42-030 (2) 779 WESTHAMPTON RD BP-2020-0071
GIS#: COMMONWEALTH OF MASSACHUSETTS
MW:Block:42-030 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2020-0071
Project# JS-2020-000117
Est.Cost:
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRYAN HOBBS 83982
Lot Size(sa. ft.): 79714.80 Owner: SHEPARD KEVIN&TARAH
Zoning: Applicant. BRYAN HOBBS
AT: 779 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
PO BOX 1535 (413) 775-9006 WC
GREENFIELDMA01301 ISSUED ON.7/19/2019 0:00.00
TO PERFORM THE FOLLOWING WORK.-AIR SEAL & INSULATE KNEEWALL SLOPE,
CRAWLSPACE CEILING, RIM JOINT & KNEEWALL GABLE; 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: OI: 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 7/19/2019 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2020-0071
APPLICANT/CONTACT PERSON BRYAN HOBBS
ADDRESS/PHONE PO BOX 1535 GREENFIELD (413)775-9006
PROPERTY LOCATION 779 WESTHAMPTON RD
MAP 42 PARCEL 030 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
LOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: AIR SEAL&INSULATE KNEEWALL SLOPE,CRAWLSPACE CEILING,RIM JOINT
&KNEEWALL GABLE,WEATHERIZATION
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
INFORMATION 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
emo y
Signature of Build' g O c' 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.
Department use only
,�. City of Northampton Status of Permit:
31
Building Department Curb Cut/Driveway Permit
I A 212 Main Street Sewer/Septic Availability
ROOM 100 Water/Well Availability
} Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PI t/Site Plans
ther ecify
APPLICATION TO CONSTRUCT,ALT R, R D OLI H A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION JUL 1 a 2019
1.1 PPrroopertyj Address.�(y� �,,nv This section to be completed by office
1 � "'" 'P NORTHAMPT00
DEPT.OF SUILDIN PECTIONS Lot 6�� Unit
Zone Overlay District
Ili �v Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Recoor�d,:, _
Name(Print) Cu r nt ailing Address:
Telephone
Signature
2.2 Authorized Agent:
046o s &M&Le a lot , U c
i t) Current Mailing Address:
`'j -1 V- 9 CX5 l�
Signa rure Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building U (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total =(1 +2+ 3+4+ 5) Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) RoofingEl
Or Doors E]
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding [O] Other[pe,
Brief Description of Pro o ed QX S4-&A i
Work: i &S\(�.t�p -,n g f �� 1 �k-PA �—C A'C'S l.�SL�<<.A_s'tit�,�, YI�;�i 5� ��ut,e 1Q.Q,�
Alteration of existing bedroom Yes -/ No Adding new bedroom Yes
Attached Narrative Renovating unfinished basement Yes 0
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, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I,/? A6421 � as Owner/Authorized
Agent ereby pec are that 1he 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.
?�M
Prin
Signatu Owner/ rent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable
❑
Name of License Holder:
License Number
� 4 a
ess Expiration Date
Signature Telephone
9.Re istered Home Improvement Contractor: Not Applicable ❑
19 L2 095-
bafifl9aMe Registration Number
kcu C I �� �� l
Address (� Expirati n Date
z 2= 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 buildipg permit.
Signed Affidavit Attached Yes....... No...... ❑
}` Permit Authorization
fx^rmass sage Form
.:^l:.a';kre<er5yh{:iroyt t5`e�;'z7ae2.:y.
Site ID: 3680244 Customer: KEVIN SHEPHARD
owner of the property located at:
(Owner's Name,printed)
779 Westhampton Rd Northampton MA 01062
(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,
Owner's Signature:
Date:
...0 I
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project;
Participating Contractor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
Page i of 1 For Office Use oniy
Rev.102015
elx;
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: LLC
BRYAN HOBBS REMODELING,LLC. Registration: 196045
Expiration: 06/25/2021
P.O.BOX 1535
GREENFIELD,MA 01302
Update Address and Return Card.
SCA 1 0 20M-05/17
.711-11
�rriviirviri rub/% ��. ��iriiirr/lair//•i
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:LLC before the expiration date. If found return to:
Reaistration Expiration Office of Consumer Affairs and Business Regulation
196045 06/25/2021 1000 Washington Street -Suite 710
BRYAN HOBBS REMODELING,LLC. Boston,MA 02118
BRYAN HOBBS /
576 LEYDEN RD
GREENFIELD,MA 01301 Undersecretary Not valid without signature
®� Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction Supervisor
CS-083982 Ej[plres: 0502/2020
BRYAN G HOBBS
PO BOX 1535
GREENFIELD MA 01302
Commissioner
i
rhe Commonwealth of Massachusetts
Department of IndustrialAcc�dants
1 Congress Street, Suite 100
Boston, MA 01114-2017
www,mass,gov/die
Workees' Compensation Insurance AfMCIPM BUIlaers/Contractors/Electricia s/,Plumbters.
TO BE FILED WITH THE PERVIITTItiG AUTHORITY.
Applicant Information I'lease Print Legibi
Name (Business/Organization/Individual): Bryan Hobbs Remodeling LLC
Address: PO Box 1535
City/State/Zip: Greenfield, MA 01302 Phone 4: 413-775.9006
Are you an employer?Check the appropriate box;
Type of roject (required);
LQ i am employer with 7 employees(full and/or parttime),« 7, ❑ N w construction
2.7 I am a sole proprietor or partnership and have no employees working for me in
any capacity,(No workers'comp, insurance requires J 8. R modeling
3,71 am a homeowner doing all work myself [No workers'comp insurance required)+ 9• ❑D molition
471 am a homeowner and will be hiring contractors to conduct all work on my propvm'. 1 will 10 B ilding addition
ensure that all contractors either have workers'compensation insurance or are sole 11.❑El etrical repairs or additions
proprietors with no employees.
aS.M Tam a general contractor and I have hired the subcontractors listed on the attached sheet. 12. P1 robing repairs or additions
These sub-contractors have employees and have workers'comp,insurance,; 13.0 Roof repairs
6.❑we are a corporation and its officers have exercised their right of exemption per MGL a 14,[Z Other weatheri2Btion
152,X1(4),and we have no employees.[No workers'comp.insurance roquired,J
;Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infonna on,
;Any
who submit this affidavit indicating they are doing all work and then hire outside contractors must submit acw affidavit indicating such
tContractAril that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whethe or not chose 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 insura
Information. nce for my employees, Below i the policy andJob site
Insurance Company Namc; Selective Insurance Co,
Policy#or Self-ins.Lic.#; WC9087270 10/20/2019
Expiration Date;
Job Site Address: �?S�h�Y1� r rn City/State/Zip,
Attach a copy of the workers' compensationpo
icy declaration page(showing the policy num er and expiration date
Failure to secure coverage as required under MGL c, 152, §25A is a criminal violation punishable b a fine up to$1,500.00,
and/or one imprisonment, as well as civil penalties in the form of a STOP WORK ORDER an a fine of up $ ,500,00 a
day against the violator,A copy of this statement may be forwarded to the Office of Investigations f the DTA for insurance
covers a verification,
I do here b c tl y under the pains and penalties of per,/ury,rh at the lnformatlon provided above true and correct.
i
P bo no
413- -9006 D to
Officlal use only. Do not write in this area, to be completed by city or town offlclal,
City or Town: Permit/License
Issuing Authority(circle one). — -----
1.Board of Health 2.Building Department 3, City/Town Clerk 4,Electrical Inspector S, Plumbing Inspector
6.Other
Contact PArAnn!
'4��� CERTIFICATE OF LIABILITY INSURANCE OATE(MMDDIYYYY)
THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS"UPON CERTIFICATE HOLDER.TH07/2512018
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE HE CERT 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 cartlIVED, holder la an ADDITIONAL INSURED,the policy(lec)must have ADDITIONAL INSURED provisions Or be endorsed,
If SUBROOAT{ON IS WAIVED,subject to the terms and condltlons of the policy,certain policies may require an KED provisions
A Otbo and t on
ae
thla certificate does not confer rights to the certificate holder In lieu Of such ondorsomont(s),
PRODUCER
Webber&Grinnell c MTA Adina Edgett
a"oNe
A North King Street (413)586.0111t'.•MAIL AtC No): (413)58e-8481
ADOREss: aedgett�webberandgrinnelLCOm
Northampton MA 01080 INSURERS AFFORDING COVERAGE NAIC N
INSURED INSURER A: Selective Ins CO Of S Caf011na
i
Bryan Hobbs Remodeling, LLC INSURER e: Selective Ins Co ofAmerica
12572
349 Conway Street INSURER C: Selective Ins Cc of Southeast 3992e
INSURER D:
Greenfield INSURER E
MA 01301-1518
COVERAGES INSURER F
CERTIFICATE NUMBER; Exp 08/19
THIS IS TO CERTIFY THAT THE POLICIES DF INSURANCE LISTED BELOW HAVE Biiii EEN ISSUED TO THE INSURED NAMED A OE E REVISION
HE PNUMOLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM CR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VV TH 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.
