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38A-034 (5)
BP-2023-1047 201 GROVE ST COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 38A-034-001 CITY OF NORTHA PTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGIS ERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA FUND (MGL c.142A) BUILDING P RMIT Permit# BP-2023-1047 PERMISSION S HEREBY GRANTED TO: Project# INSULATION 2023 contractor: License: Est. Cost: 1894 BRYAN HOBBS CS-083982 Const.Class: Exp.Date:05/02/202 ZIVAS TIANRACH NAVAPORN Use Group: Owner: ANNA OGELAND Lot Size (sq.ft.) Zoning: URB ,applicant: BRYAN HOBBS REMODELING LLC Applicant Address Phone: Insurance: PO BOX 1535 (413)775-9006 WC9057270 GREENFIELD, MA 01301 ISSUED ON: 08/07/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERI ZATI 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 NOR 'HAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: II Fees Paid: S65.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commiss' ner Ailli / /� 1 '�2i)1[..T /I The Commonwealth of Ma- achu-etts `5 Board of Building Regulations • u d gf:, o- a s <9/M.. 'OR Massachusetts State Building Code, ''®. �J M CIPALITY q, v USE Building Permit Application To Construct,Repair, Renova t' .u a . h . R, ised Mar 2011 One-or Two-Family Dwelling A0'�o�ONs �Q ,0). 2 This Section For Official Use Only Building PP rmit Number:er a'" ' ' # Date Ap lied: be elJaIJ(Koss /firs ZOZ 3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 11.1bP,Property Address: S� 1.2 Assessors Map&Parcel Numbers 1.1 a Is this anaccepted street?yes no Map Number r 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: 1.6 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' 211 Owner'of Record: Name(Print) City,State,ZIP eQ01 few, e S\ an-MI- Cola') Shei bk I L SIN aS c,t-% No.and Street Telephone Email Addr s 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 ❑ Accessory Bldg. 0 Number of Units Other pc,Specify:Lotalhe Brief Description of Proposed Work': clorywywns, cur Sen.121 a" 1%1.L.osia 1-141-r h ulQd- ! C6i fi a 4( ci 1-,1"i.k_G Jill QflL4.ax_(,lr.>H1C as ,—jD1t aJolla SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ I 1 gclt! or 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ CIStandard City/Town Application Fee ❑Total Project Cost3(Item j6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees.g16. Liii i Check No. I Check Amount: (A Cash Amount: 6.Total Project Cost: $ 1 aQ d,or 0 Paid in Full 0 Outstanding Balance Due: b -I'l SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Uggp�2 Oa) q (� 1�Q S License NI umber Expiration Date N of C L Holder List CSL Type(see below) ?a d Stre t b- Type Description ,A U Unrestricted(Buildings up to 35,000 cu.ft.) O/TPtlI V► )4z 01 3�Z- R Restricted 1&2 Family Dwelling ityown,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 4139W lo6lp A1.1DKt vitlaLare.o L In ulation Telephone Email addr D D molition 5.2 Registered Home Improvement Contractor(HIC) I CAC Tom! .`(Yk VU • (� HIC R gistration Number Expiration Date C Company Name or HIC Registrant Name O �yy��,,`1_ o.and et - T' -•'^'�,S eNrr1CL Q Ca' Email address �C �1r4, M z C�13cz 43 r1% 9 polo tty/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? Yes No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR B>4JILDING 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 contained in this application is true and accurate to the best of my knowledge and understanding. g-,I )1.3 Print Own 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 iiet 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" itm mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM 1, Anna Hogeland owner of the property located at: (Owner's Name) 201 Grove Street Northampton (Property Street Address) (City) hereby authorize the Mass Save° Home Energy Services Program assigned Participating Contractor to act on my behalf and obtain a building permit to perform insulation and/or weatherization 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. 4uua Rofelaud Owner's Signature 07-06-2023 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced oroject: TD(\jiyI eiz;f`cl LL( _ I1)23 Participating Contractor Date Document Ref:XLYQY-KMMXJ-NBTHV-AXPRG Page 4 of 6 Commonwealth of Massachusetts k5 Division of Occupational Licensure Board of Building Re ulations and Standards r' Cons , Ion rvisor CS-083982 x . I • i pires:05/02/2024 BRYAN G HQBBS •e, l. p - "�P O BOX 15311. GREENFIELIJVIA 01302 • Commissioner duia K. YF.nt-h . THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration l" r 1= Type: LLC 96045 BRYAN HOBBS REMODELING,LLC. __=�1 egipiration: 6/25/2 P.O.BOX 1535 _ Expiration: 06/25/2025 GREENFIELD,MA 01302 ink —s i mmir ©* F 1rl M i� W q Update Address and Return Card. 1 THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 196045 06/25/2025 Boston,MA 02118 BRYAN HOBBS REMODELING,LLC. BRYAN HOBBS 576 LEYDEN RD i° } j,, ,,.yet, /a ,4 GREENFIELD,MA 01301:.,y,/j✓ r�' Undersecretary Not valid without signature '., The Commonwealth of Massachusetts = '= Department of Industrial Accidents = .... o Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A lfcant Information Please Print Legibly Name (Business/Organization/Individual):Bryan Hobbs Remodeling, LLC u— Address:576 Leyden Rd Po Box 1535 Cit /State/Zip;Greenfield, Ma 01302 Phone#:413-775-9006 Are you an employer? Cheek heek the appropriate box: 1 _ 1.® I am a employer with 7 4. El am a general contractor and Y Type of project(required): employees (full and/or part-time).* have hired the sub-contractors 6. 0 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' 9. Buildingaddition [No workers' comp, insurance comp.insurance.t required.] 5. [3 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 MOL 12.0 Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' 13.®OtherWeatherization 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. 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. 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. Lk.#:WC9057270 gxpfon Date: Job Site Address: C>\ City/State/Zip:V WA-Norv1( . 1 /la- 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 MOL 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 hereby cert ►under the pains and penalties of perjury that the information provided above I byre and correct. Signature: f---N4m6v-‘ - -- Date: 1`1 2_3 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): lOBoard of Health 20 Building Department 3DCity/Town Clerk 4.0 Electrical Inspector 5D'lu tubing Inspector 6.DOther Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/25/2023 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: Alera Group,Inc. PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C,No): Webber&Grinnell Division E-MAIL aed ett webberand rinnell.com ADDRESS: 9 @ g 8 North King Street INSURER(S)AFFORDING COVERAGE NAIL# 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 01302-1535 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 08/24 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYYL(MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X DAMAGE TO-RENTED 500,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 A S2289042 08/04/2023 08/04/2024 PERSONAL&ADVINJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO JECT 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 08/04/2023 08/04/2024 BODILY INJURY(Per accident) $ AUTOS ONLY /".. AUTOS XHIRED NON-OWNED PROPERTY DAMAGE AUT v OS ONLY AUTOS ONLY (Per accident) Underinsured motorist BI $ 20,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 1000,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA WC9057270 10/20/2022 10/20/2023 E.L.EACH ACCIDENT $ , 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 $ 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 City of Northampton ? Massachusetts �s.' c, :1 F .. . •• ,, DEPARTMENT OF BUILDING INSPECTIONS % III 212 Main Street • Municipal Building yJ, , CL �� Northampton, MA 01060 4:6144 e: 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: V 1 , Zau, i 4 - D34 f'Q,g ZS The debris will be transported by: Name of Hauler: 44.2_6\-- rivr Signature of Applicant: a„ Date: gf 1 )2_.