38C-047 (2) 40 SOUTH PARK TER BP-2018-1381
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38C-047 CITY OF NORTHAMPTON
Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2018-1381
Project JS-2018-002448
Est Cost:$3017.00
Fee $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRYAN HOBBS 83982
Lot Size(sp.ft.): 7579.44 Owner: FLEURY HAILEY
Zoning,URB(100)/ Applicant. BRYAN HOBBS
AT: 40 SOUTH PARK TER
ApplicantAddress: Phone: Insurance:
346 CONWAY ST (413) 775-9006 WC
GREENFIELDMA01301 ISSUED ON.612512018 0:00:00
TO PERFORM THE FOLLOWING WORK:EXTERIOR WALL INSULATION ATTIC
INSULATION, BASEMENT INSULATION, 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 N 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 S'anature:
FeeTyoe: Date Paid: Amount:
Building 6/252018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northampton Status of Permit
j uta Building Department Curb Cut/DdVsway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
A01000 N rthampton, MA 01060 Two Sets of Structural Plans
one -587-1240 Fax 413-587-1272 Plot/Site Pians
Other SpecBy
APPLICA'.'.DN TO CONSTRUCT,ALTER REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTIONI -St-E:NFORMATION
1.7 Propertyd:ass. his section to be completed by office
(01 V tMap Lot 0�� Unit
/ yc(W
Zone Overlay District
Elm St.Distinct CB District
SECTION 2-PROF'_RTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Rec�:d:
zt-I I �IL�r1i�POI 1Drf-nr Jk u lli�t n A
Name(Print) Current Maili Address'
//,�, 3illAZ4
" � ,y c, (til )()1-; ?rCh� I (1l N✓) ephonT�IP ,
Signature _
2. Authorized LtaL _t 1 /
'ill IA I h L l_LC �� �iy , 535 / i/yuv��i���/�)✓� /./D'QQ
ame riot) � Cu)rr�ent ailing Atltlress'.
Signage Telephone
SECTION 3-EST.-ATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
_
completed bermilapplicant
1. Building .l 2 U 11 7 b (a)Building Permit Fee
2. Electrical (b)Estimated Total Cast of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (tVAC) 111
5.Fire Prated on
6. Total= (t *%-_`_-+ *5) Check Number /.
This Section For Official Use Only
Date
Building Permit v',.c::,er Issued:
Bignatur
3Li:ding Co issionerllnspector of Buildings Data
ltocujw kobh5 @ %.marl . Cowl
E TAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section=. ZON WG All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be❑IIM in by
Building Department
Lot Si,
Fromm,.
Setback, Front
Side L: R: L: R'
2 ar
B c N it
Blo
Ope S:- ac :..age %
ttotr,, _...grim€xpaved
of s;aces
Fi!I:
on]
A. -.a a Special Permit/Variance/Finding ever been issued for/on the site?
G DONT KNOW Qf YES Q
IF Yom, date issued:
IF 1'.-3S: Was the permit recorded at the Registry of Deeds?
r C O DONT KNOW ® YES O
Ir ES: enter Book Page. and/or Document#
B. Dcs the si:e contain a brook, body of water or wetlands? NO DON'T KNOW O YES O
r'YES, has a permit been or need to be obtained from the Conservation Commission?
I,reds to be obtained O Obtained O , Date Issued:
C. any signs exist on the property? YES O NO
!S YES, describe size, type and location:
D. Are :here any proposed changes to or additions of signs intended for the property? YES O NO
!P YES, describe size, type and location:
E. VN' :ne coosrcction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
sae: M11 dist_rb over 1 acre? YES O NO 0
1:= ' -S, tier a Northampton Stan Water Management Permit from the DPW is required.
SECTION 5-DES.S PT'ON OF PROPOSED WORK(check all aoollcabla
New House _] Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑
Or Doors D
Accessory Bld.1 Cemolition ❑ New Signs [0] Decks [p Siding[0] Other
Brief Oesc ip --posed
W
ork. a,u rLl miC iksi
Alteration of ex,s- ;a.:mor,_Yes No Adding new bedroom Yes X/ No
Attached Nanat.;C Renovating unfinished basement Yes X No
Plans Attached Rc -Sheet
6a.If New hoose and or addition to existing housing, complete the following:
a. Use of build Ctic Family Two Family Other
b. Number cf n -s in each family unit: Number of Bathrooms
c. Is there a gere. =
d. Proposed S, e rose's of new construction. Dimensions
e. Numberofs' ''s?
I. Method of hes:.:g? Fireplaces or Woodstoves Number of each
g. Energy Corse•at o^ Compliance. Masscheck Energy Compliance form attached?
h. Type of cors_-tion
i. Is construct.s- :It. ii 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain_Yes No
]. Depth ofbase'sa or cellar floor below finished grade
k. Will building c,.-Srm to the Building and Zoning regulations? Yes_No.
I. Septic Tans ___ Cay Sewer Private well City water Supply
SECTION 7a -C': -R AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGE.'T .:R CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
property I
hereby enmonrx, 1170(]�F �( this1
l
to ect on my bet �i sl.n-attars relative to work authonzed Cwldmg permit application.
i Fo��LLPI
fli—V ..to,, Date
n
I, �11 in I)�I(p`I` (t i / as Owner/Authorized
Ag nt he eby-coat s tl.a!the statements and inf abon on the foregomg apphcabon are true and accurate,to the best of my knowledge
and belief.
Sigr]ed unce r . '.. :r_ ,_ralnes of perjury.
PrintPrinl Noo
SECTION 8-C01, -R'u--TION SERVICES
8.1 Licensed Ce.._ coon Supervisor: Not Applicable ❑
Name of License's_.�i C-�)- ( " 0a � U�
as 1535 License Number
Iobb C reenfield, MA 01302
x(413) 775-9006 h�ra�c7l)
Address Expl�tlon Date
Si atu Telephone
9 Registered P'_ I.nomvzment Contractor Not Applicable ❑
139 5ULJ
Company Nance. PO 13o, 1535 Registration Number
}'a
Grcenfinticld, MA 01302 aal1�
Address Expirati n Dale
Telephone
SECTIOi. [2R3' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(e))
Workers Cor,pa c' c -s:::ance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result
in the denial u'i-u ,--,e -'the building permit.
Signed Affdavic,soirec Yes.......19f No...... ❑
i)lumbia Gas
of MaSSaChUSCTTS 60 Shawmut Road, Unit 2 Canton, MA 02021
OWNER AUTHORIZATION FORM
I, Hailey Fleury
(Owner's Name)
owner of the property located at:
40 South Park Terrace
(Street)
Northampton, MA 01060
(Town, State, Zip)
hereby authorize �/y� r
,UjG' tl (-FobtaS r1c)910ACY1 1-L.C-
(Subcontractor)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a buildre
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 homec vler's
responsibility to close out this permit by contacting their municipality at the completion c t�,. -:ork.
r
-Customer Signature
rsj (yII �
-Sign Date
511 412 01 8
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
licersed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: H O din i Al �"' -lin') a 01
T;.e debris will be transported by: e tt 61)hn 1Ze')1 .I1C L4 <J
T"e aebris will be received by: I7 X014 7 W rIA �"snuo
B-j; permit number:
Nanta of Permit Applicant ] 61')LAS K")i ,mu )bjI ez LLG
Da' Signature of Permit Applicant
tly.k.,
The CommonwealthofMassachuseffs
Department PfIndustrialAccidents
7 Congress Stress,Sulu 100
Boston,MA 02114-2017
wramnmefgotasdu CompeonlLulamraaee AfDdavDe Bada WContrsetInMeetrkbm/plumbers.
TO BE FILED WrFH THE PEBMDTING ADfHORMY.
Abmlimot toform ,ties Please Print Ledhly
Name(amiressAO mimdo rineividml):
Address: ob C:reenlield,MA 01302
(A13)iib 900E
City/Statelzip: Phone M
Me you m err aleW C'keb the Annodate lore Type of project(required): .
I.�tmempbyawm,ambym(daadMpn-time).•
7. ❑New construction
1.❑ImamYpapdn«erpmmemdp emdlowmempbym WaeYma faemeh B. ❑Remodeling
em'wecid.lPY wadmn'mmp huunmmm egvhedl 9. C3 Demolition
y.❑I mahmmmwmdoYaawmkowWC IIlm wadm•mmp bauome ayu6W.]r
1.❑lmaaomcetemrmdwtlbekeigmmrmnmmoauaal.nhmery papery. IvN 10❑Building addition
mmedmeltamsmndYemw.atee'aogmeetimYmeem«mmb ll.❑Electrical repairs or additions
emOi °0 12.❑Plumbing repairs or additions
L❑I m a weed amnamnd l love UW dm mbemmclaa loam dm amebdahae -
71mrubemmumban=~Lid lowwaden'camp.borLwO 13.❑Roofrepairs p
d❑We Or =p0ndeed lo mKas Yweeammd debeialdmfeampdm per Me. 14.190ther 1 eek
131 fl(Ih and mhmm mmplaaa Die wvb be camp.bmmmaeeOW&I
Ma appanmdmahmlm ba el mmraleo all an the aaden below abniq dek Wd.W mmpcmd."Her kkanalm
t Hommwmwhomdmathe amdakW au qday redoes a wmhand sun Wamade amammemanaubauamramdevn Yanmgm L
ICmhwmedetaerk db bre aat=,had m almtlmel abet alowloa de mm u(uo aabmtmtas and OWN,wbehm«ret d,meuldn have
mpbym. Hdembemnatehm mpbyem,dgmapnn3dtrhdr wa mWemaRp ley mwbr.
Ianenmspfoyer6dhyrovhOng nrorksn'mnpenrodon fmurmrceformy employee. Below BekepolleyamdJokaMr
lmursnee CompmyNsmer-- (�
Policy d or S.Vns.Lia.N: �1J0)51 errs F.xpbatbn Dae:' Inla�n..l�anlu
Job Site Addtas yrs �(,V ", !�(j,47,adwyn , errlr>Sraid-F:,uA�kt�liji,��.112�1A(31000
Afschacopyofthe worken'enmpamationpolley dedarsdompage(thawlogthe pogeynumber ands badundate).
Failure to setute coverage m required under MGL c.152,$25A is a admmal violation punishable by a flan up to$1,500.00
ad/or om•ysu hopedsonamm,as welt a civil peadtia in the form of a SCOP WORK ORDER and a frseof up to$230.00 a
day against the violator.A copy of this statement may be forwarded to the Offica of Investigations of the DIA for Insurance
covems,vedficatim
I de hereby can%ander shape(�(y /d,Pmdtles ofperJmry starts b1hemadonprodded above is arae Mwret
Sisnamre. Z Idg,Li II/7 )/ 4 Date: (P -
Phoma:
Offrchd me only. Do not wrffaln this arm,m be mmnptded by el0'orSoaw g0dd
City arTowun PermltrUmme a
Issuing Authority(circle one):
1.Baud of Haft 2.Balm log Department 3.CYyffowo Clark d.Electrical Inspector 5.Plumbing Impactor
Q Other
Cooled Person: Phone
Commonwealth of Massachusetts
It
Division of Professional Licensure
Board of Building Regulations and Standards
Construction Supervisor
C"83982 Expires: 0510212020
BRYAN 0HOBBS
35
PO BOX
'
GREENFIELD MA 01302 ✓1
Commissioner
` :�eis� �i rreeeeera�ernfv✓!/rJ">i r�/ !;-�IaJJnC�uJet�3
Office of Consumer ANalre and Bualnese Reguldon
10 Park Plaza • Supe 5170
BOOM, Maaaaohusette 02116
Home Improvement Contractor Regletratlon
RpIBtratl
ndliddit
BRYAN Explretlon: 1 07MyeOie
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SSe CONWAV 8T
GREENFIELD,MA 01801
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�y�p Office,of Ooneuansprin"INUM ee 11"Maden
13M O71`7AIe018 to Pak Mese•Bulte 0170
BRYAN MORN BOOM.MA 00110
DIB/A BRYAN M0836 REMODELING
BRYAN O.NOUS
SCS OONWAY ST
GREENFOX.MA 01301 UndereeOrWery Not valid without elanatune
CORD° CERTIFICATE OF LIABILITY INSURANCE °""NN➢OPIY
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THIS CERTIFICATE 18 ISSUED ASA MATTER OR 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(8),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
I R ANT, the cerllllato holder N En AODITI N L INSURED,the pollay(les)must have ADDITIONAL INSURED provisions or be endorsed.
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this u rifest,does not confers tits to the oertlNoete holder In lieu of such endareemanl(s.
PROODOM T AL1!Edged
Webber a Grinnall 11 a (413)888.0111 1413)580 1
8 No King Street T04asE: aBd981webberandgri,nmI.COm
INSURE AFFORDINDa0VINU E WK
NOnhempWn MA 01080 IN6WlRAI Selective Inc Co Of S Carolina
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Bryan Hobbs Retracting INSURER c: Salecove Ina Co of SOLID eeat 399:
346 Conway S reel INSUFAR O'.
INSURER E:
GraenBsld MA 01301-1516 11811M P'.
COVERAGES CERTIFICATE NUMBER: EXPOate 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, NOTWITHSTANDING MY REQUIREMENT,TERM OR CONDITION OF My 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 ALLTHE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTq ttPI OP IxWgANC! POLICYNUMeSR N amml LINTS
X COMNIRCMLOENIRALLWILnY EACH CCCUNFENCE 11.000,000
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VNERELLALAd OCCUR EXOHOOCURRENCE a 1,OOn000
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DESCRIPTION WOPRUP 41 LOCATIONS IVIHIOLER IACORD141,AbdltlenalMmnh MAAule,mry NMM<hWIfinenepeesle.gwndi
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANGELLEO BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WIN THE POLICY PROVISIONS,
AUTHORIZED REPRIMENTATIVE
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