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25A-147 (5) 49 NORTHERN AVE BP-2019-0875 GIs#: COMMONWEALTH OF MASSACHUSETTS MV-.Block:25A- 147 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv: INSULATION BUILDING PERMIT Permit# BP-2019-0875 Proiect# JS-2019-001461 Est.Cost: $1262.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BRYAN HOBBS 83982 Lot Size(g. ft.): 5009.40 Owner. MESSER TIMOTHY A&EILEEN A Zoning:URB(100)/ Applicant. BRYAN HOBBS AT: 49 NORTHERN AVE Applicant Address: Phone: Insurance: PO BOX 1535 (413) 775-9006 WC GREENFIELDMA01301 ISSUED ON.211112019 0.00:00 TO PERFORM THE FOLLOWING WORK.-SEAL AN INSULATE ATTIC HATCH, RIGID BOARD, CELLULOSE KNEE SLOPE WALL, AIRSEALING 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: Amount: Building 2/11/2019 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner htutiv Department use only City of Northampton of rml Building Depa met Curb �ut/D vexaay ermit a 212 Main S reet F E B _ 8 201 ew /Se Av>�Ilabi�ty Room 1 0 W Nu0lt vasty Northampton, A 0� F c iNSP ria S I Plans phone 413-587-1240 F x 413 7UNC, MA 0 Ite Pws Other Scfy APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 49 / ?-f "— 1.1 Property Address: This section to be completed by office c./ yp1 �u( n �'wL Map—��•� l I,q. Lot / 77 Unit (1Ur1�A,np �, MIN O)i,04u Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2-..1 Owner of Record: \ t '191 1 N("-D-V1j2hXN Name(Print) Current MailingAddress: Telephone Signature 2.2 Authorized Agent: 01 JaN-V nA1?� 153 C�reu� �@ hpt oisai Name( rint) Current Mailing Address: tea., Ll 1OIL Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) VV 5. Fire Protection 6. Total=0 +2+3+4+5) ' t �.(,�;j, l:. Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: 7 -Z-I 1-26 Building Commissioner/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 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 Q DONT KNOW © YES Q IF YES, date issued:'; IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW 0 YES Q IF YES: enter Book Page and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q 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 applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors t] Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[1--3] Other[[ Brief Description of Proposed Lf IncV1 Q0 f 1etAnr Work: S a-1 + In PAA N( 4aa4� qac'rk ltA-U0 Alteration of existing bedroom Yes No Adding new bedroom Yes No 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, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. A ature of Owner Date I i v1ct 6*0 '&a L l L_ as Owner/Authorized Agent hely deblare that the statements and information on the fore in�g application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of O ner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: `— Not Applicable ❑ Name of License Holder: L)f\xe(l lS1 . t't J�1 C` o&--�,q fi a License Number C- spa Iat)a-<--) Address \\ Expiration Date Signature Telephone 9.Reallstered Home Improyement Contractor: Not Applicable ❑ Company ame Registration Number R, \ `-IlaaI )9 /Address �1 c c Expira ion Date �aren�n � CA car 1 Telephone-W- l VUR 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...... ❑ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual): Bryan Hobbs Remodeling LLC Address: PO Box 1535 City/State/Zip: Greenfield, MA 01302 Phone#: 413-775-9006 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓❑I am a employer with 7 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.M I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]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 11.❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑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.*- 14.M Other weatherization 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 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. TContractors 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. Insurance Company Name: Selective Insurance Co. Policy#or Self-ins. Lic.#: WC9057270 Expiration Date: 10/20/2019 Job Site Address: �-\O% o-r mavm Nxk,— City/State/Zip: (��(k� p1vC1 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 certify under thepains andpenalties ofperjury that the information provided above is true and correct. Signature: Y4 Date: ���'1 Phone#: 413-775-9006 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#: ACo® CERTIFICATE OF LIABILITY INSURANCE DATEtMMIDDMYY) 164.� 07/25/2018 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 pollcy(les)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 PHONED (413)586-0111 FAX No: (413)586-6481 8 North King Street ADDRESS: aedgett@webberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC N 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 POLICYNUMBER MMDDY LTR /YYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEU CLAIMS-MADE FX OCCUR PREMISES(Eoc Hence $ 500,000 MED EXP(Any oneperson) $ 15,000 A S2289042 08/04/2018 08/04/2019 PERSONAL&ADV INJURY $ 1'000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 X LOC 2,000,000POLICY ❑JET OTHER: $ AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ 1,000,000 Ea a.'dent ANYAUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED A9105300 08/04/2018 08/04/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X $AUTOS ONLY X AUTOS ONLY Per accident Underinsured motorist BI $ 20,000 X UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 52289042 08/04/2018 08/04/2019 AGGREGATE $ 2,000,000 DED RETENTION S $ WORKERS COMPENSATION X SPER TATUTE ERH AND EMPLOYERS'LIABILITY Y/N 500,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE N/A WC9057270 Bryan Hobbs Excl. 10/20/2018 10/20/2019 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/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 26(2016103) The ACORD name and logo are registered marks of ACORD 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 licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: o<`\1f1 The debris will be transported by: C a u �Aa. The debris will be received by: C'Q' �\f' Building permit number: Name of Permit Applicant �z„ Date Signature of Permit Applicant Commonwealth of MBSsilehusetts Division of Professional Licensure Board of Building Regulatlens and Standards Construction Supervisor CS.083982 Expires; 0502/2020 BRYAN G HOBBS PO BOX 1636 GREENFIELD MA 01302 Commissioner Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Individual BRYAN I-10688 Registration: 139664 D/B/A BRYAN HOBBS REMOOELINQ Expiration: 07/22/2018 346 CONWAY ST GREENFIELD,MA 01301 Update Address and return card. Mark reason for change. Addrzat M-Renravi al C?.Employment M 1..a:at4azd. Office of Consumer Affairs&Business Regulation °` :• HOMO IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Individual before the expiration date, if found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 139564 07/22/2019 10 Park Plaza•Suite 8170 RYAN HOBBS Boston,MA 02118 /B/A BRYAN HOBBS REMODELING RYAN G.HOBBS \2 Ciw a CONWAY 3T (� REENFIELD,MA 01301 Undersecretary Not valid without signature RISE ENGINEERING' OWNER AUTHORIZATION FORM I, Timothy Messer (Owners Name) owner of the property located at: 49 Northern Avenue (Property Address) Northampton, MA 01060 (Property Address) hereby authorize (Su contractor) 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. Owner's Signature Date RISE Engineering,a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 1 Canton, MA 020211339-502-6335 www.Rl5Eengineering.com c , w 1 is Ell 2. s a..,t,._ t s i.- - coo C ___.un. r .. O�}3_}3 .. _-t.t ,.. „ a,t A .- L -, T.--"i2.. Y�, as 3r°'yf-7. €iWl S. L. .,`' Tttnpt y Messer ar � 474930 sm 49 Norfhern Avenue Northam tonDoc 413 044632 "",pqmcast.net d r, abs{t ... ell x, S .r°` 4c�raYr�c=zu SignatureSignature ^::���...»_.��aiCL�rC�ate: ...AC' /. W._4..... Hiq�'Carbon Monoxide;Ano�Vu 1 to GW'QV Wd rw X"%W nwowyw:"Aw"A""n owe on.my inns.� -n-1, ,,,r< - ,�✓ ,��r,,,: ,gay,,,, r�-r�. ,�.,a9� St iaz Stam' i govt 5pd CO C�4r". E vrstir,c;,- Draft ft 3; Hcattr� System �.. _._. Hot Water Seller �._.__.._.... .................11_..._._..__............ Other; SoMagie:Come,,„ .- �r v ,,.f,y W f e ga,...5€.,Me , ?".,,wo Iwo WOW a .U", <41< Y Of XV, 10 ,- w-c'.-'.,s VA..3 - 1 -.j W"I wow, i., _. .. _.. Contractor Signature