23C-101 (3) 579 RIVERSIDE DR BP-2019-1350
GIS#: COMMONWEALTH OF MASSACHUSETTS
WPM Ock: 23C-101 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-2019-1350
Proiect# JS-2019-002176
Est.Cost:$2675.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contmctor: License:
Use Group: BRYAN HOBBS 83982
Lot sizelso.R.1: 35937.00 Owner: SAMUEL RUSSELL
zoning:URB0001/ Applicant. BRYAN HOBBS
AT: 579 RIVERSIDE DR
Applicant Address. Phone: Insurance.-
PO
nsurance:PO BOX 1535 (413) 775-9006 WC
GREENFIELDMA01301 ISSUED ON:5/2812019 0:00:00
TO PERFORM THE FOLLOWING WORK:RIGID BOARD IN KNEEWALL, 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 5/28/20190:10:00 S65M
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
�nlac��-7`rov
Department use only
City of Northa pto j; j
isBuilding Depa men way Permit
212 Main St et �IAY ?_ 4 ? vailability
Room 10 ailability
Northampton, 01 OFeull�„ . ucturai Plans
phone 413587-1240 F
Other Specity
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION e,,A j q' / -35”
1.1 Property Address: /
This section to be Completed by office
'5-kpL IL\kXlSIcAR l� Map �� C Ln(n f Unit
r 10r-UIQ.L, M2 Zone Owrlay District
Elm SL District CB Dbblut
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2�.1+Owner of Record:
-YIIYKM � z-ysYall 5'19 'Q\Ltem'.d .
Name(Prim) Current Maili Md
�1,5 5 _ 331
Telephone
Signature
2.2 Authorized Agent:
�1L,tos +Yx:�e►oh r u� 19, �-11AA 9rd, l,-1 w (J3da
Nem rin Currem Mailing Address:
40a AblQ
X113- ��r gavco
Sig re I Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Oficial Use Only
Completed by permit applicant
1. Building , S-0 (a)Building Permit Fee
0-4
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee L� /
4. Mechanical(HVAC) r�lp F7
5.Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Onl
Date
Building Permit Nu r. Issued:
Signature: 5-29-2619
Building Cornmissionerdnspeetorof Buildings ❑ate
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION S-DESCRIPTION OF PROPOSED WORK(check all aoolicablel
New House ❑ Addition ❑ Replacement Windows Alteration(s) Q Roofing
Or Doors D
Accessory Bldg. ❑ Demolaic ❑ New Signs ]0] Deeks IO Siding i[3] Other
Brief Description of Proposed
Work: Yt,A bm i r.. )(n i.ru.-" OLV-sea l"ic:
Alteration of existing bedroom_Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basemen) Yes No
Plans Attached Roll -Sheet
s■.tf New house and or addition to existing housing. complete the followlirm
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?
I. Method of healing? 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_Yea No
f 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 authadze
to act on my behalf,in all matters relative to work authorized by this building permit application.
SlgnaWreMOmter 11 11 Date
I, I"�yU(hn i't.6bi ,as Owner/Authorized
Agent ere y 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.
l�Tya�
Pd ems
Sgvwra Owner/Agerd D.N
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not
/Applicable ❑ n
Nam.of License Holder:'YU(1(% 1�h� l .g—( 6b
'�9dZ
/ (1 Lbense NumM,
Add \C3\ I�IAOVN'l11(! Gt3oa �r. Z'Z --.
Cvi (413-
sigmure I Telephone
9. Registered Home Improvement CgntreClgr. Not Applicable ❑
&4a-) N„U�;, fru.La,,tl l,r , U_L� 13�j SZo
man”Name Registration Number
�3 Q)abi
A/Cldress (n) 1 ' 2 Expiraho at.
l�Ilflip/1A-I D uj Ha (,I�Z Telephone—ns- iw,r la
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L o.78Y,§t5q"
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...... ❑
Apr. 9. 2019 11 :48AM Williamsburg Internal Medicine No. 1916 P. 2
RISE
ENGINEERING
OWNER AUTHORIZATION FORM
I. Samuel Russell ,
(Owne/a Name)
owner of the property located at:
579 Rlverslde Drtve
(PfWdy Addma)
Florence, MA 01062
(PmpertyAddreaa)
hereby authorize C7Yl l!'r, R��1r-i'�;
�(Sob�onbecMrJ
an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a bulldktg
permit and to parfoml work on my property.This form Is only valid with a signed oonbmt.
�
— d
Owes,Slant"
9-9
Dore
RISE Englneering,a Division of Thielsch Engineering,Inc.
60 Shawmut Road Unit 2 1 Canton,MA 020211 339.502.6335
www.RISEengineering.com
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The Commonwealth of Massachusetts
Department of induatrialAccldents
I Congress Street,Suite 100
Boston,MA 02 114-2 01 7
www,mass.govldia
V��orkersl Compensation InguraaCa AMAMI Bulidees/COnVaClOrs/Electrldana/Plumose.
TO BE FILED WITH THE PEAv11TTING AMHOR17Y.
