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13-010 (2) BP-2022-0149 14 COLES MEADOW RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 13-010-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0149 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 9042 BRYAN HOBBS 83982 Const.Class: Exp. Date:05/02/2022 Use Group: Owner: FABRE, NICOLE Lot Size (sq.ft.) Zoning: RI/SR/WP Applicant: BRYAN HOBBS REMODELING LL(' Applicant Address Phone: Insurance: PO BOX 1535 (413)775-9006 WC90572270 GREENFIELD, MA 01301 ISSUED ON:02/16/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of V1 iring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I ' • , • y� - (NT Fees Paid: $65.00 212Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner „. / ----,Q,L.,.-. ,, / ........, rz.. , , ,,,, The Commonwealth of Massachusetts % FF'B 4\_`•L 'FOR Board of Building Regulations and Stand4fds 1 W Massachusetts State Building Code;7801C' S �� M IUII LITY Op Building Permit Application To Construct,Repair, Reno'vaf0701, ish a ised,Alar 2011 One-or Two-Family Dwelling _(IA, ,Is,,- n This Section For Official Use Only ��°�''N Building Permit Number: _j(''2 y f/ Date Applied: ` Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION Fhb &J I LT- 1.1 Property Address: 1.2 Asses ors Map&Parcel Numbers I c1( ) 14 Cr�1tl Meade.,) IdI GYO 1.1 a Is this an accepted street?yes no Map Num r Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of cord: Name(Print) City,State,ZIP 14 Cass MQado6N 'Qc9 9c • ?( -105i9 nicolcvdt((Ia-a .hoo.c..” No.and Street Telephone mail Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other Specify: Wea jltItp Brief Description of Proposed Work2:sai,( Seal, IS"cA ll1� (alloy talc Ckc O(, dense. CL1lul . exkr.,.• walls., lnvi c.ri.� • '' t ba cw� QMMvnY SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ CI icHa. m5 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x , 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees Q Check No.�'6heck Amount: Cash Amount: 6.Total Project Cost: $ CI a, av 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CAM ta 51a bac icsq)s License Number Expiration Date terYPSOlolder 1' Z"T ,5-C- List CSL Type(see below) and Street Type Description U Unrestricted(Buildings up to 35,000 Cu.ft.) clitA tc) � a►3�a R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 4'JC/CdP InVbibr9DINC6SeVrtaLL I Insulation Telephone Email address L D Demolition 5 Registered Home Improvement Contractor(HIC) ir Was* tt I T D 1 i L.�. HIC Registration Number Expiration Date Ci pany Name or HIC Registrant Name eeA11- and Strat n �L 61Z I� 1�S 1006 Email address V City/Town�Statte,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 V- 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:OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information co ed in this application is true and accurate to the best of my knowledge and understanding. Z672_ Pr ner's r Authorized Agent's Name(Electronic Signature) ate NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,fmished 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"may be substituted for"Total Project Cost" Permit Authorization mass Sale Form Site ID: 4366433 Customer: NICOLE FABRE Nicole Fabre I, , owner of the property located at: (Owner's Name,printed) 14 Coles Meadow Rd Northampton, MA 01060 (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. Nieele Fa6re Owner's Signature: Date: 12 / 13 / 2021 •••••••••r••/••Mi•l•i4/il••is#•Ir•rr••••f•••••••••l••••••#Mt1/•••.•t•*aw FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: tAPA ".t- 01)9)%?;14. Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Crl, Document Ref:5AIKO-B2ETQ-HMZMO-NCAKV Page 17 of 18 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 P.O.BOX 1535 Expiration; 06J25J2023 GREENFIELD,MA 01302 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOLIE 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 0B/2512023 1000 Washington Street-Suite 710 BRYAN HOBBS REMODELING,LLC. Boston,MA 02118 BRYAN HOBBS 676 LEYDEN RD 4.0(44.4.4' GREENFIELD,MA 01301 Undersecretary Not valid without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards CS-083982 Expires:05/02/2022 BRYAN G HOBBS 26 K ST GILL MA 01354 Commissioner cc f'. it ncl ut. W401, The Commonwealth of Manaohnsetts •..,...� .may{ /*.wy �/_�_JQ� •YC •1 J'M emu Ott• Department Of rl, AccW { r (!;1 Ogee ofInva Ons 1+t�,.` Leapt& �Cam` : 2� teaus de Boston, • MA 02111-1750 •7;7 A:k,yiT waist i Ii.govA Wcitere Compensation Insurance Affidavit:Bnlldorl/Contractors/El c dand!'lumbers &sic Name(2usineseIOrinizetiotiludividual):Bryan Hobbs Remodeling, LLC Ada. _ ..eyden Rd Po Box 1588 sty t to/Zip:(3raenfieid, Ma 01302 Phone#:413-775-9008 Are iva akt, linfloyer?Check the appropriate bent Type of project(required): 7 1.® e am a rrployer with 7 4. ❑ I am a general contractor and I 61 New construction employees(fltll and/or part-time),* have hired the sun-contractors a se proprietor or partner- listed on the attached sheet. 7. ❑Remodeling yap and"Awe no employees These sub-contractors have 8. ❑Demolition working fox roe in any capacity. employees and have workers' 9. l3 addition [rig ';o r comp.insurance comp.insurance.* ❑ s ni gredo S. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am Elton/comer doing all work officers have exercised their 11.0 Plumbing repairs or additions • myself. [No workers' comp. right of exemption per MOL 120 Roof repairs insurance required.] t c. 152,t 1(4),and we have no 13.�Otherweatherization employees. [No workers comp.insurance required.] *Any applicant that cheeks box#1 must also fill cut the seotlon below abowingthair weaken'eompensation policy information. lie eowners,x+hc submit this affidavit indicating they are doing all work and thenhire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional.sheet showing the Shame of the sub-contractors and state whether or not those entitles have employees. lithe sob tontraators have employees,they must provide their workers comp,policy number. I ens ma employer that providing workers'conipe►asation§23a s awe for my employees. Eelow Is the policy and hob the irtbmntlon. Insutaaoe company Name:Selective Insurance Company Policy#Of soli-ins.tic,#:WC0087270 • Expiration Date:10/20/2022 Job Site Address: 14 CbIts 14QGdL/.3 Kc9 City/state/zip: (lc�/1�1crrip4 t'-1A Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage u required under Section 2SA of MOL c. 152 can lead to the imposition of criminal penalties of a fine up,to$11:tt.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$20.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigay a.the DIA far insurance coverage verification. I do herffby fif r Zi\fg2„..\-)itgli(k. te under prig esd pukkae f perjury that the Info Ovation proWded above lr t ue wad connect Sig° Date: z�41u �,j� y� . _ ,y I✓9 ate;yr/It die area,to be ear-rJleeed city or town offic City ue` oevw Per°mlta,icenae# X Beare ei C Building Department 3DCity/Town Clerk 4.D Electrical Inspector salumbing Inspector ¢t. „1Ott eft TE ' AC CERTIFICATE OF LIABILITY INSURANCE DAB/4/2 rrvY)21 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 CONTACT Adina Edgett, CISR NAME: g Webber & Grinnell (Pat.Ext): (413)586-0111 FAX No): (413)586-6481 8 North King Street ADDREAIL SS: aedgett@webberandgrinnell.com INSURER(S)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:EVanston/ XS Brokers INSURER E: ___ Greenfield MA 01302 INSURERF: COVERAGES CERTIFICATE NUMBER:Exp 08/22 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR ,INSD VD. POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 500,000 PREMISES (Ea occurrence) $ S2289042 8/4/2021 8/4/2022 MED EXP(Any one person) $ 15,000 PERSONAL 8ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED A9105300 8/4/2021 8/4/2022 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ Underinsured motorist BI split limit $ 20,000 X UMBRELLALIAB _ OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$ 92289042 8/4/2021 8/4/2022 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ^ E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED? I I N I A (Mandatory in NH) WC9057270 10/20/2021 10/20/2022 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below Bryan Hobbs is Excluded E.L.DISEASE-POLICY LIMIT $ 1,000,000 D POLLUTION LIABILITY CPLMOL105179 1/19/2022 1/19/2023 PER OCCURRENCE $250,000 AGGREGATE $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 7 W Grinnell, CPCU, CIC 1.1/1_-D '�,--- I ©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 o �,�,Yra, `s. .. �. ,.+� Massachusetts is - I ( * CG ¢�Y ( *� 1s DEPARTMENT OF BUILDING INSPECTIONS v` 212 Main Street • Municipal Building I. Ca " Northampton, MA 01060 s4;i1;•^ `;.o CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: 6C0 Pcur, \-Ul )4fN The debris will be transported by: Name of Hauler: CQ5t.,\1a Was\e, Signature of Applicant: 1, )0y0 Date: