31B-251 (2) WORKERS COMPENSATION AND EMPLOYERS LIABILITY
INSURANCE POLICY Liberty Mutual.
INSURANCE
AR INFORMATION PAGE
175 Ber"Street Boston,MA 02116
Issued by LIBERTY MUTUAL FIRE INSURANCE 16586
Policy Number WC2-31S-375070-033 Issuing Office 016C
RENEWAL OF: WC2-31S-375070-022 Issue Date 09-24-13
Account Number 1-375070 Sub Account 0000
1. Insured and Mailing Address
BRYAN G HOBBS DBA BRYAN G HOBBS REMODELING
CONTRACTOR
RISK ID 842909
346 CONWAY STREET
GREENFIELD,MA 01301
Status 01 — INDIVIDUAL
Other workplaces not shown above: SEE ITEM 4. PREMIUM-EXTENSION OF INFORMATION PAGE
2. Policy Period: The policy period is from 10-20-2013 to 10-20-2014 12:01 A.M. standard time at the
Insured's mailing address.
3. Coverage
A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states
listed here: MA
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits
of our liability under Part Two are:
Bodily Injury by Accident $ 500, 000 each accident
Bodily Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 500, 000 each employee
C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here:
REFER TO RESIDUAL MARKET LIlVIITED OTHER STATES INSURANCE ENDORSEMENT WC 00 03 26A
D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE
4. Premium: The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and
Rating Plans. All information required below is subject to verification and change by audit.
Code Premium Basis Total Rate per$100 Estimated Annual
Classifications Number Estimated Annual Remuneration of Remuneration Premium
See Extension of Information Pane
&q.Y -Bsi
31 a
Initial Construction Control Document
To be submitted with the building permit application by a
i� tr T'J Registered Design Professional
for work per the di' edition of tile
Massachusetts Mate Building Cede, 7801 CMR, Section 107.6.2
Pro ec t Title-, Bt it;iing insulat_i.ot?_..Prole:,,_ Date: 12/3D,,113
Property Address: 76 Elm St . , Northarrptot�, MA 01,3G3
Project_ Check; une or both as applicable: ;t ew construction X Existing Construction
Prcvjectdescription, ir.s alate attic rafters with dense pack celltt.lose. Air seal
'h'A a tir'S sC f' �t'it t:-ex--.:wit:.i1 1 1=Oam-. L
wits den g 4<--'k c, I!.,1Ii Out.
l Cnaries P. Sharples 1'+,A Registration'`trmber: = '`k Expiration date: "wG '3.0/2C 14.ani J
r i t rc:elrt ri�n rr3,rc s.ti {„�c:F anal hwrekPy c�riify that f hav--- prepared or directly supervised the preparation of all design
plans, computations and specifications concerning;
I Entire Project Architectural i i Structural JXj Mechanical
J Fire Protection [ J Electrical ( ] Other
for the above named pr(Ject and that such plartS,ccanzptrintions andspecifications meet tite applicable provisions of the:
Massachusetts State Building Code.(7511 CNIR).and accepted engineering practices for tite proposed project. I
understand and agree that i (car my designee)shall perform the necessary, professional services and he present on the
construction site can a regular and periodic basis to:
I, Review, fear confornrtrnce to this code and the design concept. shop dr'avvings.samples,and other submittais by tile
contractor in ttecerclztnce vv tlr the reyarirc rnerita of rite+c�nslrtrcticrn cl�csuner�ts.
Perform t1Zc duties fc�r re iste.red design professionals in 780 CMR Chapter 17,as applicable.
3. Be present ut internals appropriate to the stage of constru Lion to become generally 11imiliar with the progress and
duality of the work and to determine i f tine %, ork is bring perforrrtcd in a manner consistent with the:approved
constrtcction documents and this ciide..
When required by the building c-,ilicial 1 shall suhmit tielcl'progress reports tree.item 3.)together with pertinent
comments, in a fours acceptable:to the building official.
OF Upon completion of the work, i shall submit 10 the KlildinLv official a 'F=inal Construction Control Docurne.n
+ CHARLES
P.
