24D-233 (8) 212 PROSPECT ST BP-2018-1311
GIS a: COMMONWEALTH OF MASSACHUSETTS
Map'Block:24D-233 CITY OF NORTHAMPTON
Loc-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Cateeorv' INSULATION BUILDING PERMIT
Permit 4 BP-2018-1311
Project# JS-2018-002333
Est. Cost: $2574.00
Fee, $65.00 PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRYAN HOBBS 83982
Lot Size(sp.ft.): 10802.88 Owner. DONNELLY SUSAN
Zoning URB(100)/ Applicant: BRYAN HOBBS
AT. 212 PROSPECT ST
ApplicantAddress: Phone: Insurance:
346 CONWAY ST (413) 775-9006 WC
GREENFIELDMA01301 ISSUED ON:611212018 0:00:00
TO PERFORM THE FOLLOWING WORK.-ATTIC AND BASEMENT INSULATION FGB WITN
2" FOAM BOARD, AIR SEALING, WEATHERIZATION
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 q 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:
FeeTyoe: Date Paid: Amount:
Building 6/12/20180:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Dr, e'L LGt�-ror\-
ECEIV fNo hampton Status of Permit: Department use only
Buildi g D partment Curb CutlDriveway Permit
2gjg21 Mai Street Sewer/Septic Availability
00 100 Water/Wen Availability
- Northa pton MA 01060 Two Sets of Structural Plans
T c;p,,DRm4,1*S8¢ 240 Fax 413-587-1272 PWSib Plans
mon rna^=tom.'!n o,cm.: Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 6,9-11 131/
1.1 Property Address' This section to be completed by office
I'a f�St Map Lot Unit
Zone Overlay District
Elm St.District _ CS District_
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Racertl:
�
�, � 1�o u�11y ala �ro;( rfN�ztt,nnton 111�J
'ame(Pont) Cunent�lalpng Atl ess' O
C
_ (:IA 1nn11d1(/h ib[V" lselephone
Signature
2.2 Authorized ApenC /�
LN' ll IIT hN� � N1oc� it n�, (�� pn Y a X535 L�eu�6�Icl A nl a
Namg( nnt) Current Mailing Address.
� J
(43)-775 - 0IM16
Sipsture I Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
cam leted by permit nnnfinant
1. Building a �'�y �� (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee Stu
4. Mechanical(HVAC) Vr
5.Fire Protection
6. Total=(1 +2+3+4+5) Check Number / [ y
This Section For Official Use Only
Date
Building Permit Num Issued:
Signa e:
BuildingC missioner/Inspectorof Buildings Date
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..I.n t.be filled in by
Building Depaemenr
Lot Size
Frontage
Setbacks Front
Sidc L R: L: R:
Rear
Building Height
Bldg, Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW 1 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 � 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 Ct
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
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 Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs (D] Deeks IM Siding[o] Other
Brief Des tion of Proposed , `,.
Work'( 4 � R ",
1 N l C➢ Gln F J` FT am {1ouid &Lh 6N
Alteration of existing bedroom_Yes No Adding naw bedroom Yes No
Attached Narrative Renovating unfinished basement Yes >( No
Plans Attached Roll -Sheet
sa.If New house and or addition to existinn housing, complete the follow]ng:
a. Use of building:One Family Two Famili 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?
I. Method of healing? Fireplaces or W oodstoves 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 a 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 COMPLETEDWHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
^\
�
I, U SW ��e W U as Owner of the subject
property
hereby authorize /LL's �1v] Il(� LA. _
to act on my behal, in aY hi-afters relative to work autFwr¢ed by this b ing permit application.
.CSO arrnl�ln rtr1 f R� , PV][L 11 �Z118
Signature of Own lerL
Data
I, f�ILhs UAM1r10(l U.�l1-�-� ,as Owner/Authorized
Agent hereby declare that the statements antl formation on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the
pains and penalties of perjury.
f11(i 1 ��5
Print Ne e
Signiii of Owner Agent Dal
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0 1
Name of License Holder: liti,yan Wall RemO6e_ling-LL-G 1/�1930)el d l.l.
License Number
PO Box 1535
Gr nfleld MA O13n2 5falab
Atltlres Exair a[io Dafe
775 9CAP
5, u Telephone
9ReigiisteredH ImpiravementG trap Not Applicable ❑
Br"n Hobbs Remoriefin.7 LLC 139 5UO
Company Name .y --pu box 53 Registration Number
Greenfield, Pito 07302 -f ' n D ) C)
Address I7 Enpirali n Date
Telephone
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....... x No...... ❑
CNumbta Gas
of MassaChllSCMS 60 Shawmut Road, Unit 2 Canton, MA 02021
A NlSou ComYnnY
OWNER AUTHORIZATION FORM
I, Susan Donnelly
(Owners Name)
owner of the property located at:
212 Prospect Street
(Street)
Northampton, MA 01060
(Town, Slate, Zip) -- .
hereby authorize brLjat- How))_.;�t11QCtilt
(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 ttA
hheir municipality at the completion of this work.
ustomer Signature
-Sign Date
5/15/2018
The Caarmonwealth OfMassachoseas
Department ojjndustrieldccidents
1 CangrMsiem4 snug 100
Boston,MA 01114-1017
wwnemasrgosddia
W{Taken'Compensuflon lesutome Atlldovlt:BuidadCoatraclunMatricloaa?tumben.
