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23D-164 (3) 17 MAPLEWOOD TER BP-2017-1053 GIS s: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D- 164 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c1144/2�A) Category: INSULATION BUILDING PERMIT Permit# BP-2017-1053 Protect JS-2017-001809 Est.Cost: S2320.00 Fee: S6 .00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BRYAN HOBBS 83982 Lot Size(sq. It): 24001.56 Owner: SILVER JOSHUA M &NUN IA T MAFI Zoning:URB(100)/ Applicant: BRYAN HOBBS AT: 117 MAPLEWOOD TER Applicant Address: Phone: Insurance: 346 CONWAY ST (413)775-9006 WC GREENFIELDMA01301 ISSUED ON:3/22/20170:00:00 TO PERFORM THE FOLLOWING WORK:AIR SEALING, WEATHER STRIPPING ATTIC INSULATION, R-22, R-19, VENT FANS 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 3/22/2017 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck- Building Commissioner Fite#BP-2017-1053 APPLICANT/CONTACT PERSON BRYAN HOBBS ADDRESS/PHONE 346 CONWAY ST GREENFIELD (413)775-9006 PROPERTY LOCATION 117 MAPLEWOOD TER MAP 23D PARCEL 164 001 ZONE URB(l00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Paid Fee dai � P idg Permit Filled out Fee Paid Typed Construction: AIR SEALING. WEATH R STRIPPI G ATTIC INSULATION R-22 R-19 VENT FANS 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 INFORMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR_ _ Special Permit With Site Pian Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § _ Finding Special Perms 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 Dergolition Delay Signet ofBuilding 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 40k Contact Office of Planning& Development for more information. Dopwbiient use only City of Northampton Status of Penna: # Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability r7 et/ Room1D0 WaerWelAvailabilty Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify \ ,- APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING s SECTION 1 •SITE INFORMATION 7.1 Property Address: This section to be completed by office k 11 ,uckp\Q,wcna TQ-'RR Map Lot Unit „nce, tuts 01d02' ZoneOverlay District Elm St District Ca District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 3c,:s- S;Autfs i17- Mc,Q1t u orA TeRR . Name(Print) {A,��\ Current Mailing Address: ?7.69 J \.Z-G.+.,k'iL'3('' Telephone qis - ;2,43 - y Signature 2.2 Authorized Aaent; Sryufl 6c4os 3 % Conway S4eea i-te4tt, M Name(Pfintk.- Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Onty completed by permit applicant - 1, Building a 3 at) (a)Building Permit Fee - 2. Electrical (b)Estimated Total Cost at __ Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) cv 6. Fire Protection 6. Total=(1 +2+3+4+5) S a90 — Check Number a{_p rj�} This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING AR Information Mug Be Completed. Permit Can Se Denied Due To Incomplete Information Required by Zon This column to fitednig in by DepartmentBadding 1.11.11111111111.1111111 1111.1111111 Setbacks Front Side 12 Si__ Btu Bldg.Square Footage _111111a_- Open Ooen Space Footage 1111111111.111.11 minus bldg&paved kin: 111.11111111111.1111111111111111.11111111111.11.11 A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO (J DONT KNOW 0 YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW ( YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 , Date Issued: C. Do any signs exist on the property? YES ® NO tii IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO , IF YES, describe size, type and location: E. Will the construction activity disturb(Veering,grading,exe¢vation,or filling)over 1 acre or is it part of a common plan that will disturb over I acre? YES 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ..CTI•. .- ! . z -7 ON •F --!-'- ! 1 t re kill :.. i .... =) New House Addition ❑ Replacement Windows Alteration(s) El Roofing C Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ Now Signs [C3 Decks ;p Siding[ID) Other u Brief Description of Proposed Vim} n5 Work: C?af Szcs..Ve5, U32.1a X' tnsiAl .A-tiSn, -•L? yR-9/ Alteration of existing bedroom Yes X No Adding new bedroom Yes N9, Attached Narrative Renovating unfinished basement Yes X No • Plans Attached Roll •Sheet es. 