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18C-116
46 ALLISON ST BP-2021-0093 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C- 116 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-2021-0093 Project# JS-2021-000144 Est.Cost: $2844.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BRYAN HOBBS 83982 Lot Size(sg. ft.): 9539.64 Owner: MARTIN JOHN H TRUSTEE Zoning: URB(100) Applicant: BRYAN HOBBS AT. 46 ALLISON ST Applicant Address: Phone: Insurance: PO BOX 1535 (413) 775-9006 WC GREENFIELDMA01301 ISSUED ON.7/24/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.•INSULATIONNVEATHERIZATION 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 7/24/2020 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner F The Commonwealth of Massy etts VIC", Board of Building Regulationsan a aha FOR Massachusetts State Building Code;. ? M�JNICIPALITY Mnl ��in USE Building Permit Application To Construct,Repair,Reno 0>, a evised Mar 2011 One- or Two-Fandly Dwelling �r�s�oNs This Section For Official Use Only Building Permit Number: t> 73 Date A lied: c-U 1 tJ �, 7 2y wzv Building Offtelal(Print Name) Signature bate SECTION 1:SITE INFORMATION 1.1 Proper Address: 1.2 Assessors Map&Parcel Numbers .� 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zealr*Dlstrict Propowd Ilse E t Area(oq A) Fr'oatsgs(A) 1.3 Building Setback*(A) Front Y"d Sulo Yards' — Rear Yard il!•squ4vd Previdsd Raquirad Provided Required Provided 1,6 Water Supply:(tv1,O,L e,40,154) V Mood Zone Information; 1,9 Sewage Disposal Systanas public D Private Q . zones . Outside Flood Zone? Municipal 13 On site disposal system( D Cheek if yesM 59CTION Zt PROPERTY OW1VEltBURI 2. Owners of Records Name(Print) -city,state,zn> -- �-IlD ��l�c�'1 S� X13-Ln�1S�— o1c�IS� _ • No.and Street Telephone Erna i Andress SECTION 3;DESCRIPTION OF PROPOSED WORK'(check all that apply) New Commotion. l'r�tietltld Building D Owner-Occupied t� 'Repairs(s) p Alteratiom(r) 0 Addition D -- Domontion D Aaaep pry Bldg,D Number of Limits Othcr Spaaify:_ Briofl)escripoon ofProposed Work2: "' SECTION 4:ESTAYIATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only - Labor and Materials) I.Building S y� 1. Building Permit Fee: S Indicate low tee is determined: 2,Electrical $ O Standard City/Town Application Fee Q Total Project Cost'(Item 6)x multiplier x 3.Plumbing S 2. Other Fees: S 4.Mechanical (HVAC) S List: 5.Mechanical (Fire Suppression) Total All Fe�s:3, Check No.1` Check Amount: Cash Amount: 6.Total Project Cost: S (� X10 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5. onstruction Supervisor License(CSL) Z�ZZ- License Number Expiration Date Name of CSL Ho der List CSL Type(see below) ' l No and Street Type Description r-�(\ p Q11 o' a ,� /\I o Z U Unrestricted,2(Buildings s u to Dwelling cu,ft.) City/Town,State,ZIP ]� lJ R Restricted l&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding b�yanlrwlobs�cmltny e SF Solid Fuel.Buming Appliances q 1(7o`p I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(AIC) IG(v()u �" Cd 7—s HIC Registration Number Exlikation Date' Com ny Name or HIC Registrant Name T o � _ N and Street —1 7� a�o �Y rU Ct/1h� x r�fYw L�C) (�y A1,O � G'3w— City/Town, ! Email address City/Town,State,ZIP Telephone SECTION 6: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.......... D-� No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S 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. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. F`� l Print er's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an o«ner who hires an unregistered contractor (not registered in the Home Improvement Contractor(RIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass_aov/oca Information on the Construction Supervisor License can be found at N-.ww.mass.£ov/dns 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" i RISE ENGINEERING OWNER AUTHORIZATION FORM I, John Martin (Owner's Name) owner of the property located at: 46 Allison Street (Property Address) Northampton, MA 01060 (Property Address) hereby authorize ` \Q�l 4&. 