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10B-038 (3) 44 FRONT ST BR•2019.1009 GIs a COMMONWEALTH OF MASSACHUSETTS MV.Block: 10B-038 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit, Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv:INSULATION BUILDING PERMIT Pennit p SP-2019-1009 Proica# JS-2019.001662 Est Cost: $2465.00 File, $61j PERMISSION IS HEREBY GRANTED TO., Conat Clan: Contractor: License: 11se Oroun: BRYAN HOBBS83982 Lot Size(sa. it): 10626.64 Owner: HAAR SAM Zoninw URA(1001/ Applicant: BRYAN HOBBS AT: 44 FRONT ST Applicant ddress: P one: Insurance: PO BOX 1535 (413') 775-9006 WC GREENFIELDMA01301 ISSUED ON:4/16/1019 0:00:00 TO PERFORM THE FOLLOWING WORKATTIC INSULATION, AIR SEALING, VENT BATH FAN, WEATHERSTRIP, CELLULOSE TO WALLS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Undorgroundi serviaat Motor; Footings: Rough; Rough: House Foundation: Driveway Final: Final; Final; Rough Frame; Gas: Fire eoariment Fireplace/Chimney: Rough: Pill Insulation; Final: Smoke; Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of 01ccui3ancv Signature: Fgg„Typ$,• Date Paid: Amount: Building 4/26/2019 0:00:00 $65.00 212 Main Straol, Phonc(4 M 387.1x40,Fax: (413)987-1272 I,ouis Hasbrouck-Building 4ommissionor art/uc�� Ti oiV Department use only i City of Northampton Status of Pornt: ,,g Building Department Curb Cut/Driveway Permit �r 212 Main Street Sewer/Sepgc Availability I, .! 7( Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/SAa Plans Other Specify— APPLICATION pedryAPPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH ONE OR TWO FAM ILY DWELLING SECTION 1 -SITE INFORMATION 3P-' ct, /VV IL 1.1 Property Address: This section to be completed by office '-1 ( 1' ` } S� Map� Lot i2 J d Unit `—� 1"Tl%1 Zone Overlay District VLX(7S, M� c�luS� Elm SL Disbler CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 1 Aaar Name(Print) Currenl Maili Atltlress'. l��e- °I Iy - S--4q - 3UI fr Telephone Signature 2.2 Authorized Agent: Name Print) 7 Current Mailing Atltlress'. On yetl IC�� Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit alaplicount 1. Building 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= (1 +2+ 3+q+5) p7, Check Nu miner IgOU This Section For Official Use Only Date Building Permit Numb e : Issued: Signature: �-Z5-20)p / Building Commissioner/Inspector of Buildings Data EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Sectional. 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 Depanmcnt Lot Size Frontage Setbacks Front Side L R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage (Lot area minus bldg&paved kin I #of Parking Spaces Fill volume&Location A. Has a Special Permit/Variance/FinNdingeye r been issued for/on the site? NO O DONT KNOW VO YES O IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O 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 0 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 O 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 O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, xcavation,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 Stoon Water Management Permit from the DPW is required. SECTION b DESCRIPTION OF PROPOSED WORK(check all applicable) Now House ❑ Adtlition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors Cl Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [p Siding [0] Other(Od t T Brief Description of Proposed Work: li�i+u ♦�\.,\c,-hug (1\t it Llt�Y�1,A�n4 �ail lhl hZin . 1.12:�L!v�cyv� � �'o lL.:l�sz V x111. , Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ba.If New house and or addition to existing housing. complete the following: a. Use of building :One Famili Two Family Other It, 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 Wilding 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. Signature of Owner 1 ,l Date I as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name �C1� 4- h-� -��7 X 19 Signatu caner/A ent Dale SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable El Name of License Holder: ( PC~i `lrl5 C ." -0^ License Number Morass Expiration Date ��I tobh 113 1�C - 9 Sig re Telephone 9 RrMistiamd Home lmurornnem Contrilli Not Applicable ❑ 1�rUnn 1w�r�srn s, It l 139 Si,V Comoanv Name Registration Number j7-� �� x 1S'�r �laali5 Atltlress Expira i��on D- a�^ Lr fS� Telephone 7Qu SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§251 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...... ❑ RISE ENGINEERING OWNER AUTHORIZATION FORM I, Sam Haar (Owners Name) owner of the property located at: 44 Front Street (Property Address) Leeds, MA 01053 (Property Address,,) hereby authorize�Yl.\?1 —(Sub ntractor) 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 gnature it I�.x� i8 Date RISE Engineering,a Division of Thielsch Engineering,Inc. 60 Shawmut Road Unit 2 1 Canton, MA 020211339-502-6335 wwwAISEengineering.com ®� commonwealth or Massachusetts Oivision of PfOreaslOnal Lice retire Board of B wl ding R91116110nIs no Standards COnstrAC110n Supervisor Cs-083982 EXplrae, O6r02@020 BRYAN O HOBBS PO BOX 1636 ' GREENFIELD MA 01302 Commissioner r'�llP //40,///(2//(UF'(/I(/1 _75c, ' _. Office of Consumer Affairs and Business Regulation 10 Park Plaza • Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type'. Individual BRYAN HOBBS ReaalstratlOn: 13GS64 D/S/A BRYAN HOBBS REMODELING Expiration: 07/22/2019 34e CONWAY ST GREENFIELD,MA 01301 Update AddreW and return card. Mark ration for Change, . ..,w,.,c u ❑ Add=s 17Aonouual E:Employment- M LoaLC4d. ';//. r,,,,,,,,,,,,,,,///.,� �L...,,./,,,. :G OMlOe of Consumer Mal'.a Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:IndMoual before the expiration data if found return to: at ig atl90 Excitation OfflOo of Consumer Affair$and Business Regulation 1386566 07/22/2018 /0 Park Plaza•sults 6170 RYAN HOBBS BONon,MA 02116 /B/*BRYAN HOBBS REMODELING RYAN G.HOBBS aCONWAYST REENFIELO,MA 01301 Undersecretary Not Valid without Signature The Commonwealth ofMassaehusetts Department of lndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gorldia V11'riteril Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED\PITH THE PERMITTING AUTHORITY. Applicant I { t' Please Print Legibly Name (Business/Organixationandividuab: 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): I.Q lmn a employer with 7 employees lfull and/or pamtime) 7. ❑New construction 2.❑l am a sole proprietor or partnership and have no employees working minicar 8. Remodeling any capacity.[Noworkerscompinsurance required.] 9. El Demolition 3.❑1 am a homeowner doing all work myself [No workers'com,.insurance required.]' 10❑Building addition a.❑ensure homeowner and will behiring convectorssoconductall workce or ssole . Twill ensure Nawll contractors either have wodrers'compensation insurance or are sale 11.❑Electrical repairs or additions propriemrs with no employees ❑ 12. Plumbing repairs or additions 5 1 am a general contractor and I have hired the sub-contractors listed on the aluched sheet 13.❑Roof repairs sub-eonvacmrs have employees and have workers'comp.insumnce 6.❑We area corporation and its officers have exercised their right ofexempnon per MGL c. 14.0✓ Ocher weatherization IS-,gl(a).and we have no employees.[No workeri comp.maurance rcquvedd `Any applicant that checks box 01 must also 611 out the section beloe'showmg their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are domg all work and Nen hire outside contractors must submit d new affdav It indicating such. :Contmoom that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'com,policy number. 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.Lie.#: WC9057270 Expiration Date: 10/20/2019 Job Site Address:yy 6\nl S\- City/State/Zip:(PPCI","' -, U\oS -3 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 ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under(he pains and penalties of perjury that the information provided above is true and correct. SignatureWh h, Date: Wil]ZA 15 Phone#. 4 13--17-59006 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?own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: A R0® CERTIFICATE OF LIABILITY INSURANCE0)252018°"SIMS/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 DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERISI,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT. Ifthe Certdlcete holder is an ADDITIONAL INSURED,the polky(Iaa)must have ADDITIONAL INSURED provlslons or am,endorsee. If SUSROGATION IB WAIVED,subject to the terms and conditions of the policy,certain policies may require an andoreement. Ajtstenlant on Into certificate does not Confer rights to the certlNcate holder In lieu of such andonamen s. PRODUCER NTA Adins Edgeh NAME: 8 Northr6gStree ,S NE (413)586-0111 AK xe: (413j 5986681 B NOM King Street nDREBI aedgett@Jwebbarandgrinnell.com INSUREPBS)AFFORDING COVERAGE AIF III Northampton MA 01050 INSURERA. SBledive lna Co olSCenlina IHWRED INSURERS: SSIBtlIVe Ins DPOt Arnonce 12572 Bryan Hobbs Remodeling,LLC INSURER C: Selective Ins CO Of Southeast 39926 348C HI&real INSURER D: NSURER E: Greenfield MA 01301-1515 INSURERF. COVERAGES CERTIFICATE NUMBER: Exp 08119 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 SHOM MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN. Tq TYPE or INSURANCE UDL A. MATI POLICY NUMBER MMIDO MMID P LIMITS COMMEACIALOINERALLIASILITY EACH OCCURRENCE 51,000,000 CIAIMSMAOE ©OCCVRR-EmRAI $ 500,000 MED EXP(Any on o $ 15,000 A 52299042 0810412010 001042019 PERBONALSADVINJUxY j 1.000,000 GEN'L AGGREWTE LIMITTAPPLIES PER GENERALAGGREUTE g 2,000,000 X `DULY❑JKT 11 LOU PRODUCTS-COMADPAGG S 2,000,000 OTHER. S AUTOMCBIL IJUJULITY .— INEO MORMSa INGLELIMIT b 1.000,OM ANYAUTO PDOIBY INJURY Fer Wnm) S B OWNED ACnE0uLE0 A9105300 08/042018 0810412019 BODLLYINJURY NIFGMMI s AUTOS ONLY VTg9 1 HIRED NONOVMEO OW O Eq pp}MGE y AUTOS ONLY AUTOS ONLY per Underinsured motorist Bl s MON UMBRELLA WB OGGUI EOLXOCCURRENLE a 1,OO D,000 A E.F.,UAB n1IIMSMADE 82289042 OB/O4I2018 08/04/2019 A GREmre E 2,000,000 DED RETE Ipl i j ""ERB COMPENSATION Eq OTW AND EMPLOYERS'LABILITY T T T C JOY R TOOF FICERAIEYPROPRMeE"ART' EmEWEELUTIVE O NIA M9057270 Bryan Hobn Ex01, 1W20I201e 1 012012 01 9 EL EACHACCIDENT E 500'000 IMUErb in NMI EL.DISEASE-EA EMPLOYEE a 500,000 OSCRIWION OF OPERATIONS blow E.L°ISIMSE. E00,000 POLICY LIMIT b COMMERCIAL PROPERTY SWIM, 3493.04 A S2289042 080412018 00104MOl9 BPP $50,000 DESCRI TKA OF OPERATIONSI LOCATIONS I VEHICLES PCOR°101,AeenlpnPl N.M.SPh dJJI mi,M MLehed Ilmon PPLO s nGulntl CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AVTHORIEED REPRESENTATIVE 2/,16 ©1988-2013 ACORD CORPORATION. All rights reserved. ACORD 29(2016103) The ACORD name and logo ere reglstsrW marks of ACORD The Commonwealth of Massachusetts Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR DEBRIS REMOVAL FORM i Section 105.3.2.2 780 CMR, Massachusetts State Building Code states: a condition of issuing a permit for the demolition,renovation,rehabilitation,or other alteration of a building or structure, M.G.L. Ch. 40 § 54,requires that the debris resulting there from shall be disposed of in a properly licensed said waste disposal facility as defined by M.G.L.c.l 11,§ 150 AY Date: Z _/' Permit Number Job Location: � A eo�Y LQ-k<a S , HA Cer t .11a lAXL-"1e szcv.c."D Lo&b Location of Facility or waste Disposal Company's Name and Address l Silmadas,rofPermilApplicant Print Name 2018 WEATHERIZATIQN mass save BARRIER INCENTIVES Savhgs Nm W n annex lnkM,KY Basedon your Energy Specialudl recommendations.your home can benefit from program-eligible insulation and/or air sealing improvements.Before moving forward,please follow all the Instructions below to remediate your"etherization barriers. CUSTOMER INSTRUCTIONS 1.Hiro a qualified.Roamed contractor to evaluate and/or remediate the weatherization borrier(s). X Submit signed and completed copies of this form and a copy of the paid contractor invoice(¢)within 60 days of your He"Energy Assessment Ux RISS Snalmadng,60 Shewmut pQ Unit 2,Canton,MA 02021 Or email to COWmblsOesMA1Mo(MpISFenglnaatlng.com. S.The waeItudzation incentive will be deducted from the customs,copayment amount of the weatherization work.A rebate check will be issued in the event the amount exceeds the customer's co-payment amount. a.Complete the recommended weatherization improvements. Customer Name; Sam Haar Client A or Site 10: 474987 Site Address: 44 Front Street city: Leeds state: MA zip: 01053 N,wv..a'or T1'4 Phone Number. 9�a e�a•so�8 Emaik mayambajak@gmail.com ;,rc,,..,.,-lir .x;''v',—,_Kat., cudRwwvHaMeww StgnNiRe: X Dafei KNOB - .. . AND I UBE WIRING To determins if then is any active knob and tube wiring,the contrattot will evaluate the following areas where eligible Mass Save weatherization recommendations haus been made: ,OAtticmmcoaw roFloor OAtbc Wall OAttic Slope OExterior Wall (Basement OOther: ther: (OiMnxmYsr� 1 performed my impaction and determineddetermined there is no active knob and tube wiring in the areas safected below. lY.atbc Floor OAttic WMI OAttic Slope a-t000r Well 138asament OOthar ❑Other. roMlallo-s Miretmneeue:�i,ru, ❑ I have read and agr�p`gto,the Tortes and Conditions on the back of this form. Contractor Name: /a��-FLl)[ .eX Ne1 e _ r,�p Addren: 1 65 fJn.n SA $ city A).._ �.cnt�Ty`,/� State:tai i n ZIP: �r.GA Company Naa{mdre�s—14oczeA 11- Lice em Number 1-1'I� S,R . 'I_�R�R- 'G'�."-:#T'a'x' k �1�_ � D EIECIIANICALSYSTChISARRIERS High Carbon Monoxide:Comraetor is to service and re-evi loate the selectod mechanical system(s)and reduce the carbon monoxide level, as measured in the undiluted flue gas,to below 100 parts per million(ppm). Draft Fapwa:Contractor is to correct the draft in the selected flue(s).Refer to table on reverse for acceptable draft ranges. Sgelem iiot WateyHNter,.' 'Dlltemi ::; y Spillage:Contractor is to cormot the spillage of flue gases in the selected mechanical system(s).Must not spill after 60 seconds of operation. 0 Heating System 0 Hot Water Heater 0 Other: 0 l have performed his,Impaction and have convicted the items noted in the areas selected above. 0 1 have read and agree to the Terms and Conditions on the back of this farm. Contractor Name: Address: City: State:_ZIP'. Company Name: License Number: Cagnow llgpabaat �4,::. � 3�' 3: .^..�... .. Continued on back (page 1 of 2)