TO BE FILED WrM THE P1RMrMNG AUIBORM.
Atolbaorhfa Motion Pleas.Print LeMbiv
Name(BmipemlQganWtlmdhdividal);
Address:
Greenfield,MA 01302
ob tlt3j 776 000'
City/Statelzip: Phone#:
.trereu entepktedChedt mrapproprhmbmu Type of pnlat(required):
1.[41mempmyer corm,empbym(mll eadw oto.).- 7. []New construction
2.❑Im.mbpmpkwwp.uw,Wpmdbowmmptayewwoddm fwmem e. ❑Remodeling
mycrm u.tnaaadm'mmp.Wmam rmaheal ❑ errag
5.❑Ian.boamwoacduioarawmk MWE(14a owl.,W map.4nemm egded.)t 9. ❑DBemlition
1 wpl 10
Building addition
❑I m.hmmme and w9 b hkha maa.rme.m moYa.a cram m q pgmty.
mem do as e.ebrame.cohwh.m webere tapeavc .Wwm vasal. 11.0 Electoral repair or o"dons
prodewawX6 0 aeo t 12,❑Plumbing repaint or additions
i❑I an a owed rmmenrmd i bwcuw meaubmnmenem r w an the em&rir 13.❑Roof repalrr
7Mt eubommamabe.employee no ham wahm•Con,'hmnemJ
6.❑Weore amepmeto,and is ewer lnw.satpd Bea data ofampam per MOL a 14.CffOtba I '*-"%Qat ±n
ts;FIN),.edwebvammpbym[nowat6w.'meF.t.m.eeteQmed,j
',tm..ppatmamdayboe MI mn.W tmmtlheemnamhebw rhonW mehwnlme•ampmmebapatlry hfamea.0
r Rmmwm come mauue.md.abd w ha M mdahadlw ekmdmm Bmomddeao.heemeeuawbm .ametd. the wdm
have kmarmrtwcheckmihmtwwehedm.dampddeetehowlq Poemm memblm.arammrodWmwhehwwamommade v
empigen. gEeama4embnlmamybym,mgmmpmyesthak wemm'amp pdky.mbe.
Immmepgyerrhetlspmdingwmkcrs•mnpensadentmsuranpeJormrsmpfoyaer. Bdow$phepaikyeadJobsfa
htsurmce CaopCampmyNamcf��r8lre Tnw LCCIM.Ca �t()
Policy N a Self-in.Lk.#: ki30 551 A-10 Expiration Datr.![AaLba!(
Job Site Addrac ��� P(/7 Ci'L�Ff DTA 09t1Su`mMp:/�,�(C'�R(1, �tVV
Aflaehaeopyofthawmheroe otpenutton PW4T deeluotlot page phowhrg fire policy rtumba and erylntlmdah).
Failure to acme coverage as required under MGL c.152,b25A isar+Immal violationpunisbable by a fine up to Sl,SW.00 _
andfor one-year imprisonment,as well a civil penalties in the form of a STOP WORK ORDER and a fine ofup to 5250.00 a
day against the violator.A copy ofthis document my be forwarded to the Office ofinvestigatlons of the DIA for insurance
coverage verification.
Ido hereby ntf6 oda 1lwpaWudpenab4a ofpodury that Me lnjanaaonproWilotabowtt tons and correct
r; 6 p-�d Date: U1-71 le
Plame a: u � .�I nn i e
Official our only. Do not wits In tbh area,to bee mpkkd by rtip or town gplat
CBy orTown• PermiULlame#
JoiningMthortty(circle ane):
1.Boord of Bealth 2.BoOdlogDeparfinent 7.CRyrfown Clerk C Electrical umpector S.Phrmbhng lmpector
G Other
Contact Parent: Phone be
City of Northampton
C
•�'" '"'
Massachusetts
f DEPARMW OF BUILDING INSPECTIONS
� 212 Hain Street •Municipal Building p p
N- Moxthamptan, HA 01060
Debris 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.
The debris from construction work being performed at:
old N) p f R1.
(Please print house nurnber and street name)
Is to be disposed of at:
—700
�IdJ 11�ltota ,1� i c pD Hni �e ke dh'u1 D I ULI b
(Please print name and location o
Or will be disposed of in a dumpster onsite rented or leased from:
bnanan 4n�hs un(1r�1 a, levo, 'ylrl �.Q U6�I
'(Company Name and Address) 71—
S' ure 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.
ACOR& CERTIFICATE OF LIABILITY INSURANCE
w+w2o1T
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 A CONTRACT BETWEEN THE ISSUING INSURERS,AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
NPORTANT. V the cortifleals holder If an ADDITIONAL INSURED,the pollcy(la)Must have AD RIONAL IN URED pmvitlons or he andarad.
N SUBROGATION IS WAIVED,subject to the terms and conditions of the polity.Certain policies mey require an endoeeemeM. A staNmanE an
this cartMcate does not wnfsr rights to the certificate holder In ilou of such endor eemeM B.
FRGOOd" f: Atllne Edged
Webber a Grinnell '
NUO N. , (413)588.0111 (413`,6589481
a NPHH Ring Street ADUREaa. aedgm9weDDerandgmnnelixom
INSURe aAFFORDING Gov tf MM
NOMemplon MA 01060 INOORRA, Selective Ina CO of 9 CEPOIIPB
INLURED INOVRER B' •SBI.nYe IPS CO OIAMer.F. ' 126'
¥ HODbe Remodeling INSURER C: SBIBCNVB IN CO Of SOWM1eOet 3881
346 Conway Street INSURER o-,
INSURER I:
GreaMWd MA 01301-1616 IWURS,
COVERAGES CERTIFICATE NUMBER: EXP OSMB REVISION NUMBER:
THIS IS TO CERTU YTHATTHE POLICIES OF INSURANCE LIVED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR 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,
SCLUSIONSAND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LT0. NPf 0i1XSURANCfIlEg POLICYNUMBER MMmOurryY,I(MMDIYfYYl ILIANTB
CmoRACNL09NERALUMBITY EACH OCCURRENCE f 1,000,000
CLMMSMADE �-.UR PPIWASUINEI , f00,DT0
MEO E%P An yR No'
S 15'p00
A 52289062 0w04rz01I 'I pER80N BMVIWURT 1,OD0,000
GHNI AGGREGATE LI MI APPUIS PER'. OfiNERLL A00gF0ATfi i Z.ODO,WO
POLICY❑JMEL 7 LOL PRODUCTS OO"PNPMD 2.000,000
MON. S
AUTONOMOUS LIABILITY I BINE 9 LIMI F 10DD000
MYAUTO aONLYINJURY1PWRmom $
B µroe ONLY SCHSBULED A91053M Ow042017 08I04I2018 600aY IxJugv lPM r.N.nD r
HIRED
X NIAUT
60NLY
E0 F D S
Underineurad maroem 81 4 2.000
UMR44 LIAe 'r•"'••"•• 1,000.000
OCCUR EAOM RgENtf E
A 0lCa0nW CWMa�MME 32288042 0w04G011 OB/O4rzO1B Ao0flfi0ATE a 2•000'000
ION i
AND IMP ng-LIAT10N X TAT E
ANY MG IMPLOVIRB'LIABILITY
C bFlt[ILMSMOeR ExCTMw9M FCVTIVE YY NIA WCM67270 Bryon HObW EVC]. 1WOM17 10/2012018 EL.EACHALOIDINT 6 $0.000
0A.,In NNI F.L.DISEASE EAEKLMIE 8 500,000
DES 0MuMo
OEHCRMTICN OF SPATIONlib. E.L.DIIIII LIMIT i NI
DESCWRION W OPEMnONSILMATIONB 1WHICUS 1ACORD 1M,A441NPni1 Mmob BOM4Wr,mFy OUNeba If man AW»N M'UIPH)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DEBC&BM FOLEIES BE CANOCLLCO BEFORt
THE EXPIRATION DATE THEREOF,NOTICE WILL 09 aLNEUD IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORISED RUMOENTATVC qq
L� -- �
0 1980-2015 ACORD CORPORATION. All rights real
ACORD 25(201 w03) The ACORD name and lege are registered maria of ACORD
Commonwealth of Massachusetts
®Or Div is,on of Professional Licensure
' Board of Building Regulations and Standards
Construction Supervisor
G5-083982 Expires: 05,0212020
BRYAN G HOBBS
PO BOX 1536
'
GREENFIELD MA 01302
Commissioner
;-may. " '���s� `� r�eiiurr�airrrvr<�d� eA/ �`-�rryJJfY!'�riJel?�
„7.: ..
i Office of Consumer Affairs and Business Reguladon
10 Park Plaza - Sulte 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
' Individual
BRYAN HOBBS Ishloo, 130M
DBIA BRYAN S0838 REMODELING IrBtlon: 07AMlit
SIE CONWAY ST
GREENFIELD,MA 01501
umua AaerAAA And mum lw0. Weld
0 AdtlmAe ❑.eswi l C.ampi"Bm
NOM
ltf 9 IMPROANalnA=mff µWbn
NOM6IMPROVBMBNT OONTRACTDR V
R NireBAnvalid tet WNWup yp ori_ Trre:ImMam w7er.ln�mWrlMan dlnA. nmwa rAenntm
littedirmirtinin
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07@yY010 lopwtOPYk Mme• elTo
BRYAN HOBBS eabn,MA 0!118IG
W"RYAN HOBBS REMODELING
BRYAN 0.HOBBS
SISCONWAYST
GRKNPIBLD,MA 01301 UndArowroVy Not vBNtl without eleNehRB