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24D-250 (4) BP-2022-1341 88 CRESCENT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-250-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-1341 PERMISSION IS HEREBY GRANT•D TO: Project# INSULATION Contractor: License: Est. Cost: 9912 CS-083982 Const.Class: Exp. Date: 05/02/2024 GEORGE, MICHAEL G. & BARRY-GEORGE, Use Group: Owner: KRISTEN E. Lot Size (sq.ft.) GEORGE, MICHAEL G. &BARRY-GEORGE, Zoning: URC Applicant: KRISTEN E. Applicant Address Phone: Insurance: 88 CRESCENT ST NORTHAMPTON, MA 01060 ISSUED ON: 10/18/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/W EATH ERI Z ATI ON 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIO ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner Auto- 1?Ab The Commonwealth of Ma ach ett T 7 I1 FOR Board of Building Regulations nd S an r 2022 M ICIPALITY Massachusetts State Building C de, 80 CMR USE Building Permit Application To Construct,R air, e°4warlorOp•_ s R ised Mar 2011 One-or Two-Family Dwe mg- + ''• � �i�j This 1"Section For Official Use Only Buildin Permit Number: big-Pi e I 3 ` Date Applied: J EU4—) a05, /2 /0'i �� 7ZbzZ Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers Sg r rel:C zn.} sV aY D •250 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' pi Owner o Reco d: Name(Print) City,State,ZIP Fs% Greuv,'- s\- H 6-uak,-9,49 a No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other iv Specify: We.ahiLintajncn. Brief Description of Proposed Work2: oar 5,i 1 ( nmM 1 12'' bk,A,a c o\1...IWyt Ca. Clourt Z" GU4'0u 4li,c lniM.b, \n\t-ncr WO-11 c( pact. cdkk. k 211 yv6+_ r,r, J1.),.I- SECTION 4:ESTIMATED CONSTRUCTION COSTS ,Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ Q,CI la 3y 1. Building Permit Fee: $ Indicate how fee is determir ed: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: S i' Check No.AT6 Check Amount: (,c' Cash Amount: 6.Total Project Cost: $Q, C11 a . -) 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 08-39 0V a S)a I a1/ License Number Expiration Date ame o CSL Holder 153C List CSL Type(see below) and Strpq Type Description CY /'UJ. Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS _ Window and Siding 91 M 9 SF Solid Fuel Burning Appliances J t Gip I Insulation Telephone Email addres (',d1 D Demolition Registered Home Improvement Contractor(HIC) 1 oOLIC____ Olds-la 3 L. I•• ■ •.�► • HIC Registration Number Exiration Date pany Name or HIC Registrant Name r:L1 rQii..b .10/ S aj rArr. • and QS Q134. qI3Mcelab Email addres City/Town,State,ZIP Telephone SECTION 6: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? Yes1567No . ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S 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. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information c fined in this application is true and accurate to the best of my knowledge and understanding. j0/13) !'2 w er's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system _ Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Permit Authorization Form I, 2i Y ' �1d owner of the ro er located at:, -' P P h' (Property Street Address) (Town/City) Hereby authorize Bryan Hobbs Remodeling, LLC to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. o \� Z2 /bwner Signature ate City of Northampton Massachusetts ',IiiiiirrG j.' .� `� mi u .3 "k DEPARTMENT OF BUILDING INSPECTIONS yJ,, �' b4 212 Hain Street • Municipal Building `, pC Northampton, MA 01060 A, 3"‘1 Property Address: U1 je3Q i i OV Contractor Name: CT(1 CIxvv EltCkrICG Address: 1 31 WQj r g4' City, State: QACAVAAN, MA Phone: 1 ' 515-c1oo Property Owner Name: WC4NO.C...1 Cit.Q1 Q 4, Address: Q C'cQSCQ * S4 City, State: !�--VVA INklt^' . }`AA-- I, 'X<< C►t C1.h(t,rtik. (contractor)attest and affirm that the building I intend t insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and th t I have provided the property owner with a copy of this affidavit. Contractor signature G� `/ "/ - Date /O / Z/ZZ r Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02110 Home improvement Contractor Registration Type: LLO 0 BRYAN HOBBS REMODELING,LIC. �atotretlon: Man Fe.O.BOX 1886 Basp!retort: itt02023 GREENFIELD,MA 41302, Update Address and MAf4 Gent Office otoaneumurAleorsaluaus ReeutMton Ht1lNEUI1PAp11 I YCOARRACTOR Vt gtotrolonventerMendedeatonly tYft LL0 footers the afpt sUen debe.Iffau>td reunites MOM ENNBLEBB One etcamanunerMetre end Nelms R guletlon 12040 amass Ma 8}teet.Butte ll® BRYAN HOES REMOOE4.tN3,Lit Boston,NU! Z11d • BRYAN HOBBS Wil oRt�iF�oa°r�a BIM Undersecretary Not valid without signals Undersecretary C® umweawealth of AHassachusetts�'�, Division of Occupational LiCensure Board of Bui{ding Re ulations and 3tandarcis «�ae6ta �re`yc�ri�u CS-083982 BRYAN G H B "pines;05/02/2024 POBOX 153 a9 CREENFtELL A 01302 -` '4)4' ') .1`r)CIA'rIS3.3, r Commissioner (JvdQ �;. itarci2. , The Commonwealth of Massachusetts o_ Department of Industrial Accidents Office of Investigations r.. `�� Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 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:576 Leyden Rd 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.❑■ I am a employer with 7 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.# 9. ❑ Building addition required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other Weatherization comp. insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check 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 is the policy and job site information. Insurance Company Name: Selective Insurance Company Policy#or Self-ins. Lic. #:WC9057270 Expiration Date:1 0/20/2023 Job Site Address: j j Q City/State/Zip:/State/Zi H.P v �C Q'1�� "� tY p f�l 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 crimina, penalties of 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 and a fine of up 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 her hererNI e• rtify under the pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: M • 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(check one): 10Board of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone #: Pjhr.-.."'".1113ryan ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/24/2022 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 have ADDITIONAL INSURED provisions or 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 Adina Edgett,CISR NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C,Noy 8 North King Street &MAIL aedgett@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Selective Ins Co of S Carolina 19259INSURED INSURER B: Selective Ins Co of America 12572 Hobbs Remodeling,LLC Selective Ins Co of Southeast 39926 INSURER C: PO Box 1535 INSURER D: Evanston/XS Brokers INSURER E: Greenfield MA 01302-1535 INSURER F: COVERAGES CERTIFICATE NUMBER: LIAB EXP 8/2023 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 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 TERM, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER (POLICY/YYYY) POL(MM/DYE) LTR INSD WVD POLICY NUMBER MM/DD LIMITS X.COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO REN rED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 A S2289042 08/04/2022 08/04/2023 PERSONALBADVINJURY 1 $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 1-1 PROJECT LOC PRODUCTS-COMP/OPAGG $ 2•000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED s/ SCHEDULED A9105300 08/04/2022 08/04/2023 BODILY INJURY(Per accident) $ AUTOS ONLY /� AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY (Per accident) Underinsured motorist BI $ 20,000 X UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE S2289042 08/04/2022 08/04/2023 AGGREGATE $ 2,000,000 DED RETENTION$ $ WORKERS COMPENSATION X STATUTE EOTH AND EMPLOYERS'LIABILITY Y/N C ANY PROPRIETOR/PARTNER/EXECUTIVE NIA WC9057270 10/20/2022 10/20/2023 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE. $ 1,000,000 If yes,describe under 1000,000 , DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per Occurance $250,000 Pollution Liability D CPLMOL109637 01/19/2022 01/19/2023 Aggregate $500,000 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 4. • • • • 0 • 8 II I ' rip qi fp \ „ top ,r1131awc-q 1713"0.1449 Ir. 7._,Ncrarryvjz.mv. ..7.74 op Pr 177,itr, PC: "11111.1.8";""1111 ZT\ roe no • • Vollap 141. ON /.14116""arlittitirgWil t""N 104110$0 Imovimtpi"we fun 1VAORN Mgt VD it tePV NON „ 11"1"10 fiNfaraw,4 qg Zr