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25C-048 (10)
BP-2023-1454 224 NORTH ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-048-001 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-2023-1454 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 8688 BRYAN HOBBS CS-083982 Const.Class: Exp.Date: 05/02/2024 Use Group: Owner: TRUSTEE BRODWYN JANE MEYERSON Lot Size (sq.ft.) Zoning: URB Applicant: BRYAN HOBBS REMODELING LLC Applicant Address Phone: Insurance: PO BOX 1535 (413)775-9006 ECC6004001133 GREENFIELD, MA 01301 ISSUED ON: 01/09/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION 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: I 5r° Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner *1-4;- -1) V - - RFf-\nyiviI ca &_ -5 r Et-PI IL. lD- le RECEIVED < <f- . I �,. / i� 4vii-r MO 1 �I 17 0 CT 1 1 �0 � �""�. The Commonwealth of Massachusetts 23 W Board of Building Regulations and Standards (I�OR a. W`ar Massachusetts State Building Code, 780 CMRDEPT.OF BUILDING IN15F�cl t3PALITY NORTHAMPTON.MA 01060 USE Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Sect' n For Official Use Only Building,Pirmit Number: ,38',A .� iLIC7 Date Applied: Aei)►f-/Z5 /7Z I. g-zOz Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers D9y norW sE- 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 ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2 1 Owner'of cord: C9 WO rD A l.w L r, 1 )(Y\4\co., , - ame(Print) City,State,ZIP ,a Li (l.0CiAm. s\r go-31t-1- Ws3 Jcr,e bnxl&Ain e,5rY,cLs.ctrti. 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) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other pecify: (A) 2.hvj 74Acn Brief Description of Proposed Work2:( 0. - 11/4A ue py be. crW J&e?cam cl r, r, ! cX s C�1\ �rrx u C�rn t..,.}h_ nsi kin* `JC - \besK fre/'L -- ('JfC.�, Ser_1s+, (�l\\S Z' c [- j h� �\1 LAM,..1(1St Lam' i c.. C`o`Y, O x..A.r 1 Qu rTC I L, t 3� SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ct o�,. 1. Building Permit Fee: $ Indicate how fee is determined: 0 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 F es: Check No.,/ Check Amount: (a� Cash Amount: 6.Total Project Cost: $611os .' 0 Paid in Full 0 Outstanding Balance Due: ' SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 0?39g-a S.- JIcD 1 (�/� 1— ' License Number Expiration Date of Holder t ` List CSL Type(see below) v No.amend Str5-3c Type Description /1p/� ` /� U Unrestricted(Buildings up to 35,000 Cu.ft.) `Kl t 1 � V� 4 R Restricted l&2 Family Dwelling t own,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 1 SF Solid Fuel Burning Appliances yL�l' r 9(o� V&,'-1>wn�c�ase Sip,,Q I Insulation Telephone E ail address C D Demolition 2 Registered Home Improvement Contractor(HIC) 19 Lob�f S Cojac dr �ln \ H S F�QXYIA 1 ClC— HIC Registration Number Expiration Date C pany Name or C Registrant Name `. 153 , , S r C .11 ��?r►� .an t n � h)�� -)1``9 6d r) Email addre dl �13� 7 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? 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 co in this application is true and accurate to the best of my knowledge and understanding. I-2Ah ,-, toJ1z)Z 3 Print ner's or uthortzed 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, _C t,\Q.J7' Z , owner of the property located at: NoAmon , Ai (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. gig\ a-5 Owner Signature Date ‘1.1° fffr't1 Ck-41, ICt.e1 o13n ` Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Real`ations and Standards ils4 `YDo4,ry �r CS-083982 ' Spires:05/02/2024 BRYAN G HOBS P O BOX 1530 GREENFIEUrJJIA 01302 J ! . Commissioner rJu f;. Yeen jia THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration I Type: LLC BRYAN HOBBS REMODELING,LLC. -+' Registration: 196045 P.O.BOX 1535 �i • Expiration: 06/25/2025 GREENFIELD,MA 01302 Update Address and Return Card. 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 Reoistratiort Expiration 1000 Washington Street -Suite 710 196045 06/25/2025 Boston,MA 02113 BRYAN HOBBS REMODELING,LLC. BRYAN HOBBS 576 LEYDEN RD GREENFIELD,MA 01301 Undersecretary Not valid without signature . St. The ailiMONWesith oft aaramtr �* - = cent ofIIedtimtialAeelden to 4 =- *'i-:- of Itivesdiations ,;7,_,--_L!_:.,___=_-7:-: _, CLb+Ca�iw 2*eau LfiOg►etae, BeabeSvaiy MA 021114950 Waken' C wwwitnarssmon/dte ;,,o mipmmation, , Insurance Affidavit:Baliders/ContraatoratEIectricia�nr/Plumber Name(Businese/Organkition/nndividual):Bryan Hobbs Remodeling, LLC Address:570 Leyden Rd Po Box 1535 City/State/Zip:Greenfield,Ma 01302 phone#:413.778.9005 Are you en employer?Cheek the appropriate box: Type of project(required): 1.11 I am a employer with 7 4. 0 I and a general contractor and I employees(611 and/or part-thne).* have hired the sub-contractors 6. ®New construction 2.(] I en a sole proprietor or partner` listed on the attached sheet 7. 0 Remodeling ship end have no employees These sub-contractors have 8. ®Demolition Working for me in any capacity. employees and have workers' ,g Buildingaddition [No workers' comp.insurance comp.insurance.t L required.] 5. Ell We are a corporation and its 10.0 Electrical repairs or addition 3.[l I am a homeowner all work officers have exercised their 11.0 Plumbing repairs or addition► myself [No workers' comp, right of exemption per MOL 12.0 Roof repairs insurance required.]'t c. 152,§1(4),and we have no Bit Other Weatherization employees. (No workers' coin .insurance uired.) •aro eppReattintshmikshozil lout she fill out the section below allowing their wariest,'connpensatlat policy information. t listramisslie submit this ettidavitiedbethigthey are doing all work and then lire outside contractors must aubwit a new arltdavitindicatingsuch, t_eel_eeleirlZdinkddehen Brut Malin edditionel sheet showing the sane off the nth-contractors and state whether or not those entities have .L zeksalbemesion irraeatg6deeb der must provide their workers'comnemummemmernmasanamaaw, p.policy number. a rue ots employer then iprtrol wbin ntr'compensation humane.jar a,em aim s. k the pally NNW Tiro h+ellsoame Compaq Nome:Selective lneunmen Company hayloft 5114bes,Lie.#;WC9057270 Expiradon i 10VZ0/2023 Job Site Addresk DA _ City/Statal72 `�( '1(' Acids aim of the workers'compensation policy deeiaratlon page(showing the policy number end minas dais) Failure to Immo coverage as required under Section 2SA of MOL e. 152 can lead to the imposition of criminal perlddes a!s fine up to$1,500.00 and/or one-year imprieormmaut,as well as civil penalties in the form of a STOP WORE ORDER and a fine of up to S250.00 a day against the violator. Be advised that a Dopy of this statement maybe forwarded to the Office of Investigations of the DIA for issuance ooysm a verification. Ido node the and p slider efperjury that the iafr,m on prosided ales.Is owe andaorread . .....Alats.../.447Z Vbani h 413-775 S008 I use en(µ -Da not write in t co wee,to be api by�or town o ciaL City snow, Penult/Wow 4 lodes Aud q►(e one)t lLOBoarrd d 1116 8l.....uo--- . • ACo D® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ‘i.../- 08/03/2023 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 CONE:CONTACT Adina Edgett,CISR Alera Group,Inc. PHONE (413)586-0111 FAX (413)586-6481 AIC,No,Eat): (A/C,No): Webber&Grinnell Division ADDRIesS: aedgett@webberandgrinnell.com 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC# 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: t 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 ADDCSUBR - LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF PM/DDI EXP (MMIDDIYYYY) {MM1DDlYYYYL LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE !X�OCCUR DAMAGE rOl1ENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 A S2289042 08/04/2023 08/04/2024 PERSONAL&ADV INJURY $ 1,000,000 G'E�N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n Mr n LOC PRODUCTS-COMP/OP AGO § 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 - (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED A9105300 08/04/2023 08/04/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED �/ 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.MAOE S2289042 08/04/2023 08/04/2024 AGGREGATE $ 2,000,000 DED I 1 RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,000 C OFFICER/MEMBER EXCLUDED? n N/A WC9057270 10/20/2022 10/20/2023 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!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 I 'k//.4«..,� `� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD COMMONWEALTH OF MASSACHUSETTS DEBRIS DISPOSAL AFFIDAVIT Town of , Massachusetts IN ACCORDANCE WITH THE PROVISIONS OF MGL Chapter 40, Section 54, A CONDITION OF BUILDING PERMIT NUMBER IS THAT THE DEBRIS RESULTING FROM THIS WORK SHALL BE DISPOSED OF IN A PROPERLY LICENSED SOLID WASTE DISPOSAL FACILITY AS DEFINED BY MGL Chapter 111, Section 150A. DISPOSAL/DUMPSTER FIRM K.)&s ,\ h `'\-`', o9A A `(-)41rAn,eke M - CONSTRUCTION SITE ADDRESS ) t L SIGNATURE OF PERMIT APPLICANT DATE City of Northampton ...., .5... e Massachusetts ..V. .* , DEPARTMENT OF BUILDING INSI,ECTIO?4TS 212 Main Street vo Municipal Building /tv a, Ncrthraiiten, MA 01060 , ():- L-1 '.k \ Property Address _ Contractor Name .,„, otill) , ,....-,..t,,._''' „...,-,.;„, 1 ., Le , z:(:(___, A I Y l 0' / Address: City, State: ._... LP5o1(,\(.-1 vVti,*-7)V1 r /Ail,/4--, C) t 0---f-7 Phone: Property Owner Name: Address: 2.7-4' t.\.)( -'- j\ '::-;+ City, State: '' ' -..C) C'.•) '..-)C-.) t -- ---7.--, 2 "I— I, 1 ,7 7.4't." A/`?".Z•i,„,) .7,1,',,--1 (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I hay( provided the property owner with a copy of this affkiavit., Contractor signature /// ,Zi i , ,'7 V--1 , (..' ` /(.71,/ + , // Date / // , // / / / . . , . . . .. .