TR TYPED,INSURANCE
LI LIC
X COMMERCIAL GENERALL�ABILITV POLICY NUMBER MMOD� MMDD/YYYY
LIMITS
CLAIMS-MADE 7x OCCUR EACH OCCURRENCE $ 1,000,000
P a occurrence s 500,000
A
82289042 MED EXP An one 111 5 15,000
GENL AGGREGATE U 08/04/2018 08/04/2018MITAPPLIESPER: PERSONALBADVINJURY § 1,000,000
X POLICY 1:1 JE ❑LOC GENERAL AGGREGATE s 2,000,000
OTHER: PRODUCTS•COMP/OPAGG t 2,000,000
AUTOMOBILE LIABILITY
a
ANYAUTO COMBINED SINGLE LIMIT
Eaa id s 1,000,000
3
OWNED OS ONLY X SCHEDULED A8105300 BODILY INJURY(per person) b
XHIRED AUTOS 08/04/2018 08/04/2019 BODILY INJURY(Per accident) $
AUTOS ONLY X AU70S ON LY
AUTOS ONLY
PROPERTY DAMAGE
$
X UMBRELLA LAB OCCUR Underinsured motorist BI S 20,000
EXCESS LIAB CLAIMS-MADE 52289042 CCC
RETENTION
HOURRENCE 1,000,000
08/04/2018 08/04/2019 EAAGGREGATE $ 2,000,000
eo
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY S
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N X PER
TE
(MandaOFFICtory
In N ) EXCLUDED? N/A WC9057270 Bryan Hobbs Excl. 10/20/2018 10/20/2019
(Mandatory In NH) ry E.L.EACH ACCIDENT S 500,000
Ir ea,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYEE $ 500,000
COMMERCIAL PROPERTY E L.DISEASE-POLICY LIMIT $ 500,000
S2289042 Building $493,004
08/04/2018 08/04/2019 BPP
$50,000
ICRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,gddltlonal Remarks Schatlule,may be aBecMd If more space is required)
tTIFI ATE HOLDER
CANCELLATION
SHOULD A7OFTHEOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRHEREOF,NOTICE WILL BE DELIVERED IN
ACCORDAPOLICY PROVISIONS.
AUTHOR¢;;R
RD 29(2016103) The ACORD name and logo are registered marks of ACORD
1b ACORD CORPORATION. All rights reserved.
2018 WEATHERIZATION
mass save' BARRIER INCENTIVES
Savings through energy efficiency
Based on your Energy Specialist's recommendations,your home can benefit from program-eligible insulation and/or air sealing
improvements.Before moving forward,please follow all the instructions below to remediate your weatherization barriers.
CUSTOMER INSTRUCTIONS
1. Hire a qualified,licensed contractor to evaluate and/or remediate the weatherization barrier(s).
2.Submit signed and completed copies of this form and a copy of the paid contractor invoice(s)within 60 days of your Home Energy
Assessment to:Pre-Wx Barrier Incentive,c/o CLEAResult,50 Washington Street,Suite 3000,Westborough MA 01581
or email to prewxofferoclearesutt.com.
3.The weatherization incentive will be deducted from the customer co-payment amount of the weatherization work.A rebate check will
be Issued In the event the amount exceeds the customer's co-payment amount.
A.Complete the recommended weatherization improvements.
CUSTOMER +• •
Customer Name: Kevin Shepard Client#or Site ID: 3680244
Site Address: 779 Westhampton Rd City, Florence State: MA ZIP:01062
Phone Number: ars seg-sse5 Ermall. shepmedic@yahoo.com
��• �yt�f vt�k�'�"o" S icy �.
KNOB AND TUBF WIRING
To determine if there is any active knob and tube wiring,the contractor will evaluate the following areas where eligible Mass Save`
weatherization recommendations have been made:
M Attic Floor M Attic Wall E Attic Slope F Exterior Wall S Basement E Other:Crawlspace Ceiling ❑Other:
?tl,F iri£.J.ii,.i 17?i?CI`I:'.', .i:L'•.c,.
4J I have performed my inspection and determined there Is no active knob and tube wiring in the areas selected below.
ARAttic Floor IZAttic Wall IfAtticSiope io Exterior Wall rd Basement MOther: ❑Other:
b t%F r:;IdK:dU•4v rhu-C,r,:in:;AC 1-iE,.,•pi::r
�•1 have read and agree�to/�the Term i and Conditions on the back of this form.
Contractor Name:
Address: L-2 /!S 40 k- �'�� _ ,City: � 7��+rtZ,t.f'GI��^,/ state:�fiAA zip: � (S�73
�Y 1
Company Name: 4(4 r 1 r7 G,A C License Number: yl�4J —1S
MECI IANICAL SYSTEM BARRIERS'k,be 101-d oul 13Y
High Carbon Monoxide:Contractor is to service and re-evaluate the selected mechanical systern(s)and reduce the carbon monoxide level,
as measured in the undiluted flue gas,to below 100 parts per million(ppm),
Draft Failure:Contractor is to correct the draft in the selected flue(s).Refer to table on reverse for acceptable draft ranges.
High Carbon Monoxicic., Draft Failure
He ,tirig Siistsrrt'
Hpf Waiter.Heeter
ffii
Spillage:Contractor is to correct the spillage of flue gases in the selected mechanical system(s).Must riot spill after 60 seconds of operation.
❑ Heating System ❑ Hot Water Heater ❑ Other:
❑ 1 have performed my inspection and have corrected the items noted in the areas selected above.
Cl I have read and agree to the Terms and Conditions on the back of this form.
Contractor Name:
Address: City: State: ZIP:
Company Name: License Number:
AA
NMI
Continued on back
(page 1 of 2)
City of Northampton
r Massachusetts ��?S
{ DEPARTMENT OF BUILDING INSPECTIONS �.
212 Main Street •Municipal Building
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�U )eS4)u2qp,h,3 CO
(Please print house number and street ame
Is to be disposed of at:
0 az�'Q C 42 46-1
Please rin ame and location of facilit S+Hoj-r,, 44(�,14Uj--
( P y)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
T':::�)wq,,
ature Permit Applicant or Owner Date
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.