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31A-115 (9) Fwd: 38 Vernon St. Subject: Fwd: 38 Vernon St. 22 From: Kevin Ross <kross@northamptonma.gov> J( - b Date: 12/1/2022, 8:48 AM To: Beth Willard <bwillard@northamptonma.gov> Forwarded message From: Jessica Miller<info1bryanhobbs@gmail.com> Date: Wed, Nov 23, 2022 at 2:26 PM Subject: Re: 38 Vernon St. To: Kevin Ross <kross@northamptonma.gov> Hi Kevin, You can throw away this application. We will not be moving forward with this work. Thank you for your time, Jessica Jessica Miller Bryan Hobbs Remodeling LLC 576 Leyden Road Greenfield, MA 01301 (413) 775-9006 On Fri, Nov 18, 2022 at 11:22 AM Kevin Ross <kross@northamptonma.gov> wrote: Good Morning, I have a permit application for 38 Vernon St, unit 1 for insulation. The structure was built in 1900, so I will need a knob and tube affidavit before I can approve the application. I have attached one here, you can fill it out and email it back to me. Any questions, please let me know. Thanks, Kevin Kevin Ross Local Building Inspector 212 Main Street 587-1240 Northampton,MA 01060 Fax 587-1272 kross@northamptonma.gov 1 of 2 12/1/2022,8:52 AM e kEEo ►L,i=r AFF►04v 1;- L.A LLC-O Lam- 'r 1151. II-1E3 }.,.trF-1RIL�l� it-se, :.C=J 1 Jn ` t -�1 J4l i''JIJ�LI I`700 :"� The Commonwealth of Massachusetts I it Board of BuildingRegulations and Stndar NOV / FO ''1,.) 2022 M ICIALITY Massachusetts State Building Code, 7$0 C R U Building Permit Application To Construct,Repair, Reno • Re�i ised* r 2011 One-or Two-FamilyDwelling ','nrITHA M°TNT ION M'A ni ;io;,; This Section For Official Use Only ' `" Building Permit Number: 60,11..(50(p Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 33 Vernon s1- , t 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 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 1 1 ;caner'o�ford: `,——m 142 � � ey (IT11Ul , Name(PtSnt) City,State,ZIP 3% V2tnbn S1', '1_ Cyl3 pip•3643 -ryn o �cau „1. c..n No.and Street Telephone E it Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 I Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other pecify: (NCA}Itr%tA hc% B 'efDescripti n of Proposed Work': " Qfl b'Oc..) C01010U_ c_ to 010e.chOnt_v_p'LVILif_A-V1 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only • (Labor and Materials) 1.Building $ 1 15...n.,vp 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Feed;$ f Check No. heck Amount: ( Cash Amount: 6.Total Project Cost: $1 1 511.1 l.o 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5 Construction Supervisor License(CSL) OR 39&a. 5)a)aq W License Number Expiration Date e of older List CSL Type(see below) U . 1 WcV. o.and Str Type Description �r1� ` U Unrestricted(Buildings up to 35,000 cu.-1.)ra� (y- Mz ^13t�2- R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 4 1^V-C)1 lt1M l�� qY1�( I Insulation Telephone Entail address V Gpel Demolition 5.2 Registered Home Improvementj� Contractor(HIC) i pK _OL t (el ado t1 I 1A4L LC_ HIC Registration Number Expiration Date -" C pang Name HIC Registrant Name • Ig 1n lisNan ,aSesMa.0.4r^ OCo n c'. 41311 r cl�� Email addreir tty/Town,Stattee,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? Yes No .0 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 'ned in this application is true and accurate to the best of my knowledge and understanding. 0.%. 4114 b 1114I Z P Owner 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" DocuSign Envelope ID:2B98B3B2-AEBF-4536-AF63-7FC868A15209 RISE ENGINEERING' OWNER AUTHORIZATION FORM I, Kelly Coffey (Owner's Name) owner of the property located at: 38 Vernon Street , (Property Address) Northampton, MA 01060 (Property Address) hereby authorize4 DS T_QIWZILLAylt_ �( , ( ubcontractor) 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. The permit will be secured by the subcontractor, at no additional cost. DocuSigned by: C Owner sv'gFta'fe 11/7/2022 I 6:59 AM EST Date RISE Engineering, a Division of Thielsch Engineering, Inc. 60 Shawmut Road Unit 2 I Canton, MA 02021 1339-502-6335 www.RlSEengineering.com Office of Consumer Affairs and Busing Regulation lotto Wallington Street-Bub 790 Boston,Massachusetts 02118 Home Improvement Contractor Registration BRYAN HOMO REMODELING,LW. Re�tra an: ismsP.Q.Soft 1Cf88 BaptrattaC 0001 0ft8 GREENFIELD,MA 01S02 UpdeteAddmssud Rehm Oerd. ens eGaagiumelfifies&Ulnas tILMAt T NTRA B t pllli$er EXIMal5Ian ea 100448 01113 028 11/ gm AGO BRYMI HOBS R8TAODELINO,LLC, Mob BRYAN H080046•040.!'�",'�,"" , �t3 i8D�LtrlA meintlndeiiwtetety Nota11i Eoard ojjmmOItholMassac Buitdinonf ccupational Re 9 ulations Licen and Stansuredards Cn611as�J,b' tsger�V 4'�D9�iesr,, CS-083982 ,ty BRYgN G HOBS tPires:05/02/2024 P O BOX 1535 GREENFIELONA 01802 WASP ' 0 Commissioner r'�a�s9.2 f; ,.Cs.- 1ir.�lc Ge',, The Commonwealth of Massachusetts Department of Industrial Accidents y •.�'ti� Office of Investigations ti bsi Lafayette City Center ..f.„ . .r`/ 2 Avenue de Lafayette, Boston,MA 02111-1750 "w= r1 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): 1.0 I am a employer with 7 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance. t required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 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.❑ Roof repairs insurance required.] t 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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors 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. 1 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:j2$ 'Q_(feim S\ 2 City/State/Zip: 11'YThe Milk 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 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 fy under the pains and penalties of perjury that the information provided above is true and correct. Signature: Oft, \L M Date: I 11 I q\?AM-Zr 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 30City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: DATE(MMIDD/YYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 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,No):. 8 North King Street ADE-MAILSS: 9@ aed ett 9 webberand rinnell.com DRE INSURER(S)AFFORDING COVERAGE NAIC# 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: 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 HIS 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 'ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE /� OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 A S2289042 08/04/2022 08/04/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY nPRO- 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG , $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED A9105300 08/04/2022 08/04/2023 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS i XHIRED v NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ 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 I N C ANY PROPRIETOR/PARTNER/EXECUTIVE Y 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 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per Occurance $250,000 D Pollution Liability CPLMOL109637 01/19/2022 01/19/2023 Aggregate $500,000 DESCRIPTION OF OPERATIONS/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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton Massachusetts ��?'' .1 :I) � r}/b, DEPARTMENT OF BUILDING INSPECTIONS y, �r .T.4S. 212 Main Street • Municipal Building vs. Dti! Northampton, MA 01060 ss'IN 3'7^�` CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: ca�j'[ E ocn QC& 1VO�iiv p Ofl �' The debris will be transported by: Name of Hauler: i \c(1r\ktcl- '1 Signature of Applicant: Date: I I\ l \ZRZ_