29-110 (6) 584 RYAN RD BP-2020-0789
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29- 110 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-2020-0789
Project# JS-2020-001370
Est.Cost: $4000.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ROBERT HUNTER 88742
Lot Size(sq. ft.): 22520.52 Owner: LIVELY ANTIGONI
Zoning. Applicant. ROBERT HUNTER
AT. 584 RYAN RD
Applicant Address: Phone: Insurance:
P O BOX 10432 (413) 575-1097 WC
HOLYOKEMA01041 ISSUED ON.1/9/2020 0:00.00
TO PERFORM THE FOLLOWING WORK.-EXTERIOR WALL INSULATION
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:
FeeTylpe: Date Paid: Amount:
Building 1/9/2020 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
j City of Norti-?arnpt
i Building Dep "rTteli ��t . �
f'
212 Mair
� St eet
Roorn 100 �_-
Northampton, MA 106
phone 413-587-1240 Fax 12-5 7.,1 �, : �
w �.
APPLICATION TO CONSTRUCT,ALTER; REPAI RE96VATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be cornpleteti by office
11 E,22kdy Address
584 Ryan Rd Map, !_ :_�_.._.. �` �_�/ _...__v....y apt _
Northampton MA 01062
=une Overlay
3rrt ,Dis District C�Distrmct
_ _- —
__ .
SECTIGN PROPERTYY C'WNERSa-W AI THOPI'ED AGENT
.
2.1 Owner of Record: 584 Ryan Rd
_Anti oni Livel Northampton MA 01062
Name iPrint} � current Mailing Address,Telephone
tigynatu7e
2,2 AUtltCift@CI At18lit: ._..,....�____.._._,. ..,..,,..�,,-m.�........�..,..._>....�-......-_ .._....n_.. �. _______ __. __..._...__...._ i
Robert Hunter
PO Box 10432, Hooke; MA 01041 ,
Name(Print) ___.._..
ALI;
413-575-1097
—sigt at—i,
✓vIf'mI1011
SEC�IC3t�3 STtM�4`�"I= � C3t� "I' 1}C`rIL`tt cC3STS ..��.__..,..............� ....:.._......_..-_w____�........._
Item Estimated Cost( oflars)to be (focal Use Oniv
completed by r,rartit a iicanC�,....-..
�..�..F�-
ri, Building ..�... _ ._.....___.._�...
_..
4000 r 44 Building Pe
(tai Est «ated Total Cost of
Gonstri c t cvn YIol � i
__.�..._.._.._. ...sfSlem......_......_ �_
3, Plumbing Building Pormit Fee
4_ Mectianic:al(HVAC) F !
a Fire Protect cr t�
u Tc tai t +3 4000 ...._..._
This Section For Official use Oq i
il�If Pt`y'^'7I'`I'S Us'31bt3':
E
sZii`i,3tUt�.
PRlpermits gmail.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
i H T1 1,' --gSCRIPTI 3 OF 1 F' O ' ORK ck all uLtic jq)
I
New House ❑ Addition ❑ Replacement Windows Alteration(s) 1:1Roofing
Or Doors ❑
Demolition New Signs 101 Docks '0 Siding[C31 Other
Accessory Bldg. ❑
nsulation
Wioefkteso pilon of Proposed 1400 sf exterior wail cellulose dense pack R13
Alteration of existing bedroom Yes �X No Adding new bedroom Yes X No
Att Chad Narrative unfinished basement Yes X No l
Plans Attached Roll itt5et i
1 UAL ilt aid t ;ltt�d¢,,,u' ?C _C S#ft $Jt i 9lete the followiMj
I a. Use of building: One f�mdy
b. Number of rooms in each family unit Number of Bathrooms �
i
c. Is there a garage attached?
d. Proposed Square footage of new construction,_-_ Dmiensions
e> Number of stories?
f. Method of heating?� _ Fireplaces or Woodsteves Number of each j
g Energy Conservation Compliance. _ _ Masscheck Energy Compliance form attached? _m
h. Type of construction
i
i, is construction within 100 ft,of wetlands? Yes No, is corst oction within 100 yr. floodpiain Yes No t
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regLalabt ns? __Yes No.
i
Sel
—%is Tar-*, City Sewer Private welt _,.w _ City water Supply
r;6TTION 7a-OWNER AUTHORQATIOM:O BE COMPLETEDWHEN
OWNERS A SENT~OR CONTRACTOR APPLIES FOR BUILDING PERM17
1, Antigoni Lively : as towner of the subject
property
hereby authorize Robert Hunter
to act on my behalf, in all matters rolative to work autho,zed by this building pormit application_
_Please see attach Permit Authorization form 3 Jan2020 i
Signature of Ovvne _ __ _ w gate
1, Robert Hunter as Owner/Authorized
Agent hereby ceclare that the statements and mIlo rtaation on the foregoinq awlicatiao are trace and accurate. to the best of rrty knowledge
and belief.
x
Signers Lander the pair=s and penalties of perjut y.
Robert Hunter
Print Narr>e
3 Jan 2020 '
Signature crf�(Olv.e"J�A'4errit Cate
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction SupRn�isq: Not Applicable t-
i
Names LInse Hotttr Robert Hunter CS88742m ................
icense Number
PO Box 10432 Holyoke, MA 01041 1/16/2020
Expiration Dale
413-575-1097
blT)ature- lel done
'�
RegI rg t1 a tr t Not AD licable 0
Precision Remodeling; Inc. 152922
Ctimlaanvaarn �_e._.._ Registration Number !I
21 Roosevel Ave, 10/13/2020
Adr3ress Expiration[late
Hol oy ke MA 01040 Telephone
413-575-1097
i `1iorkers Cc,Irper sat on insurance affidavit n-wst be corn iaU c;and submitted with this application. Failure to provide this raffdavi will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes.�.....A3 No...... 0
City of Northampton
Massachusetts
DEPA.R'rMNT OF ZVrXZ XXG INSPECTION.5 f
212: Main Street Y Htln,ielpsl BW 1dinj
Northo2tipton, MA 01060
)v
:AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
'The Office of Consumer Affairs and BUSincMss RepulatiOn("OCABR")regulates the registration of contractors and
subcontractor,,performing improvements or renovations oft detached one to four family homes.Prior to
performing work on such homes,a contractor must he registered as a Home Improvement Contractor CHIC:").
OM.G.L.Chapter 142,A requires that thereconstruction,reconstruction, alteration, renovation, repair, modernization: conversion,
improverrient removal. dernotition, or construction of an addition to any pre-existing owner-occupied building contairtirr
at least one but not more than four dwelling zriaits:...or to shuclures which are adjacent to such residence or buildigV' be
clone by Legistered contractors,
J cote..If'the horo:evwner has r.ontrrxr led it-ilk a corporation or LL( ihat en irj,ntum be registered.
Type of Work: Insulation- ............ Est, Cast: 4000
:address of Fork: 584 Rin Rd_ Northampton MA
Date of Permit Apj)1ication 3 Jan 2020 � _�_._.......
I hereby certifv that:
Ref*istration is not required fior tate fbl low ing re,tso a(s):
Werk excluded by lace,(explain):
.__............._._ _W.__...,..........................
_.._..�.. __._...___
Joh under$1,000.00
Owner obtaining own permit(explain):_��....
Building not owner-ocenp ed
_._Other(specify) _.._.__._..._�._
OWNERS OB'T'AINING THEIR OWN P RMIT OR ENTERING INTO CONTRACTS wvrij UNREGISTERED
CONTRACTORS OR SUBC,Olti"FRAC"T ORS FOR APPLICABLE IT£1ME IMPROVEMENT T WORT ARL NOT
ELIGIBLE FORAND DO NOT 11AVF AC£ ESS TO Tit ARBI I R4110N PROC.ItAM OR GUARANA I'S' Ei`;VTI
UNDER Chatter 142A.SSC II OWNERS ALSO ASSI:;1•Tt:'I'HE RE:SPO SIBILTTES FOR ALL WORK
PERFORMED t;NDUA THE 111.TI.I)ING PERMIT.SEE NE XT PACE. FOR MORE: INFORMATION.
Signed unfit,-r the penalties of ljerjury:
I hereby apply= for a building permit :a5 the ape nt ofthe i+t mer:
3 Jan 2020 Robert Hunter 152922
D aie Contractor Nairje 141C Registration No.
