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35-221 (7) 34 LADYSLIPPER LN BP-2019-0368 GlS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35 -221 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# BP-2019-0368 Project# JS-2019-000597 Est.Cost: $5915.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BRYAN HOBBS 139564 Lot Size(sq. ft.): 39552.48 Owner: MARTIN-REHRMANN RUTH zoning Applicant: BRYAN HOBBS AT. 34 LADYSLIPPER LN Applicant Address: Phone: Insurance: 346 CONWAY ST (413) 775-9006 WC GREENFIELDMA01301 ISSUED ON:9/24/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-AIR & DUCT SEALING, ATTIC INSULATION (CELLULOSE), KNEEWALL INSULATION (CELLULOSE & FOAM BOARD) 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 Occupancy signature: FeeType: Date Paid: AMognt; Building 9/24/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner /1rsj.4WM File#BP-2019-0368 APPLICANT/CONTACT PERSON BRYAN HOBBS ADDRESS/PHONE 346 CONWAY ST GREENFIELD (413)775-9006 PROPERTY LOCATION 34 LADYSLIPPER LN MAP 35 PARCEL 221 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid ,U Typeof Construction: AIR&D C IC INSULATION CELLULOSE KNEEWAL INSULATION(CELLULOSE&FOAM BOARD) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 139564 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: r/Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: §_ Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay 91-74 Ile Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit ;A 212 Main Street Sewer/Septic Availability J Room 100 Water/Well Availability ' Northampton, MA 01060 Two Sets of Structural Plans ' phone 413-587-1240 Fax 413-587-1272 1 Plot/Site Plans RECEIVFFYpecif APPLICATION TO CONSTRUCT,ALTER, EPAI , RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION SEP 2 1.1 Property Address: T s se tioon to be c le ed by office DEPT.OF BUILDING INSPECTIONS 35 t NORTHAMgIj*,MAO 1060 Lot Unit Zone Overlay District Elm St.District CB District --7SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �k1VA a- Q ncw�n Name(Print) nt Mailind Address: 3.-2ys-nq 9I S Telephone Signature (siv An 2.2 Authorized Agent: 0 Qom, 152c5 r0Q�Jr1 MA 0ISO,p are Print) QCurrent Maili6j Address: X13 -1-75 - 26C,Ia Sig to Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building �r r, I (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= 0 +2+3+4+ 5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 1 ONWA �\066, @ 11rn d -Co AA EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) _ i . .�_ .; � , .... *=x t �,. c .. . °_._...w.s 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 Department Lot Size Frontage Setbacks Front Side 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 DON'T KNOW (D YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW IYES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO C� DONT KNOW © YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO la 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 © NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. i SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) 0 Roofing 0 Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[O] Other rr Brief Description of roved (}.� Work: / ( W - d Alteration of existing bedroom Yes___y No Adding new bedroom Yes No b C ft 410J Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. 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? 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? 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, A'(11AI �Q (`(/)�j((( as Owner of the subject property hereby authorize L- to act on my beha , in a I matters relative to Work authorized by building permit application. S ( )0Pd c.S a4 i] (VMA �P��Clea �/ I iR g' ignature of Owner Dat I, &JOAA as Owner/Authorized AgV'ereby declare that the statements and info ation on the foregoing application are true and accurate,to the best of my knowledge and-belief. Signe under theand penalties of perjury. X Pr' t m T Signature o Owner/Agent Date i SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ^❑ Name of License Holder: �O,/. �P License Number ya PO Box ]535 1 ��ebbs Greenfield, MA 01302 {- o Ad5,t (413)775-9006 Expiration Date i I ro I j Rbb� z Sire Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ L-39 5(Dq Company Name ya PO Box 1535 Registration Number •+ Greenfield,MA 01302 -7 1 RQ I Address -9111141116 Expiration! 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...... ❑ Permit Authorization mass save° Form $.;E':ifi4':..lFa c:,g-.�1 f-synYp�1'•''?f>::F;iV�Y Site ID: 3399945 Customer: RUTH MARTIN-REHRMANN I, (Z -f ��u,•rS /`tum 7r�t- I`e �„� �"W ,owner of the property located at: (Owner's Name,printed) 34 Ladyslipper Ln LOT 18 Northampton, MA 01062 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building performpermitins ation and/or weatherization work on my property. t Owner's Signature:.,-. , 1— Date: S LZ- i�: ( l ! 1,i 0 92&6ed aN &Ci IL C "M.. - :' :;3 :bs i,SOA.n. ?3 .tom... FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email For Office Use Only Rev.102015 City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Northampton, MA 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: ,5q (Please print house mber and street name) Is to be disposed of at:a nm A a l/ �,, �� 7 � U�lu-l./V 1 ,o Oicyd (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: �7to (Company Name andAddress) Zuau Sig re bf Permit Ap'pRant 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 Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 y www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): PO Box 1535 Hobbs Preen teld, MA 01302 Address: (413)775-9006 City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.P I am a employer with _employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.[:]l am a homeowner doing all work myself[No workers'comp.insurance required.]' 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.r7 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs These sub-contractors have employees and have workers'comp.insurance.- 6.[:]We are a corporation and its officers have exercised their right of exemption per MGL c. 14.1!�Other t/h 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached 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'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. n. n n Insurance Company Name: ( a In X4 A�t.�{�1 Policy#or Self-ins.Lic.#: 1& 9 6 g5 7 3 76Expiration Date: Job Site Address: City/State/Zip: A Attach a copy of the workers'coi#pensaki6n 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. Ido hereby certifZy under the ains andpenalties ofperjury that the information provided above is true and correct. Si nature: Date: Phone#: 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.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: K .. � • �i ., � l�if: �� � 2 'Y� 'f.: ... .. A � A��® DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/25,2016 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(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Adina Edgett NAME: Webber&Grinnell A/c NE E)dl, (413)586-0111 A C No): (413)586-6481 8 North King Street ADDRESS: aedgett@webberandgrinnell.com INSURERS)AFFORDING COVERAGE NAIC 0 Northampton MA 01060 INSURER A: Selective Ins Co of S Carolina INSURED INSURER B: Selective Ins CO of America 12572 Bryan Hobbs Remodeling,LLC INSURER C: Selective Ins Co of Southeast 39926 346 Conway Street INSURER D: INSURER E: Greenfield MA 01301-1516 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 08/19 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 ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSD WVD POLICYNUMBER MM/DDIYYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 A A 500,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 15,000 A S2289042 08/04/2018 08/04/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 1:1 ECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ B OWNEDIx SCHEDULED A9105300 08/04/2018 08/04/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Underinsured motorist BI $ 20,000 X UMBRELLALIAB OCCUR EACHOCCURRENCE $ 1,000,000 A EXCESS LIAB HCLAIMS-MADE 52289042 06/04/2018 08/04/2019 AGGREGATE $ 2'000'000 DED RETENTION$ $ WORKERS COMPENSATION Y/N AND EMPLOYERS'LIABILITY X STATUTE I I ER 500,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE NIA WC9057270 Bryan Hobbs Excl. 10/20/2017 10/20/2018 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ry 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ COMMERCIAL PROPERTY Building $493,004 A S2289042 08/04/2018 08/04/2019 BPP $50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD f Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constroc lbri°Supervisor CS-083982 Fp I res: 05/02/2020 BRYAN G HOBBS PO BOX 1535 GREENFIELD MA 01302 Commissioner C"I' G_. 7 j - " = Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Individual Registration: 139564 BRYAN HOBBS D/B/A BRYAN HOBBS REMODELING Expiration: 07/22/2019 346 CONWAY ST GREENFIELD, MA 01301 Update Address anci return card. Mark reason for change. A 1 0 20M-05/11 _ n n.+a...e.. 7I Dn..n f..�l n C".,..In��...e..♦ n I nn♦r`grrl Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: Individual before the expiration date. It found return to: Registration Expiration Office of Consumer Affairs and Business Regulation ARP 139564 07/22/2019 10 Park Plaza-Suite 5170 BRYAN HOBBS Boston,MA 02116 D/B/A BRYAN HOBBS REMODELING BRYAN G.HOBBS -- 346 CONWAY ST GREENFIELD,MA 01301 Undersecretary Not valid without signature