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36-325 (4) BP-2024-0263 228 CARDINAL WAY COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-325-001 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-2024-0263 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 6206 BRYAN HOBBS CS-083982 Const.Class: Exp.Date: 05/02/2024 Use Group: Owner: L RIVERS CHRISTOPHER D&JENNIFER Lot Size (sq.ft.) Zoning: WSP Applicant: BRYAN HOBBS REMODELING LLC Applicant Address Phone: Insurance: PO BOX 1535 (413)775-9006 ECC60040011332023A GREENFIELD, MA 01301 ISSUED ON: 03/12/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATI 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: Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner . I, 1---I _-_.. i ,fir 1,10 , , tt 2L1b3 .. The Commonwealth of Massihus is 2024 4" kV Board of Building Regulations a/id Sttt /FOR 7 Massachusetts State Building Coded�8d�o '{ t�itr /MU/ICIPALITY � _a�on,'��,Nsp USE Building Permit Application To Construct,Repair, Renovate rfai 11% Ns Re sed Mar 2011 One-or Two-Family Dwelling - _ „ This Section For Official Use Only Building Permit Number: 4/'dt y--q .3 Date Applied: Yeti t o //2 3-I Z ZOZy Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Prooper�t Address: 1.2 Assessors Map& Parcel Numbers as Card tr LA Wee 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: )a(c. A�ie\gbe r5 UtAlcovoin, J-ii Name(Print) City,State,ZIP 3 S e�,0 liC1 °I►%-4a.- 4ag 1 Sgadelslc-e - Co ma-2- city', No.and Street Telephone Email, ddrest SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 1 ..Specify:Wejak r 2ah' '' Brief Description of Proposed Work': ear r'cxeq el I i j 61- CoL u$, 1 " 4- )V" W O blow C�.11k1014- alit c_ CI QtL(.02 I .I1 b&senatAI- Ct,ly . l 1- 1nsula ►er, SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 16�. (� 1. Building Permit Fee: $ Indicate how fee is determined: O ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fee : (� r - Check No.��'Check Amoun 1� ' Cash Amount: 6.Total Project Cost: $ (n r1&Co t-j f 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES construction Supervisor License(CSL) D E+3q C -d 1-�LS License Number/ Expiratio D e Name of C L Holder , �VT '53V List CSL Type(see below) U No.and Street Type Description GrQQ � (� 1 n , Z U Unrestricted(Buildings up to 35,000 Cu.ft.) /1 u P I R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering I' n (� 1"_I L- WS Window and Siding "1 L•i 1 c c I n�o 1-beli n d bS-e a SF Solid Fuel Burning Appliances C J I Insulation Telephone Email address y% D Demolition 5.2 Registeredd Homeom Im rove ment Contractor(HIC) 19 (OS ac )� T LL/ HIC Registration Number Expiration Date pany Name or HIC Registrant Name 153V" 1n01bw�,hdbbsc co-via-Q. car, =et Email addre S� PA 01 413 77 ref OW.. Ssi 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 . ❑ SECTION 7a:OWNER UTHORIZATION 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 contained in this application is true and accurate to the best of my knowledge and understanding. rmt Owne 's or Authorized Agent's Name(Electronic Signature) I t_aki-__,zw___ te 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" • 40*illtt mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM 1, Sara Adelsberg owner of the property located at: (Owner's Name) 228 Cardinal Way 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. .Sara 467fetromfr Owner's Signature 02-14-2024 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Y-DA-pfx \-\1A4rA eziyunkiiy\v,, 4c1.4\4 Participating Contractor Date Document Ref:AEJQN-BCPNG-RBE61-N3CDJ Page 4 of 4 Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards CS-083982 spires:05/02/2024 BRYAN G HIBS PO BOX FtEL{Si"EU , r GREEN ,;{1AA 01302 q Commissioner Jia f,� f;. `f Fi1lLd�x, THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration Type; LLC 196045 BRYAN HOBBS REMODELING,LLC. Registration; osi25i2025 P.O.BOX 1535 Expiration; 6/2 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 Registration Expiration 1000 Washington Street-Suite 710 196045 06/25/2025 Boston,MA 02110 BRYAN HOBBSREMODELING,LLC, BRYAN HOBBS 576 LEYDEN RD 4c?.,' a01' GREENFIELD,MA 01301 Undersecretary Not valid without signature ' The Commonwealth of Massachusetts Department of Industrial Accidents 1 �� Office of Investigations zi sw\ 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): 1.0 I am a employer with 7 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 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. ❑ Building addition [No workers' comp. insurance comp. insurance.* 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' right of exemption per MGL y comp. 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no Weatherization employees. [No workers' 13.0 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. 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:AIM Mutual Policy#or Self-ins. Lic. #:ECC60040011332023A Expiration Date:1 0/20/2024 Job Site Address:aas- Ca rd in eLA W 6441 City/State/Zip:,U Q,Ylp f, 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 c ' under the pains and penalties of perjury that the information provided above is true and correct. Signature: - Date: (1 dal/ Phone#: 4n- ^n s- _ `jots, 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): 11:1Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: 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 aedgett@webberandgrinnell.com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIL# Northampton MA 01060 INSURERA: Selective Ins Co of S Carolina 19259 INSURED INSURER B: Selective Ins Co of America 12572 Bryan Hobbs Remodeling,LLC INSURER C: AIM Mutual PO Box 1535 INSURER D: Evanston/XS Brokers 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) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE n OCCUR DAMAGE TO RENTED 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 2 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ,000,000 POLICY PRO I )LOC PRODUCTS-COMP/OP AGG $ 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 $ AUTOS ONLY X er accent)AUTOS X HIR �/ N -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 08/04/2023 08/04/2024 AGGREGATE $ 2,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER OTH PEATUTE ER AND EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1000 000 OFFICER/MEMBER EXCLUDED? n N/A ECC60040011332023A 10/20/2023 10/20/2024 (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 Pollution D CPLMOL121333 01/19/2024 01/19/2025 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 0 04-v 25.. :..SICK A Massachusetts a�:•� 1 et G wl 111111 I DEPARTMENT OF BUILDING INSPECTIONS ;. he St 1{ 212 Main Street • Municipal Building Js;•., Northampton, MA 01060 sSj ... 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: O` c � Q� 1 � ���nncn, The debris will be transported by: Name of Hauler: Signature of Applicant: \-Uo\O- Date: 6t(10.0.,