31B-012 mass save
PERMIT AUTHORIZATION FORM
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1,a//floc/ CHv&Ek—G ay , owner of the property located at:
(Owner's Name, printed)
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(Property Street Address) (City/Town)
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
alt 113
Date
FOR CET OFFICE USE ONLY
Center for EcoTechnology has assigned the following Mass Save Home Energy Services
Participating Contractor to the above referenced project:
Participating Contractor Date
Rev.5/24/2012
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The Commonwealth of Massachzcsetts
Department of Industrial Accidents
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600 Washington Strea
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Boston;Mass. 02111
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dryer'G.Hobbs Remodeling
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0- Ian”.a-homeowner verforming all work myself Project Type: Li New Const-qcdon. ItaaRznodel .
0 I am a sole. ..,'etor•and have no one worlinW,cabacirv. 0 Buildiaz Additicra
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. . I.a=an employer pro-vidinewarkwe ccrapensg-don for my employees working,on thisjob.
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have the 1011Qwin.g-vicaizu—si compmsedon polices: V •
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Failure to secure coverage as required under Section 25A of MGL 152 can imd to the itnpoSition bf criminal penalties ore fuse up to S1.500.00 andfor
one years imprisonment as well as eilliptnalties in the form of a STOP WORK ORDER and 2 fine ofS100.00 a day against Ind- I understand that a
copy of this statement may he forwarded to the°Mee of InvestigatIonia the DIA.for coverage verification. ..
I do hereby certify under the aim-and penalties of-perjury that the information provided above is true and correct,
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OfDeltir.Sc only do not tr-..ttL in this area to be kin:Mich:a by city or to official . -
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SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Bryan G.Hobbs Remodeling q� �
Name of License Holder: 346 Conway St. License Number
Greenfield,MA 01301
Address Expiration Date
LA ( V .%I Gt 3) 7 75--
Si ature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
B an G.Hobbs Remodeling st Registration S6
Company Name �Y Rea Number
346 Conway St. -7� 13_
Greenfield,MA 01301 l
Address Expiration Date
TelephonE( (3)775-rde6
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 building permit.
Signed Affidavit Attached Yes ❑ No ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition El New Signs [D] Decks [Q Siding[D] Other
Brief Description of Proposed
Work: / 41 C .T t i ju16,/m'�I (ciTaio5 , 4-1 r. it`
Alteration of existing bedroom Yes i/No Adding new bedroom Yes ✓No
Attached Narrative Renovating unfinished basement Yes i/"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 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
,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, PO 4 t$ j/r ?-j .('1i/l 6d ei 1 as Owner/Authorized
Agent ereliy declare 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.
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Print Nam
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Signature of Owner/Agent I Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW YES 0
IF YES, date issued:.
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW Q YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO e
IF YES, describe size, type and location:
E. Will the construction activity disturb(cl aring,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO (P 1'
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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Department tot only
ity of Northampton Status of Permit:
B ilding Department Curb CutfDdveway Permit
4 �v t fi 212 Main Street Sewer/Septic Availability
Room 100 YVaterlW Availability'
OF®� o N�N� Sao ort ampton, MA 01060 Two Sets of Structural Plans
AE NgRTHAMPT•••'3 - - 87-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property This section to be completed by office
0 1 61 f,.SI Map Lot Unit
,,j /1 . ,n pici7 Al/ Zone Overlay District
Elm St District Ca District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
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(.f✓1Ct.l'Id(t-1 -- (u y 1 C i e Sei't 1- T . 4.,If)r-t 4 ripit,'7 /'fiJ
Name(Print) Current Mailing ddress:
( f3)39 - 5/ft2
Telephone
Signature
2.2 Authorized Accent:
G 65 goir ‘rii 346 Cc u a- 5 -. /ACC i o13oi
Name(P i) Current Mailing Addres .
‘ 'f:f (y13) 775- 9666
Signature ! Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection J
6. Total=(1 +2+3+4+5) 5 47,3 ,x6 Check Number /39� idri
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
•
Ammionsiiimik
File#BP-2013-1168
APPLICANT/CONTACT PERSON BRYAN HOBBS
ADDRESS/PHONE 346 CONWAY ST GREENFIELD (413)775-9006
PROPERTY LOCATION 11 CRESCENT ST
MAP 31B PARCEL 012 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 1:65--Fee Paid /396
Typeof Construction: ATTIC INSULATION/AIR SEALING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 83982
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION PRESENTED:
pproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
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Signa • - of Build fig Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
11 CRESCENT ST BP-2013-1168
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B-012 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-2013-1168
Project# JS-2013-001909
Est.Cost: $5474.00
Fee:$55.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRYAN HOBBS 83982
Lot Size(sq. ft.): 7143.84 Owner: CHANDLER-GUY CINDY&STEPHEN B GUY
Zoning:URC(100)/ Applicant: BRYAN HOBBS
AT: 11 CRESCENT ST
Applicant Address: Phone: Insurance:
346 CONWAY ST (413) 775-9006 WC
GREENFIELDMA01301 ISSUED ON:6/7/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:ATTIC INSULATION/AIR SEALING
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 6/7/2013 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner