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17C-038 (3) 24 HILLCREST DR BP-2020-0954 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-038 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-2020-0954 Proiect# JS-2020-001624 Est.Cost: $8809.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BRYAN HOBBS 83982 Lot Size(sq. ft.): 34281.72 Owner: HAMMERLE TERESE Zoning: URA(68)/URB(33)/ Applicant. BRYAN HOBBS AT. 24 HILLCREST DR Applicant Address: Phone: Insurance: PO BOX 1535 (413) 775-9006 WC GREENFIELDMA01301 ISSUED ON:2/24/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.•ATTIC INSULATION, VENTILATION, BASEMENT SILLS, AIR SEAL 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 Sianature: FeeType: Date Paid: Amount: Building 2/24/2020 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit t , 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans. phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: /�TJhis section to be coDleVdy office Map ! ` � Lot // Unit 1-A,ll(�,rtsv -Ur\'Oc� Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT (" ' C9v j 0 2.1 Owner of Record: -�� ;,�-�� l�t•,n m t,rlA. ��l lr�s� �n�e_ , �l�r nc_v, l�l z Name(Print) Current Mailing Address: lei) - y68 -91z9 Telephone Signature 2.2 Authorized Agent: -,, Name(Prinf) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (,V09 , /{, (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 �/ v V 6. Total =(1 +2+ 3+4+5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: 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 Alterations) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [1--3] Decks [p Siding [[ ] Other[ Brief Description of Proposed Work: a%c In�i�lU�t,,r,� lX�r��,ln� r, , �Mwsts rnn�� S, �l� Cir sC,.�rW Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. 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 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 Date as Owner/Authorized Agent hereby deblare 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. e z Z0 ,. Signat4w r/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ElName of License Holder: Qb? fj License Number A essExpiration Date SiXidre I Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Cd—mparN Name Registration Number Address Expiration Date Telephone -go7j 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...... ❑ RISE ENGINEERING OWNER AUTHORIZATION FORM I, Terese Hammerle (Owner's Name) owner of the property located at: 24 Hillcrest Drive (Property Address) Florence, MA 01062 (Property Address) CJ hereby authorize `.�� c.K4-bb,) (Sri ontractor) 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. ' 7 ,A~/f L � Owner's Signature nate RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 1 Canton, MA 02021 1339-502-6335 www,RISEengineering.com J1e: K;w2l.22 t.-12clel e G•l�C�e: G'C/GG�J^�LG�/UL��I t�G GCi Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 196045 BRYAN HOBBS REMODELING,LLC. Expiration: 06/25/2021 P.O.BOX 1535 GREENFIELD,MA 01302 Update Address and R, SCA 1 0 2OM-06/17 •�/-- ./fir' //'/I////rVi//vvl�/fi /�. ��riivrir/ra)r//•1 Office of Consumer Affairs 3 Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE;LLC before the expiration date. if found return to; Registration dation Office of Consumer Affairs and Business Regulation 196046 06/25/2021 1000 Washington Street -Suite 710 BRYAN HOBBS REMODELING,LLC. Boston,MA 02118 BRYAN HOBBS / 576 LEYDEN RD �l".Gr'�r�i 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 0 HOBBS PO BOX 1635 GREENFIELD MA 01302 Commissioner CZ !� The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations �1 600 Washington Street Boston, MA 02111 -'' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Bryan Hobbs Remodeling, LLC Address: P.O. 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.® I am a employer with 7 4. ❑ I am a general contractor and l 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additio 3.❑ 1 am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing repairs or additio myself. [No workers' comp, right of exemption per MGL 12.❑ Roof repairs insurance required.] ' c. 152, §1(4), and we have no Weatherization employees. [No workers' 13.® Other comp. insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ,Contactors that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. 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 iv the policy and job site information. Insurance Company Name: Selective Insurance Co Policy #or Self-ins. Lic. #: ,WC9057270 Expiration Date: 10/20/2020 .lob Site Address:ZyH,��C,t!r�3�- �)ri► pe . City/State/Zip:O0(,rn o, }1(y Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date; Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of. line 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 t Of tip to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereunder the pains and penalties of perjury that the information provided above is true and correct. T Sianat Date: Phone#: 413-775-9006 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/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: ACo CERTIFICATE OF LIABILITY INSURANCE 7-10/10/2019 TE(MM/DD/YYYY) 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(les)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 CC)MT CT NA Adina Edgett Webber 6 Grinnell PHONE (413)586-0111 FAX A/C No (413)586-6481 8 North King Street E-MAIL ADDRESS: aedgett@webberandgrinnell.com ett@Webberand rinnell.com INSURERS AFFORDING COVERAGE NAIC 0 Northampton MA 01060 INSURER A: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 INSURERF: COVERAGES CERTIFICATE NUMBER:Exp 08/20 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. 1�7R TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000100 A CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED 500,00 PREMI occurrence) $ S2289042 8/4/2019 8/4/2020 MED EXP(Any oneperson) $ 15,00, PERSONAL&ADV INJURY $ 1,000,00� GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00, X POLICY❑jRC7 F1 LOC PRODUCTS-COMP/OPAGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000,07 accident) 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 $ Underinsured motorist BI split limit $ 20,00, X UMBRELLA LIAB X OCCUR S2289042 8/4/2019 8/4/2020 EACH OCCURRENCE $ 1,000,00, A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,00 DED RETENTION $ WORKERS COMPENSATION X I PERT'TE OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,00 N/A OFFICER/MEMBER EXCLUDED? Y❑ C (Mandatory in NH) WC9057270 10/20/2019 10/20/2020 E.L.DISEASE-EA EMPLOYEE $ 500,001 If yes,describe under DESCRIPTION OF OPERATIONS below Bryan Hobbs is Excluded E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/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 lut_ - ©1988-2014 ACORD CORPORATION. All rights reserved ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) The �ommanwealth of 4assachusetts ` Boa?d of Building pegulatdons and Standas "assachusetts State Building Code, 780 CMR D AI S RDNVIOVAL FORIq Section 105,3,2,2 7ga CMR Masssohusstts Stat$ 6ui4ng Code stats, A pormit For the d©molition,renovation,rohabilitation, or oth$r alteration of a b M-01, Ch 40 § $4, r$quiros that the d$bris r$sulting th$r$flrom anal( a condition of lioensod said waste disposal Facility as daf�nod by M,Q,L, c,l 11, § 15 0 A." building or sm bo disposmd of in a pr( � . Pormit Number Job Location; --....1r I-,-Ycn(-o 2 Locxt ono BoiHty or Wwece Dlspostl Company Nemo an Sl �7 NIB P nt tm