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25C-088 (9) 22 LINCOLN AVE BP-2017-0763 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25C-088 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-2017-0763 Project# JS-2017-001275 Est.Cost: $2473.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BRYAN HOBBS 83982 Lot Size(so. ft.): 6621.12 Owner: GELLER MARIAN 1&GINA-KAMAS B CHOI Zoning: URB000)/ Applicant: BRYAN HOBBS AT: 22 LINCOLN AVE Applicant Address: Phone: Insurance: 346 CONWAY ST (413) 775-9006 WC GREEN FI ELDMA01301 ISSUED ON:12/12/2016 0:00:00 TO PERFORM THE FOLLOWING WORK INSTALL 2" R-14 RIDGID FOAM TO INSULATE WALL & OPEN BLOW R-38 CELLULOSE IN ATTIC 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 12/12/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0763 APPLICANT/CONTACT PERSON BRYAN HOBBS ADDRESS/PHONE 346 CONWAY ST GREENFIELD (413)775-9006 PROPERTY LOCATION 22 LINCOLN AVE MAP 25C PARCEL 088 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid , /7 Building Permit Filled out II)' Fee Paid Tvpeof Construction: INSTALL r R-14 RIDGID FOAM TO INSULATE WALL&OPEN BLOW R-38 CELLULOSE IN ATTIC New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owned Statement or License 83982 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 oli n Age i Signature of Buil mg 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. Department useoMy City of Northampton Status of Permit wilding Department CurtiCWDdveway PermR / h / 7 212 Main Street• Sewer/SephcAvadabHty " Room 100 waw/wellAva buIt), " Northampton,240, MFax 010603-5 Pwn8te Plans Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plaru Other Specify -P (CATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address 7 ,yy4ue y LL- cp, i l Lt6 This section to be completed by office 4/0( }lna04el01A I MA Map Lot Unit 01060 Zone Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: AA r�/ /1 (:OV\ 6-:ii,,!te( 2z L.v1co/ft 4VCMUie /Volilnm.„pon //if Name(Print) Current Mailing Address (� / 1 111 {' 413 1e/, - r>.va See repWlt# IN. (d(*il Telephone Signature 2.2 Authorized Acent: £rya✓1 Nobbs 3 Lib Cato t,4-4y sf Craw reed Ml1- Name(7, � Current Mailing Address: `iia- 7)S-yaod Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building t .7.3 I 3 a (a)Building Permit Fee 2. Electrical l (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection , i r 6. Total=(1 +2+3+4+5) 3 2 j 73430 Check Number Gen /Vn0 This Section For Official Use Only Building Permit Number: Date at etl: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING AU 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: I,: R: Rear Building Height Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved parking) 44 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 O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and Location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House rl Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ NeXSipU§tCa i er� [O ,. � ang[0] Other1 -oyl Brief Descriptioqn Qf Proposed !/�� �j` � a y�� Work_ INSten I 2 a-Pi [ZikgeI Co.nw1 To L1'1Sbi�C k./A{1 anti Open blow -3S Cauloaciw Alteration of existing bedroom Yes No Adding new bedroom Yes ^ No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet se. 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? Ye> d. Proposed Square footage of new construction. Dimensions e. Number of stories? I 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? V Yes No I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR ICTOR APPLIES FOR BUILDING PERMIT Mal I, al leb\\ (7(/l`C"•OR , as Owner of the subject property hereby authorize $lryCVO /IV665 ii.CW1oJ6)i Nc4 tact on my behalf, in all matters relative to work authorized by this buil permit application. CCC Alf tiP/1 ,4Ntt7t. rerK/1 II/ z10+6 Signature of Owner Date I, /7 v , as Owner/Authorized 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. (3 me 0405 P t Name .JIB 1V2WI4 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: � 1 Not Applicable IDName of License Holder 0 rya vt lizbb3 a 3 9 z License Number 39 & Com w'a 5'F Erccyt-c;eId Al4 0130 3/2/ii( Address Expiration Date Fir a . I. - I- X13- - gp06 Signature Telephone 9.Realatered Home Improvement Contract r Not Applicable ❑ 8nj4n G. Nabk Rosily hni5 I395oCI Company Name Registration Number 39 LolwwaA> . -i- is -eetn-Cgel A /t14 013171 ? / z3/I Address I1 Expiration Date Telephone 913-72.“4 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C. 162,§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 B' No ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 seC__pG(WII �__ kJ- k Form 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,Ias defined by MGL c 111 ,1 S 150A. Address of the work: ZZ Uvco)h 5+ N�fi-L yl-nVt The debris will be transported by: (On49)C IL \4)9.561.1 Lo. The debris will be received by: (own QId t I sposeti Co, Building permit number: I 1 I Name of Permit Applicant Q f yaiA 1-16 01)3 2 awi aG e-11 n j 1/7 6 egg_ Date Signature of Permit Applicant City of Northampton Massachusetts ,4, e fil h F ` tk' t(/1 DEPARTMENT OF BUILDING INSPECTIONS 2, wry il,$ 212 Main Street a Municipal Building p oc h Northampton, MA 010600 \ ''��77 by NS"' Property Address: 2-Z L;‘Ac elm /}vrvlcte No4\\az.fl- I 1 or Contractor Name: 1-5tAp 6- It hi,S R CLAW )01 %N�c Address: 3'16 tov\ Wcty, 51- City, State: pfcev\Y Bid iM A Phone: 913- Property Owner Name: Address: 2-2 L'"'4otiA /ttenvlc City, State: 1 OIrfliQwt p 100 Ai 4 I, Q G✓\ tto44 (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 Date I / W/I • The Commonwealth of Massachusetts Department of Industrial Accidents 31171 l _ jt Office of Investigations t 600 Washington Street =":I= Boston, M.4 02111 www.massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Bu srOrpmratiodia4ividual): Bryan a Hobbs Remadebng 346 Conway St Address: Greenfield,MA 01301 City/State/Zip: ' Phone d: Lid 3'q? 5-"el 00 ig Are you an employer?Cbet/k the appropriate box: Type of project(required): l.yy 1 am a employer with 4. ❑ I am a general contractor and 1 6. ❑New conswcoon employees(full and/or parttime).* have hired the sub-contramon 2.❑ 1 am a sole pmprictor or panzer- listed on the attached sheet 1 7. ❑ Remodeling ship and have no employees These orb-conuacmrs have 8. 0 Demolition working forme in any capacity. workers' cramp. insurance. 9. 0 Building sddidon [No workers' comp. insurance 5. 0 We are a corporation and its required.) officers have exercised then 10.� Electrical rears or additions 3.0 1 am a homeowner doing all work right of exemption per MGL I l.❑ Phmnbing repairs or additions myself.[No workers' comp. c. 152,41(4),and we have no 12.0 Roof repairs insmince required.]t employees. [No workers' 13.R1 Other ca St-1(L ala I temp.insurance required.' ?{I Y c rnJi n V •Avy strPlicant the Seek Es#1 poo do fill.. the em®below*Davy their works'comtrmsrim policy mhn1111•dua: ✓' t Hoontovaers,. t this effidvi Slice*they as doing d want aid thee tore outride contreermr mon Snit•new nib's mthmiaa such *Contrition thd aback dim box mon niched m edditiaW Wen*o was the was of Ow born tare sad their sass'coop.policy informstroa. I am or employer Mm bproviding workers'cmnpausidon inwanet for my employees. Below is are polity and Job site infonuwioa /d /r �I lnswanrt CaaymW y Name: 1l 4JUA K-D i f).St �t v)O2 (O/n 1'c t 14 _._ Policy ft or Self-ins.Lic.tt: 12-n 2 i4 J 5 15—1 bfc Expiration Dam: 10/100 ,(' ,[ lob Site Address: 2.Z L's scold 5k City/Statdlip: Net 11,wnq, -1-001 M I( 0 106 0 Attach a copy or the workers' compensation polity declaration page(showing the policy member 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 51,500.00 and/or one-year utnrisomtent,as well as civil presides in the form of a STOP WORK ORDER and a fore of up to$250.00 a day against dm violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurmee coverage verification. I do hereby terrrflJ widerthe paha and penalties of popery dim the hrfgenr i..,provided above Ls due and court* %gunge: ,%J WI's Date: /1/1016 Phone It: yI — q ? S— no(j Official use only. Do nae write In dile area,to be completed by nary or town official City or Town: Permh/Lleease p bailing Authority(circle one): 1.Board of Health 2.Banding Department 3.Cay/rown Clerk 4.EIecVIW Inspector S.Plumbing Inspector 6.Other Contact Person: Phone H: ACOR0- CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDEVYM 1e...a a- 01712016 TMS 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 policynes) 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). PRmucca CONIANaomi: Da kola Coughlin Naomi: A. H. RIST INSURANCE AGENCY INC. PHO (A.t.c N Exti, (413)M3-4373 I(Aric,Noi, MAIL ADDRE dakotagahrisl.corn P.O.BOX 391 _ INBURERI&f AFFORDING COVERAGE 1- NAM Il NAMIl TURNER FALLS 01376 1NsuRERA-- AMGUARD INSURANCE CO 42390 INSURED _..... .... _ _ . _._ _ ..