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16D-016 (2) 185 NORTH MAIN ST A&B BP-2017-0813 GIS a: COMMONWEALTH OF MASSACHUSETTS Map:Block: 1613-016 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 N BP-2017-0813 Project a JS-2017-001244 EsL Cost$2480.00 Fee:$84.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Grou BRYAN HOBBS 83982 Lot Size(sq. ft.): 18164.52 Owner: BONOIS JEREMY Zoning: UR&IOO)/ Applicant: BRYAN HOBBS AT: 185 NORTH MAIN STA & B Applicant Address: Phone: Insurance: 346 CONWAY ST (413) 775-9006 WC GREENFIELDMA01301 ISSUED O.N:12f30/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:ATTIC 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 it 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: FeeTvpe: Date Paid: Amount: Building 12/30120160:00;00 584.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck -Building Commissioner File#BP-2017-0813 APPLICANT/CONTACT PERSON BRYAN HOBBS ADDRESS/PHONE 346 CONWAY ST GREENFIELD (413)775-9006 PROPERTY LOCATION 185 NORTH MAIN ST A&B MAP 16D PARCEL 016 001 ZONE URS,109)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIS ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid .,_ s 0 Building.Permit Filed out 'f1f7 J�/ Fee Paid Tyoe9f Construction: ATTIC INSULATI • New Construction Non Stmcmral 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 122EMATION PRESENTED: pproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:ss 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 v_ 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 ' in I•lay r i '� i? or In, Si_ e ding 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 use only Cay of Northampton Status of Permit: „r��.-� _ ' / Building Department Curb Cut/Driveway Permit / �% ' 212 Main Street Sewer/Septic Availability / Room 100 WaterNVell Availability C /./ Northampton, MA 01060 Two Sets of Structural Plans \ phone 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 1.1 Property Address: This section to be completed by office _Si }l Flit\ 0 Map Lot Unit ) G u L Sf A4 a"- iF\-�r -0 Cfa ' Yv� 0 ( O (12- Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: - 1u,ce m J be tv.3 1 is ISI UN-h H ci a t_ + isl Name(Print) Current Mailing Address: t 04 \C` UZ Svc.-')- --) Telephone Sig tune U -40) -CC 99—CcTS-58 2.2 Authorized Anent: � )) /� ,tl rJ\AO li . KP N�Olr! I/1 V OV✓1 In'I Chr/1- ' -f-.Name(Print) Current Mailing Address: l SLS 77� 900 Signal re 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 __1 J _ _ ' id Q- / 6. Total=(1 +2+3+4 +5) = V80 08 c26-C76- YV_ Check Number /` V 7. 60 This Section For Official Use Only Building Permit Number: Date Issued: 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 'rim column to be filled in by Building Department Lot Size Frontage Setbacks Front J. h: RA_......_ L: R:__ ............... Rear Building Height Bldg.Square Footage .o Open Space Footage (Lot area minus bldg&paved parking _ s of Parking Spaces Fill: (volume(volume&Locar,nn) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW O YES 0 IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO let DON'T KNOW YES 0 IF YES: enter Book Page and/or Document u B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 41, YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO 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(cl Bring, grading, xcavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO '(C•e1� 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 D Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition E New Signs [p] Decks [q Siding[O] Other{ Brief Description of Proposed__ // - I' 11 Work: nti\c CI 6 v1J ,A HIC_,, Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea. 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 I, �Q.10 v---'l -�' as Owner of the subject property ��JJ hereby aee r�ela� my ��� to act on my behalf, in all matters relative to work authorized by this building permit application. a cuieUp v. C 1-17/4,50/1) //-Z/- /CB Signof Owner Date 11 I, /51-1/,,v?1'/51-1/,,v? /•(�,/,h b , 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 paigs and penalties of perjury I) ril(it')- ivbli Print Name a Signature of,0 - /••en • Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Not Applicable CI !Mame of License Holder. L >�9'(\ RJ ,, o Q }?_ License Number Co C{ n\ tot...) MI— SIC? /!a Address Expiration Date Si lure Telephone c g.Registered Home Improvement Contract. ' Not Applicable 0 Yom` • - e ..