SSHARPLES
Enter in the space to the right a "vvet"or 20940
electronic signature and seal: NTIOL v
ks 7cr�
Phone 11Limber. (413') 732=4336 Email: rsbarplasi?linedgr nsharp- es .com
ltiiilding.Officla,U c 01111
Builditty Of Cial N1a«nc, Pes'tesi:Nc,:
Trial ncn�ioll 10 r?'3 2ti1
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: X3 ! V
Bryan G,Hobbs Remodeling Li nse Number
346 Conway St. /
Greenfield,MA 01301 Jr!alr y
Address Expiration Date
z W<3 ) -7-75'- oo-
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
135`)by
Company Name Bryan G.Hobbs Remodeling Registration Number
346 Conway St
Greenfield,MA 01301 0n 3/
Address Expiration Date
Telephone C��3)77 466k
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....... 13/' No...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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 buildinE 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
Replac emeW Windows
Or Doors
Alteration(s)
Roofing
Accessory Bldg.
Demolition
New Signs[]Decks[)Siding[]Other Qj
Brief ric i�iui dP envelope insulation - dense-pack cellulose
Alteration of existing bedroom Yes Y Adding new bedroom Yes_ No
Attached Narrative Renovating unfinished basement Yes X No
Plans Attached Roll-Sheet
ga. if New house and or addition to existing housing, complete the following:
a. Use of building:One Family Two Family other Of f ice
b. Number of rooms in each farii unit: n/a Number of Bath,
oos 2
c.Is there a garage attached? No
d. Proposed Square footage of new construction. n/a Dimensions
e. Number of stories? 2 .5
f.Method of heating? steam from cent rat plalfkeplaces or Woodstoves 0 Number of each
g. Energy Conservation Compher". n/a Masschecc Energy Compliance form attached?
h.Type of constriction wood
i. Is construction within 100 ft.of wetlands? Yes X No.Is construction within 100 yr.tloodplain Yes
X No
j.Depth of basement or cellar floor below firdshed grade 51
k.Will building conforn to the Building and Zoning regulations? z3 In Yes No.
1.Septic Tank City Sewer X_Private well City water Supply X
SECTION Ta-OWNER AUTHOR17ATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, The Trustee's of the Smith College c/o Facilities Management,asownerof
the subject 76 Elm St.
prop"
hereby authorize
Bryan Hobbs Remodleing '1
to ad on my behalf,in all matters relative to work authorized by this building permit application.
� .
S*wsthse of owner Date
1, .as
Owner/Authoized
Agent hereby 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.
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 Q DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 1 DON'T KNOW YES 1
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 V) YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Q , Date Issued:
C. Do any signs exist on the property? YES 0 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 Q NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, p1cavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
�- Department use only
City of Northampton Status of Permit:
f Building Department Curb Cut/Driveway Permit
3 2011 ..1 212 Main Street Sewer/Septic Availability
�� Room 100 Water/Well Availability
i _ t1Ons Northampton, MA 01060 Two Sets of Structural Plans
0"Q a 413-587-1240 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
This, ion to be&gmpleted by office
L1 Property Address: ll
-76 5/m J Map Lot" Unit
�J p r a wtp f�� ►� Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
'�M nll eu 76 L�g S"
Name(Print) V Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
-P, o y u A G /4zb;S 316 �nc�CcN S ('� bt 3of
Name Tint Current Mailing Add
644rae2 (�!f 32 -7 -7 5S-16 6
Signature V Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 5�� o0
(a) Building Permit Fee
d ,3 ,
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) Check Number CIA
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2014-0798
APPLICANT/CONTACT PERSON BRYAN HOBBS
ADDRESS/PHONE 346 CONWAY ST GREENFIELD (413)775-9006
PROPERTY LOCATION 76 ELM ST
MAP-31B PARCEL 251 001 ZONE EU(100)/URC(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 11 10r7
Fee Paid
Tyneof Construction: BUILDING ENVELOPE INSULATION
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 FOLLOW G ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ON 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
Dem 'tion
/� 3r
Signature o Buildin Offi al 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.
76 ELM ST BP-2014-0798
GIs#: COMMONWEALTH OF MASSACHUSETTS
MV.Block: 3 1 B-251 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-2014-0798
Project# JS-2014-001360
Est. Cost: $10350.00
Fee: $62.10 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRYAN HOBBS 83982
Lot Size(sg. ft.): 5619.24 Owner: SMITH COLLEGE OFFICE OF TREASURER
Zoning: EU(100)/URC(100)/ Applicant: BRYAN HOBBS
AT. 76 ELM ST
Applicant Address: Phone: Insurance:
346 CONWAY ST (413) 775-9006 WC
GREENFIELDMA01301 ISSUED ON:111312014 0:00:00
TO PERFORM THE FOLLOWING WORK:BUILDING ENVELOPE INSULATION
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 1/13/2014 0:00:00 $62.10
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner