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22B-108 (2) 194 SPRING ST BP-2020-0400 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22B- 108 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeory: INSULATION B UI LDING PE RM I T Permit# BP-2020-0400 Proiect# JS-2020-000680 Est.Cost: $311 1.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: BRYAN HOBBS 83982 Lot Size(sq.ft.): 31319.64 Owner. BRINE DAPHNE Zoning: URA(100)/WSP(100)/ Applicant. BRYAN HOBBS AT. 194 SPRING ST Applicant Address: Phone: Insurance: PO BOX 1535 (413) 775-9006 WC GREENFIELDMA01301 ISSUED ON.9/27/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-ATTIC INSULATION 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 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: FeeTvve: Date Paid: Amount: Building 9/27/2019 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 Permit: ` Building Department Curb Cut/Driveway Permit �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 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH /�A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION (b?— 'l/ --q 9V 1.1 Property Address: This section to be completed by office Map 'J Lot 0 Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: -Dap\-,w L�r►ne. Iqy Sr�Yl�,e s 'rforencQ, IA NamePint) Current Mailing A(dress: Die(413- g�I�l� Telephone Signature 2.2 Authorized Agent: '� lobs I&W 1 Sly C�1 i iR lc�, J�-ll�130 Name( int) Current Mailing Address: — Sign ure f Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building J 2 1 ` Z (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) W 5. Fire Protection 6. Total= 0 +2+3+4+5) �, °)Z Check Number This Section For Official Use Only Building Permit Number: Date Issued: 11 P Signature: X 7 ' / 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) Roofing ❑ Or Doors L] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [O] Other[p] Brief Description of Proposed Work: IU" atJe��, C �1�\ems C , lXn�,le.kur, C IxSLe�t. Q.x .hy1- be it, co'- Sr�o�►�rY Alteration of existing bedroom Yes 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 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, Yl�C1f1 .``rah 1 as Owner/Authorized Agent ereby eclare that the s atements 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. l Prin me V1 on 9 V4 Signa of Ow er/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ` — Not Applicable ❑Q -7 Name of License Holder: j �YUQn ��IF 7�Js CS - U�s -1�Z "�— License Number Address Expiration Date Signature I Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ cki 1 �- +�c� lel�,�, L.LL 191,co 4 5— Co-im Pahy Name Registration Number Address Expiren Date C f�?fl`CtkJle�, 1 C�)302 Telephone lW 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 buildin permit. Signed Affidavit Attached Yes....... No...... ❑ DocuSign Envelope ID:C1C784A9-95464F1F-BF09-793F2E1A72B9 R I S E v--- ENGINEERING- OWNER AUTHORIZATION FORM 1, Daphne Brine (Owner's Name) owner of the property located at: 194 Spring Street (Property Address) Florence, MA 01062 (Property Address) hereby authorize Y�l � �� 4� F LLL (Subc ntractor) 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. 0-11g—1 by- P'9�tfature 11/28/2018 13:57 PM EST Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 1 Canton, MA 020211339-502-6335 www.RiSEengineering.com 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 E xpf tali on: 06/25/2021 P.O.BOX 1535 GREENFIELD,MA 01302 Update Address and Return Card. SCA 1 0 20M•05117 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: Registration 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 ��ff Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-083982 Expires: 05/02/2020 BRYAN G HOBBS a PO BOX 1636 GREENFIELD MA 01302 Commissioner The Commonwealth of Massachusetts Department of Ind4strr?alk0dents 1 Congress street, Suite 100 aoston, Mid 02114-2017 www,mass,gov/dia Workers'Compensation Insurane6 Afficiavltl Bulldere/ContraCIO rsl&lec>;rlcla s/Pi mbers. TO BE FILED WITH THE PERMITTIN'G AUTHORITY. Name (Bualneaa/Organization/Individual): Bryan Hobbs Remodeling LLC Address: PO Box 1535 City/State/Zip: 131`eenfleld, MA 01302 pholle 0: 413.775.9006 Are you az employer?Check the appropriate boxi Type of roject(required); 1,2]I am a employer with 7 o"ployees(NII and/or part-time)," 2.7 I am a sole proprietor or partnership and have no erttploy-om workinj for me in 7' [1 N w e 9tt'uCt10n any capaoity.(No workers'oomp,insurance required,] 8 ❑ R modl ling 3,171 am a homeowner doing all work myself (No workers'comp insurance required 1 9• ❑D moli ion 4.71 am a homeowner and will be hiring contractors to conduct all work on tri e ro v 1 will 1 ❑ 13 ildin addition ensure that all contractors either have workers'compensation inwranoe or are soli proprietors with no employees. 11.❑E1Writ; 1 repairs or Additions S,rl I ant a general contractor and I have hired the subcontractors listed on the attached shoot. 12.❑P1 tubi g repairs or additions Those sub-contractors have employees and have workers'comp,insurance,; 13•❑R of re airs G.❑We are a corporation and its offloers have exercised their right of exemption par MGL c. 14,00ther WheriZAti0n 152,x11(4),and we have no employees.[No workers'comp.insurenee required,] #Any applicant that oheoks box M1 must also till out the section below showInQ their workers'compensation policy infortae'on. Homeowners who submit this attldavit indicating they are doing al(tivork and then hire outside contractors must submit a I ew aft davit indicating such. tContraotoro that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whethe or no those entities have employees, If the sub-eontraotore have em ]cysts,they must provido Choir workers'Qomp,Policy number, 1 ens an employer that is providing workers Information. 'eompensatlon insurance for my employees, Below 1 tine Policy andjob site Insurance Company Name; $AIeCtIVe InSuramee CO, Policy 0 or Self ins.Lio.* WC9087270 Expiration Date; 10/20/ 019 Job Site Address: ,� �13 Attach a copy of the workeolicy declaration page(showingtthetpolicy num or and expiration date), Failure to secure coverage as required under MGL c, 152,§25A is a criminal violation punishable by a fie tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER an a fln of up to$250,00 a day against the violator,A copy of this statement may be forwarded to the Office of Investigations f the IA for insurance covers a verification. !do hereby certo atrdrr the pains and penalties ojper/ury that the lVbrmatiox provided above is mare nd correct. sionatur7wP,'A . 47 3'.:T7 -90 8 y QI(jrlelalass onty. Do not writs to this area, to be completed by etq,or town ofylcial, City or Town: issuing Authority(circle ong)r Permit/License a L Board of Health 2,Building Dopartment 3, City/Town Clerk 4,Electrical Inspector S, lum ng Inspector b.Other TE A�® CERTIFICATE OF LIABILITY INSURANCE FDA7/(ia/2o 9' 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(ies)must 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 NAMCT E: Adina Edgett Webber & Grinnell PHOA/CNE E (413)586-0111 A Ne: ( 13)586-6481 B North King Street AIL ADDRESS: aedgett@webberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC if Northampton MA 01060 INSURER A:Selective ins Co of S Carolina 19259 INSURED INSURER B:Selective Ins Co of America 12572 Bryan Hobbs Remodeling, LLC INSURER c:Selective Ins Co of Southeast 39926 PO Box 1535 INSURERD: INSURER E: Greenfield NA 01302 INSURERF: COVERAGES CERTIFICATE NUMBER:Exp 10/19 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. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDD/YYYY MMIDONYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO A CLAIMS-MADE ❑X OCCUR PREM SE.(EEN Dente $ 500,000 52289042 8/4/2019 8/4/2020 MED EXP(Any one person) $ 15,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PROJECT a LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B ANYAUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS A9105300 8/4/2019 8/4/2020 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ Underinsured motorist BI split limit $ 20,000 A X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE S2289042 8/4/2019 8/4/2020 AGGREGATE $ 1,000,000 DED I I RETENTION$ $ WORKERS COMPENSATIONX PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? Y❑ N I A C (Mandatory In NH) WC9057270 10/20/2018 10/20/2019 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below Bryan Hobbs is Excluded E.L.DISEASE-POLICY LIMIT $ 500,000 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 �J lI W Grinnell, CPCU, CIC '�- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) _ City of Northampton S Massachusetts l 't DEPARTMENT OF BUILDING INSPECTIONS 9 212 Main Street •Municipal Building Jd. CD ti 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: 19H - ,rkn r_ �lYez-y (Please print house nu ber and street name) Is to be disposed of at: a Wcas -.- (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: CD( 7" S�- k I Cake (Company Name and Address) n? S5gnaturb of Permit Applicant or Owner 15ate 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.