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35-053 (3) BP-2024-1400 956 RYAN RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 35-053-001 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-2024-1400 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est.Cost: 3647 BRYAN HOBBS CS-083982 Const.Class: Exp.Date: 05/02/2026 Use Group: Owner: LEAH FORBUSH, WENDY(L/E), CARVER Lot Size(sq.ft.) Zoning: WSP Applicant: BRYAN HOBBS REMODELING LLC Applicant Address Phone: Insurance: PO BOX 1535 (413)775-9006 ECC6004001 1332023A GREENFIELD, MA 01301 ISSUED ON: 10/23/2024 TO PERFORM THE FOLLOWING WORK: 1 NSULATI ON/WEATH ERI ZATI ON 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: 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. Signature: l' P Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ; / 4 /.\<<\ w S , The Commonwealth of Massachuse %Te, 7 ��Flo { Board of Building Regulations and Stands 4/0 O� /. Massachusetts State Building Code, 780 CM'�'o+(le '? ICIP LITY u so . E Building Permit Application To Construct,Repair, Renovate Or :,; . Rev'.ed Mar 2011 One-or Two-Family Dwelling °o°4, This Se on For Official Use Only Building Permit Number: O/Z A 1 Aim) Date Applied: 17n4, cicr ,,,.-- ."--;: z Building Official(Print Name) ignature ate SECTION 1:SITE INFORMATION Proper ddress: pp 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: 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 ‘--1( L Qh Owner'of I}gcord: lJi(V� ICI 1 Name 'Catnt) City,State, P No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ppeci Brief Description of Proposed Work'-: /� I t cP r -/ I- `7Y► '`N✓� r . V' ISv SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 31 4(WW, /) . vac,vac, 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 $ Total All F eeVt�(] -(1 6 Suppression) �Y Check No. Check Amount. Cash Amount: 6.Total Project Cost: $ 2,I Alt) UP 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Oil 39 C 1 License Number Expiration ate 7e o L Holder List CSL Type(see below) U and Type Description 1bA 61�Z U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted 1&2 Family Dwelling City own, tate,ZIPS M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances M l3 me 9 64‘.0 1 P31 I Insulation Telephone E ail address C..e" D Demolition �',��`� 5.2 Registered Home Im ovementiContractor(HIC) 19 too`iC c JCL V w .A1 (J_(_ HIC Registrationl Number Expiration Date C n•any a\ IC Registrant Name I. la 'vs tand Stre }.401 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 V14, No .0 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 contained in this application is true and accurate to the best of my knowledge and understanding. oliilliy P er's r Authorized Agent's Name(Electronic Signature) Date 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/dos 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"may be substituted for"Total Project Cost" • Permit Authorization mass save Form Site ID: 5000388 Customer: LEAH CARVER ,,L�II__ ,/ ,owner of the property located at: (Owner's Name,printed) 956 Ryan Rd Northampton, MA 01062 (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. Owner's Signature: CeV4A/\'' Date: L� •••••••••••••i•••••••••tava•••••••••••••••••••••••••••••••••••••••••• FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Up,", 114m,bjaNy 141\e}i n , Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only THE COMMONWEALTH OF MASSACHUSETTS 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: 08/25/2025 P.O.BOX 1535 GREENFIELD,MA 01302 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for Individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:LLC Office of Consumer Affairs and Business Regulation Registrattori Exo'ration 1000 Washington Street -Suite 710 196045 06/25/2025 Boston,MA 02118 BRYAN HOBBS REMODELING,LLC. BRYAN HOBBS 676 LEYDEN RD Fk rwo(a..s fdr,(• GREENFIELD,MA 01301 Undersecretary Not valid without signature Commonwealth of iV1asoachusatr:s Construction Supervisor gip Division of Occupational L€cerisure Unrestricted-Buildings of any use group which contain less than Board of Building l3eguiotts atu€SIanctBrds 35,000 cubic feet(991 cubic meters)of enclosed space. ,ti13' 4„.tp C8.083982 ' . Rives:0i0102/2028 BRYAN G HQ8S is •0• • o+ P 0 BOX 15 \ I }" GREEMFIEL A 04302` . • 2p e; Al `t'OI.Lfiai0 ,0?".0 Failure to possess a current edition of the Massachusetts State ..eL .•-i Building Code is cause for revocation of this license. Commissioner _SA.,LLEI4tAlias, Contact OPSI:(617)727.3200 or visit www.mass.gov/dpl/opsi • _ The Commonwealth of Massachusetts • Department of Industrial Accidents i t Office of Investigations =+� v Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Bryan Hobbs Remodeling, LLC Address: 576 Leyden Rd. PO BOX 1535 City/State/Zip: Greenfield, MA 01302 Phone #:413-775-9006 Are you an employer? Check the appropriate box: Type of project(required): .n I am a employer with 7 4. n I am a general contractor and I 6 New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P tY 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. D We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no weatherization employees. [No workers' 13.0 Other comp. insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AIM Mutual Policy#or Self-ins. Lic. #: ECC60040011332024A Expiration Date: 10/20/2025 Job Site Address: 0 CZ14)j-% ZeSI City/State/Zip. \ta, Attach 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 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 hereby ce i y under the pains and penalties of perjury that the information provided above is true and correct. Signature: ' p,J Date: 1, )\1 i\7A 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(check one): 10Board of Health 20 Building Department 3❑Cite/Toww n Clerk 4.❑Electrical Inspector 501Plumbing Inspector 6.1:10ther Contact Person: Phone#: DATE(MM/DDNYYY) A`2 RD® CERTIFICATE OF LIABILITY INSURANCE 10/01/2024 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 have ADDITIONAL INSURED provisions or 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 NAME: Alera Group,Inc. PHONE (413)586-0111 FAX (413)586-6481 (NC,No.Ext): (NC,No): 8 North King Street EMAIL adina.edgett@aleragroup.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC N Northampton MA 01060 INSURER A: Selective Insurance Co of The Southeast 39926 INSURED INSURER B: A.I.M.Mutual Insurance Co. 33758 Bryan Hobbs Remodeling,LLC INSURER C: Evanston/XSB PO Box 1535 INSURER D: INSURER E: Greenfield MA 01302-1535 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 08/25 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 LTR TYPE OF INSURANCE IN O SUER POLICY NUMBER POLICYDO/EFF POLICY EXP LIMITS (MMlDDlYYYY) (MMIDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,DAMAGE ro 000 CLAIMS-MADE F OCCUR PREMISES(Ea occurrence)ence) $ 500,000 - MED EXP(Any one person) $ 15,000 A S2289042 08/04/2024 08/04/2025 PERSONAL&ADV INJURY $ 1.000,000 GEN-'L AGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $ 2.000,000 POLICY PRO 2.000.000 J2-• LOC PRODUCTS-COMP/OPAGG $OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED �I SCHEDULED A9105300 08/04/2024 08/04/2025 BODILY INJURY(Per accident) $ AUTOS ONLY ' AUTOS X HIREDAUTOS O NON-OWNED NLY PROPERTY DAMAGE (Per accident) $ X AUTOS ONLY Underinsured motorist BI $ 20,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,001),000 A - EXCESS LIAB CLAIMS-MADES2289042 08/04/2024 08/04/2025 AGGREGATE $ 2.000,000 DED RETENTION$ $ WORKERS COMPENSATION '/I PER TE OTH- AND EMPLOYERS'UABILITY YIN /� STATU ER B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA ECC60040011332024A 10/20/2024 10/20/2025 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Pollution Per Occurrence 250,000 C CPLMOL121333 01/19/2024 01/19/2025 Aggregate 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Addkional 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 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton _ #0% ` ' '�; SAS _S'C• " Massachusetts ,?• DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building sJti' c�` Northampton, MA 01060 �sVti wj ' 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: gt'j'\ Exas\A10.0np\-if, ca k_vw\a,6„, The debris will be transported by: Name of Hauler: .) Wag Signature of ApplicanT ¢i, ' L Date: 1,0 111 ?