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11A-045 (2) 50-52 FRONT ST BP-2020-0663 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: l IA-045 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO N OT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2020-0663 Prosect# JS-2020-00112f Est.Cost: $3048.00 Fee: $65.00. PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BRYAN HOBBS 83982 Lot Size(sg.ft.): 20865.24 Owner: PIPPIN ROSE M Zoning: URA(100) Applicant. BRYAN HOBBS AT. 50 - 52 FRONT ST Applicant Address: Phone: Insurance: PO BOX 1535 413 775-9006 WC GREENFIELDMA01301 ISSUED ON:11/22/2019 0:00:00 TO PERFORM THE F LLOWING WORK.INSULATE ATTIC, AIR SEAL, VENTILATION POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspec or of Wiring D.P.W. Building Inspector Underground: Servic Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smok : Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occubangy Signature: Feer e: Date Paid: Amount: Building 11/22/2019 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner CJGA -7`/t) V Department use only �~ City of North pt Status of Permit: 4 -% Bui ding Dep rtm nt veway Permit 212 Main' tree r/Sep is Availability Room 00 Nov �® Wa rNV- Availability. Northampto MA 1060 2019 Tw Sets of Structural Plans " phone 413-587-124 Fadi' -1272 PI t/Site Plans her S ecif T IAlSp 7 APPLICATION TO CONSTRUCT,ALTER,REPAIR, :.NO q DEMO ISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section,to be completed by office 1.1 Property Address: 4 Map Lot Unit �JIJ� Zone Overlay District Elm St:District CB District SECTION 2-PROPERTY"OWNERSH P/AUTHORIZED AGENT 2.1 Owner of Record: Vl SU- MA Name(Print), Current Mailing Address: y1 - ���- ate Telephone Signature 2.2 Authorized Agent: Q Name(Print)T Current Mailing Address: y1� -��-12Gobt,. Signature Telephone SECTIONS-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. BuildingOC' (a)Building Permit Fee" —1 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) 4 , 9q Check Number This Section For Official Use Only Building Permit Numb ate er�1" �� / IIsssued: Signature: Xvauo�) Building Commissioner/Inspector of Buildings Date EMAIL ADD ESS (REQUIRED; EITHER HOMEOWNER OR-CONTRACTOR) i G SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) EJ Roofing D Or Doors E] Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks U71 Siding[0] Other[� Brief Description of Propose Work: Alteration of existing bedroom Y s No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa. 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 un t: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new c nstruction. 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 b Dlow finished grade k. Will building conform to the Buildin 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 relati a to work authorized by this building permit application. Signature of Owner Date I ( ,as Owner/Authorized Agent hereby 6clare that the statemei its and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Si ned under the pains and penalties f perjury. Print ame 1•� q Signature of 0 ner/Agent Date SECTION 8-CONSTRUCTION SERVI ES 8.1 Licensed Construction Su erviscr: Not Applicable ❑ Name of License Holder: �a `� n License Number Address I Expiration Date . vt Signature Telephone ,9. Registered Home Improvement Contractor: Not.Applicable ❑ : 19(�cs�r Cd—mpanY Name Registration Number Address Expirati6 Date Z i Telephone —77,�-" c/u-�-Lo _ SECTION 10-WORKERS'COMPENSI TION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affi�avit 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.......ZIK No...... ❑ RISE ENGINEERING W THORIZATION FORM I, Rose.Pip ink (owner's Name) owner of the property lobated at: 50 Front-Street ( roperty.Address) Leeds MA 04053 ( roperty Address) hereby authorize (�u contractor) - an authorized scbcontr otor for RISE Engineering.,to act on my behalf-to obtain a building permit and to perform work.on mY property.This form is onl .valid with a sned:contraot, t l u Ow or' Signature Date _. - .RIS. Engineering,a Division of Thlelsch Engineering, Inc. 60 Sha mut Road Unit 2 1 Canton, MA.02021 S39-502-E335 www.RISEengineering.com RISE - . ENGINEERING OVINER AUTI- ORIZA'1 ION CORM (c wnQrame� owner of the prApctty located at. 52 Front-Street —=--- -- ( roperty Address) - Leeds, MA 01053 ( raperty Address) - hereby authorizeOwns. ( u onfraotor .an authorized sabcontraotor for RISE Engineering,to act on my behalf to obtain a building permit and to perform V ork-on myproperty.This farm is only valid with a signed contract. r Owe Signature Date. RISE Engineering,a Division of Thielsch Engineering, Inc. 60 Shamut Road Unit2 Canton, MA_02021 339-502=6335 www.RISEengiheering.com Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts: 02118 Home Improvement Contractor Registration Type: LLC Registration: 196045 BRYAN HC BBS REMODELING,LLC, Expiration: 06/25/2021 P.O.BOX 1535 GREENNE LD,MA 01302 Update Address and Return Ca SCA 1 45 20M-06117 Office of consumer A fairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only T1ration I PE-.LLC before before the expiration date. If found return to: I Office of Consumer Affairs and Business Regulation 4960 06/25/2021 1000 Washington Street -Suite 710 BRYAN HOBBS REMO FLING,I.I.C. Boston,MA 02118 BRYAN HOBBS 576 LEYDEN RD Not valid without signature GREENFIELD.MA 013 31 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 s=w GREENFIELD MA 01302 $ `' Commissioner AJLI The Commonwealth of Massachusetts Department of Industrial Accidents F. Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensatio Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Indivi ual): Bryan Hobbs Remodeling, LLC Address: P.O. Box 1535 City/State/Zip: Greenfield, M� 01302 Phone #:413-775-9006 Are you an employer? Check thelappropriate box: Type of project(required): 1.® I am a employer with 7 4. ❑ I am a general contractor and I employees(full and/or part-ti e).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partn r- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capaci y. employees and have workers' 9. ❑ Building addition [No workers' comp. insurancc comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all m ork officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no Weatherization employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also f 11 out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indic iting 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. I am an employer that is providing orkers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: elective Insurance Co WC94.7270 10/20/2020 Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: fr-, - 5Z k- c, - City/State/Zip: Cep d S, Hi-- Attach zAttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 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 of up to $250.00 a day against the vi lator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb i y under thepains ndpenalties ofperjury that the information provided above is true and correct. nat Si ure: Date: Phone#: 413-775-9006 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 IDepartment 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: ACORbr CE iTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/10/2019 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 'DDITIONAL INSURED,the policy0es)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certin policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorseme t(s). PRODUCER CONTACT NAME: Atli na Edgett FAX Webber & Grinnell INC.Mo.PHONE Ext, (413)586-0111 A/C NO; (413)586-6481 B North King Street ADDRESS: aedgett@webberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC# 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 INSURER D: INSURER E: Greenfield MA 01302 INSURER F: COVERAGES CERTIFICATE NUMBER:Exp 08/20 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF IN URANCE 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 POLIC IES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AD L SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD/YYYY MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DA AGE ToRENTED A" CLAIMS-MADE FOOCCUR PREM SES Ea o Cu".nce $ 500,000 52289042 8/4/2019 8/4/2020 MED EXP(Any one person) $ 15,000 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 X POLICY E PRO LOC JECT 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 A9105300 8/4/2019 8/4/2020 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Per accident $ Underinsured motorist BI split limit $ 20,000 .UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONX PER OTH- ANDEMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? Y❑ C (Mandatory in NH) WC9057270 10/20/2019 10/20/2020 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under B an Hobbs is Excluded DESCRIPTION OF OPERATIONS below r E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES( CORD 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) The Commonwealth 01ma whuseas .Boa?d a fUldin0eguladons and standapds 'assachusetts State Building Code, 780 CUR DEBRYS RENIO'VAL FORM Section 105 3,2,2 780 CMR, Massaohusetts State Building Code states; 'i,, a aodition a A©rmit for the demolition,renovation,rehabilitation,or other alteration of a buildin or s MAL. Ch, 40 § $4,requires that the debris resulting there from shn11 be disposedof issuing licensed said waste dfsposal A01litY as defined by M.G.L.c.111, § ISO A,++ i �'op6rly, of in a properly ` Permit Number Job Looatiors; _ Looatloe of Faoll ty or VV ase Dleposal Compen 's Na Y me and Address 91grature a a it Applicsnt Print erne . rp+•s mBez«n c y 1 1�>1 1 nTr 1 F.,nmre vnOlVa 1 aese flalv7�AfyOonlOmeUa � 9 BIAS 1149T1 tbeelryQ�6fnCb�em 1� t4.88 At6T Il T9rd�l46t 1 61.11 0\t1T ' t�Fl)R lama 1 0.l6 0.)6T �mrn . . .. still). •u.6. � . . w.n �e.roMw. ..M.a•ou Total t(4as.A� Bay.loc.ImmNbNly.t(412)6"4737.olb.net....r.ale - ��►.d�weeuswM�Y..tauae.. pow �A anrfe.eF.q.d71Q7L Yae.h tdt.r 20 12%� , raGrr)awam�s�vua rc lnvoll:o - ism:e4A gBsi . i.6oECT . 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