OR:
\Notwithstanding the above notice. I hereby apply for a_building,Ixrattit as the taw-ner of the above property_
i
Datil, Ofokner Nance and Signature
I
I
i
City of Northampton
Massachusetts
DZ.;r''ARTb2 NT OF B 7XLDING INSPECTIONS
212 Main Stxoet; aMuricipai Bolding �y
Northampton, HA 01060
Debris Disposal Affidavkc
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting frorn the constrUrtion 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 frorn construction work being performed at:
584 Ryan Rd
-[ua t,amptoa-MA II.106,2 __._.._........
w wd
(Please punt house number and street name)
Is to be disposed of at:
K&W Materials, 138 Palmer Rd, West Springfield, MA
{Please pritname and location
of facility,
Or will be disposed of in a dumpster onsite rented or leased from:
_*0�—Permi
_ 3 Jan 2020
Sid att Appllc nt r�r"caner Cate �_..__....__..
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.
' The Common wealth of Masserhuseas
Department of Industrial accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
wvw mas&gouldia
Workers'Compensation Insuraaame 11l'fklavh.*BW]derslContmdors/EkctrlclesuMumbem
TO BE MED WrM THE PERMCt7ING AUTHORMY.
n ation 1
Name(Businessit)tganizatio l lividual}; Precision Remodeling. Inc.
Address: 21 Roosevelt Ave
City/statelzip: Holyoke, MA 01040 Phone#. 413-575-1097
Are you an ewrploYtf?Cktr t the appr"rWt bus. Type of project{retltalretl}:
i.o 1 aan a tmptoyer wick 6 easrpiayeea(fttlt seed paru•t ts1.• 7, 0 New construction
2.0 i am a sole proprieta or partsaft sad have so txuployces wodking for me hs
$. Remodeling
any w ;cern'aap.b anaft trxtufitil
1C]t am a bomcownadciny an wort auyxel£[Now•aritars'tamp,ittparaatr reu�si
quF"
, Demolition
4.[]lam AllowwwocrandwiIIII be hiring conaw:.tofs br cooduct all workas say MDpeMtwill 10 0 Building addition
em" all either bave WO&M,ctsttzpertsstift masrsr+mm at arc Sox 11.[J Electrical repairs or additions
prophetors With no employtxs.
12,[]Plumbing repairs or additions
5.C]t AM a geWSM conbutor and l have hired No v listed on dare ataadbcd s 13.a hoof repairs
lbasm mA contractors have emptaytes acid have workers' .iorzo ce.a
Ea.[J—'Weutaa=V012tiftand its atmoshave exacmdtheirdg*otexe nperMGLc. 14.E]Od In5t11atlOI1
15Z 1144).asd was hare no .[No+t?•orL-;Nes'cow j0vz==rMuim&l
'Any applicant that rheGlrs bot 01 must also M opt the section below akawier tlscir wrorkmn'toatpeesaboa polio'khowdoe,
t H o+woas who tubmit dols afWavitt'indscatwg dicy ase doing all work sad dwo biter cmtt uxts faux sab Ak a WW affidavit such.
tCwbuton daxt chsc t dais boot asWout anschcd an ad&tioad obeet show*the mw of'dm vA—c naaceara And state wbedwr or not thaw=tiu s have
aaployas. 1tdW 06400bulon lance et*oy@W dwy atmt provide their wanes`couqL policy ostober•
Ian an ewleyer thou isprovidlatg workers'compensedon Insurance,for my employeti Below is the policy djob site
tOw"athm
InsttranceCompany Name: Guard Insurance
Polity#or Self-ins,Lit. PRWC014187 Expiration date: 16 December 2020
job site Address. 584 Ryan Rd City/state,'Zip:Northam ton MA 01062
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expirationdate).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to 51,500,013
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 forward to the Office of Investigations of the DIA for insurance
coverage verification.
1 rio hereby Gerd-fy u der the paha and prnaWrs of pedury Mot the Information provided above is trace and cornet
i atur : , 3 Jan 2020
1'laortc#: 413-575-1097
Offidal am only. Do root)wUr In tW are to be tompXNftif by c*or to official
City or Towyn: PermitlLicexase
Issuing Authority(circle corse),
1.Board of Health 2.BuRding Department 3, :1 1T°own Cleric 4.Electrical Inspector S.Plumbing Mgpector
b.Other _.
