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17C-275 (5) 8COSMIAN AVE BP-2019-1013 GIs 0: COMMONWEALTH OF MASSACHUSETTS MVI"1k: 17C-275 CITY OF NORTHAMPTON L54--al PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Pomit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category INSULATION BUILDING PERMIT Permit a BP-2019-1013 Proiectk JS-2019.001668 Es[ Cost 5849 00 Fee, o PERMISSION IS HEREBY GRANTED TO: Cqndt. s: Contractor: License: UileQroum BRYAN HOBBS 83982 Lot Size(sa,&)l 10193.04 OWner: JUNG PATRICIA 1SABEL&JULIA CREVAN Zoning: URB(100)/ Applicant: BRYAN HOBBS AT• 8 COSMIAN AVE Ap.dieaistAddress: Phone: Insurance: PO BOX 1535 (413) 775-9006 WC GREENFIELDMA01301 ISSUED ON. 0:00:00 TO PERFORM THE FOLLOWING WORIL4" dense pack cellulose to walls, exterior door weatherstripping, door sweep POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Motor: Footings: Rough: Rough: House N Foundation: Driveway Final: Final: Final: Rough Framot Gas: e a Fireplaee.1Chimney: Rough: 0111, Insulation: Final: Smoke; Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. CgrilIflgate gf OccupenCV Signature! FeeTy,Le: Date Paid: Amount: Building 5/21/2019 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)5871272 Louis Hasbrouck—Building Commissioner =,V_S ()C'It i0 f✓ Department use only City of Northampton Status of Permit: �- - Building Department Curb Cut/Drlveway Permit 212 Main Street SeeverlSeptic Availability Room 100 Water/Well AvailabRy \, Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PlIAGAS Plana Other Spotty APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION Il 101 �j 1.1 Property Address: This section to be completed by office pUZ Map Lot -2-75 Unit z Zone Overlay District Elm St District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: I C.. Ch CII S CY'%N of A'Jr Nalhi Name(Print) Currentng 5 Adm s 41 �i - &92Y Telephone Signature 2.2 Authorized Agent: �obr'� 4A N nt) Current Mailing Addreas Ut3�d Signal Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by Iermit a licant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cast of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanics (HVAC) ^UC) 5. Fire Protection 6. Total=(1 +2+3+4+5) . 3Check Number This Section For Official Use Only Date Building Permit Numb Issued: SignaNre: �J'2� �)9 Building Commissioner/Inspector of Buildings Data 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 U R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bldg&paved ,kin N of Parking Spaces Fill: volume&Location) A. Has a Special Permit/Variance/Finding er been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the!RejP 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 © 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 O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over t acre or is it part of a common plan that will disturb over 1 acre? YES O NO O 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 AHeralion(s) ❑ Roofing or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [O Siding [0] Other[Mr� l.leakhe�ui,hr.-, Brief Description of Prggosed Work: H" rlonse 1' L f 11 i\ to iro 1eYA11Sl eXk r1."_ Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Sa. If New house and or addition to existing housing. complete the followina: 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 1. 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_ CitySewer 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 ,, cc Date as Owner/Authorized Agent here y dad re that the statements and infonnabon on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. �Y117n ��1'J� Pont Name Sig na um of Own r/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable eL1C Name of Lloense Holdar'. �\rte �h Q CS-(,R-3q o a License Number Address Expiration Date C3r'42QD etc) Mz rn�c1a �4�� = 9oa� Signature Telephone WYE 9.Realetered No.Improvement Contractor. Not Applicable ❑ Company ate- Registration Number 1? 153 76 ) 101 Address lnr_ ` 1 \ 1p Expiration Date �n�eonSULll1 'vlZ �`�la Telephone --ns:- I l� 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 buildin ermit. Signed Affidavit Attached Yes....... No...... ❑ AWN Permit Authorization mass Save Form Site ID:3670244 Customer: JULIA CHEVAN 1, Julia Chevan ,owner of the property located at: (OwWs Nemo,pdp d) 8 Cosmian Ave Northampton, MA 01062 (Property Strem,Wdrm) (aw) 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. OWuef f Signature: _ Deft: 2/1/2019 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: �1M t &,,,I,i..__ l2 �. q Participating Contractor d" 1�ate Name: CLEAResult Phone: 800480-7472 Email: Page 1 of 1 for Ofice U.Only Rev. 102015 ®� Divi lan f Pic I cI1sBonI 6ehossure -Divi Bionof R99VI Ion and Standards Board of awltlmg gpgUMHDnB and snntlartle construction Supervisor C9-OQ3Q82 Exp�raet 05,0212020 BRYANX0888 ' POSox133 GREENFIELD 11FIELD MA/01302 commiccion4l l/^" A., &W ewlllejeffJ at:'S f.. Office of Consumer Affairs and Business Regulation 10 Park Plaza• Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: IndlvId" RBplstrotlon: 138584 BRVAN HOBe6 Explr>tfon; 0772211019 DWA BRYAN HOB88 REMODELING 345 CONWAY aT OREENFIELO,MA 01301 Update Addreee and return card. Matic rwon for ehsepe. AddmSa AAorne" r smploy"a M LoelCeid. OdlHOME ISSRWar ABMMalodas CONTRACTOR NTR C7T0UlRetlon ReenvdldtorIndividual USA y TYPe:Individual lors the exnGandata raturnt Registration excC O"los of ConVma AXein andBUSnoss Regulation ulatlon 735 0712240i8 10 Park Plaaa•sUae 4170 YAN HOBBS Boston,MA 02113 IA BRYAN MOBBB REMODELING 'ANG Hoam CONWAY3T U . eaoratary Not vend Without sleneture E.WFLO,MA WWI Under The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 01114-1017 www.mass.gorodia Wl�'rkdsrsl Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAIITTISG AUTHORITY. Applicant 1 f rmation Please Print Leeibly Name (Business/Orgy ization/Individuab: 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.Qimnaemplove'voth 7 employers(full indoor pars.imc).' 7. New construction 2.❑tam asole proprietororpartnetship and haveno employees working formein 8. Remodeling anv capciry.Me workers'comp.insurance required.( 3❑lamahomeowner doing allwork myulf[Noorkctseron, muancerequired]' 9. [:]Demolition w 6.❑I am a homeowner and will be hiring contractors m conduct all work on my propem. 1 will 10 ❑ Building addition ensure that all contractors miner have workerscompensation insurance or are sole 1I.❑Electrical repairs or additions proprietors with no employees. , I_2Plumbing repairs or additions 5 lama coral contractor and i have hired the sub-contractors hated on the attached sheet. These s b-contractors have employees and have workers'comp insurance. 13.❑Roof repairs 6 We area corporation and in officers have scd their right of exemption per MGL c. 14.DOther weratherization 152,61(0),and we have no employees.[No wo000rkers'comp.insurance«quired.l "Any applicant that checks box al must also fill out the section below showing their workers compensation policy Information. t Homeowners who submit this affidavit indicating that are doing all work and then hire outside contrition must submit a nen affidavit indiezting such. :Contractors that check this boa must earthed an additional sheet showing the name of the w1heommctors and state whether or not those entities have employees. If the sub,contractors have employees,thev must provide their workers'comppolicy number. I am an employe,that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Selective Insurance Co. Policy N or Self-ins.Lie.9: WC9057270 Expiration Date: 10/20/2019 Job Site Address: 0 CL\SM\n ,/�n F-AIe City/State/Zip: (luC ��tO HA 04gb2 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failare to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a foe of up to$250.00a 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�ceIJrtify under deputies and penaaies of perjury that the information provided above is true and correct. Sienat ;:T� Date: 112A7,J1g Phone 4� 413-775-9006 Oficial use only. Do not write in ibis area,to be completed by city or town official. City or Town: Permit/License 4 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone h: ACORo' CERTIFICATE OF LIABILITY INSURANCE °"TB'""°" " ' oyr25r201B THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND,EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOTCONSTTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT. Nelle certificate holder Is an ADDITIONAL INSURED,Ne pollCy(Ne)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the tomms and conditions of the pallet',certain policies may require an endorsement Astatement on NN eMHleate does not confer rights WNle certificate holder In/lou of Such endorsement el. PROPUCER ME:•TAT Adma Edi Webber a GrinnellP NE (413)588-0111 F x (413)5859481 . B NOM King Small n ops, aetlg¢q®webberendgdnnell com INSORER9AFFORDING COVERAGE NAICM Nonhampton MA 01050 ININERA. Selective ins CoofSCamifna INSURED INSURER.: SBNICIINIns C..f AnmmF. 12572 Bryan Hobbs Remodeling,LLC NSURBR C: SeiscrVe ins Co Of Southeast 39926 345( nwsy Street INSURERO: INSURER E'. Greenfield MA 013DI-1516 IN F.. COVERAGES CERTIFICATE NUMBER: Exp 08110 REVISION NUMBER: THIS IS TO CERNFYTHAT THE 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 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. 'N. AUDLLTR TYPE OF INSURANCE POLICYNUMBEq MMD = Li WV LIMITS x COMMERCMLGWERALLA&L11Y CH CCLVRRENCE S 1,000,COD LIAIMSMADE ©OCCUR FR y 500,000 MED EXP(AM o 15,OCG A $2289042 08/0412018 08104/2019 PERSONAL 1A°V wIURY f 1,000,000 GFNLRGGRE TE LIMITAppLIES PER: GENERALAOOflFGATE b 3,000,000 FOLICY�jF. LOC PRODUCT$ CONIMPAGG S 2.000,00D OTHER'. S AUTOMMILELM.ILITI COABINE°SIWELIMIT $ 1,OW000 ANYAVTO BWILYINJURY(FirM n) f B OWNED 50HEWLEO A9105300 08/04/2018 08/04/2019 SODILYIWUFYFss. o.l $ AUTOS ONLY AV.. X n REC NON-0WNED PROPERTY DANCE AUTOS ONLY x AUPOS ONLY R j Vndennsured motorist Bl s 20,000 x UMBRELLA Use OLCUq gpLHOCCURRENCE a 1,000,000 A ExcEsB UAB CIAIMfiMADE 52289042 0810412018 08/04/2019 A ooTsj 2,000.000 DIED I RETENTION 3 j Mis"MS C°MEENS4TW PEA OTN ANDERIPLOYEAS'LMBLITrT T C. ANY PROPRIET0.4NARTNERIEXECUTIVE YIN EL FACHACCIDENi b 590,000 OFFILERNEMBER FJ(LLUPS ❑V NIA M9057270 BIY¢n Hobbs E%CI. 10/20/2018 10120/2019 blnds�wgy,lgn NNl EL.°ISEAS6 FA EMPLOYEE S 500,000 °E6CRIRICN OFOPERATION$bbw EL DISROBE' CYLIMIT f 500,000 COMMERCIAL PROPERTY Builtlln9 E491op4 A 52258042 0810412018 08/04/2019 BPP $50,000 DESCRVTMN OF WEMTIONSI LCCATONSI VENRLES(ACORD 101,AaaI110nd WT4Nv nodus,TAlli.. hwi Ilan.APLp N,qulrytll CERTIF CATEHO DER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHURIZED REPRESENTA9VE 01888-201b ACORD CORPORATION. All rights rMo"d. ACORD 29(2018101) The ACORD name and logo are registered mares of ACORD i City of Northampton Massachusetts c x ' DEPARTNBNT OF BUILDING INSPECTIONS 313 Win street •Municipal Building Bontha ton, M 01060 "Pe Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: e ,, b CU SrYI ICSH �K_ K)o/e,^�T N'LP4%n (Please print house number and street name) Is to be disposed of at: n (Please print name and location of faality) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) � -�-fA%0� Sigma ut�re of P6rmit Applicant or Owner Date If,for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. �r+•awa wmmim : �+o -€' wntwYht+roaFJao iJquu,N eaura�} �N wldujoo .._.MRS QIJ vwippy woA•w Nxpv9 wiuP wvINPUPJ pwewmw vpawx l'.❑ 'mn9v PNNIav LM,pBw W�1W eu,r1!eW Pna•uaa+^vJ put W 4A!LtvGP.n,Pup+wNMq P+w f❑ ....�.:w..,_...__._—:»wo a mmaH+��a uapAS enPvaH ❑ 'uaw•ooN 9PWh•a 09,WMNMv]Wit^N'<fNu%vRs!v>lua4i�+•W0»pswi W nave anYN VEHgdv Vwl�vW>al:W+oDa9�]�+INB _ L1YgI x• .:e..._�wMM tqa f q . -. sramia�LVN NPviP,weiol'nv'vnattm r19�61�n)3N'(�ryl WSjnnKaW YliJwP Wtia%iJm n)aragx�IUP};wvproyep ., YuMtl)uonpu xo wino m v1oIW w^sea eny Pw^lPun W$W Ownaaaw r 'M^N wlnvww a,P appewpayPM1,r�qM( 77' , ,.. 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