2-S � ytis UL (Subcontractor) 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. DocuSignned by. J -L OAL r l�a1ta' Q;vgg�,gigMture 5/19/2020 1 11:24 AM EDT Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 1 Canton, MA 02021 1339-502-6335 www.RISEengineering.com -- Tlie Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumber Applicant Information Please Print Leeih Name (Business/Ot•ganization/Individual): Bryan Hobbs Remodeling, LLC Address: P.O. Box 1535 City/State/`Lip: Greenfield, Ma 01302 Phone #:413-775-9006 _ Are you an employer? Check the appropriate box: Type of projecter quired): L® I am a employer with 7 4. ❑ 1 am a general contractor and 1 employees(full and/or part-time). * have hired the sub-contractors 6. New construction 2.[] 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.¢ required.] 5. cot We are a oration and its 10-F] Electricalrepairs or adc ❑ p 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or adc myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] ' c. 152, §1(4), and we have no Weatherizat employees. [No workers' 13.® Other __ior_ comp. insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers•compensation policy information. `I lomcowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating sue �Conu•actoi:s 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. Iftile sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for My emplgpees. Below is the policy and joh s, information. Insurance Company Name:____._ Selective Insurance Co Policy #or Self-ins. Lic. 4. WC9057270 Expiration Date: 10/20/2020 .lob Site Address: 11Scn S� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration d Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties line up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER anc Of tip to $250.00 a day against the violator. 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 here rtify under the pains and penalties of perjury that the information provided above is true and correct. Si*nature: Date: Phone#: 413-775-9006 Of ficial use only. Do not write in this area,to he completed kv 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#: 4C"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 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 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 CT N ME: Adlna Edgett Webber & Grinnell PHONE (413)566-0111(AIC-No-EXtI1 AC No: (413)586-6481 8 North King Street ADDRESS, aedgett@webberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: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: THIS9S 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. 'NSR ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER YYY Y X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE �OCCUR DAMAGE TO RENTED 500,000 PREMISES Ea occurcence $ S2289042 8/4/2019 8/4/2020 MED EXP(Any oneperson) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY F PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 X JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 fEa acrdent) ANYAUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS X AUTOS A9105300 0/4/2019 6/4/2020 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIREDAUTOS X AUTOS raccident) Underinsured motorist BI split limit $ 20,000 X UMBRELLA LAB X OCCUR 52289042 3/4/2019 6/4/2020 EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION $ WORKERS COMPENSATION X PERTUTE OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETORIPARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 500,000 (MandaOFFICEtory in H)EXCLUDED? WC9057270 10/20/2019 10/20/2020 E.L.DISEASE-EA EMPLOYEE $ 500,000 C (Mandatory in NH) If yes,describe under Hobbs is Excluded DESCRIPTION OF OPERATIONS below Hr Yan E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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 i.�// J V•�I� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) The Cote 3oa�d D manwealth ofAassachusett,� �1a'ssao�'Bu ddtnp pogurations and huserl+s Sate�utld Sta�cda�ds Code, 780 c�� 4 OpR NMV YiO�A �O✓1 1 1 V • � 2 2 7�0 CMn, Maaaachuaerts Stara 9uildln cod$States, a Anrmitbr chn dornolitio ,r® oVeEfOn,rehabilitatio M'�'�"' Ch' 40 :� �4, requires Chat the dtib:. re �i oro her alteration r'111, a aa}�ditio�of liaerssed said waste dfsgoaal t�oiliry as dame of a butrdin eulting gists ftm#ball bar di�aposod of�n str, d by MIG L, Date,�r? • Job Looatioz�r w � `""`"` permit Numbmr.,,,�� Low ono aoflity or /aa D posal o mARny a Narna and Haarpm p� $trRturo o erg,r App Dant P nt 4me I