AUTOS A9105300 08/04/2018 08/04/2019 BODILY INJURY(Per accident) $ X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Underinsured motorist BI $ 20,000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR ICLAIMS-MADE S2289042 08/04/2018t/04/2019 AGGREGATE $ 2,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN X STATUTE ER 500,000 C ANY CERIMEMB R EXCLUDED? CUTIVE NIA WC9057270 Bryan Hobbs Excl. 10/20/2018 10/20/2019 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ry $00,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ COMMERCIAL PROPERTY Building $493,004 A S2289042 08/04/2018 08/04/2019 BPP $50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ®� Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-083982 Expires: 05102/2020 BRYAN G HOBBS , PO BOX 1635 GREENFIELD MA 01302 Commissioner Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Individual BRYAN HOBBS Registration: 139564 D/B/A BRYAN HOBBS REMODELING Expiration: 07/22/2019 346 CONWAY ST GREENFIELD,MA 01301 Update Address and return card. Mark reason for change. L7 m toVM ent El!_oAt-Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 139564 07/22/2019 10 Park Plaza-Suite 5170 BRYAN HOBBS Boston,MA 02116 D/B/A BRYAN HOBBS REMODELING BRYAN G.HOBBS �2 346 CONWAY ST , GREENFIELD,MA 01301 Undersecretary Not valid without signature