31B-055 (3) 27 LANG WORTHY RD BP-2016-1074
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mqp,Block: 3 1 B-055 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-2016-1074
Project# JS-2016-001830
Est. Cost: $4923.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BRYAN HOBBS 83982
Lot Size(sq. ft.): 5183.64 Owner: MACISAAC RIPHARD
Zoning: URA(86)/URC(14) Applicant: BRYAN HQBBS
AT. 27 LANGWORTHY RD
Applicant Address: Phone: Insurance:
346 CONWAY ST (413) 775-9006 WC
GREENFIELDMA01301 ISSUED ON.31812016,0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL ATTIC INSULATION
POST THIS CARD SO IT IS VISIBLE FROM THE �TREET
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:
Cas: 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 3/8/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2016-1074
APPLICANT/CONTACT PERSON BRYAN HOBBS
ADDRESS/PHONE 346 CONWAY ST GREENFIELD013'I 1 (413)775-9006
PROPERTY LOCATION 27 LANGWORTHY RD
MAP 31 B PARCEL 055 001 ZONE URA(86)/URC(14)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid '
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL ATTIC INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildine Plans Included:
Owner/Statement or License 83982
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF02.0.MATION PRESENTED:
Approved 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
D
Sig of tui 14ffigEcia 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.
i
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
L
Department use only
City of Northampton Status of Permit:
' 019 Building Department Curb Cut/Driveway Permit
�» 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060
Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587.1272 Plot/Slte Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Zq L r'2..nJ L.v OY 1` % k'-d Map Lot Unit
NO r-4 -4 0 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
.. j
2.1 Owner of Record:
gICVA 1-i (.Lc ISr,"�L 2'7 l!a wco-4Ji GJ
Name(Print) Current Mailing Address:
Signature —TOW G7 Telephone
s emo e n
2.2 Authorized Agent: 346 Conway St.
Greenfield,MA 01341
Name(Print) k Current Mailing Address:
Signa re Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
cam feted by permit applicant,
1. Building 7 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
6. Total=(1 +2+3+4+5) t2 5, Check Number
This Section For'Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
'
Section 4. ZONING All Information Must Be Comf leted. Permit Can Be Denied Due To incomplete Information
Existing Proposed RcqLlired by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
of Parking Spaces
(volume&Location)
A. Has a Special Permit/Variance/Fi ndin g ever been issued for/on the site?
NO () DONT KNOW YES
V
IF YES: Was the permit recorded at the Registry nfDeeds?
\
T"
NO �) DON'T KNOW � YES
IF YES: enter Book Page and/or Document #
»��� �~�
B. Does the site contain a brook' body ofwater orwetlands? NO \�»r�� D0N7 KNOW �_ Y±5 �~/
IF YES, has permit been or'need to be obtained from the Conservation Commission?
Needs tobeobtained ~/�~� Obtained »~� Date� \~� ' '
C. Doany signs exist on the property? YES 0 NO
IF YES, describe size, type and location: |
D. Are there any proposed changes tooradditions !f signs intended for the property 7 YES 0NO
IF YES, describe size` type and location: \
/
E Will the construction activity disturb(clearing,grading,excavation, orfilling)over Iacre oriaitpart ofecommon plan
that will disturb over 1acre? YES NO KD
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all iDOicable)
New House F-1 Addition ❑ Replacement Windows Altoration(s) ED T—Roofing ❑
Or Doors
Accessory Bldg. ED Demolition F-1 New Signs (0] Decks [M Siding[0] Other
Brief Description of Proposed
Work:I rlwla-te r'Irr J01'SJ' a,+4t(-f(LX)I-, r4e'-'J"V' wa'k, o.-01c, s topc )r(,,1ej6 ve,),,,t 4 'frfn'l
e"'f
Alteration of existing bedroom_Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement —Yes —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. Messcheck 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
1, 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
Signature of Owner Date
ia - M
Corti W 0 6�� as Owner/Authorized
Agent here 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.
C) y- t2J
Print Name
b
Signature of Ow'ner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Namg of License Holder - 082
:,,q 92
deling
346 Conway St License Number
Greenfield,MA 01301 5-12-
Address Expiration Date
Signa re Telephone
9. Real-stored Home Improvement Contractor: Not Applicable 0
Company Name uryah-G. Hobbs Hem6aeling
346 Conway St. Registration Number
Greenfield,MA 01301
Address
Expiration Date
Telephone -to
115* 7"
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...... 0
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.CM R 780, Sixth Edition Section 1108.3.�.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 hn 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 12ermit.
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
The Commonwealth of Massachusetts
Department of I dustrial Accidents
Office of I�vestigadvns
kip 600 Wash> on Street
Boston, 02111
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Ac►nlicant Information Please Print Leelbly
Name (BusinessiorganizationllndividuaD: Bryan G.Hobbs Remodelin
Conway St.
Address: Greenfield,MA 01301
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with 4. ❑ I am a general contractor and l 6. Q New construction
employees(full and/or part-time).* have hired the sub-contractors 7
2.Q I am a sole proprietor or partner- listed on the attached sheet, # ❑ Remodeling
ship and have no employees These sub-contractors have 8. Q Demolition
working for me in any capacity. workers'comp.insurance. 9. Q Building addition
[No workers'comp. insurance 5. Q We are a corporation and its 10.F1 Electrical airs or additions
required.] officers have exercised their
3.Q I am a homeowner doing all work right of exemption per MGL 11 Q Plumbing repairs or additions
myself[No workers' comp. c. 152,§1(41 and we have no
12.0,Roof repairs
insurance required.]t employees. No workers' 13.(Z Other ,S,#(L vPi
comp.insurance required.]
' M r1
*Any applicant that cbeetrs box#1 must also fill out the section below abowing*i r 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
4Contraclors that ebeck this box must attached an additional sheet sbowing the narbne of the sub-contractors and their workers'comp.policy information.
I am an employer that,is providing workers'compemvadon inrurance for my employees. Below is the palicy and job site
information. ,,rr�� ,�
Insurance ConvanyName: 'Y!� (--i . A 4 0 [ 11!j, fl,1lrQM 1�06 C
Policy#or Self-ins.Lie. kZ L��9 9 ExpirationDate:__ate: [o1wJ 1,6
Job Site Address: Z c] }C.7 r~� 1�v� 1 ra City/StatelZip: N o Y�f"�i✓ vt[0[p�� }�/i lG� c'�( c�(�t
Attach a copy of the workers' compensation policy declarations 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 ane-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 certify under the p'ain``s and penalties of perjury that the information provided above is true and correct:
Sitmature syt - 1�0 Date 21/1
n #:
0,rkid use only. Do not write in this area,to be completed by 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#:
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: 2--7
The debris will be transported by:
The debris will be received by: Co�j2lr4<-, 0isgosc,_1
Building permit number:
Name of Permit Applicant
_3 12-�i b nlv� (4Q, 4�
Date Signature of Permit Applicant
Permit Authorization �''`��"'`' ,
mass save porm
^c rhr crnr�c t. crc Y PAfMCf•PATING
GUNTRItmIll
Site ID: 500050166374 Customer: RICH MACISAAC
I, RICH MACISAAC ,owner of the property located at:
(Owner's Name,printed)
27 Langworthy Rd NORTHAMPTON
(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 pro a y.
Owner's Signature:
Date:
FOR CSG OFFICE USE ONLY
Conservation Services Group has assigned the following Mass Save Home Energy Services Participating
Contractor to the above referenced project:
Bryan G. Hobbs Remodeling
346 Conway St,
Greenfield,MA 01301
Participating Contractor Date
[3f'O
15
For Office Use Only
Conservation Services Group + 50 Washington Street,suite 3000 • Westborough,MA 01581 • 180GA80.7472
Rev.062015
City of 'Northampton
Massachusetts
,A
DEPARTMENT OF WILDING INSPECTIONS
212 main street 0 Municipal Building Off, pb
Northampton, MA 01060
Property Address:
Contractor
Name: la"A G.WohhS Remnriplinn
346 Conway St.
Address: Greenfield,MA 01301
City, State:
Phone: 0 L)
Property Owner
Name: C -S a a- c
Address:
City, State: VIJ 0 r4�rk-Y-Ip4L,),
)q (contractor) attest and affirm that the building I intend to
insulate does not have any open air (knob and tube)wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit.
Contractor signature J4)L I
Date Z 12-