Loading...
23A-083 (4) BP-2023-1048 15 MAIN ST COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 23A-083-001 CITY OF NORTHA PTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGIS ERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARAN FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1048 PERMISSION S HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 3983 BRYAN HOBBS CS-083982 Const.Class: Exp.Date: 05/02/202' Use Group: Owner: FATH LAH MIRIAM&KATHLEEN HULTON Lot Size (sq.ft.) Zoning: GB Applicant: BRYAN HOBBS REMODELING LLC Applicant Address Phone: Insurance: PO BOX 1535 (413)775-9006 WC9057270 GREENFIELD, MA 01301 ISSUED ON: 08/08/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERIZATI 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. • Signature: 14 yg • I , Fees Paid: S65.00 212 Main Street,Phone(413)587-1240,Fa :(413)587-1272 Office of the Building Commis Toner )Jc2D K-'T Arrappvir 5sc, i) , 19<<\ The Commonwealth of Ma- achu is Board of Building Regulatio •rid dards 6- � �� IC PALITY W Massachusetts State Building Co.• R V SE Building Permit Application To Construct, Repair,R 9•. •, Dem h a Revis,d Mar 2011 o One-or Two-Family Dwelling ti;1/y This Section For Official Use Only 1ZO; Building P rmit Number: ` d+3 �0 Date Applied: %ehs �,►+,� /llox ��� 8-8-Zoz3 Building Official(Print Name) Signature ' Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 15 Ma.n S1- Cl oren(A.- 1.1a 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 OWNERSH*' i�q 2.i Owner+of Record: IA, hjt.rcutrd C1Q. l y1t" ic1Uxv‘ Fa4-ka110. _l__r,co Name(Print) City,State,ZIP 15 Ma,, s1- (413-53o-Q810 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(t heck all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition Cl Accessory Bldg. 0 Number of Units Other bSpecify:•ltjtaiLg1 LittAtael Brief Description of Proposed Work2:'j S(11-t n 1-- CA, nil I pnly VCa f o bar .- e' duck Sta-Itnt, f-Zc C)astra e i I cereal �v'am c- A & to}t 3n t�). pa.,,l- ba When,- Sill prAk.c_l 1 Ge46,1124Lo toaIls • C,EKwl a S.I1, 2 &hole, a I1c doer, Clllm.tsh� Htp plpt t afr:A10 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Of#cial Use Only (Labor and Materials) 1.Building $ 3983.-44, 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town A lication Fee 2.Electrical $ ❑Total Project Cost3(Ite 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: Check No.0 eck Amount: Cash Amount: 6.Total Project Cost: $3i E3. 1 49 0 Paid in Full 0 Outstanding Balance Due: , ' -,3 - ( og9 WIC , SECTION 5: CONSTRUCTION SERVICES 5. onstruction Supervisor License(CSL) (Lit, p\ S License Number Expiration Date Na of Cdl.I-!older 7o �5J� List CSL Typo(sec below) U N end Slrect J Type Description �_ t n U Unrestricted(Buildings up to 35,000 cu. ft.) ��P e n YC.1 UC H ��3 C)2 ►t Restricted I R2 Family Dwelling City/Town.State.ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances t'113 /r� I�1 GS /OOV InQ31-ka,ci 1r e C%y Q I Insulation Telephone E•nail address Li(,,.- D _ Demolition 5. Registered Home Improvement Contractor(HIC) 9�(�� tPI �� ti t U-L it I-IIC Registration Number Expiration Date I jcp tpAy Name or 111C Registrant Name n (/Q 1 -s s' tnto I. ✓Iku s �n-�a.1,�• c.v., No. Street Ismail ar tfress ceeftkALIcQ )12, ai36-L gg13 99 -4a6b City own, 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 0 SECTION 7i OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,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. K--(_,/fe4.,,,k .\ I1L7/ zz rint 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. __ JZ.- )23 Prtnt Owner's oo,Authorized A nt's NailW(Electroiiia 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(I IIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A.Other important information on the 111C Program can be found at www.mass.eov!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. fl.) (including garage, finished basement/attics,decks or porch) Gross living area(sq. II.) 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" Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re ulations and Standards IT' Cons ion rvisor CS-083982 spires: 05/02/2024 BRYAN G H9BBS P O BOX 1530 GREENFIELI Jv1A 01302 y r Commissioner 'aQ �/ K. Eimato, THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration 1 •!lc --v _-fsjff Type: LLC BRYAN HOBBS REMODELING,LLC. -- � t ation: 196045 P.O.BOX 1535 „ '� Expiration: 06/25/2025 GREENFIELD,MA 01302idi Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs 8.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 • �G r M C! %• GREENFIELD,MA 01301 . Undersecretary Not valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents 124 �i 4 r Office of Investigations 1` { Lafayette City Center r r' 2 Avenue de Lafayette, Boson 8'0 �' 9 Boston,MA 0211�..j?50 www.mass.gov/die Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Le bl Name (Business/Organization/Individual):Bryan Hobbs Remodeling, LLC Address:576 Leyden Rd Po Box 1535 City/State/Zip:Greenfield, Ma 01302 Phone#:4 13-775-9006 Are you an employer?Cheek the appropriate box: '- 1.® I am a employer with 7 4. 0 I am a general contractor and Y Type of project(required): 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 g. ®Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9• ®Building addition required.] 5. [] 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 12.0 Roof repairs insurance required.] .. 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. teontractors 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. Nate sub-contractors have employees,they must provide their workers'comp.policy number. d 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: 1 j-, City/State/Zip: (1 vr-cn )--1/ 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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature ) ni, \,o\� Date: 112? 123 Phone#: 413-775-9006 Official use only. Do not write in this area,to be completed by city or town official. j'i cial. City or Town: • Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3EICity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other ACo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/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 ADDRESS: aedgett@webberandgrinnell.com 8 North King Street INSURER(S)AFFORDING COVERAGE NAIL# Northampton MA 01060 INSURER A: Selective Ins Co of S Carolina 19259 INSURED Selective Ins Co of America 12572 INSURER B: 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY)_(MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000'000 DAMAGE TO RENTED 500,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 A S2289042 08/04/2023 08/04/2024 PERSONAL S ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO 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 s/ SCHEDULED A9105300 08/04/2023 08/04/2024 BODILY INJURY(Per accident) $ AUTOS ONLY /� AUTOS HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS 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 0TH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A WC9057270 10/20/2022 10/20/2023 1,000,000 OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT $ (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 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 SAS r...SIC,• Massachusetts �? �._ , �I I F Xi DEPARTMENT OF BUILDING INSPECTIONS .. p IA ? '` "�' 212 Main Street • Municipal Building v•., �D * Northampton, MA 01060 sb .•• ��4 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: 'y ��gl-h}v, es kllek4v1n-1,0 The debris will be transported by: Name of Hauler: Amw}- vvckww Signature of Applicant. � Date: —7) 21 I Z3 , . 1 t......„,.•".1'......••;,i • ,.,:iti LI i„.i''•:.,' IP r','N'-1::$148.0;12:Zi-,,,t6,44.... P..1.-,,, 1,.,, .. ••- "• of Rages ."4,4„.. At50. ,.., •••••••20/60.44.01..016....A.11110.0010,111•601101141.0.1.11•110.101.0 1 i WAVieZ . i he v#114., at* EL.12,C4 C PROPOSAL SUliOnirra:`• G,., n iltrini1.:,:n-,i:tAti Aon ct r . STREET - MB d-ioeer Vatiey 'A , ., CITY,9?AlE ANt,-.1 VP COOS - ii,,,,ji .OX 1 4; JOB OliA,' OiN .- S • ,ar, '14,...0. . ; I 5 i A) 5f — oil-PA-6e ..evo - JC43 PHONE 1 . "' • r ,/ iev 44....-0,. ::,...i.."ji::-:::,..r.i.,..„7:::-,.,.-k....:,,ti';."7.,-".T::'r--77-•:1','::-77'''';':'*;-77::'I' -777-''---..'.;'. :‘ --.7.- ' • .- - We;iv eliv,Jci,::1-,ii.cpct-A):titc-rit,arei agid. '•- tof: . - . . 4 -1 ..,., ,„-,..:,-;1..,,;•..,.*,ir,,.....,> .,'r',...,''''';',., lj I , ' ,,'....---.. .' oo...r.rsr•*....,,7 :...0•-•./4t,i . • -",',14e,'",,ik?.k.1,,,,-.,,, - fr. 1 — — - f ' , f --1 --------,-- , — t• —It,---------- i --- , _ — — I' —- -_----. ...........••••••••••••1 " . I Wet le t:'1Y;;10.6t I emir/tic turalah Notarial and Mbar•complete In accordance icy,abctv e ope:Incal14--,, T.,:r trie a,timq?jr71/ 14 1 _ dc,rfars 1.1, PtInetrii ir::I'M PrIal*el Fdtows l _ • __ -- , . , -- „_. -_-__-___ -.3•7,-, le .....................- 4111 irIZIWIA: la goasaftbani if, to ra i.441ileil Ali oaork. itc tsa Orapiatt4 in a , , 1 I '-kivorik.-rsariii$fill?flamer tif.c.e.rd,r.g k•tits', id plac.ticire Airy a:Watkins Ili 4./o1Atki41 ^tP,,,r1L71' f - n." hq.iti, ------ fran v.. ...4,1 rpooilc,•aiok-,ii,A...1+..ing twit C4e/b MA LI 3411-4stiso ixey+.4X.ri wrIttall C--,,r` otdor&arid wiii become;lei s'Ara:thir•-•-ug• "di'argil arA3Ai a-,ii otAltivdtt.1,11 Nipper,non 1 , wilt-N.4ot uxr.airts,.64. saN: rtrat Of dq' yis ttoyc41,1 nur conief °whir tva cvorry(tit, tOrNaric.OP,1..:4rior not*mar,-inatirenca Lir wottkorti eta faC)xAsied y W;sitertir4 Note:This proposal may be C•yrperranik.,0!rie...irscp:* astitidrei.vri by us it flOt SCcepted wittlif I ci! ..,.. .13161/e2texas0V641.4XIIMENef-j.tr"."-2-,3-41s-ert..*.acrger .1% arttpti3 P.t't Of,t3 t Op q'Aft 1 •Trio r..t..*:•,,, pile.:4a,spai;iit.v71-xl anti roixliffor.ta i)ta aatiE.14;:ti.iiry and act.Ve41,0),'i;':..C4Spiaci'4 /..:iti ilia authoriZtrci'i'0 iiQ the svcrn V.4 41)00- _ Pa-yrriarrt ma Ix inta.,. ea Z,thiined ailVvos, Signature 44:41416 Ell AC46p110:+7,8 1 Sighaturs -- \--1‘4143 _ (\hof)fAJ ("sip 74).110 )17-r4 •v Low;) / ( V-khf,fai.' I‘r .1 jrl‘4.A 3n 4,erd1n $ J3 rtofb) ' 5 1! 5 A -frh.4 -�S fl J AIIIIIIIIr 7 i k"%...Ml'" + .3fli ('1 1`1 >4 3 a490 i 'b0c\ J?r`'' '1 1.1)l O \ V 1 4 CM® J ?1#6 i i p -fib '4' — i D f '3. +C 0—D‘') U '"\0 1\ r„• v 1 S o t---o City of Northampton 1 df .'T SAS... ...!siC 1 Massachusetts ,' .- 4 * It 4 4 S't a w - 1 k'' DEPARTMENT OF BUILDING INSPECTIONS y. If ; ` - .--,5 212 Main Street • Municipal Building Jf•. . Oa Northampton, MA 01060 SdY•'3d' c. Property Address: / 5.-- Contractor 'L �� V S Ac o J( � j Name: l�( Q�l�/ 11 /1 Address: 5-1 6 L..c i p n C al 7 City, State: Gre-kr\ ^-tom;'I 01\ (1 4 Phone: u\ 1 3- -'j - 9 0010 Property Owner /k1 Name: ( rI A - — o 1 1 c I, r" Address: I /l a,i, 5 ri-- City, State: Fi 6 c4 A c.( ( / ' 4 l I, / a.` ) I (contractor) attest and affirm that the building I intend to in'sul doe not have y 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. <---e...6 Contractor signature Date F, 8-,,a3/