- _ 13n 'um Company Nam= t Registration Number Address ( Expirat on Date C AlQh\ Lv-&.CI l Telephoner? ~ ( 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 or the building permit Signed Affidavit Attached Yes ,. No 11. - Home Owner Exemption The current exemption for"homeowners='was extended to include Owner-occupied Dwellines 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 85 supervisor.CMR 789. Sixth Edition Section 108.3.$.t 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 hetshe shall be responsible for alt such work performed ender the buitdina 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 far 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 _ _, 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: ( S5 o i rt4h P4l]u{1 7.* Al, t� The debris will be transported by: C., nyi,<*v. ulk CO The debris will be received by: Cr-.36,1C-k- IJy7a.)J 6 Building permit number: Name of Permit Applicant 3Y1r47 1 Y 1 ni 1 i /-1114, Date Signature of Permit Applicant City of Northampton /i 5\5.�. SSC i + k Massachusetts o2 4 4 /•s�� DEPARTMENT OF FOT.[r(JZHCa INSPECT TONS Sk ✓ ,i, 212 Main Street • Municipal Building dC� _ Northampton, IM 01060 ,SOC Property Address: ) ?4'7 Lo'sh fl Q.1 S) 24 Contractor Name: _ t'l(a l\ itil3k3Th Address: M-o CAA.)u? c� j*' City, State: Rs,r(1 c1...atf i (" (I\ r, ( ' 0 Phone: N4V - )-25-9(,(, (6 Property Owner „� Name: J Oil lQfr';^-4 /Lc\ N C(37 Address: ) ljv1 X441 d C/1 c k • A q V City, State: 1 dl-R,/KJ )4A - 3 I U C0 - I, ryi iv )'(\1i))D (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 112 I ,16r' • RISE60 Shawmut Road, Unit 21 Canton, MA 02021 1 339-502.6335 ENGINEERING www,RISEengineering.corn OWNER AUTHORIZATION FORM I, J Pt 1? 60/1-) / O S (Owner's Name) owner of the property located at: �,, gi5 A,10 - ltim `?jY.f,1 (Property Address) Lv /2 / k74 . o /° O7_ (Property 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 property. 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 close cut this permit by contacting their municipality at the completion of this work. Owner's Signature /37/dsz Date 6.2016 RISE60 Shawmut Road, Unit 21 Canton,MA 020211339-502-6335 ENGINFERING www.RlSEengineering.com OWNER AUTHORIZATION FORM I, \I 2-, (Ay 13Oti/0s (Owner's Name) owner of the property located at: t 6S NU, Ment) 5Li fes( (Properly Address) 0/1)6,4)6..i. /J pg . 0 r (Properti•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 property. This form is only valid with a signed contract. Ther Permit will be secured by the insulation contractor. at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. 1 Owner s Signature I / 3 1 ( b Date 62016 The Commonwealth of Massachusetts te • 3 a Department of Industrial Accidents t-'2e—slit= Office of Investigations e � _ 4' 600 Washington Street Boston,At! 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aoulicant Information Please Print Leelbly Name (BuS s rgSzationandividuaq: Bryan G.Hobbs Remodeling 346 Conway St. Address: Greenfield, MA 01301 �i City/State/Zip: Phone n: � 3''1? $"-1 00w Arer}I you an employer?Check the appropriate box: Type of project(required): l.ry I am a employer with 6 4. ❑ I am a general convenor and I 6. ❑New cad= employees(full and/or part-time).• have hired the sub-contractors 2.0 1 am a sole ploytietor or partner- listed on the attached sheet. I 7. ❑ Remodeling ship and ban no employees These sub-contractors have 8. D Demolmon working for me in any capacity. workers' comp. insurance. 9. 0 Building addition [No workers'comp.insurance 5. 0 We area corporation and its • required] officers have exercised thea 10.❑ Electrical repave or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers' comp. c. 152,91(4),and we have no 12.0Roof repairs insmince required.]t employees. [No workers' 13.® Ow N]5 TWA comp.insurance required.] rR t Y t crJr n t! *Ally epplkcd Ma checks box e I mus also MI oLi the sedan below lawiz4 thein wtua'cannon policy vdmmdo,, 1 Bmtxvwn=Mtn=bran this dfiti t Winn tier In doing all watt sec On con awl=anincon most snail a on BtM1vb'tlTmpa nab. lCovactaa that chock cups boa mama nand m dditiond Wast=owing the nme of the subcouunon ad Thee worm.'en.policy information. f am an employer that if providing workers'cm pensmlon influence for my employees. Below is the pe&y andJob dee information. N Insurance Company Name: a (-)UA4 D I /IS( UotY1 pail LI Policy N or Self-ins.Lie ft: 221 1.5 I ;j el K C Expiration Date: l0/2.01 I�' Sob Site Address: ' $S SU m+h N(n ,,n 4 A