16D-016 (3) 185 NORTH MAIN ST BP-2018-1086
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 16D-016 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Pertnh: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv: INSULATION BUILDING PERMIT
Permit# BP-2018-1086
Project# JS-2018-001958
Est.Cost: 8732.00
Fee: 565.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRYAN HOBBS 83982
Lot Size(su R), 18164.52 Owner. BONIOS JEREMY
Zonlne�URB(100) Applicant: BRYAN HOBBS
AT. 185 NORTH MAIN ST
Applicant Address: Phone: Insurance:
346 CONWAY ST (413) 775-9006 WC
GREENFIELDMA01301 ISSUED ON.4/25/2078 0:00:00
TO PERFORM THE FOLLOWING WORK.AIR SEALING, 6.25' FGB TO R-19 IN BASEMENT
OVERHANG
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 Sienature:
FeeTvpe: Date Paid: Amount:
Building 4/25/2018 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
1 Sndu lf� � r
Department use only
.,.,;,,s City of Northampton Status of Permit
I °`; : ,i�ki " Building Department Curb Cut/Driveway Permit
r 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/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION bp— ( D - )09t%
1.1 Property Address' This section office
ection to be completed by oce
se
Map I % Lot—D—h(S--Umt
185 North Main Street A, Florence MA 01062 zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORrLED AGENT
2.1 Owner of Record:
Jeremy Bonios 185 North Main St A, Florence MA 01062
Name(Print) Current Mailing Address. 310.699.6598
Telephone
Signature
2.2 Aute orized A —nt:
n�coL� t OTAinS 4 ox rh l I a I 'LL Q� ) 1535 , �ra sl y(nA /113Q
Nam (Print) —� Cu crit Mailing Address.
4,gz,ie k13.-775.9WLo
nature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by Permit applicant
1. Building 732.40 (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) 732.40 1 Check Number
This Section For Official Use Only
Building Permit Number: Date
issued.
Signature
Building Co ssioner/Inspector of Buildings Data
infolbryanhobbs @ gmall.COM
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
nis column to M filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg, Square Footage %
Open Space Footage %
Qat area minus bldg&paved
,kin )
#of Parking Spaces
Fill:
rnlume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT 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 Oi
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 ❑ Atltlition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[❑] Other[EJ
Brief Description Of Proposed M—Save work;Air sealing,625'FGB to R-19 in basemen merhang
Work:
Alteration of existing bedroom_Yes X No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes x No
Plans Attached Roll -Sheet
68.If New house and or addition to existina 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 stones?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
In. 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 _ . IPSPth'gI [J O1, 5 ,as Owner of the subject
Property
Bryan Hobbs Remodeling LLC
hereby authorize
to act on my behalf, in all matters relative to work authorized�bb��y this building permit application.
�' Cil.li/10 fAm4a-he�t -F79 hnn ghRill Q"
Signature M�lO�wner //,n, ���,,,, f /
Data
(', - I (7 4 1/ �+�+ as Owner/Authorized
and belief.
declare that the statements and infor tion on the foregoing application are true and accurate,to the best of my knowledge
and belie(.
Signed under the pains and penalties of perjury.
Is1�' 19
Print Nam
i�
Sign re of caner/Agent Oete
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Suuerv'sor: Not Applicable D
Name of License Holder'. Bryan Hobbs
PO Box 1535 License Number
083982
Address Expiration Date
Greenfield MA 01302 05/02/18
Signature Telephone
413.775.9006
0.Repietemad Home Imomvement Contractor Not Applicable D
Company Name y PO Bos 5 Registration Number-
rubb Greenfield,MA01302 139564
(JI-3)775_9006
Address Expiration Date
Telephone 07/22/19
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(e))
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...... 17
DocuSign Envelope ID:81775 F3-]E55-4C)F-83A -50823F11920A
60 Shawmut Road, Unit 2 Canton, MA 02021
RISE
ENGINEERING'
OWNER AUTHORIZATION FORM
I, Jeremy Bonios
(Owner's Name)
owner of the property located at:
185 North Main Street A
(Street)
Florence, MA 01062
(Town, State, Zip)
hereby authorize 0000 t^L ')
(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.
6(�n=mswnoaW
1sior�e Lure
31512018 12 22 PM EST
-Sign Date
3/5/2018
City of Northampton
Massachusetts
DEPARTBdENT OF BUILDING INSPECTIONS
212 Main Street a Municipal Building �y 1Y Cs
Northampton, MA 01060 srq-yj�a
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, 554, 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.
The debris from construction work being performed at:
!P r )orlon Ufum �. /)
(Please print house number and street name)
Is to be disposed of at:
CQ1pLLct I00,61t 4ub{olk2M,'
(Please print name and location of facility) Or C)Ud
Or will be disposed of in a dumpster onsite rented or leased from:
���rehttz�s Pto�^n �>rloCl t c 1 �� Qom( k1�35 G z1�,h1�
(Company Name and Atldress) �)a
�gprbturb of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
�\ The Commonwealth ofMassaehusents
Department of/ndustrial Accidents
] Congress Street,Suite 100
7
Boston, MA 02114-2017
www inass.gov/dia
Workers' Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
ADolicant Information Please Print Legibly
Business/Organization Name: 3'a PO Box 1535
ob reen to ,10f10f302
Address: I (413)775-9006
City/State/Zip: Phone#F:
Are you an employer?Check the appropriate box: Business Type(required):
L�j I am a employer with�_employees(full and/ 5. ❑Retail
or part-time).' 6. ❑Restaurant/BarfFraing Establishment
2.❑ I am a sole proprietor or partnership and have no 7_ ❑Office and/or Sales(incl,real estate,auto,etc.)
employees working for me in any capacity.
[No workers'comp.insurance required] 8. ❑Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per e. 152, §I(4),and we have 10.0 Manufacturing
no employees. [No workers'comp.insurance required]s' I 1 ❑Health Care
4.❑ We are a non-profit organization,staffed by volunteers,
with no employees.[No workers'comp,insurance req.] 12.NOther I Wahv-n
'Any appllrant that checks box KI trust also fill out the section below showing their workerscompensation policy infovreu n
—Iffhe corporate officers ha,c exempted themselves,but corporation has other employers,a workers'compensation policy is required and such an
organization should check box#1.
I am an employer that is provi�ngpqwpo�rk�ers'compensation insurooce for//m�y__e k yees Below is the policy information.
Insurance Company Name: C-J��+ IV's �✓ (�,titfl' W.
Insurer's Address: () &Vc�vy
City,Statc/Zip: bclvnQLNu �IQ_1 /T "-)V' Ju
Policy#or Self-ins.Lie# lx"", g857 a /7 f�0 Expiration Date- ���t�(1 �(
.Attach a copy of the workers'compensation policy declaration page(showing the policy number and el piration 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 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.
!do hereby certify,under the ains ondpena(des ofperjury that the information prov�id/ed above is true and correct
Signature I%Z,�J // g Datr g113b -_
Phone# 11.3.775, 906lJ/
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
Contact Person: Phone#:
wwwmasa gov/diu
®� Magsaohusettt De part ment of Public Safety
Board of Budding Regulations and Standards
Licence: S-083982 .
Construction Supervisor
BRYAN 0 HOSES
646 CONWAY STREET
OREENPIELD MA//91�301.
I',-M LA— Expiration.
Commissioner 0610612018
',°�d>✓' Q"i t'seire�°�+ieirrr��r✓1`�"� r�/ �,` ��cr,lJrtc�tlref�
yY� Office of Consumer Affairs and Business Regulation
10 Park Plaza • Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: Individual
BRYAN HOBBS Regidlin don: 139864
DB/A BRYAN HOBBS REMODELING Expiration: 07120(2019
348 CONWAY ST
GREENFIELD,MA 01301
Update Address and return card, Mark n
Add=-- !2Aaaiddaw rasatpbytb
,i.............it
Cala in eonaurwr Attain a Business Raaulanon
HOME IMPROVEMENT CONTRACTOR Registration valid for Individual we only
_ TYPE IndMdua before the explrstbn dtle. Nfound return tar
Reeuaratmn Eypl(aggg Off"of Consumer Affairs nd dualities RegWetlon
188664 07/22/2018 10 Park PIRA•sults 8170
BRYAN HOBBS Boston.MA 02116
D/B/A BRYAN HOBBS REMODELING
BRYAN G.HOBBS
348 CONWAY ST
GREENFIELD,MA 01301 Undersecretary Not valid W1111out figneit"
ACORCERTIFICATE OF LIABILITY INSURANCE DAn"waD
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THIS CERTIFICATE IS ISSUED ASA 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 CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED
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this certhICate does not confer rights to the certificate holder In RON Of Stich endoroeman a).
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8 Nornx (413)SB80111 (413)588-04E
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N.".TP10D MA 01060 INSURER A: SNedrve lne CO of S DEIOIIne
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346 COMI Street INSURER D
INSURER E'.
Graenheld MA 01301.1615 MSUR6 I
COVERAGES CERTIFICATE NUMBER: EXPOWIS REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOO
INDICATED. NOTWITHSTANDING PNY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
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SHOULD ANY OF THE ABOVE DESCRIBED POLICISE EE CANCELLED BEFOF
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORLZ0 REPRESENTATIVE qq
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