— INS_pNERe' HOBBS BRYAN 0 INSURER C„ _ ..._.__ —i.—_ TA BRYAN G HOBBS REMODELING CONTRACTOR INSURER B: 346 CONWAY STREET INSURER E'_ GREENFIELD MA 01301 1NS1jRER P. , COVERAGES CERTIFICATE NUMBER: 94101 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 OP SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LHSP� .ABOCSVBR POOCT CPC FOLACYEXP- TA TYPE OF1NSURANCE iNCDIWVp POLICY NUMOER (MMIoIOOIYYYY) IMWDOCNTYI LIMITS COMMERCIALGENERAL LIABILITY I EA(POGCUREENCE $ I I — ' DAMGEY(TFEFYED 'I.�._ —_.— CLAIM /MADE OCCUR I PRF SES( curt e) „5 _. MED EXP'MY opeper5on) - '$• N/A PERSONA/.d ADNM1IVRY' I3_ GENT AGGREGATE LIMT APPLIES PER: GENERAL. •'S_ r _Et. i POTM' j JEST I LOC. PRODUCTS-COMP/Oe AGG '5 .OTHER ". S AUTOMOBILE LIABILITY } COtde1NE1151NGLE LIMIT S • WY AVM _ _ .S SOMA MGM TS, , ) IS ALL OWNED BGNEDULW.O BODILY INJURY DM S 'AUTOS N/A ner a m'Il AONEMBIED PPERM DAMAGE _. jrvIwED Autos Au (Pr Y1 _ >5 .- — — • S. —I 'UMBRELLA LIAB i OCCUR I t EACH OCCURRENCE _ S E%CE9StiA8 CUM-MADE WA " AGGREGATE . S PED RETENTIONS rt . I S V W HERBLIABILITY pX i _ STAJ,J E 1 OFR TANDEMPLOYERS'LIABItry �"—"— ANICE :ETORRPARTNENSEXEUIIIVE VIN E AenBEME T 500,000 A I OFF CeWMEMNEPEXc UDED. I MAI.N/A I IIIA' REWO768203 10/20/2016 10/20/2017 (Mandatory1c NH) EL DISEASE-EA EMPLOYEE I$ 56l)ODD ; EscRlvrlONS=RasuN or OPERATIONS BelowOLICY E.L.E.L DISEASE- LIMIT t s 500,000 oE N/A I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 1 01.Additlenal Remarks Sthedu*.may be attached If more Space to r,gwval Workers Compensation benefits will be pad to Massachusetts employees only.Pursuant to Endorsement WC 20 03 MB.no authorization is given 10 pay claims for benefits 10 employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue data of this certificate of insurance). The status of ihscoverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool el wwemass govnwd/workers-oompensafionfinveslgatonsi. Sole proprietor has not elected coverage. 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. Bryan Hobbs Remodeling 346 Conway Street AUTHORIZED REPRESENTATIVE Greenfield MA 0'11101 ` L Ta Daniel M.Cro�}i ey,CPCU Vice President-Residual Markel-WCRIBMA ©198B-2014 ACORD CORPORATION. AR rights reserved. ACORD 25(2014/01) The AGGRO name and logo are registered marks of ACORD oFine iaaarcn 'aefclC��i/troci r ree//; � Office of Consumer Affairs and Business Regulation 10 Park Plaza • Suite 5170 Boston, Massachusetts 02116 Home improvement Contractor Registration Registration' 139564 Type: DBA Expiration' 7/23/2017 TO 267354 BRYAN G. HOBBS REMODELING --_-- BRYANHOBBS 346 CONWAY ST -- GREENFIELD, MA 01301 Update Address and return card.Mark reason for change. Address Renewal fl Employment 71 Lost Card '.CA I fl 90%1 Ovn — _.. __. '-7f, f r hnn.:nread r/"•//u.,n.'n. //. _. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ?1 1., 0ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: * , g9, aglatration: 138564 Type: Office of Consumer Affairs and Business Regulation' ' '.'Expiration: 7123/2017 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 RYAN G. MORES REMODELING RYAN HOBBS 06CONWAY ST REENFIELD,MA 01301 Undersecretary Not valid without signature • • • • • • • Massachusetts Department of Public Safety Board of Building Regulations and Standards _c License: CB-0839882 }P� - . . __.. BRYAN G HOBBS 346 CONWAY STREET GREENFIELD MA 01301 r' 't A . n Expiration: , Commissioner 0 310 212 018 RISE60 Shawmut Road, Unit 2 I Canton, MA 02021 1339-502-6335 ENGINEERING- www.RlSEengineering.com OWNER AUTHORIZATION FORM I, Mdt-Cfi— 6- L/ M, (Owner's Name) owner of the property located at: 22., LINLoLid 'V . , (Property Address) 1‘JOn.-1Z4ft 4-0,J MA - 010(00 , (Prbperty Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my properly. This form is only valid with a signed contract. The Permit will be secured by the insulation contractor, at no additional cost. It is the homeowner's responsibility to dose out this permit by conta ting their municipality at the completion of this work. OwnAr S n re Date 62018