23A-043 (4) 15 WEST CENTER ST BP-2018-1087
GIS#: COMMONWEALTH OF MASSACHUSETTS
MawBlock:23A-043 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 SP-2018-1087
Protect JS-2018-001959
Est.Cost: $5532.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License.
Use Group: BRYAN HOBBS 83982
Lot Size(sa.ft.): 1785.96 Owner: ABRAMS MAURY
Zoning URB(I00)/ Applicant: BRYAN HOBBS
AT: 15 WEST CENTER ST
Applicant Address: Phone: Insurance:
346 CONWAY ST (413) 775-9006 WC
GREEN FIELDMA01301 ISSUED ON:4/25/2078 0:00:00
TO PERFORM THE FOLLOWING WORK BLOWN IN CELLULOSE, VENTA BATH FAN,AIR
SEALING, EXTERIOR WALL
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 Occuoancv Signature:
FccTVDe: 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
I Department use only
Iof rthampton Status of Permit
,a q°avP- no epartment Curb CutDriveway Permit
.�' 212 Main Street Sewer/Septic AvailabiAry
Room 100 Water/Well Availability
1 Northampton, MA 01060 Two Sets of Structural Flans
phone 413-587-1240 Fax 413-587-1272 Plot/Sde Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Q
SECTION 1 -SITE INFORMATION (1�O- ( d ( U e+
1.1 Property Address:
This section to be completed by office
j5 �J,�QSI (Q Iuqx St Map Lot
Flo" QX\C -I )�I' Zone Overlay Distad_
D(o�a
Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record,
IM lila, iRfud Fm to pYd� �io�a
theme(Print) r 1 Cu rent Mallin Atltlre;s
G -0US �4 l{ 0 9(C) '.V Telephone
Signature.Wne
2.2 Authorized A can
4n Poem (i Ik/1U &-a �,?2 LEO 3-0a
ame mnnl) �j Curtent MalOnq Atltlress:
�l13 7:2 9L22o
aturb Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 5,530 90 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee 4(rb
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) 5; 53-.90 Check Number / 7
This Section For Official Use Only
Building Permit Number: Dale
Issued'
Signalur
Building Comm 6.
of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Mus[Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be fills in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L:-R: L R:
Rear
Building Height
BldgSquareFootage %
Open Space Footage %
(Lot area minus bldg&paved
,kin I
#of Parking Spaces
Fill:
("lame&Leafinu)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW �S YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW & YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO (5 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
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 C
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,/e')xc(avation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO U
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing E]Or Doors F3
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[0] Other[
Brief D ��riptian of ProPofCCi(��fl�fM ^rJ�O�(771 �✓4 Lx.�LWIUk 11/�ih{'�L'�.iWt k'L IG{Ll. C(t/' .K.Gt,I�
Alteration of existing bedroom Yes �No Adding new bedroom Yes rl No L� rUr- -"-
Attached Narrative - Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Be.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?
J. Proposed Square footage of new construction. Dimensions
a. 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, as Owner of the subject
property n
hereby authorize &mall
(1L1 4 I .VV1 h(I O [ ! (j'.
to act on my behalf, ll m tters relative to work authonzed by t building permit application.
� cgmpi'aQI�1p �Zl 'rm {�)rN f�14�ISf
Signature of Owner rr Date
I, )� ,}7jn (/ 'N L-L�- , as Owner/Authorized
A he1l'eby declare that the statements nfonnation on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
t�
g'vl �T L�nelfLeL
Pd
��urdof Owner/Agent Dale
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: 0 9'�Cl in[
PO Box 1535 License Number
t Greenfield. )I\01309 5I
Address a (4199 375 91111r Baal K
Expirat n ate
Signature Telephone
9.Realstared Home Improvement Contractor: Not Applicable ❑
_yail� PO Box 1535
G eenfetd,Al A 01'0'
Company Name ®(413)775-9006 Registration Number
Address Expiratio rDet
telephone
SECTION 10-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-_.. ❑
�.CJUall)ld Gas
ul �jmjaSsaC}lluCiiS 60'Shawmut Road, Unit 2 Canton, MA 02021
A NISounv Company
OWNER AUTHORIZATION FORM
1, Maury Abrams
(Owner's Name)
owner of the property located at:
15 West Center Street
(Street)
Florence, MA 01062
(Town, State, Zip) fiYa
PO Box 1535
ob Creenrield,MA01302
hereby authorize (413)775-9006
(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.
`
/�(/'
,/ -Customer Signature
`, [_Va _�
-Sign Date
4/10/2018
�\ The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 700
Boston,MA 02714-2077
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
A licant Information Please Print Le 'til
PO Box 1535
Business/Organization Name:
(413)775-9006
Address:
City/State/Zip: Phone#:
Are
p you an employer?Check the appropriate box: Business Type(required):
L Ey I am a employer with —1 employees(full and/ 5. ❑Retail
orpan-time).' 6. ❑Restaurant/Bar/Eating Establishment
2.❑ 1 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 a 152,§1(4),and we have 10.❑ Manufacturing
no employees. [No workerscomp. insurance required]* 11 ❑ Health Laze
4.❑ We are a non-profit organization,staffed by volunteers,
with no employees. [No workers' camp. insurance req.] 12WOther r
•Any applicant chat checks box#1 must also fill out the section blow showing their worke%con awation policy information
—ur a corporate officers have exempted themselves,but the corporation has other employeeS,a workerscompensation policy is required and such an
Organisation should check box#1.
I am an employer that is provr(d�tngl workers'compensation insurance for my employees. Below is the policy information.
Insurance Company(Nn�amc::, �D}(11� Q ��(„L:_(r 1Li'0 C�1
Insurer's Address: 1'6 t rn� LAn
City/State/Zip: 6Yn a 6U (L OT 0:1, U
Policy#or Self-ins.Lie.# A)I qh)c 7,Q7(j Expiration Date: /n�r�n J[
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expLon 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form oCa STOP WORK ORDER and a fine
of up W$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 certify,under the pains andpenalties of perjury that the information provided above is true and correct
S m �-�, Date:
Ph #- `413-775-96U)
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#:
www.mass.govldia
City of Northampton
y iC
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Kai. Street .K i.ipal Building
Northampton, N 01060
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:
I� CG�� GA �!rPGl FimQ1AC : M UlCloa
(Please print house number and street name)
Is to be disposed of at:
1 1 -7WM"- \Et,
C➢;1211�k 1A�(] ntxro� MiliA A LID46
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
PO &x /535
bml(m, W64nn rid, (n0 Di 3D
/ (Company Name and Addr )
hl
1n)A /7 a
atu e 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.
®1 Massachusetts Department of Public Safety
Board of Budding Regulations and standards
License: CS-083982
Construction Supervisor
BRYAN O Ho888
US CONWAY STREET
OREENPIELOMA 00'1801
(:A -. Expiration:
Commissioner 051021018
V..
>eiee/s�ee�rror✓!�9� r90 �` f'�a.1Jf�'����ref�
Office of Consumer Affairs and Business Regulation
10 Park Plaza • Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: Indivbuel
BRYAN HOBBS Rs9lSlretlon; 139684
D/B/A BRYAN HOBBS REMODELING aplia on, 07=2019
346 CONWAYST
GREENFIELD,MA 01301
update Address and rabun card. Mark n
: . :. ;as; ,l ❑ A.:1:z0.•,E .r,.yRosswal alwaloym
wiaasf COMM.,M.I.Aeualnm Rejulaon
HOME IMPROVEMENT CONTRACTOR Rogstratlan valid for Individual use orgy
TYPE: IndNidUBI before the szplraecn data. 3}bund realRlte:
="06 HOpICrStl00 EYpILE011 Office of ConsumerAlMln and WMnHe ReelWSen
130864 07/22019 10 Park Plaza•Sults 3170
19PYAN HOBBS Boston,MA 02116
O)B/A BRYAN HOBBS REMODELING
BRYAN G.HOBBS `
348 CONWAY ST
GREENFIELD,MA 01301 Undersecretary Not valld without alpnelulr
COROm CERTIFICATE OF LIABILITY INSURANCE pAro
101191919
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(a),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT "the urtlheEu holder Is in ADDITIONAL INSURED.the pohcy(lea)must have AO MIONAL INSURED proMbid.or he 4"Ad a
H SUBROGATION IS WANED,GUI to the terms and Conditions of the Polley,certain policies may require an endommant. AstMemw on
this CerdScate does not Confer rights t0 the certificate holder In Ilsu Of SUeh antloroemeM e.
MODOOM g01na EDOed
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346 Conway Slmel INSUAER D
INSURER E'.
GreanXelb MA 01301d516 INSURER F:
COVERAGES CERTIFICATE NUMBER: EX4OSI15 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. NOTWITHSTMOINO ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY CERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$SUBJECT TO ALL THE TERMS,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NetIn MCOi1Ne0MNC! POLICY NUMBER MNI00 MNJppIY1YY pMT1
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1.000'M
CLAM&MADE 7x OCCUR p0. 5..,000
MEO t 10,000
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CERTIFICATE HOLDER nANCPLI ATION
SHOULD ANY OF THEASOVE DeSORIBED POLICIES BE CANDELLEC BCI
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRCCENTATY2
01888-2015 ACORD CORPORATION,All rights I
ACORD 25(201/09) The ADDING name and logo on,registered marks of ACORD