37-083 (14) 266 GROVE ST-UNIT 31 BP-2020-0140
GIS#: COMMONWEALTH OF MASSACHUSETTS
MW:Block: 37-083 CITY OF NORTHAMPTON
Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2020-0140
Proiect# JS-2020-000234
Est.Cost: $1326.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRYAN HOBBS 83982
Lot Size(ssq.ft.): Owner: SMALLEN ANN LOUISE
Zoning: Applicant: BRYAN HOBBS
AT. 266 GROVE ST - UNIT 31
Applicant Address: Phone: Insurance:
PO BOX 1535 (413) 775-9006 WC
GREEN FIELDMA01 301 ISSUED ON.81512019 0:00:00
TO PERFORM THE FOLLOWING WORK.INSULATIONNVEATHERIZATION ATTIC FLOOR
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 8/5/2019 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
rjtUt IV Department use only
City of Northartpto of P mit:
Building Dep rtme t Curb ut/D veway Permit
f.- 212 Main reet QV� — 2 20 $ew r/Sep c Availability
}, Room 1 0 Wat r/Wel Availability
Northampton, A
p F U Two ets f Structural Plans
phone 413-587-1240 Fax_4.Z3s8t� 'iNsPr f�YdNSite ans
MA Ot gQ
�fY
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
g�-C v-/Vo
1.1 Property Address. This section to be completed by office
Ju .k Lnro' L 5� Map ! Lot Unit
Un 3 ` Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
7Uu 9
Telephone
Signature
2.2 Authorized Agent: (�
(Pri ) Current Mailing Address:
q)2.)- 11 y-9��
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) 5
5. Fire Protection r
6. Total=(1 +2+3+4+5) % Check Number �/�f
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: D-5-Zo) /
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors (]
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding [0] Other[W"
Brief Description ofPro osed n
Work: 1U" (_kpCin"i.) Ct c F-\tN Y, 0,1T S.[c
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 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
1, ,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 Date
as Owner/Authorized
Agent h reby d clare 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.
Y�o
Print Name
J
Sitriatvre of wner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: L�Ci }�a� S ( - A a I �t-1,14
License Number
ess Expiration Date
Sig ature Telephone
9. Registered Home Improvement Contractor: 1 r � Not Applicable ❑
C� �d�1�L��
omNa v Name Registration Number
Address -1 GLXCExpirat�n Date
g
Telephone /1S 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 building permit.
Signed Affidavit Attached Yes....... No...... ❑
Permit Authorization
mass save Form
Site ID: 3838021 Customer: ANNELOUISE SMALLEN
"iJ,owner of the property located at:
(Owner's Name,printed)
266 Grove St unit 31 Northampton, MA 01060
(Property Street Address) lcny)
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.
Owner's Signature:
Date: l 1
FOR OFFICE USE ONLY
INE have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
articipating Contractor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
Page 1 of 1 For Office U=e only
Rev, 102015
'/Ct�
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: LLC
6045
BRYAN HOBBS REMODELING,LLC. Registration:
P.O.BOX 1535 Expiration: 066/25/2/25/2
021
GREENFIELD,MA 01302
Update Address and Return Card.
SCA 1 t3 20M-05/17
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:LLC before the expiration date. If found return to:
Reolstratton Expiration Office of Consumer Affairs and Business Regulation
196045 06/25/2021 1000 Washington Street -Suite 710
BRYAN HOBBS REMODELING,LLC. Boston,MA 02118
BRYAN HOBBS /
576 LEYDEN RDlw�K�
GREENFIELD,MA 01301 Undersecretary Not valid without signature
®� Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction Supervisor
CS-083982 Expires: 05/02/2020
BRYAN G HOBBS .
PO BOX 1535 .
GREENFIELD MA 01302
Commissioner "
The Commonwealth of Massachusetts
Department of IndustrialAccidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
www,mass,gov/die
Wohkers' Compensation Insurance AMCME1 BUlldere/Contractors/EIec>r(cta s/,Plumbers.
TO BE FILED WITH THE PEIMITTING AUTHORITY,
Applicant Information Please Print Leei-bly
Name (Business/Organization/Individual): Bryan Hobbs Remodeling LLC
Address; PO Box 1535
City/State/Zip: Greenfield, MA 01302 Phone 0: 413-775.9006
Are you an employer?Check the appropriate box;
I.Q I am a amployor with 7 emType ofroject (required):ployees(full and/or part•time),°
2.❑I am a sole proprietor or partnership and have no employees working for mo in 7. ❑ Nw construction
any capacity,(No workers'comp. insurance requiroci,1 8. ❑ R modeling
371 am a homeowner doing all work myself [No workers'comp insurance required 19• ❑D molition
4❑I am a homeowner and will be hiring contractors to conduct all work on my propvm, 1 will 10 ❑ 13 ilding addition
ensure that all contractors either have workers'compensation insurance or are sole 1 1. El ctt'ical repairs or additions
proprietors with no employees.
5.r7 lam a general contractor and I have hired the subcontractors listed on the attachod oheet, 12•:]P1 robing repairs or additions
These subcontractors have employees and have workers'comp insurance. 13.❑R of repairs
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c, 14,(Z 0 her WeathditatlOn
152,x11(4),and we have no employees.[No workers'comp.insurance required I
Any applicant that checks box#1 must also fill out the section below show ng their workers'cuntpensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a rcW affidavit indicating such.
1Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whethel or not those entities have
employem 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 i.�Me policy andJob site
Information.
Insurance Company Name; Selective Insurance Co,
Policy#or Self-ins.Lic,#; WC9087270 10/20/2019
----
Expiration Date;
Job Site Address:_ � Glp (�n5 x c� l _7�i City/State/Zip;
Attach a copy of the workers' compensation policy declaration page(showing the policy num er and expiration date),
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable b 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 an a fine of up to$250.00 a
day against the violator,A copy of this statement may be forwarded to the Office of In
covorvestigations f the DIA for insurance
a a verification,
do hereby undxr the pains and penalties ofperlur)'that the information provided above!si true and correct.
l
Phone
413-775-9606 Date'
Ofykial use only. Do not write in this area, to be completed by city cr town offlcial, �r
City or Town: Permit/License
Issuing Authority(circle one), —
L Board of Health 2.Building Department 3. City/Town Clerk 4, Electrical Inspector S, }dumbing Inspector
6.Other
Contact PerRnn!
ACOOR"® CERTIFICATE OF LIABILITY INSURANCEDA7, ( )
18/20 9
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 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 NAME: Adana Edgett
Webber & Grinnell PHONErxtj (413)586-0111 A� Ne: (113)566-6481
B North King Street E-MAIL
ADDRESS: aedgett@webberandgrinnell.com
ett@webberand rinnell.com
INSURERS AFFORDING COVERAGE NAIC N
Northampton MA 01060 INSURERA:SeleCtiVe Ins Co of S Carolina 19259
INSURED INSURER B:SeleCtiVe Ins Co of America 12572
Bryan Hobbs Remodeling, LLC INSURER C:Selective Ins Co of Southeast 39926
PO Box 1535
INSURER D
INSURER E:
Greenfield MA 01302 INSURER F:
COVERAGES CERTIFICATE NUMBER:Exp 10/19 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
I T R TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
X COMMERCIAL GENERAL LIABIUTY
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
A CLAIMS-MADE X OCCUR PRE a occurrence) $ 500,00C
S2289042 9/4/2019 8/41/2020 MED EXP(Any oneperson) $ 15,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY D JELO2,000,000T
OTHER $
AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT $ 1,000,000
B ANYAUTO BODILY INJURY(Per person) $
ALL OWNED X SCHEDULED A9105300 8/4/2019 8/4/2020 BODILY INJURY(Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE
X HIREDAUTOS X AUTOS P $
I
Underinsured motorist BI split limit $ 20,000
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED I I RETENTION $
WORKERS COMPENSATIONX PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000
N/A
OFFICERIMEMBER EXCLUDED? Y❑
C (Mandatory in NH) WC9057270 10/20/2018 10/20/2019 E.L.DISEASE-EA EMPLOYEE $ 500 00C
If yes,describe under
DESCRIPTION OF OPERATIONS below Bryan Hobbs is Excluded E.L.DISEASE-POLICY LIMIT $ 500 000
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
W Grinnell, CPCU, CIC
C 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025(201401)
City of Northampton
Massachusetts
��. DEPARTMENT OF BUILDING INSPECTIONS
`^ 212 Main Street •Municipal Building
�\ Northampton, MA 01060 ssrh T��^``
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:
(Please print house number and street name)
Is to be disposed of at:
Q� Sle X\ �C Q/ 4L t
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
'i CM 11-Lkn
Sign ure of Permit 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.