Contact Person- Phone!#:
City of Northampton
Massachusetts � �f
DEPARTMENT OF BUILDING INSPECTIONS
ri 212 Main Street + Municipal BuildingL`'
Northampton, MA 01060
Property Address: 584 Ryan Rd,Northhampton MA
Contractor
Name: Robert Hunter
Address: 21 Roosevelt Ave,
City, State: Holyoke MA 01040
Phone: 413-575-1097
Property Owner
Name: Antigoni Lively
Address: 584 Ryan Rd,
City, State: Northhamnton MA
I, Robert Hunter (contractor) attest and affirm that the building I intend to
insulate does not have any open air (knob and tube)wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit,
Contractor signature
Date
3Jan2020
Permit Authorization
mass 'savForm
Site ID: 3932342 Customer: ANTIGONI LIVELY
1, Antigoni Lively ,owner of the property located at:
(Owner's Name,printed)
584 Ryan Rd Northampton, MA 01052
(Property Street Address) (city)
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: 11/27/19
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
Precision Remodeling, Inc. 9dec2019
Participating Contractor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
Page 1 of 1
Rev. 102015
...��r,t'% C`>C�f�`i?�,��fCt:/1,1'��{.-'.;✓1"✓t!� t :..��(.� J��!.�'t.",�1fI,G'c,�tr>�l','`.:�.
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Name Improvement Contractor Registration
Type:y Corporation
PRECISION REMODELING, INC. �� ' Registration: 152922
P.O.BOX 10432 Expiration: 10/13/2020
HOLYOKE, MA 01011
Update Address and Return Card.
£iYl 1 40 0M-W17
t
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration date. if found return to:
Re gistratioExpiration Office of Consumer Affairs and Business Regulation
152922 10/13/2020 1000 Washington Street-Suite 710
PRECISION REMODELING,INC. Boston,MA 02118
i
ROBERT R.HUNTER f\,k.,CQ�
21 ROOSEVELT AVE.
HOLYOKE,MA 01041 Undersecretary Not valid Without signature
Commonwealth of Massachusetts
Divssion of Professional Licensure
Beard of Building Regulations and Standards
CS-088742 Expires 01x16 2020
i�
ROBERT R HUNTER � N
PO SOX 104324
HOLYOKE MA 01041 �
csilk
Commissioner
Worker's Comoensation and EwjzLQyer's Liability Pol
N,,1,e'*Berksh ire Hathaway NorGUARD Insurance Company - A Stock i
a Policy Number PRWC0141
Insurance s u ra n c e
I go
�iOmr�ies Renewal of PRWC9385
NCCI No. [258x
Policy Information Page
[i]Named Insured and Mailing Address Agency
Precision Remodeling Inc THE DOWD AGENCIES, LLC
21 Roosevelt Ave 14 Bobala Road
Holyoke, MA 01040 Holyoke, MA 01041-1900
Agency Code: MADOWD10
Federal Employer's ID 04-3317682 Insured is Corporation
Risk ID Number 273479
[2] Policy Period
From December 16, 2019 to December 16, 2020, 12:01 AM, standard time at the insured's mailing
address,
[3] Coverage
A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation
Law of the following states: Massachusetts
B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed
in item [3]A. The limits of our liability under Part Two are:
Bodily Injury by Accident - each accident $500,000
Bodily Injury by Disease - each employee $50(),000
Bodily Injury by Disease - policy limit $500,000
C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in
item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming.
D. This policy includes these endorsements and schedules:
See Extension of Information Page - Schedule of Forms
8 [4] Premium
0
The Premium Basis and, therefore, the premium will be determined by our Manual of Rules,
4� Classifications, Rates, and Rating Plans. All required information is subject to verification and change by
audit, (Continued on another page)
I_
Total Estimated Policy Premium 12,059
Total Surcharges/Assessments $403.00
LTotal Estimated Cost $ $12,462.00
it _E "__'_'_' __'�`—_—
_E U5 L_Xx Page - I
MGA : PRWC014187 Information Page
Date : 11/11/2019 WC 000001A
MANOTE
Issuing Office: P.O. Box A-H, 39 Public Square, Wilkes-Barre, PA 18703-0020 t www.guard.com