23D-164 (3) 17 MAPLEWOOD TER BP-2017-1053
GIS s: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D- 164 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c1144/2�A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-1053
Protect JS-2017-001809
Est.Cost: S2320.00
Fee: S6 .00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRYAN HOBBS 83982
Lot Size(sq. It): 24001.56 Owner: SILVER JOSHUA M &NUN IA T MAFI
Zoning:URB(100)/ Applicant: BRYAN HOBBS
AT: 117 MAPLEWOOD TER
Applicant Address: Phone: Insurance:
346 CONWAY ST (413)775-9006 WC
GREENFIELDMA01301 ISSUED ON:3/22/20170:00:00
TO PERFORM THE FOLLOWING WORK:AIR SEALING, WEATHER STRIPPING ATTIC
INSULATION, R-22, R-19, VENT FANS
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 3/22/2017 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck- Building Commissioner
Fite#BP-2017-1053
APPLICANT/CONTACT PERSON BRYAN HOBBS
ADDRESS/PHONE 346 CONWAY ST GREENFIELD (413)775-9006
PROPERTY LOCATION 117 MAPLEWOOD TER
MAP 23D PARCEL 164 001 ZONE URB(l00)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Paid
Fee dai �
P idg Permit Filled out
Fee Paid
Typed Construction: AIR SEALING. WEATH R STRIPPI G ATTIC INSULATION R-22 R-19 VENT FANS
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 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 Pian
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: § _
Finding Special Perms 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
Dergolition Delay
Signet ofBuilding 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 40k Contact Office of
Planning& Development for more information.
Dopwbiient use only
City of Northampton Status of Penna:
# Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
r7 et/ Room1D0 WaerWelAvailabilty
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
s
SECTION 1 •SITE INFORMATION
7.1 Property Address: This section to be completed by office
k 11 ,uckp\Q,wcna TQ-'RR Map Lot Unit
„nce, tuts 01d02' ZoneOverlay District
Elm St District Ca District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
3c,:s- S;Autfs i17- Mc,Q1t u orA TeRR .
Name(Print) {A,��\ Current Mailing Address: ?7.69
J \.Z-G.+.,k'iL'3('' Telephone qis - ;2,43 - y
Signature
2.2 Authorized Aaent;
Sryufl 6c4os 3 % Conway S4eea i-te4tt, M
Name(Pfintk.- Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Onty
completed by permit applicant
- 1, Building a 3 at) (a)Building Permit Fee -
2. Electrical (b)Estimated Total Cost at
__ Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) cv
6. Fire Protection
6. Total=(1 +2+3+4+5) S a90 — Check Number a{_p rj�}
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING AR Information Mug Be Completed. Permit Can Se Denied Due To Incomplete Information
Required by Zon
This column to fitednig in by
DepartmentBadding
1.11.11111111111.1111111 1111.1111111
Setbacks Front
Side 12 Si__
Btu
Bldg.Square Footage _111111a_-
Open
Ooen Space Footage 1111111111.111.11
minus bldg&paved
kin:
111.11111111111.1111111111111111.11111111111.11.11
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ® DONT KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO (J DONT KNOW 0 YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW ( YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES ® NO tii
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO ,
IF YES, describe size, type and location:
E. Will the construction activity disturb(Veering,grading,exe¢vation,or filling)over 1 acre or is it part of a common plan
that will disturb over I acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
..CTI•. .- ! . z -7 ON •F --!-'- ! 1 t re kill :.. i .... =)
New House Addition ❑ Replacement Windows Alteration(s) El Roofing C
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ Now Signs [C3 Decks ;p Siding[ID) Other u
Brief Description of Proposed Vim} n5
Work: C?af Szcs..Ve5, U32.1a X' tnsiAl .A-tiSn, -•L? yR-9/
Alteration of existing bedroom Yes X No Adding new bedroom Yes N9,
Attached Narrative Renovating unfinished basement Yes X No •
Plans Attached Roll •Sheet
es. 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 EV Yqq\_
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensi• s
a Number of stories?
f. Method of heating? Firepla•-. or WoodstovesNumber of each
g. Energy Conservation Compliance. I assoheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? es No. Is construction within 100 yr. floodplain„ Yes�No
j. Depth of basement or cellar floor below ' fished grade
K. Will building conform to the Build, g and Zoning regulations? Yes No
iI. Septic Tank City Sewer Private welt City water Supply
SECTION 7a-OWNER AUTHORIZATION•TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. O S \UQ S i l 0e2-- — as Owner of the subject
property �\ ( 42-54
) .a
hereby authorize '�l I'\/yr 1 C41\AS T`5Qcr oc\Q\\nc\
to act on my beh)alf, in all
��\matterrr,s��relat to work authorized by this building permit application. b
signature of Owner Date
, Y Q(1 - C ♦' t) ..t as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing applicaao are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of,-perjury.
RC\JoS I T1C3040
Punt Name
.1)..,,-, e --- 1 h•i`�
Signature of OwnertAgent Date
SECTION 8-CONSTRUCTION SERVICES
.1Li.= • or tr.. • r ,<- i:.r: Not Appli�ccraable/(❑
Name o(Lleanw NOWer:, ,,,_ 0. 83gg
Bryant Holt n RemodelingLicense Number
340 `,don'St. S
Address eternal ,' "'+• •
Expiration Date
OO
Slj rt Telephone
. ... • u' up „n C.n. Not Applicable 0
_ - 3a 5'.
Comoanv Nam. St. Registration Number
Cfir. c '.:;Lint ^j /( ';
Address Expiration ate
_Telephone I^ ' ! cl
a-
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G.L.c. 152,§250(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit win result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
21. - 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 thg owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Hermitian of Homeowner: Person is)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"shalt 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
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: 111 /WI()\k uiCKY,1 Ttr r-
The debris will be transported by: NSA —
The debris will be received by: kJ/A.
Building permit number:
Name of Permit Applicant
C3 -kAr6Iii/a-'
Date Signature of Permit Applicant
City of Northampton
Massachusetts h. e
(�tip ')
wDEPARTMENT OF BUILDING INSPECTIONS ti
If•2t2 Wan Street • SunidP•1 Building 1j 0?
e -�„1VV/�..
Northampton, 1N 01060 • 1
Property Address: I I -7 Map\Q u io S Tex r.
Contractor I (('',, 1
Name: �V'�/Qr. h1 - s Ce rrnr7 Qli nc\
Address: , ,Hh Cc ou_nY Si- ,
City, State: C-1 ?rC-1 dCIr t.A i 0,301
Phone: q13 -`t -75 - 900(o
4o
Property Owner 1
Name: LV Il /t42
Address: `Z 41\A0,0@ @ VUOGC- -Mr 1,
City,-State: "7-r- (3'6- \ �
�(3Q ce_1• IA
I, r f �dri rs (contractor) attest and affirm that the building I intend to
insulate dries 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 zz ,,,,
ja
Date - IL 1 -q-
RISE60 Shawmut Road, Unit 21 Canton,MA 020211339-502-6335
ENGINEERING www.RlSEengineering.com
OWNER AUTHORIZATION FORM
I. To5au4- S.'?L-1/ _
(Owners Name)
owner of the property located at:
!i Nkl6' cU .6 77--fi/ dz_
(Property Address)
• U / ° 4-
(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 out this permit by contacting their municipality at the completion of this work.
Owne ignature
1 - l �l ' f
Date
6.2016
The Commonwealth of Massachusetts
I"f_' ift Department of Indubtrial Accidents
!i =ter- 5 1 Congress Street,Suite 100
kine
e a��RS Boston,MA 02114-1017
www"mass.gav/iia
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Inforivation ��_" �� Please Print Legibly
Business(Organization Name: 13f y), )4O.I ��L15 RerviOCIe\Inn
Address: 33j'Li (p Conucx.y
6 l
City/State/Zip: 'vte� ytci ei`i y Mt A Phone#: "�3 ---11 5
"qQ 1C7
Are you an employer?Check the appropriate box: Business Type(required):
1.[cs( I am a employer with (p employees(full and/ 5. Q Retail
or part-time).* 6. E Restaurant/Bar/Eating Establishment
2.0 I am a sole proprietor or partnership and have no 7, 0 Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity.
(No workers'comp.insurance required] o. El Non-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'camp.insurance required)**
11.0Health Care
4.0 We are a non-profit organization,staffed by volunteers, '
with no employees. [No workers'comp.insurance req.) 12.?4 Other £C , .kit • a
'Any applicant that checks box al must also fin out the section below showing their workercompensation policy information.
"If the corporate officers have exempted themselves,but corporation has other employees,a workers'compensation policy is required and such an
organization should check box k 1.
l am an employer shafts providing workers'^ compensation insurance for my employees. Below is the policy information.
Insurance Company Name: C\YY? uo..t 'r- Urn c C Q C o .
Insurer's Addre :: /() . „ A (4 I. '. L S Y C _
City/State/Zip: t Q. 4'x(yx 1 .—_ r s[ . .j A _._.._
}
Policy#or Self-ins.Lie.# .. .. a � Expiration Date:, 5 U j t�01—L
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expi ation date).
Failure to secure coverage as required under Section 25A of MOL 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 es 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 ce
,under the pains and enalties of perjury that the information provided above is true and correct
Signature: 1 l\l/I-1 1.t.4, C)(i„//J,�C.. Date: ? - t
Phone 4: y "ri 5 - 900 Za
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):
I.Board of Health 2.Building Department 3.City/Town Clerk 4,Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.nass.gov/ala
tIo Massachusetts Department of Public Safety
• Board of Building Regulations and Standards
License: CS-083983
constconstiticiton Gu!z;visor
BRYAN G HOBBS '
346 CONWAY STREET
(*.:.)
GREENFIELD MA 01301
1r ine-an CA.-.:. Expiration:
Comnnmissioner 05/0212015
13
(7).°27e a»emoiewerrltf a/c 4' edic-ckeiett
J.•'‘.4.7„,-=,
w Office of Consumer Affairs and Business Regulation
-n-Pi 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 139564
Type: DBA
Expiration: 7/23/2017 Tre 267354
BRYAN G. HOBBS REMODELING
BRYAN HOBBS -- - —
346 CONWAY ST — —
GREENFIELD, MA 01301 -------- — --
Update Address and return card.Mark reason for chap:
SCAT 0 20M-05111Address J Renewal Employment "` Lost(
'-i/ n,„,,„,,,,,.,w7,4 rr-/(7„.:nrkcf/L
L. office of Consumer Affairs&Business Regulation License or registration valid for individul use only
SOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to:
't Registration: 139564 Type: Office of Consumer Affairs and Business Regulation
'. 'Expiration: 7/23/2017 DBA 10 Park Plaza-Suite 5170
Boston,MA 02116
BRYAN G.Hoses REMODELING
BRYAN HOBBS
346 CONWAY ST
GREENFIELD,MA 01301 undersecretary Not valid without signature
e
ACORD
4,....---
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POL
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S), AUTHOI
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder le an ADDITIONAL INSURED,the policy{les)must be seemed, IF SUBROGATION is WAIVED,cut)
the tenni end conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights
certificate holder In lieu of such endorsemsnttei•
PRODUCER Tracey Xukley:as
A.H. Rist Insurance Agency, Inc. pp,�Np fists, (413)363-6373 ^ mm sop tal3 l 812-4664
159 Avenue A EMDedk _
P.O. Box 391 SRa°ioete°w ID 6000070be
Turners Falls MA 01376 INSURER(e)APPOROINGCOVFRAGE _NI
INSURED INSURER A:L berry Grou,�, _,
Bryan Hobbs dba INSURER 6: -
Bryan G. Hobbs Remodeling INSURBLC: —
346 Conway Street INSURER a:
INSURER 6:
Greene ield MA 01301 INSURER F:
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 PI
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH
CERTIFICATE MAY Be ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TI
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDpLCLAIMS.
TUm
AR TME OF INSURANce TER f YAM POLICY NUMBER IIMAWYYYYI IMMNDAY'1T) UMM8
DENFEA: LiAaaittIf` E{ACH OCCURREuINcCE 1,00
PRMAISES(El I}ED
X commERC LGENERA.L49uTF 1 PREMISES IES Monne.)Monne.) 30
A CLAIMS.MAOE IBJ OCGJR I 34.924014828105/04/2014 8(04/2017 MED EXP{Anyene ppmm) 1
PERSONAL a ACV INJURY 1,00
—
GENERAL AGGREGATE 2,00
GENA.AGGREGATE LIMIT MINES PER: ROOUCT$-COMPI,P AGO 2,00
7E000Y7(JEM LOC Ir
AUtOMOBILJ LIABILITY COMBINED SINGLE UMtt $ 5,00
(SE.caaem4
�1 MY AUTO BODILY INJURY(PepsrsMI S
A TALL OWNED AUTOS BA1020738 61(02/201Y 01102/2018
BODILYINJURY IPer,¢W¢no $
X SCHEDULED AUTOS pROPFRttDAUA F
x XIPEO AUTOS IP',E¢NM4) _
X NCNONNED AUTOS I $
X Mau Mc/Form 4
A X UMBRELLA LIAR x OCCUR 2ACN OCCURRENCE 4 1,00t
— EXCESS UAB CLAIMS-MADE CEOS6084898 08/04/201608/04/2011.AGGREGATE 4 1,004
oEDUCDBLE '� I
X RETENTION 5 10,000 1 y.�( y� Y 6
WUSERS COMPENSATION a15MT.lugy IDFN.
AND EMPLOYERS'LIABILITY 't
MY
YDEORRSTO PAETNEEXCLUDED NT VE 1'N N)A I C L.EACH ACCIDENT S
(MEndIory m NN) E.L.O:SEAGE-EA EMPLOYEE 4
D6dRIP'ION CF¢PERATIQN6 pelow E.L.DISEASE-POLICY LLLST 4
OESORWIRON OF OPERATIONS 1 LOCATIONS I V EXCLEE(Math ACORO 181,A W MoneI REm,M Stf.dulq if roan owe Ie re0:840d)
Clsaai£Scstiont Carpentry b Insulation
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BBB
THE EXPIRATION DATE THEREOF, NOTICE WILL 9E DELIVERED
ACCORDANCE WITH THE POLICY PROVISIONS.
Bryan Hobbs
366 Conway Street
Greenfield, MA 01301 4urnauz4o aBPR6eeNTAnvE
Tracey ttuklewice/OHP C` - . 47..
AG0RD26029D9D0rksRD RD CORPORATION. All right*rase
1NO (eIThe ACORD name and logo are registered maof ACO