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17C-095 (9) 136 CHESTNUT ST BP-2019-0204 GIs#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 17C-095 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeom, INSULATION BUILDING PERMIT Permit# BP-2019-0204 Project JS-2019-000335 Est Cost:$1977.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: Use Group: BRYAN HOBBS 83982 Lot Siae(sa. ft.): 11499.84 OWner: BECKER MONTE zoning: URB(100)/URA(0)/ Applicant. BRYAN HOBBS AT. 136 CHESTNUT ST Applicant Address: Phone: Insurance: 346 CONWAY ST (413) 775-9006 WC GREEN FIELDMA01 301 ISSUED ON:8/1612018 0:00:00 TO PERFORM THE FOLLOWING WORIGATTIC INSULATION - 10" CELLULOSE, INSULATE ATTIC HATCH, VENTILATION CHUTES, 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# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Deoartmen[ 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: FeeTvoe: Date Paid: Amount: Building 8/16/20180:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner �n sc��Gih 07� Department use only Y City of Northampton Status of Penn* y Building Department Curb Cul/Driveway Perron ' 212 Main Street Sewer/Septic Availability Room 100 Water/Well AvailaWliy z Northampton, MA 01060 Tvro Sets of Structural Plans n a phone 413-587-1240 Fax 413-587-1272 PIOUSile Plana Other Specify s4, ATI N TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION OJO ✓' �� 1.1 Property Address: This section to be c3T--/w) mpler-t-atl byoffice 2U � j�sw� S- Map v Lot ©�`/ Unit Foos a -� U G L a Zone Overlay District Elm St.District Ca District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: (�1nV c�Q>2�l.cr�r 131p ��v�} sst�. �nw �� > �p r;IDiaa Name(Pring Cu rent lin dre Skn m m l dr"n Lr2� c p�1j�h9FC �f1 A { Telephone Signature 2. l: 2 Authorized Agent. - lInI1 l�r�i, t� YWdiI-ic PCL r,v 15'�� o��.l�l'Q!al (nr� 6130a Mme( rint) Current Mailing Address: �ll3.77�.�mzo S' a re Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cast(Dollars)to be Official Use Only connieleted by.permit applicant 1. Building 1,911-q3 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee #04J-t / 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) ),9-77-q Check Number This Section For Official Use Only Date Building Pe r: Issued: Sig stars: Buildin Co missionerllnspector of Buildings Data i/l�o I h oai kobhs @ 1 . CODA EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This aalumn to be filled in by Building Depanment Lot Size Frontage Setbacks Front Side L: R L R. Rear Building Height Bldg, Square Footage Open Space Footage o (Loi area unions bldg&paved ranking) Hof Parkin Spaces FIII: volume&Location) 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 �J YES O IF YES: enter Book Page and/or Document At 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 ®' 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 Storrs Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows AIteration]s) Q Roofing Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs jO] Decks IM Siding[0] Other Brief Des�nPFlon of Pr po ed Work: (111'1tinrq,l y lrm-1tlrevSt Dsel lntv.iSnte p�}il �wn4r 1�,1 /ph} la v�Pla cti.1,ci�V_01 �/ Alteration of existing bedroom_Yes_ No Adding new bedroom Yes /1 NoIZ Attached Narrative Renovating unfinished basement Yes No Plans Attached Rall -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 m each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? 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. 1. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT /O�R CONTRACTOR APPLIES FOR BUILDING PERMIT Irffi f'�pf.✓> ,as Owner of the subject proper AlI authorize d II1111 '1�� '(10 MMA QL to act on my beha , in a matters re alive to work authorized this buildmg permit application. �QQ cly tLCQu% �nmN nr SCJ S I14I�� S,ratature of Owner Date as Owner/Authorized Agefitt l by declare that the statements and in rmation on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the he and penalties of perjury. PrintN e I I Sig o OwnedAgent at SECTION 8-CONSTRUCTION SERVICES 81 Licensed Construction Supervisor: Not Applicable ❑ ya PO Box 1535 9399) Name of License Holder'. lbs.............. pen to 1c, License Number J®iVe (413)775-9006 6m/�ess 1 ExpiraOon Date lam IIF-}I bj' r S10"turd 0 Telephone 9 Registered Home Imorovement Contraglor: Not Applicable ❑ 13`l 5LDLI Comoanv Name ya ox Registration Number obbs Greenfield, MA 0I302 fa131775-9006 � nD I �I Atltlr Expirat on Da e 'LHukkc Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,§21 Workers Compensation Insurance afficavit 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...... ❑ City of Northampton Massachusetts (i) DEPARTMENT` OF BUILDING INSPECTIONS 313 Nein street arfunicipal Building NortAampton, NA 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: 13�G�s'1'!'t�l�"�o� � �InlotlrA n�4 Dlb>Da (Please print house number and street name) Is to be disposed of at: / 700 e{a n l�p � R7i 2 Nro FfDIItrAKelYla D1040 (Please print name an location of facilit ) pnOr will be disposed of in a dumpster onsite rented or leased from: CMr14426' Rovc{ � ni(IC 0r (company N Name aand Ad ress �tii A P-tOY�"1/ ® na ure of P rmit A0plicant 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 ofMassaehusetts Department of Industrial Accidents z I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia \Yorkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organizetiowindividual): 535 Hobbs Greenfield, MA 01302 Address: (�9) Hvl-9nn6 City/State/Zip: Phone#: Are you an employer'!Check the appropriate box: Type of project(required): I,at am n employer with__'J_employccs(full and/or part time) 7. ❑New construction 2 l am a sole proprietor or partmodip and have no cmployccs working for me in g, ❑ Remodeling any capacity.[No workerscomp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner tloing all work myself[No worketY camp.insurance required)' 10 E]Building addition 4 ase M1omcownnr and will be hang contractors m conduct nn work my property. I will ensure that all contractors either have workers compensation insurance neor are sole IL❑Electrical repairs or additions propaemrs with ao c111.111, 12.❑Plumbing repairs or additions 5.M l am a general contractor and l hast hired the subcontractors listed on the attached sneer 13 ❑Roof repairs cob-contactors have employees and have workers'comp.insurance.: b.❑We are a corporation and its omccrs have exercised their tight of exemption per MGL e. 14.®Other U XAAQlfrll'hfNn 152,t,ldn.and we have no employees(No worker comp-insurance requited I "Ady applicant that checks box#1 mud also fill out the section below showing their worker'cumpens noun policy information. t Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit a new affidavit Indicating such. if counters that check this or.mtet nnnelied an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees If the sub contractors have employees,they must provide their workers camp-policy number. I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information. n / Insurance Company Name: `^l0bphl(R �d)SAI OYi(y(�17 Policyrtor Self-ins.Lia JiJ( 9057X70 Expiration DateeII c� l Job Site Address: 13 0 U' 10�x V\I[„t 2t. City/State/Zip:'ODU tQI I 01 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 e. 152,§25A is a criminal violation punishable by a fate 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. 1 do hereby cc .(y under fh11ee ains1 and�penalfipes of erjury mn that the inforatioprovidded above is true and correct Signature A/rpt ) 1IUKYY�77 Date' A11HIarJ(a, Phoi' � Official use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License a Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone th RISE ENGINEERING OWNER AUTHORIZATION FORM I, Monte Becker (Owners Name) owner of the property located at 136 Chestnut Street (ProperyAddrass) Florence MA 01062 1(Property 1 Address) hereby authodze brl p rn �Subconaactor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on myproperty.T torn' only valid with a signed contract. Date RISE Engineering,a Division of Thlelsch Engineering,Inc. 605hawmut Road Unit 1 Canton, MA 020211 339-SO2-6335 www.RISEengineering.wm 6— __ ACil CERTIFICATE OF LIABILITY INSURANCE DA'-'aa"D`"Y" 0)125/2018 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 ODES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the coMicaM holder Is an ADDITIONAL INSURED,the pollcy(bs)must base ADDITIONAL INSURED provisions or be entloreetl. N SUBROGATION 15 WAIVED,subject TO Me Carona and conditions of the policy,certain policies may require an entlomement A statement on this ceHNlcats does not confer rights W the nrtMwW holder in lieu of such en0omement(s). PRCOUCER CAME"' AOim Eogetl AME'. Webber 8Grinnell PNCNEPRO_ (413)588-0111 pry. Ne; (413)588-8681 B NOM King Street Aural, aeEgettillINNebberentlgrinnell.mm INWRMSIAFFORMNO COYEMGE NAICM Northampton MA 01080 INSURERA; SeleclivelmsCoofSCarolina Mire. scrol Re: Selectivelns CoolAmenG 12572 Bryan Hobbs Ferrotleling,LLC INSURERC'. Selective Ins CO Of Southeast 39926 346 Conway SUeel INSURER D'. INSUPE0.E Greenfield MA 01301-1516 INWRPR F: COVERAGES CERTIFICATE NUMBER: E%p08119 REVISION NUMBER: THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH 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. INSma TOPE OF INSURANCE ADDLSUBK PCIgY NVMBE0. MMI'P�ICYEFF MMIOOMYY LIMnS COMMERCNLOENFNALLJAMmTY EACH Q'LVRRENCE S 1 000,000 CLAIMSMADE ❑X OccuR PREMISES Ea orcunMKe S 500,000 MEOE P n $ 15,000 A 52209042 0810412018 0810412019 PERSURALaADVINIURY E 1 000,000 GEN LAGGREGATE LIMIT APPLIES PER GENERALAGGREGATE § 2000000 POLICY ElP.Sor E:]LOC LOC PRODUCTCOMPgPAGG $ 2000,000 OTHER $ AUTOMHEILELARK-1 Y FO%NPO51NGLE LIMIT § 7000,000 AXYPVTO BODILYINIVRYEwpersml S B oANFT x scHEOmW A9105300 OBIN12018 08/04/2019 eOXITILTURYonvir Meml a AVTOSONLY AUTOS HIRED NCNCNNNEO PROPERTYDAMAGE y x AUTOSONLY AVTCS ONLY evGM Untlerinsuretl motorist Bl s 20,000 UMBRELLAUAa J.ir' " 1.000,000 x WcuR AGGREGATE s A ExCE53 Ln,e CumSMADE 52289042 08/04I2018 OBI04I2O19 AGGREGATE 5 2000,000 DED XSAnOIMI a S WONxER3 COMPEN$FPOH X SEATUTE REN AND EMMOYFAS LIABILITY E C ANY PRCPRIETORIPARLNCRICECOTNE O NIA =9057270 Siren Hobbs Excl. 10=12017 10/20/2018 EL S4LH ACCIDENT S 5170000 OFFICERMEMSER E%CLVDED'1 IY 500,000 (Munni INXI EL DISEASEEAEMPLOYEE $ FERCE.M.ie.I,m.I 500,000 PTION OF OPERATIONS PARK EL DISEASE-POucv LIMIT a Building 3493,004 COMMERCIAL PROPERTY A S2289062 08/042018 08/0412019 BPP $50,000 DESCRIPTION OF OPERATON31 LOCATIONS I VEHICLES(ACORD 101,A64XIorns Fri RMJUIq mry P,aurcM4 X mon rpi YRXulnEl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTIORRED REPRESENTATIVE 01988-201SACORDCORPORATION. Allrightareaemetl. ACORD 26(2016103) The ACORD name and logo ere registered marks of ACORD r Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards , Constru0tlon Supervisor C%<083982 EXplres: 0510212020 BRYAN 0HOBBS35 PO BOX GREENFIELD ' 6REENFIELO MA/01J02 Commissioner ✓"� /� ' 1w�d7d' C/ r''��O NFP�N//1Prr/�1! oy � f'll!'Jr(tY'�tIJP,!(J . :V ' Office of Consumer Affairs and Buelrroaa Regulation 10 Park Plaza • Bub 5170 Bolton, Massachusetts 0411a Home Improvement Contractor Fteglstraeon Rpt tYPIN I BRYAN HOBBS ium �tFl 07/�Qlppli DATA BRYAN HOBBS REMODELING Sale CONWAY ST GREENFIELD,MA 01801 UPdOm A"""&IdMW0n"y, Ak*m ❑ AddOees Maeenratl Campiapr 0MI"010IMPROV NaOeA :7"n RRpp = IIONBIMRROVBNBNT QONTRACTOIWIf" WpNWW�M VMltl tOrlNNlduM u"eMy Type:In0M0dAl =theeXFlratlsintletW "%MrA"%ai ';:.••1" Elm OWI"01 o0"umer Aralsows Wssum Row"On �0 m 07 ti 10 Fill M"e•eu1111 8170 BRYAN HOBU B01110n,MA 00110 DA/A BRYAN HOBU RBMOOELING BRYAN O.HOBBS GnnnFliA ®Lea Otmt untla"0 sM y Nawlltl wahOut 619ruiture