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 EV Yqq\_ c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensi• s a Number of stories? f. Method of heating? Firepla•-. or WoodstovesNumber of each g. Energy Conservation Compliance. I assoheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? es No. Is construction within 100 yr. floodplain„ Yes�No j. Depth of basement or cellar floor below ' fished grade K. Will building conform to the Build, g and Zoning regulations? Yes No iI. Septic Tank City Sewer Private welt City water Supply SECTION 7a-OWNER AUTHORIZATION•TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. O S \UQ S i l 0e2-- — as Owner of the subject property �\ ( 42-54 ) .a hereby authorize '�l I'\/yr 1 C41\AS T`5Qcr oc\Q\\nc\ to act on my beh)alf, in all ��\matterrr,s��relat to work authorized by this building permit application. b signature of Owner Date , Y Q(1 - C ♦' t) ..t as Owner/Authorized Agent hereby declare that the statements and information on the foregoing applicaao are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of,-perjury. RC\JoS I T1C3040 Punt Name .1)..,,-, e --- 1 h•i`� Signature of OwnertAgent Date SECTION 8-CONSTRUCTION SERVICES .1Li.= • or tr.. • r ,<- i:.r: Not Appli�ccraable/(❑ Name o(Lleanw NOWer:, ,,,_ 0. 83gg Bryant Holt n RemodelingLicense Number 340 `,don'St. S Address eternal ,' "'+• • Expiration Date OO Slj rt Telephone . ... • u' up „n C.n. Not Applicable 0 _ - 3a 5'. Comoanv Nam. St. Registration Number Cfir. c '.:;Lint ^j /( '; Address Expiration ate _Telephone I^ ' ! cl a- SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G.L.c. 152,§250(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit win result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ 21. - 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 thg owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Hermitian of Homeowner: Person is)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"shalt 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 building 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 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: 111 /WI()\k uiCKY,1 Ttr r- The debris will be transported by: NSA — The debris will be received by: kJ/A. Building permit number: Name of Permit Applicant C3 -kAr6Iii/a-' Date Signature of Permit Applicant City of Northampton Massachusetts h. e (�tip ') wDEPARTMENT OF BUILDING INSPECTIONS ti If•2t2 Wan Street • SunidP•1 Building 1j 0? e -�„1VV/�.. Northampton, 1N 01060 • 1 Property Address: I I -7 Map\Q u io S Tex r. Contractor I (('',, 1 Name: �V'�/Qr. h1 - s Ce rrnr7 Qli nc\ Address: , ,Hh Cc ou_nY Si- , City, State: C-1 ?rC-1 dCIr t.A i 0,301 Phone: q13 -`t -75 - 900(o 4o Property Owner 1 Name: LV Il /t42 Address: `Z 41\A0,0@ @ VUOGC- -Mr 1, City,-State: "7-r- (3'6- \ � �(3Q ce_1• IA I, r f �dri rs (contractor) attest and affirm that the building I intend to insulate dries not have any 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, Contractor signature zz ,,,, ja Date - IL 1 -q- RISE60 Shawmut Road, Unit 21 Canton,MA 020211339-502-6335 ENGINEERING www.RlSEengineering.com OWNER AUTHORIZATION FORM I. To5au4- S.'?L-1/ _ (Owners Name) owner of the property located at: !i Nkl6' cU .6 77--fi/ dz_ (Property Address) • U / ° 4- (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. The Permit will be secured by the insulation contractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. Owne ignature 1 - l �l ' f Date 6.2016 The Commonwealth of Massachusetts I"f_' ift Department of Indubtrial Accidents !i =ter- 5 1 Congress Street,Suite 100 kine e a��RS Boston,MA 02114-1017 www"mass.gav/iia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Inforivation ��_" �� Please Print Legibly Business(Organization Name: 13f y), )4O.I ��L15 RerviOCIe\Inn Address: 33j'Li (p Conucx.y 6 l City/State/Zip: 'vte� ytci ei`i y Mt A Phone#: "�3 ---11 5 "qQ 1C7 Are you an employer?Check the appropriate box: Business Type(required): 1.[cs( I am a employer with (p employees(full and/ 5. Q Retail or part-time).* 6. E Restaurant/Bar/Eating Establishment 2.0 I am a sole proprietor or partnership and have no 7, 0 Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. (No workers'comp.insurance required] o. El Non-profit 3. We are a corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c, 152,§1(4),and we have 10.0 Manufacturing no employees. [No workers'camp.insurance required)** 11.0Health Care 4.0 We are a non-profit organization,staffed by volunteers, ' with no employees. [No workers'comp.insurance req.) 12.?4 Other £C , .kit • a 'Any applicant that checks box al must also fin out the section below showing their workercompensation policy information. "If the corporate officers have exempted themselves,but corporation has other employees,a workers'compensation policy is required and such an organization should check box k 1. l am an employer shafts providing workers'^ compensation insurance for my employees. Below is the policy information. Insurance Company Name: C\YY? uo..t 'r- Urn c C Q C o . Insurer's Addre :: /() . „ A (4 I. '. L S Y C _ City/State/Zip: t Q. 4'x(yx 1 .