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25C-214 (5) City of Northampton Massachusetts { yS DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street a Municipal Building Northampton, MA 01060 371 Property Address: �� /J U f T Y r r� Contractor Name: Bryan G.Hobbs Remodeling Address: 24.6 GenwRYSt Greenfield,MA 01301. City, State: Phone: Property Owners Name: f5 yt cz.-i <i (% / l.el r;/t'frl r'3 Y-"< �; Address: 5- Ill City, State: i4 O 1' V C-1-vi r4 o Ya M ;ef!� D �, 0 I, P�r`_1 Aj v lT�-j (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 l have provided the property owner with a copy of this affidavit. Contractor signature 11 n � / y X11 t Date 71t City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A, Address of the work: `(S- 1,-/o r4 Li -54 - &/0 )-,mom v*P•')l N-114 The debris will be transported by: y� ) - ��1 ` ' '`�`� l"l , The debris will be received by: Building permit number: Name of Permit Applicant 49..164 1^1-6 Hki Date Signature of Permit Applicant OWNER AUTHORIZATION FORM (owner's Name) owner of the property We Wnd at c` � 1 (Pmpedy Tmpeity Aa ) ~Ta G L Bryan G. Hobbs Remodeling 346 Conway St. Greenfield,MA 01301 hereby allthoriZe (Subwnhac" an authod and wbwntactar for RISE Engine ft to act on my behd bo obtain a bui<ding permit and to perform work on my pmpMy. qWnees Signatm Deft The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street kip Boston,MA 02111 www.massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Busnessrorpnization/ln&vidual): Bryan G. Hobbs Remodeling Conway St. Address: Greenfield,MA 01301 City/State/Zip: . I: Phone#:211 Are you an employer?Check the appropriate boa: Type of project(required): LXJ I am a employer with _ 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 t ?• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical airs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. (No workers' comp.insurance required.] 13.O Other 05%_! 4 i r� •Any applicant that checks box#I must also fill out the section below showing them workers'cgn4=sation policy inforrmtion: t Homeowners who subunit this affidavit indicating they are doing all work and then bire outside contractors must subunit a new affidavit indicating such :Contractors that check this box nrust attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees, Below is the pollcp and job site information. Insurance Company Name: M i -- Policy#or Self-ins.Lic.#: 1 . L! — Expiration `� xpiration Date: 1 �� 1'6 Job Site Address: 7 5 tJO rot-i Ae f{4 City/State/Zip:6, 141 n r-Z,"f 41z, fV1 14 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 m$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. S' a e: N4 X Date: 1 i .� Phone#. A)— r7_e7_5 0 0( Q,Q'u:ial use only. Do not write in this area,to be completed by city or town official: City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#• SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: o8_; g R 2- ryas Hobbs Hemodeling License Number 346 Conway St. Greenfield MA 01301 5-12- 116 Address Expiration Date Signature Telephone 9 Restistered Home Improvement Contractor: Not Applicable ❑ 3,7 s�:4 Company Name 346 Conway St. Registration Number Greenfield,MA 01301 -7 12-3 / 1] Address Expiration Date Telephone SECTION 10-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...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildiniz permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors E] Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [❑ Siding [❑] Other[ Brief Description of Propos d r Work: V1/tc�fiL►Cr'12 (G, — (2-416 /l�lS'tsf %flC:�t Ct((c'/JfC Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _No Plans Attached Roll -Sheet sa.If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS 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. ,�G-_e6 C-- gC�e d Signature of Owner Date I. S Y(4/."cam 0 6 k: Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be tilled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DON'T KNOW YES C) IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. - !` Department use only „ r, �`=- "�City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability I Room 100 Water/Well Availability ;— orthampton, MA 01060 Two Sets of Structural Plans ;pfyone 4 3-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office �v f4 C r { t Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: 0 Z73 n Signature Telephone 2�2'( CJ Eli 2.2 Authorized Aaent: Bryan G. Hobbs Remodeling 91L'&� "C I?I ! 346 Conway St. z Na �t3 Greenfield.MA o13nI me(P�nt) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building Z t - (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) 1 'y- 1 2— (� Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2016-0794 APPLICANT/CONTACT PERSON BRYAN HOBBS ADDRESS/PHONE 346 CONWAY ST GREENFIELD01301 (413)775-9006 PROPERTY LOCATION 45 NORTH ST MAP 25C PARCEL 214 001 ZONE URC(101) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INSTALL ATTIC INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 83982 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management D lay Signa e of Buildi g Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. 45 NORTH ST BP-2016-0794 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C-214 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2016-0794 Project# JS-2016-001337 Est. Cost: $3213.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BRYAN HOBBS 83982 Lot Size(sq. ft.): 9975.24 Owner: LEGG BRIAN Zoning: URC(101)/ Applicant: BRYAN HOBBS AT. 45 NORTH ST Applicant Address: Phone: Insurance: 346 CONWAY ST (413) 775-9006 WC GREENFIELDMA01301 ISSUED ON.1211712015 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL ATTIC INSULATION 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 12/17/2015 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner