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29-054 (3) 36 GILRAIN TER BP-2020-0449 GIS#: COMMONWEALTH OF MASSACHUSETTS Man:Block:29-054 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-2020-0449 Project# JS-2020-000763 Est.Cost:$345.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BRYAN HOBBS 83982 Lot Size(sg.ft.): 14810.40 Owner. BERNINI GIA H Zoning: Applicant. BRYAN HOBBS AT. 36 GILRAIN TER Applicant Address: Phone: Insurance: PO BOX 1535 (413) 775-9006 WC GREENFIELDMA01301 ISSUED ON.10/9/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSULATE ATTIC DOOR, STAIRWELL, AIR SEAL 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 10/9/2019 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner �UIJ (W Department use only r City of Northa pton �� 7ee rmit: r Building Depa me v ay Permit L. -A 212 Main reet c^ c Availability Room 00 �Oi vailability Northampton, A lT Structural Plans phone 413-587-1240 Fax - ns44,4rfy APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE ORD SH A®®ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION pt,a- ao- q q9' 1.1 Property Address: This section to be//c+�o�mplete by office G� ,t Y-oo' Tc rrace- Map Qq Lot V� Unit �l�n� ' A ,"1� C) Zone Overlay District 1 '` 1 L�Lp Z Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPiAUTHORIZED AGENT 2.1 Owner of Record: \ rc,.I 1 e r CC,( -e �lyrer� Name(Print) Current Mailing Address: L-1)X,- `z19 9 Telephone Signature 2.2 Authorized Agent: YUnn blr�� l01 �o 6�u L53� C�r�en1cQ, 1�tR o► �z Name(Print Current Mailing Address: -7::�X2,j C' Y1"3- '715-9oc�� Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 345 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 6a 5. Fire Protection 6. Total =0 +2+3+4+5) a` Check Number This Section For Official Use Only BuildingPermit Number: Date Issued: Signature: d /9/)9 IV I Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) I SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) Roofing Or Doors I] Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[] Siding[O] Other[IK Brief Description of Proposed Work:�Icj 1OC'0h, hack '4- Q � .l�sT 1Cl$��.s1�2-5�.�% i.rA) 6u $�(_o 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, A ion S as Owner/Authorized Agent FiereblTeclare 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. mann Print Name Signa u of Ow er/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ebbs Not Applicable ❑ Name of License Holder: Yl x(1(1 ebbs C S - U 6 3 q �K Z License Number �a (50)c 153 C�i^ePn �!', MIA o►3Uz SIz,) 2,n Address Expiration D e q-' CX Si6n-aturei Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ T) U Lc ac odjjn,, IC3 (opyS- COmpay Name Registration Number HA 61 (.Q�LS"� 7_� Address Expiratio6 Date Telephone y�3 �� !U(y(e 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 buildipeermit. Signed Affidavit Attached Yes....... No...... ❑ RISE ENGINEERING_ OWNER AUTHORIZATION FORM 1, Gia Bernini (Owner's Name) owner of the property located at: 36 Gilrain Terrace (Property Address) Florence, MA 01062 (Property Address) hereby authorize (S contractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtail a building permit and to perform work on my property. This form is only valid with a signe contract. Owners nature I -- J Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 1 Canton, MA 020211339-502-6335 www,RISEengineering.com J�� /_ilt/�?/�?l�/?LL�PCl'CL��. `'(JCC�i�.iCz•C�?LL�G��r� Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 196045 BRYAN HOBBS REMODELING,LLC. Expiration: 06/25/2021 P.O.BOX 1535 GREENFIELD,MA 01302 Update Address and Return Ce SCA 1 0 2OM•05/17 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; Reaistratton FxnlrAtlon 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 �a / - 576 LEYDEN RD l Not valid without signature GREENFIELD,MA 01301 Undersecretary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-083982 Expires: 05/02/2020 BRYAN G HOBBS PO BOX 1636 GREENFIELD MA 01302 Commissioner V^ The Commonwealth of Massachusetts Department of 144strialk0dents I Congress Street, Suits 100 Boston, M4 011144017 www.mass.gov/d!a Wovk6rs' Compensation Tnsuranae AffldaWtl 13Ullder8/C0ntractors/Elictr1clA ns/ftMbars. TO BE FILED'WITH THE PEILI4ITTItiG AL'THOTtIT1', Name (Business/Organization/Individual); Bryan Hobbs Remodeling LLC Address. PO Box 1635 City/State/Zip: Greenileld, MA 01302 Phone#; 413-775. 006 Are you au employer?Check the appropriate boxi I,Q i an aemployorwith ry employees(full and/or part•time6° Type of rojeet (required); IrlI am a sole proprietor or partnership and have no employoes working for me in 7' ❑N w c 9t1'uCt10n any capacity.(No workers'comp,insurance required,] 8 ❑ Remodeling 3.01 am a homeowner doing all work myself iNo workers'comp insurance required j' 9• ❑A moll ion 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. i will 10 ❑ Btlildin addition ensure that all contractors either have workers'compensation insurance or are sole 1 L El Ctl'i 1 repairs or additions proprietors with no employees. 5,rl Iain a general contractor end 1 have hired the sub-contractors listed on the attached sheet. 12.❑P 1 ambii repairs or additions These sub-contractors haw employees and have workers'comp,insurance,; 13.❑Roof repairs 6,❑We are a oorporuion and its ot)heers have eseroised their right of exemption per MGL c. 14,IZ0 her Welitherization 151.,§1(4),and we have no employees.[No workers'comp,insurance required,] Any applicant thataheoki box N1 must also fill out the section below showing their workers'compensation policy inforina'on. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a r c art davit indicating auch, tCoatraotore that eheok this box must attached an additional sheet showing the name of the subcontractors and state whethe or nol those entities have em loyea. If the sub•contraotors have em loyeas,they mus PrOvidil choir workers'comp,policy number. I ams an employer that is providing workers'compensation Insurance for me 1 formadon. y mployees. Below 1j,the holicy andJob site Insurance Company Nemo: selective Insurance CO. Aolloy 0 or Self-ins.Lio,* WC9087270 Expiration Date; 10/20/2019 Job Site Address: Attach a copy of fhb workers' compensation policy declaration page(showing tthetpoli�y numt or and expiration date), lo�oZ Failure to secure coverage as required under MGL c. 152, PSA is a criminal violation punishable by a fille ftp to$1,500.00 and/or one-year itnprisont'nent, as well as civil penalties in the form of a STOP WO UORDER in 'Of UP to$250.00 day against the violator.A copy of this statement may be forwarded to the Office of Investigat ons f the IA for i eurence a cove verification, !do hereby eert{�y undrr the pales and pen allies of p¢r/ur) that the i>ZJormation provided above i true nd correct. Sign Phone 413-776-6006 OfflClai use onKy, Do not wrlts in this area,to be completed by elq,or town officlal. City or Towns IBSU1ngAUthorlty(circle one)r Permit/License N 1,Board of Health 2,Building Department 3. City/Town Clerk 4,Elect b.Other rical Inspeetar S, tum p ng Inspector A ® DATE /DD CERTIFICATE OF LIABILITY INSURANCE 7/18la/z019 o19 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). ONTCT PRODUCER NAME: Adina Edgett Webber & Grinnell PHONN E (413)586-0111 ac Ne: (413)586-6481 8 North King Street AIL ADDRESS: aedgett@webberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA:Selective Ins Co of S Carolina 19259 INSURED INSURERS:Selective Ins Co of America 12572 Bryan Hobbs Remodeling, LLC INSURER C:Selective Ins Co of Southeast 39926 PO BOX 1535 INSURER D: INSURER E: Greenfield MA 01302 INSURER F: 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 SUBR POLICY NUMBER MM DD/YYYY MM DDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO A CLAIMS-MADE FX OCCUR -PREMISES (EaEoccuDence $ 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❑ PRO JECT [7LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS IX AUTOS A9105300 8/4/2019 8/4/2020 BODILY INJURY(Per accident) $ X NON-OWNED PerOPERec tlenDAMAGE $ HIREDAUTOS AUTOS Underinsured motorist 81 split limit $ 20,000 A X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE S2289042 6/4/2019 8/4/2020 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N I A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? 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 BrY an Hobbs is Excluded E.L.DISEASE-POLICY LIMIT $ 500,000 D DESCRIPTION OF OPERATIONS/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 W Grinnell, CPCU, CIC {./1 J ' , ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) The Commonwealth of 3jaSS40husetts Boa?d o f Building Regulations and Standapds Massachusetts State Building Code, 780 CMR DEBRIS REMOVAL FORM Section 105,3,12 780 CMR, Massachusetts State Building Code states; a permit for the demolition,renovation,rehabilitation,or other alteration of a buildinigi or sof issuing tructure, M.G.L. Ch, 40 § $4,requires that the debris resulting there from shall bo disposed of in a r licensed said waste disposal facility as defined by M,G,�,, c,l l 1, § 150 A,i properly Dates Permit Number Job Location: �— Location o aoility or Waste Disposal C mpy s Noma and Address Signature Perm4Applcant Print ame