12C-006 (3) 44 NORTH FARMS RD BP-2019-0137
GIS#: COMMONWEALTH OF MASSACHUSETTS
Ma .Block: 12C-006 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Pertnit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2019-0137
Project# JS-2019-000220
Est. Cost: $2720.00
Fee: $65.00 PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: BRYAN HOBBS 83982
Lor Size(su.ft.): 19602.00 Owner: SMiTHLING KATELYN
Zoning:SR(100)/WSP(100U Applicant: BRYAN HOBBS
AT. 44 NORTH FARMS RD
Atin icantAddress: Phone: Insurance:
346 CONWAY ST (413) 775-9006 WC
GREENFIELDMA01301 ISSUED ON.&212018 0:00:00
TO PERFORM THE FOLLOWING WORK EXTERIOR WALL INSULATION
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 Signature:
FeeType: Date Paid: Amount:
Building 8/2/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
m Department use only
City of Northampton Status of Penna.
- Building Department Curb Cut/Drivil Permit
'2 212 Main Street Sewer/Septic Availability
i Room 100 WaterNvell Availability
z Northampton, MA 01060 Two Sets of Structural Plans
phone 413-567-1240 Fax 413-587-1272 PIoVSIw Plans
Other Spec1fy
APPLICATI N TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH
/AAONE O//R�y TWOFAMILYDWELLING
SECTION 1 -SITE INFORMATION 6119- I_fi I3 7
1.1 Property Address: This section to be completed by office
' 1, 1 ,1 Fumy, Map OCl Lot oD p Unit
F`� o-n 1 — m 0 l O u a zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: qqq
F/irmY , Rt1 - I IDfP.y ,(yW 61m
Name I riot) C ent M ling Address'.
Telephone
Signa ure
2.2 Authorized Aaent:
L Q� grnr /53S roe a
me 'nQ C)u))n�enl Mailing Address:
Signet Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building �r yr _ (a)Building Permit Fee
2. Electrical / lU (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) Iti V
5. Fire Protection
6. Total=(1 +2+3+4+5) ODJOAU Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued: per,
Signal exlzl Cf
ff Building Comm' over/Inspector of 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
This column to be filled in by
Building Depanmem
Lot Sizc
Frontage
Setbacks Front
Side L R: L: R:
Rear
Building Height
Bldg.Square Footage yo
Open Space Footage yo
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
Somme&Wrauonl
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW ® YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW ® 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 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
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 Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK( check all I' bl )
New House ❑ Addition ❑ Replacement Windows Altered n(s) ❑ Roofing ❑
0r Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding[0] Other
Brief Descn of proposetl
Werk: onirn, V�roC9 ;AntJnfl, vl 3" dcJLJPat 1r AJnse—
Alteration of existing bedroom Yes--4—No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes )C No
Plans Attached Roll -Sheet
Sa.If N w h use and r addition existin housin complete the followin :
a. Use of building: One Famil Two Family Other AJ P
b. Number of rooms in each family um Number of Bathrooms
c. Is there a garage attached?
tl. Proposed Square footage of new construction. Dime ons
e. Number of stories?
f. Method of heating? Fire ces or Woodstoves Number of each_
g. Energy Conservation Compliance. M check Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is cons Chan within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor belo mished grade
k. Will building conform to the Building and Zoning regulations? Yes o.
I. Septic Tank_ City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRIIACTOR APPLIES FOR BUILDING PERMIT
I,��(ll.� I,-1 i` Pi as Owner of the subject
pmpedY I Q _
hereby authonze77CULI LLc.
(tloo act ann(rtymy.b(e�hd'in.1a�ll-m�attttters rellaativ{e�too work auutthoorizeed /y�tr,� building permit application.
iS gn(Qa�[ure of Owner�L1�1�6�6J-4 L�Ga h'ir a'//-1--µ-urs-L`'�U'Il l l oa�, 7 la7 �l fr
q )111�41171bhs AD,619O(�GJl1 ui as OwnerlAuthorized
Ag t her by dec are that the statements and inf alion on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Sinetl untler the'=and penalties of perjury,
n MIA
In ttr�b�
Pn Na
z
Sign reo er/Agent pate
SECTION 6-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not ApplicabblleV❑
Nam.of License Holder: Q$39Ka
Ya PO Rax 1535 License Number
Hobbs Greenfield, SIA 01302 SIr�hQ
Adtlr ss ` Expiration Dale
p�ofn a,h Qt_�1 '
Sign e � Telephone
9.Reaistered Home Improvement Contractor. Not Applicable ❑
1395Loq
Company Name pb sGreenficld, MA 01302 Registration Number
x(413)775-9006 '7 a@
Address Expirafidn Date
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.......x No...... ❑
N Permit Authorization
mass save Form
Site ID: 3362897 Customer: KATELYN SMITHLING
1, k0k �,rn RN+�L� ,owner of the property located at:
JO es N.me,Pdided) . 1Oren LQ_
44 N Farms Rd -WftVmebWT, MA 01062
(Pro0 mStrce Mdreu) (City)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
Owner's Signature:
Date:
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractorto the
above referenced project:
QttunivlaIf, LLC. U 1z� 18
Participating Contractor ate
Name: CLEAResult
Phone: 800-480-7472
Email:
For pec.U.O it
Rev,102015
City of Northampton
�� Massachusetts1 �l� DEPARTMENT OF BUILDING INSPECTIONS (i)012 Nain Stcaet •Municipal BuiltlingNorthampton, MB 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:
qq A) �(Lrmc pjrl �nr ITA WOO
(Please print house number and street name)
Is to be disposed of at:
11X1h �tlm 1 . E619oke- MA CIAO
(Please print name and location of factlity)
Or will be disposed of in a dumpster onsite rented or leased from:
Bryan Hobbs Remodeling LLC
PO Box 1535
or, $ ss)
50160re of Per it 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 of Massachusetts
WlY,orkers'Compensation
Department of IndustrialAccidents
I Congress Street,Suite 100Bastan, MA 02!14-20177www.mass.govoldia
Insurance Affidavit:Builders/Contractors/Electr)cians/Plumbem.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print L obl
Name(Business/Organiz tion/Individua0: PO Box 1535
ohbs Greenfield, NIA 0130-1
Address: (413)775-9006
City/State/Zip: Phone#:
Are you an employer?Cheek the appropriate boa:
Type of project(required):
1.2g1 am a empinye,with _employees(full and/or pan-time),^ 7. ❑New construction
2.❑I am a sole rompdemr m partnership and have no employees working for me in $. ❑ Remodeling
any capacity_[No workers'comp.insurance required.]
JD l am a homeowner doing all work myself[No workao'comp.insurance require]' 9, ❑Demolition
4 F I am a homeowner and will be hiringtractors m conduct all work on m 10❑Building addition
enscon }re sole . 1 will
me that all contractors caner have workers compensation insurance or are sole 11.[—]Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5❑I an.general contactor and I have hired the sub-cuntmew.listed on the idne cd,hccl, 13. of repairs
These sub-commatoa her%
have employees and have wocomp.insommed I
6❑We am a corporation and as officers have exercised their right ofaxamtion MGI.c 14.0Otherl\n All
152,§1(4),and we have no employees.[No workers'complmuance respond,]
Any applicant that checks box#1 most also fill out the section below showing their workers'compensation policy information.
'Homeowners who submit this affidavit indicating they arc doing all work and Nen hire outside contractors must submit a new affidavit indicating such.
:CcntaUors inti[check this has must attached an additional sheet showing the name of the subcmorieters and state whether or not those entities have
employees. If the subcontractors have employees,they must provide their worker%comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-in/1sn.''Lic.#: �(� -/Qr77,�7(] Expiration Date: p
Job Site Address: A ) (/7 U115, City/State/Zip:Fba lip Q MA (mum
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby card under the p/aii and penalties ofperjury that the information provided above is truce and correea
Signature /�,(A�ryy `�/§�1-�YS/ Date
�1tYl I)Ls
Phone#: j Z5- 7 (p
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CityTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
fi.Other
Contact Person: Phone#:
CO OW CERTIFICATE OF LIABILITY INSURANCE °" 1"12°"7
a1SR01T
THIS CERTIFICATE IS 18SUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLMBR.THIS
CERTIFICATE DOES NOT APPIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(4)AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
I T BEEF lartMtplo holds Nt rADDITIONAL INSURED,the Polky(ba)mutl have ADDITIONAL IBUR D pnvrdwwr W Endonad.
If SUBROGATION 18 WAIVED,Subject to the bane and condition*of Me policy,certain policies may require an Endorsement A¢UNment eh
MIB cerdfi a does not canfSr 111911111 t0 the certificate holler In Ileo Of SUch endOnlem nl s .
FROptlOGI E, Acne Ed'
Webber B Grinnell FN E (613)388.0171 (41$)588.6481
A.
S No King Street AOOAK aedgMl�M'ebbarardptlnllBl,cOm
INSUREJUS)AFFORDING COVERAGE NAF
NornsTPOn MA 01080 WSURORAI Selective ins Co a 9 Caroline
IMWeo INFLAME: S ek,Pi, E In.Co of fMerlca - 185'
Bryan Hobbs Remodeling INSURER C. SelOCIVe Ina 00 Of Southeast 388:
346 Conway Street weURae D:
IMBURER e:
Gwrd'Nd MA 013011516 INSURER F,
COVERAGES CERTIFICATE NUMBER: ENDOBHB REVISION NUMBER:
THIS ISTD CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED 00VE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR OONOITION 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,
EXCLUSIONS AND CONDITICNS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
L R TVPE OF INBUMN°E ..so MIND P041CYNUMBER "MIO Epp LIAM}6
CpIMERCNL OENM4L LABILITY
E4CX OCCURRENCE 1'ODD'000
CLAIM WOEI OCCUR p0. B BDO,ODD
MED KP aI 1 { 15,000
A S228B042 08104/201) 011PERBO BADVMUURY 8
EGA LIMIT 1'000'000
GENIAGGRAPPLIES PER: GENEMLAOGREW 2,000,000
FCLICV 1. 1 TOT O LOC PRODUCTS.CoAftPAGG IE 2.000,OM
OTHER: s
AIRONOSILELNEILIIY L INE 81N L LIMIT 3 1,OOg,gW
MY MIND BODILY INJURY 1PSrnNPm {
S OWNED x SCHEDULED A81053M 0W00017 08104/2018 BODILY INJURY IPM lute/ {
AUTOSONLY AUTOS
AUTO AUTOS ONLY PR°PEW NAME
AUTOS QVLV x AUTOS ONLY S
Underinsured moborld Bl 8 2 ,OOC
UMWBLLA LIM ctAuaO OCCUR EgLN OCCURRENCE 81,000,000
A eFceswAe 52208042 06104)1017 88/0412010 AGDREGA E { 2,000,C0O
o P {
wpRMeRBC2M LACI
NIpFRED "S RY LIABINT' YINX TA T R
C OFR^WENBBEREE.XCLWOM CUTN" � NIA WCB057210 Bryan Hobbs EXG. 1a208017 1080/2018 ELFAOH IOpnT a 500,000
I!A'In,sYErnNNic EL.OIBEASF 6ABM OKE B 500000
°EB I%ION CF RAT/ PAN, E.L.DISEASE-PO ICY LINT S 500000
DESCRIPTION W°PEMTO.VSI LOCATIONS/VEHICLES(ACORD 141 AAMS.tl Mmvb nlneul4 mry IU t.rN.11 mon.M.IF noise)
CERTIFICATE HOLDER CAN ELLATI N
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED W
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIEED REPREBENTATIVE
01988.2015 ACORD CORPORATION.All rights me,
ACCRD 25(2816103) The ACORD name and logo are registered marks of ACORD
Commonwealth of Massachusetts
®� Dims,on of Professional Licensure
Board of Building Regulations and Standards .
Construction Supervisor
C8483982 Expires. 0510212020
BRYAN HO
PO BOX
1536
GREENFIELD MA OU002
Commissioner v"4
c rj 'l id' QJ'r'6liildr�sl/r/r�rs/`/J! r�/ !'_�-!'ZC7JJlIc/trlJeC�3
dy Ctfloe of Consumer Affairs and Business RegUdon
10 Park Plaza • Sults 6170
Boston, Massachusetts 04116
Home Improvement Contractor Realet atlon
RpIW
7
®RYAN H0888 @xpketlom W1211111cii
30 O®RYAN N0888 REMODELING
91e CONWAY 8T
GREENFIELD,MA 01801
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Plaza.sults 8170 �M M
ERYAN HOBee BMbn,MA 02114
Dii BRYAN HOBBS REMODELING
BRYAN a Hoene
MOCOWMNFleLO,MA 01301 unMn�om6ly Not valid W141idaeBWre