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22D-057 (3) 17 FLORENCE RD BP-2017-0948 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22D-057 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-2017-0948 Project# JS-2017-001633 Est.Cost: S772.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BRYAN HOBBS 139564 Lot Size(sq. ft.): 6926.04 Owner: HAMLEN CHRISTOPHER Zoning.:URA(00)/WSP(1oOVWP(75 X Applicant: BRYAN HOBBS AT: 17 FLORENCE RD Applicant Address: Phone: Insurance: 346 CONWAY ST (413) 775-9006 WC GREENFI ELDMA01301 ISSUED ON:2/16/2017 0:00:00 TO PERFORM THE FOLLOWING WORK AIR SEALING, BLOW CELLULOSE EXTERIOR WALLS, 224SF 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 ft 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 2/16/2017 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0948 APPLICANT/CONTACT PERSON BRYAN HOBBS ADDRESS/PHONE 346 CONWAY ST GREENFIELD (413)775-9006 PROPERTY LOCATION 17 FLORENCE RD MAP 22D PARCEL 057 001 ZONE URA(1003/WSP(100)/WP(751/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid , /1(j Building Permit Filled out +}r{ Fee Paid Tyneof Construction: AIR SEALING. CELLULOSE EXTERIOR WALLS,224SF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 139564 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 •e .; vow ji . Z. °, -‘111110;17 Signatureo I ui di g 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. p .,.`� / Department use only 47 / City of Northampton Status of Permit: _ N Building Department Curb Cut/Driveway Permit `,GCSE 212 Main Street Sewer/Septic Availability Room 100 WaterANell Availabflity Northampton, MA 01060 Two Sets of Structural Plane N `' / phone 413-587-1240 Fax 413587.1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELUNG SECTION 1 -SITE INFORMATION 1.1 Property Address,: This erection to be completed by office 1^i 'ice 1..re�e ISO , Map Lot Unit V'to/ace ' MA zone Overlay District Elm St District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Recor4 l ,Rf� anri3 Ham}en ' - ct& -cc.. Qd . i f ldrer7.el Name(Print) Current Mailing Address'. 3 c, !7— 2`_ ' ) R\ 1 1 J { Q V✓ l0 �Q l Y u-i ;i .'. H tM Telephone Signature 3.2 Authorized Arent: -Rn �hbbs 3% Comwl )a�r Sfy Creel) cid A44 Name(P Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 7c (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(8) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5, Fire Protection n 5. Total=(1 +2+3+4+5) Check Number IXuialv� This Section For Official Use Only Building Permit Number: Date issuu ed: Signature: Building Commissioner/inspector of Buildings Date Section 4, ZONING All Information must Be Completed. Permit Can Be Dented Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Belding Department Lot Size ��l I Frontage /tv Setbacks Front lit L: R: ,,, L It Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot am minus bldg&paved parking) k of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Findin ever been issued for/on the site? NO © DONT KNOW YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO C) DONT KNOW ytggYES 0 IF YES: enter Book ! Page and/or Documentt# B. Does the site contain a brook, body of water or wetlands? NO © DONT KNOW {,l/ YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 , Date Issued: C. Do any signs exist on the property? YES Q NO 4 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 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,ex nation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO 1i,� IF YES,then a Northampton Storm Water Management Permit front the DPW is required. SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Atteraton(s) ❑ Roofing 0 Or Doors D t�t Accessory Bldg. E Demolition ❑ New Signs [C] Decks Ip Siding IC] Other # Brief Description of Proposed CC Work: NV' 50...CN9 /UoW ce, tA05-C ekkhor Way\,S, Zz'LSF Alteration of existing bedroom__Yes X NO Adding new bedroom Yes et Np Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet . 1� ea. If New house and or addition to existing housing,complete the following: a. Use of building One Family l\ 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 stones? 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 foor 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ►II. so - .. as Owner of the subject property (� ;/ hereby authorize 61r I aL)h.b5 to act on my bell , in an matters relative to work authorized by this building permit application. SZ,C', 14 u, orl ZuA'/ten of .,3--( '7 nature of Owner Date 1, tiCikr \r1'Ob5 as Owner/Authorized Agent hereby declare that statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under tine pains andpenalties of perjury. C .. l--\6• 111.Print N� Iidnt.an\ l A� 9 0• 3'1 ? Signature of Ovmer/Agnt Date SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Constructiont1� Supervisor(CSL) 0839 c n ec a'(\ I.VJhI-, License Number Expiration ate of C' -Holder • i r {_ Qe.n1C1 List CSL Type(see below) U Addre ) `I Type Description C{�9 /7©lnt� U Unrestricted(up to 35,000 Cu.Ft.) . 6i A R Restricted l&2 Family Dwelling Siig(nature 1 r� M Masonry Only T t Q �5�7�� RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 RegistHorrte linnpprovemgnt Contraclor(kIC)&aeon krck / 45�i HIC Company Name or IC Re taut N a Registration Number f�f\w0..y . t retnR-M, rv,A 7/23P7 Address ^ ' 9t3 11� a��� (� lExpiration Date Signature Telephone SECTION 6: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 ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT S , as Owner of the subject property hereby authorize E�Y\AK\ \c$o isQ,rnocie in to act on my behalf,in all matters relative to work authorized by this building permit application. J S'p UU. tor'IZQ,1kor _ Signature of Owner Date SECTION 7b:1OWNER' OR AUTHORIZED AGENT DECLARATION ' l I, I an 'ot\'J S ,as Owner or Authorized Agent hereby declare that the statements and Information on the foregoing application are true and accurate,to the best of my knowledge and behalf. dun Print Name woos-a, Signature f er Authorized Ag'en`t Date (Signed under the pains and penalties ofperiury) NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations l IO.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq. Ft.) (including garage,finished basement/attics,decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system _ Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost' *_ The Commonwealth of Massachusetts �1r 5 7 Department of Industrial Accidents _^y� 1 Congress Street,Suite 100 _• Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information �� ,,Please Print Lenibly Business/Organization Name: " fYj A e,Y}tl OG 61 Address:`........ @'-i Co COO Way Jf. City/State/Zip: tea 1 el U U 1 Phone#: LI 13 ---1-15 5 -goo b Are you an employer?Check the appropriate box: Business Type(required): I.( I am a employer with5. Retail p 10 employees(full and/ or part-time).* 6. ❑RestaurantBar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. Cl Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] 8. ❑Nom-profit 3.❑ We are a corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c. 152,§1(4),and we have 10.0 Manufacturing no employees. [No workers'comp.insurance required)* II.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees.[No workers'comp. insurance req.] 12.R Other .}.-rh5b.la4tth .. •.Anv appliearu that checkshex#1 maw also fill out the section below showing thee workers'compensation policy information. "If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#I. am insurance m I su an employer per Na providing ��l,Aworkers' nCU Os Til i Lyra flc is vthe poliry`�rnformatinn. Insurance Company Name: Y CIrCe Ins'urer's Address: (� �''+,1' City/State/Zip: --Pc.), 2y''x t���c } , [ i) r n to Y.I ttS t MA ^} Policy#or Self-ins.Lie.# 1'l t A t �QL} 5 Expiration Date: 10, ( {� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expi�afion 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 one-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 c/eyd�'}� under the pains and enaities of perjury that the information provided above is true correct. igk Sature: 1 SVf•''t Ct(Ls.. <7(j,Jl,]X.. .......... Date: Dens - (�-} ii P one#: / 1 - C Official 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.Licensing Board 5.Selectmen's Office 6.Other i Contact Person: Phone#: — - www,mass.gov/dia Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-083982 :on Consr!1, Gu!:errlSOY (r - BRYAN O HOBBS 848 CONWAY STREET GREENFIELD MA 01301 (17--1...r. l.C.A..-14 Expiration: Commissioner 06/02/2018 s ge.\ CT)�ze +a» » auuea /� (ICI- tJelt/ G ft Office of Consumer Affairs and Business Regulation a1. s? 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 139564 Type: DBA Expiration: 7/23/2017 TM 267354 BRYAN G. HOBBS REMODELING BRYAN HOBBS 346 CONWAY ST – - GREENFIELD, MA 01301 — --- Update Address and return card.Mark reason for duo SCA+ c 2010-05/11 Address J Renewal - Employment L; Lost Off+ceof Consumer Affairs&Business Regulation License or registration valid for individul use only QOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: •'�-''w,. Megistretion: 139564 Type: Office of Consumer Affairs and Business Regulation X51 ''Expiration: 7/23/2017 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 BRYAN G.HOBBS REMODELING BRYAN HOBBS 346 CONWAY ST GREENFIELD,MA 01301 Undersecretary Not valid without signature ACORDa 4..../ ( THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEO BY THE POI BELOW. THIS CERTIFICATE OF INSURANCE COES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE/NS), AUTHO REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If tee certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,sub) the berms and conditions of the policy,Certain policies may require an endorsement A statement on this certificate does not confer rights certificate holderIn lieu of such endorsement* PRGWCE0. CNpMQAM kt TiaCey Kuewi CY A.H. Rist Insurance Agency, Inc. rat ace. (413)863-4373 1 or(413)843-966 159 Avenue A ,ADA F.O. Box 391 susHemEnt in 00007068 Turners Falls MA 01376 INSUREP(S)AFFORDINO COVERAGE 'N INURED trsnRet°:Libarty Group Bryan Hobbs dba Ixa e: • Bryan G. Hobbs Remodeling muse,c: 346 Conway Street INSURER D: INFUR E: Greenfield MA 01301 IMMERGE COVERAGES CERTIFICATE NUMBER:2017 CERT REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY F INDICATED. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER HOC M9ENT WTH RESPECT TO ANC CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE T IN AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'LTR TYPE OP INSURANCE AWL WVO POLICY NUMBER AIp�KCwow. - 1 LOWS BE'TNERALLGarutt , EACH OCCURRENCE 5 1,01 ^ mazarnsorrer }L COMMERCIAL GENERAL LIABILITY RgEmmrs+a occynnml s 31 A I CLAIMSMADE X.1 OCCUR BXB5809d89B JBfO4/201603/04/2011)MEDE%P(my one person) $ ( PERSONAL&ADVINJURY i5 1,0( GENERAL AGGREGATE 5 2,0( GEML AGGREG�ATIE LIMIT APPLIES PER. PRODUCTS-COMPCP AOG I 2,01 7PWCYI 7.2T .IOC - t AUTOMOBILE LABILITY COMBINED SINGLE LIMIT 5 1,01 (Ea exdmtl I ANY AUTO BODILY INSURE Monsoon! S A ALL OWNED AUTOS BODILY 01/02/2014 .1/02/2018 BODILY INJURY(Per aodoenO t X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS X NON-OWNED AUTOS t X Mem Pdlq Form $ A X UMBRELLA URI X OCCUREACH OCCURRENCE $ 1,0i EXCESS LAB CLAIMS MADE U9056009898 08/04/201608/04/2017 AGGREGATE E 1,01 e _DEDUCTIBLE _ I - X RETENTION 5 10,000 BLATW Ti GV WORKER.COMPMATON SNOWPLOW-RS GASL2TY t Y MITA RR ANY PROPRIETORMARMERIEXEOYTIYE YIN E.L EACH ACCIDENT $ OFFICERMPAIBER EXCLUDED? I NIA IMandMIY In NH) E.L.DISEASE.EA EMPLOYE t R y�F' to LeArger EL DISEASE PESCIRIPTICN OF OPERATIONS below POLICY Lae 1 OESOPJPTION OF WERATONS I LOCATIONS?VEHICLES(Attach ACORD 101,AddxleneMnar o Schedule,It man ewe IrtpuYW) Cleeifdeletion: Carpentry B Insulation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OP THE AtoV!OESCR($MD POLICIES BE CANCELLED BE TUE EXPIRATION DATE THEREOF. NOTICE WILT. se DELIVER! Bryan Hobbs ACCORDANCE WITH THE POLICYPROVISIONS. 346 Conway Street Greenfield, MA 01301 AHHCRi1E6RFPRc3B"T°Tess Tracey Euklewi cz/DNP P -MranoLd ACORD 25(2009/09) m 19882009 ACORD CORPORATION. AS rights re• 1108026t owin The ACORD name and logo are registered marks of ACORO 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 150k Address of the work: l 1 FLUYCY1Ce Rd., CI&ance The debris will be transported by: (v/A The debris will be received by: Building permit number: Name of Permit Applicant Date Signature of Permit Applicant City of Northampton v.: • 7 t Massachusetts c 4ti t lr . DEPARTMENT OF BUILDING INSPECTIONS Z. f -6 212 rain street i Municipal Building (� Northampton, iO O,,{{1''ps0 Property Address: \ 1 c \ 'cei e RJ, ) O'lott,rC.e+ Contractor Name: 16 rya r, kits RQmcv&d t 173 Address: 7./1-1b l (1Y) 11 vx7 ?t `J City, State: C`C‘r vaC p r,c,e ; (kAP 0130 i Phone: CI( 3- -)-25 - 90© (a Property Owner 1 l Name: C CSC ,. Y`�1Ck tQM1 Address: 1 T c \G.etre. Ra . City, State: (fiPd1Ce, , A, A 010 Lo I, b(\\G r' IIgr1h-) (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 t f . �� T drt)1y� Date Jar) i