eity/siawzip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date} Faihuc to scam coverage as required nada Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 ad/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 8250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the paha and penalties of perjury that the Mformarion provided above U Ow and correct Simatme: LL//dDate: /l- - i- "Iv PMoC N: l I i' 7 tic- C O. Official use only. Do na wrUe in shit area,to be completed by city or town gold&. City or Ton: penmen scene Issuing Anthony(elyde one): Board of Ranh 2.Balling Department 3.Ctryrltwn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone N: ACOR® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDEYYM THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: H the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certifioete does not confer rights to the certificate holder in lieu of such endoreement(D) PRODUCER CONTACT Nwer Dakota Coughlin _ A. H. KIST INSURANCE AGENCY INC. 'H AN> E�I�(413)663-4373I y,N, . F L ADOREERS`dakota0ahr_M.com _, P.O.BOX 391 _ _ INsuRE0.$)AFFORDING COVENAGF I NAIOP TURNER FALLS MA 01376 INSURER A-. AMGUARD INSURANCE CO I 42390 INSURED — ENSURER e: -__ HOBBS BRYAN G INSURER C'. _ _ __ _ __ _ TA BRYAN G HOBBS REMODELING CONTRACTOR INSURERS: 346 CONWAY STREET INSURERS GREENFIELD MA 01301 INSURER F. I COVERAGES CERTIFICATE NUMBER: 94101 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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. !NSRiYPI OF INSURANCE — ^ADR POLICYEFF TI VOLICYEXP �LWR4 . — — INSD RPM POLICY NUMBER IMMSDNYYY1'EMMIDOYYWI COMMERCIALGENERAL MARLIN EACH OCCURRENCE �$ DAMAGETCYRENTED . • CLAIMS-MADE OCCUR ' • Rflea/SES Lk'occurrence) 1 S MEC EXP(Any°nape: S• N/A I PERSONAL&ADV INJURY 1 a GEN'L AGGREGATE LIMIT APPLIES PER ' I GENEaLAGGREGATE 1 POLICY!_,JECTT I IOC • . PRODUCTS-COMP/OIs AGG4S I OTHER' AUTOMOSILELIANM LnY .—...... I CUMBEORMGLEL6UIT ANY AUTO BODILY INJURY(Per Parmaal I$ —ALE OWNED SCHEDULES ...._ _ ..� _. ...... _ N/A SEEDILY ENJWAY(Pm deaden),$ _ NONOMMED PN PEATY DAMAGE S xEDAUTOS 2 AUTOS IPer amaepll• S UMBRELLA _ 'OCCUR I EACH OCCURRENCE I 1 'EXCESS LIAR MAIMS-MADE N/A _AGGREGATE F N DEO RETENTION£ __... !WORKERS COMPENSATION r /\V Eg6,Eg J IOF0R AND EMPLOYERS'LIABIITV — - e14YPRoPRYcTORIFARrNERMYECUTIVE Y N ar..EACHAMMER, r 500,000 A •OFFICERMEMSEREXCWDEDe 1MA ea WA- R2WC768263 1020/2016 1020%2017- -- .IManeatfln NRI I . I . FL DISEASE-EA EMILOYP1 S 500000 'uea describe under I — DESCRIP CON or OPERATIONS below I I EL..DISEASE:.POLICY WAIT ,$ 500,000 i • N/A • DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD WI,Additional Remarks Sthedule,may be attached It more apace rerequired) Workers Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 E,no authorization is given to pay claims for benetis to employees in slates other than Massachusetts it the inSUr d hire,or has tired those employees outside of Ma54achusetts, This Certificate of insurance shows the policy in force on the dale that this certificate was issued(unless the expiration date On the above policy precedes the issue date of this certificate of insuancel. The status of Ins coverage cap pe monitored daily by accessing the Proof of Coverage-Coverage Venfrcation Search tom at wwwmas,c goy1fvdIw0d21s ell pensa00nirtiveStIQ al ion /. Sand 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 AUTHORIEDREPRESENTATIVE iteyd— Greenfield MA 01301 `^GA (C I DDI1lel M.Cro9ey,CPCU,Vice President–Residual Market—WCRISMA ©19&&-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of AGGRO (2J lf' 7l one»eC1417fweafa Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 139564 Type: DSA Expiration: 7123/2017 Trk 267354 BRYAN G. HOBBS REMODELING BRYAN HOBBS — —� 346 CONWAY ST GREENFIELD, MA 01301 -- Update Address and return card.Mark reason for change. Address —j Renewal !": Employment _, Lost Card nal a 9WC5'fI .._ _... .. -. _. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENTCONTRACTOR before the expiration date. If found return to: egletration: 139564 Type; Office of Consumer Affairs and Business Regulation "6^ 'Expiration: 7/23/2017 OBA 10 Park Plaza-Suite5170 Boston,MA 02116 .EVAN G. HOBn€REMODELING RYAN HOB83 46 CONWAY ST REENFtElO.MA 01309 Undersecretary Not valid without signature • • • Massachusetts Department of Public Safety Board of Budding Regulations and Standards License: CS-083982 BRYAN O HOBBS 346 CONWAY STREET GREENFIELD MA/n01301 C/� Expiration: , Commissioner 05/021018