Applicant In Please Print Legibly
Name (Buss megOrgmi¢atioNlndividuan: Bryan Hobbs Remodeling LLC
Address: PO Box 1535
City/State/Zip: Greenfield, MA 01302 Phone#: 413-775-9006
An you ea eeplayert Check the eppropr4te box: Type of pmjftt(required)'
1.0 l ane a Willcox with envicyee(full ardor on-lift).• 7. ❑New construction
2.❑I em a wit pnpriewr or pwneramp and have an employees working for an in S. Remodeling
W capacity.(No weavers'camp.insurance required.(
3.OIam aMmsearer doing ellwork myself lNoworkenoon) inswncere
aqulrecil' 9. []Demolition
10 Building addition
{.❑funs Mus all sed will be hunts edwhve worker,*
pwpem. twill
euurc thus all wnirwtaa aitlur have wnmeri compmgion uuulameaan sole 11.[]Electrical regain or additions
equation win no employee. 12.❑Plumbing repairs or addition¢
5.Q lam a genual conerecwr and l have hind the cubroomescton listed on the auwhedeMae 13.[]Roefrepa'
That wb•conaacwn have employees and have workers,comp,assurance.:
e.�Weseeacorporation sanditaofficers s. o workdmusrightofawtpnonper MCLu
14.QOther weatheriiation
132,61(6).and we save no employees.No workers eomp.:muranee roqukedd
;Any applicant dust checks box el mus,dw fill wt the motion below showing moo workers, Corporeal policy information.
i Hanownen who submit this arndavit indicating they ere doing all work and than hire Coal contreran mug submit a new affidavit indicating such.
tComtaaan that check this box mm ameNd anaddilional than showing an curve of the subbconaaaon and state whither or net hose saltie have
employee. Ifine euocontmcters have amployea,they must provide their workerscomp.policy merger.
lam as employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
Infarmadon.
Incuru:ce Company Name: Selective Insurance Co.
Policy a or Self-ins.Lie.M. W00087270 Expiration Date: 10/2012019
Job Site Address: 5-�'A' IZ ga gerSaete (J' City/State/Zip: lnk�aresvj Het
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Faillam,to secure Coverage as required under MCL c. 152,§25A is a criminal violation punishable by a fine up to 51,500.00
and/or oivo•year imprisonment,as well n civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day ageing the violator.A copy of this statement may be forwarded to the Offtu of Investigations of the DIA for Wsuranu
coverage verificadom
I do herebyfy un der the pains andpenalties ofperjury Marche Information provided above is true and correct.
Sicnatu ' _ lful "ik" Date:
Phan¢#: 413-775-9U06
Ofncial ase only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License e
Issuing Authority(circle one):
1.Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector
b.Other
Contact Penoa: Phone s:
ACORt7 CERTIFICATE OF LIABILITY INSURANCE
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THIS CERTIFICATE IB NNED AG A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TH!CERTIFICATB HOLDER,THIS
CERTIFICATE DOE$NOT AFFIRMATIVELY OR NEOATIVELYAMEND,EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INBURANCE DONS NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ILKEINS),AUTHORIM
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
—IMP TANT. H ON CORIfIOate holder M on ADDITIONAL INSURED,the polley(lo)mot RWe ADDITIONAL INSURED provision w be endorsee,
If S ISROWTION IB WAIVED,subject to the terms and conditions Of the PeIIOY,ceNMn policies may require in 1n80Melnant ABMteDNntOR
this OeHHImM doss not Gomer rl hM to the Certificate holder In IIBU of such endenamen e,
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:OVERAGE$ CERTIFICATE R: EXPO819 REVISION NUMBER:
MIS IBtO CEnFYTHATTHE POLICIES OF INSURANOE Ll6TRD 86LOW HAV$BEEN IBBUPD TOME INSURED NAMEDABOVE FORTH!POLICY PERIM
INDICATED. NOTWITHSTANDING ANY REGUIRIM$H[TERM OR CONDITON OF ANY CONTBACT OR OTHER DOCUMENT NTH RESPECT TO NMICH THIS
CEROFICATENAY BE ISSUED OR MAY PERTAIN.ME INSUIUNCEAFFOROED BY THE POLICIES DESCRISBO HEREIN 16 WWECTMALLTIIE TERMS,
EXCLuSQN6AND CONDITIONS OF SUCH POLICIES,LIMRB 8HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
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COMMERCIAL PROPERTY BuIId,ne 8498,004
62280042 OSM412018 01MO 019 BPP 800,000
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TIFICA
TE HOLDER CANCELLATION
GHOyLIDANY OF THBABOVE DGfCASID POLICIES BE CANCELLED BEFORE
THS EXPIRATION DATA THEREOF NOTICE WILL 92 DELIVERED IN
ACCORDANCS WITH THE POLICY PROVISIONS.
MJw.uCDREPREBENTAME
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The Commonwealth of Massachusetts
' Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR
DEBRIS REMOVAL FORM
Section 105.3.2.2 760 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.O.L. c.i 11,§ 150 A"
Date: SIZc)l 19 Permit Number 1
l
J,bb�Location: fi� ,%Zyu 0 H-%aa Wr$�G se-ry"AJ Lite h-Aek, «
/Q�, LQ1Loontioonar Faoilib or WUN Diapoaat Company's Name and Address
F 1 a t `+ LG Q)YI it i�iahi27
Sisnanue ofPamut pplieant Rini Na e