—_ r s[ . .j A _._.._ } Policy#or Self-ins.Lie.# .. .. a � Expiration Date:, 5 U j t�01—L Attach a copy of the workers'compensation policy declaration page(showing the policy number and expi ation 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 es 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 ce ,under the pains and enalties of perjury that the information provided above is true and correct Signature: 1 l\l/I-1 1.t.4, C)(i„//J,�C.. Date: ? - t Phone 4: y "ri 5 - 900 Za Official 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4,Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.nass.gov/ala tIo Massachusetts Department of Public Safety • Board of Building Regulations and Standards License: CS-083983 constconstiticiton Gu!z;visor BRYAN G HOBBS ' 346 CONWAY STREET (*.:.) GREENFIELD MA 01301 1r ine-an CA.-.:. Expiration: Comnnmissioner 05/0212015 13 (7).°27e a»emoiewerrltf a/c 4' edic-ckeiett J.•'‘.4.7„,-=, w Office of Consumer Affairs and Business Regulation -n-Pi 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 139564 Type: DBA Expiration: 7/23/2017 Tre 267354 BRYAN G. HOBBS REMODELING BRYAN HOBBS -- - — 346 CONWAY ST — — GREENFIELD, MA 01301 -------- — -- Update Address and return card.Mark reason for chap: SCAT 0 20M-05111Address J Renewal Employment "` Lost( '-i/ n,„,,„,,,,,.,w7,4 rr-/(7„.:nrkcf/L L. office of Consumer Affairs&Business Regulation License or registration valid for individul use only SOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: 't Registration: 139564 Type: Office of Consumer Affairs and Business Regulation '. 'Expiration: 7/23/2017 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 BRYAN G.Hoses REMODELING BRYAN HOBBS 346 CONWAY ST GREENFIELD,MA 01301 undersecretary Not valid without signature e ACORD 4,....--- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POL BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S), AUTHOI REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder le an ADDITIONAL INSURED,the policy{les)must be seemed, IF SUBROGATION is WAIVED,cut) the tenni end conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights certificate holder In lieu of such endorsemsnttei• PRODUCER Tracey Xukley:as A.H. Rist Insurance Agency, Inc. pp,�Np fists, (413)363-6373 ^ mm sop tal3 l 812-4664 159 Avenue A EMDedk _ P.O. Box 391 SRa°ioete°w ID 6000070be Turners Falls MA 01376 INSURER(e)APPOROINGCOVFRAGE _NI INSURED INSURER A:L berry Grou,�, _, Bryan Hobbs dba INSURER 6: - Bryan G. Hobbs Remodeling INSURBLC: — 346 Conway Street INSURER a: INSURER 6: Greene ield MA 01301 INSURER F: COVERAGES CERTIFICATE NUMBER:2017 CERT REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PI INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH CERTIFICATE MAY Be ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TI EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDpLCLAIMS. TUm AR TME OF INSURANce TER f YAM POLICY NUMBER IIMAWYYYYI IMMNDAY'1T) UMM8 DENFEA: LiAaaittIf` E{ACH OCCURREuINcCE 1,00 PRMAISES(El I}ED X commERC LGENERA.L49uTF 1 PREMISES IES Monne.)Monne.) 30 A CLAIMS.MAOE IBJ OCGJR I 34.924014828105/04/2014 8(04/2017 MED EXP{Anyene ppmm) 1 PERSONAL a ACV INJURY 1,00 — GENERAL AGGREGATE 2,00 GENA.AGGREGATE LIMIT MINES PER: ROOUCT$-COMPI,P AGO 2,00 7E000Y7(JEM LOC Ir AUtOMOBILJ LIABILITY COMBINED SINGLE UMtt $ 5,00 (SE.caaem4 �1 MY AUTO BODILY INJURY(PepsrsMI S A TALL OWNED AUTOS BA1020738 61(02/201Y 01102/2018 BODILYINJURY IPer,¢W¢no $ X SCHEDULED AUTOS pROPFRttDAUA F x XIPEO AUTOS IP',E¢NM4) _ X NCNONNED AUTOS I $ X Mau Mc/Form 4 A X UMBRELLA LIAR x OCCUR 2ACN OCCURRENCE 4 1,00t — EXCESS UAB CLAIMS-MADE CEOS6084898 08/04/201608/04/2011.AGGREGATE 4 1,004 oEDUCDBLE '� I X RETENTION 5 10,000 1 y.�( y� Y 6 WUSERS COMPENSATION a15MT.lugy IDFN. AND EMPLOYERS'LIABILITY 't MY YDEORRSTO PAETNEEXCLUDED NT VE 1'N N)A I C L.EACH ACCIDENT S (MEndIory m NN) E.L.O:SEAGE-EA EMPLOYEE 4 D6dRIP'ION CF¢PERATIQN6 pelow E.L.DISEASE-POLICY LLLST 4 OESORWIRON OF OPERATIONS 1 LOCATIONS I V EXCLEE(Math ACORO 181,A W MoneI REm,M Stf.dulq if roan owe Ie re0:840d) Clsaai£Scstiont Carpentry b Insulation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BBB THE EXPIRATION DATE THEREOF, NOTICE WILL 9E DELIVERED ACCORDANCE WITH THE POLICY PROVISIONS. Bryan Hobbs 366 Conway Street Greenfield, MA 01301 4urnauz4o aBPR6eeNTAnvE Tracey ttuklewice/OHP C` - . 47.. AG0RD26029D9D0rksRD RD CORPORATION. All right*rase 1NO (eIThe ACORD name and logo are registered maof ACO