25C-217 (4) 36-38 WALNUT ST BP-2019-1361
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Map-.-Block:25C-217 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-2019-1361
Proiect# JS-2019-002191
Est.Cost:$1517.00
Fee,$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Groum BRYAN HOBBS 83982
Lot Size(sa. ft.): 6272.64 Owner: WEISS BEN
Zoning: URCG08y Applicant. BRYAN HOBBS
AT. 36 - 38 WALNUT ST
Applicant Address: Phone: Insurance:
PO BOX 1535 (413)775-9006 WC
GREENFIELDMA01301 ISSUED ON:5/30/2019 0:00:00
TO PERFORM THE FOLLOWING WORK INSULATE BASEMENT SILLS, CRAWL SPACE,
ATTIC ACCESS, AIR SEALING
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 Rush
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 Stimulate:
FeeType: Date Paid: Amount:
Building 5/30/20190:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
�3.7-le1v
EQE \ ( _ Department use only
City Of NOrtamp ClJ V g s of Kermit:
.r Building De artm nt curb Cuu dveway Permit
212 Main tre MAY 2 9 7019 Sewer/Se tic Availability
ROOM 00 Water/Ydll Availability
\ Northampton, A 060 -g Sets of Structural Plans
phone 413-587-1240qq
axWV- WM1272 Idt/Site sans
o Hn mt
.. OtherSp city_
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONNE)r
E OR TWO FAMILY DWELLING
MATION
SECTION 7 -SITE INFOR8 pv I t`
7.1 Properly Address: This section to be completed by office
z,kO A 36 Wikt-Nv, yr Map .2 Lot a/7 Unit
Zone Overiay District
Elm St.District CB Drama
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
��_`p�2t5S Sl
Name(Print) Currem flingtires-: p
r1i Ll?f' � S— fo(8r
Telephone
Signature
2.2 Authorized Agent,
F,," Cu- (? Awc IS3f 6n"o. H-.--
Na/mLd(\Pr�i t) 1 1 Current Mailing Address:
4 -4401, "u, —
Si re Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bpermit applicant
1. Building I (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 8
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
_ 5.Fire Protection
6. Total=(1 +2+3+4+5) S Check Number /
This Section For Official Use Only
Date
Building Permit Num r: Issued:
Signature: 5-29.2019
Building Commissioner/inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK Icheck all applicable)
New House ❑ Addition ❑ rRepiacement Windows ANerNionis) Roofing ❑
rsAaessory Bltlg. ❑ Demolition ❑ igns i[I] Decks [q ,,,=g[E3] Other[gg].
Brief Description of Proposed
Work:�yapAe 4-+-e�.....1.<.1\t fir:+:.\� Y+L r.Vr' CU'eja a+r Sen Ln�.
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
a. Number of stories?
I. Method of healing? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
In. 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 CitySewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS 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.
Signature of Owner , ` Date
I, fll(](1 }')t}I^1'1 S ,as Owner/Authorized
Agent hereby d are that the statements and information on the foregoing application are We and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
�rVm � }�ahhs
Print
�i('v\ h� �I2t1 �I4
Signature M O.me enl Dale
SECTIONS•CONSTRUCTION SERVICES
9.1 Licensed Construction Supervisor:, 1 j NotApplicable
Cb�le 13
Name of License Holder: ronQ) "
A. i CS V 6 s - 59 6
License Number
►off k ►S3� C`vt a3/11ia leD
Ne X130? S 4170
LAtltl ss Expiration Dale
l-4obh� -nt aac,�
Si ture Telephone
9.R Registered Home1Improvement Contractor. Not Applicable ❑
r �ru1k1 I�bbi 0Q1Y_14j-1Ln4. � � . )395(014
mpa ame Registration Number
G7�. �oc IS3� `�-�aa-� ►9
dress Expiration Date
rn�9on�T91oD. � OIC
Telephone�llr 9Q�b
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,§25C(li
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 me buil g permit.
Signed Affidavit Attached Yes....... No.__. ❑
I
RISE
ENGINEERING
OWNER AUTHORIZATION FORM
1, Ben Weiss
(Owner's Name)
owner of the property located at:
' tM Walnut Street
(Property Address)
Northampton, MA 01060
(Property Address)
hereby authorizeYUCK b�hS Pp AYIajaw
(Sub nt.ctor)
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.
Owne $Siy ature
Date
RISE Engineering,a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 1 Canton, MA 02021 1 339-502-6335
www.RISEengineering.com
T
OOmmonwukh osMuleenu.dr
Division of pro1e6113/1 ImN
IUro
Board of Dundmg sill I Intl atandems
Conit(UCIIOn elpervllor
C9 0E3B81 Expires:*0212020
BRYAN 0 XOBBB r r'
PO BOX 1636
GREENFIELD MA 01302
Commissioner
rZ
Office of Consumer Affairs and Business Regulation
10 Park Plaza• Su to 5170
Boeton, Masuchusa to 0411 e
Home Improvement Contractor Registration
Type: mmvldual
BRYAN NOBBB Rep14tratlon: 130884
O/B/A BRYAN HOBBS RBMODELINO G1�Iratlon: 07/78/001•
$46CONWAY ST
GREENFIELD.MA 01801
Upsets Address and return end. Mark uson 10,ohangs.
L7 Add—* M.0tener" C3.2at0oymact Z.L,,l m,d.
dnaof
HOME
IMPROVEMENT
MPROVEMMNT CCOONNTTRRApbu0lnRlen
Registration10Ytlldler Indivdes. If found
only
TYPE:IntlMoud b4tomOnto of consumer dete. and Bu messrituirto:
07�i o0 park Mall-lUlts 311t710 end Business Regulation
HOBBS Boston,MA 02111
IYAN HOBBS REMODELING
I.HOBBS c4i;
NAY 3T
EL.,.- 013x1 undwasar"ry Net Valld without elgnature
The Commonwealth of Massachusetts
Department of Industrial Accidents
91�avkersl
1 Congress Street,Suite 100
Boston,MA 01114-2011
www.mass.gowidia
Compensation Insurance AIfldBvltl Bullaera(Contractors/Electricians/Plumbers,
TO BE FILED WITH THE PERMITTING AVTHORITY-
AtinilearatInformation Please Print Lesihly
Name (BusineeerorganivatioMndNiduall: Bryan Hobbs Ralmodeling LLC
Address: PO Box 1535
City/State/Zip: Greenfield, MA 01302 Phone#: 413-775.9006
Are yw as employer?Cheek the appropriate box: Type of project(required):
I.Q l an,a emptoyor with 7 mnployees(full and/or Wmtimel' 7. ❑New construction
2.❑I un a Sale proprietor or partnership and have w emDloyeaa working for me in S. Remodeling
my capacity,Mo workers'comp.insurance required.]
9. ❑Demolition
3.01 am a homeowner doing all work myself[No women'comp inswence required!'
10 Building addition
4.❑ewaMmwwner and will be hiring comractorsroconductall wnkon ca t,Boll trill
smuts thuaa coruactorseither Mve wnrkeri compamatian wutamr orae sou 11.0 Electrical repairs or additional
proprietors with no employers. 12.❑Plumbing repairs or additions
SO Inst a game]connector and l have hind the sub•contnctom listed on the attached sheet.
These sub•wntramom have employees and have workers'comp.insurance.: 13.�Roof repairs
d.QWe are(wand we h are its officers have oexercisedworkin amt right of exemption per MEL c.
1CMOther waetherizetion
152,01(4).and we have no employees.(No worker'comp.buwarae rpulndJ
'My appllunt mu ekeks box al mutt elan fill cut the uchis,below showing their workers'compensation policy iMotmation.
t Homwwnua Sano submit this affidavit indicating they us doing dl work and that hire outside aonm ium,must submit a raw of davit indicating such,
tConeaero s that check this box must attached anadditional sheet showing the Sane of the wb•connwmrs and nate whether or not those entities have
employees. If the eubconuaewra have employees,they must provide their workeri comp,policy number.
lam an employerthal Isproviding workers'compensation insurancefor my employees. Below is Neepolicy andjob site
informndan.
I.e."Company Name: Selective Insurance Co.
Policy#or Self-ins.Lid.#: WC9057270 Expiration Date: 10/2012019 1 1
Job Site Address: j(�,•-S( �:ha� K.} City/State/Zip: nnrl�p�pl.r.. f-1r OI Q1.0 O
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance
coverage verification.
I do hereby'certify under the pales and penanlas ofperjury rlmt the information provided above is true and correct.
Signature' !,44th "6LXZI Date' S)7-Li
Phone 0. 413-775-9608
OJ,pcial use only. Do not write In this area,to be completed by city or town offidal
City or Town: Permit/Llcense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CitioTown Clerk 4.Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person; Phone#:
ACOR& CERTIFICATE OF LIABILITY INSURANCE M elNYmomml
OT06@010
THIN CERTIFICATE IS ISSUED ABA MATrER61"11,111116KNIATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIPIWR HOLDER,THIS
CERTIFICATE DOES NOTAFFIRMATIVELY OR NEOATIVELYAMENO,EYTIND CRAVER THE COVERAGE AFFORDED SY THS POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS),AUTHORIlED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
ANT R the 66REIute holder Is in ADDITIONAL ID,the pa oyI of mUSI hive ADDITICNAL IMAUKED provlslou or be endomd.
If SUBROGATION IS WANED,subject to the terms and conditions of the polity,eeRAin policies may N991re In enDOMement A shtem9nt On
thio Certificate does not corder rights to the certMkats holder In IISU 0f sdeh end marrunt s,
MOM= NAN.: Adins Edods
WNbber 6 OdmRe , (41))660-0111 (All)504"1
B Nod,HEO SUM A, R "09$RvaFOGnndamme.Dom
wR CAVaIYo MNIY
rvW1MmDbn MA 01080 mum, 9neWnim CO OrB Cerollm
NBUNIO IH RNR,: BENC6VE Ina GOWN11lNW 12572
Bryan Hobbs ROmodwng,LLC INSURER c: S"W"Ins Co Of SOVmesat 60026
148 Conway Man INSURVI01
NIURSAU
OreanOald MA Oil 1-1615 1
F,
:OVERAGES CERTIPICATI NUMBER-- EXP Wig RIVIEION NUMBER-
THIS MTO CERTIFY TMATTHE POLICIES OF INSURANCE LISTED BELOW HAVE OEM ISSUED TO THE INSURED NAM60 ABOVE FOR THEPOMY PERIOD
INDICATED. NCTVRIIBTANOINO ANY RCOUIRIMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH REBPICT TO WHICH THIS
CERTIRCATE MAY BEUMMWYPERTAIN.THE INeURANCEAFFORDEDWTHEPOLICIESDBSCAMEO HEREIN ISWWECTMO THETEAMS,
EXCWMONS AND COMMON$OF SUCH POLICIES.LIMITS SHOWN MAY HAV!SEEN REDUCES BY PAID CWMS.
was OF INSURANCE PDNDY Me R 11.71- UMITI
=.MMCALOWWLWE MX=WERitNu 1,ca0•D00
LWM61M0[ ®OCCUR s000k
MID EV A pxn 165
1 =90042 OSM4001e MVOM2019 A A I V 1,000.000
AOOPEWreuµNITpMy��FeR OpnULA Ta 1 3,000,00D
Pp,CY JFCT L.J KC PR TS.COM I,DDD,000
OiNEM
1
AUTOMMLAUJAILITY IN LE a 100DDDOD
ANYI= pp,LrIWVRY(M1rpF,un) s
A0RMOCHLY eC,le01XJ0 AS10l6ca OMOIIt010 0810412MO eWILY IfWRY1PRAmM4nd e
Km
UndennwrM mobrNl Sl a 20,Oca
uYWuwuu W �OOR MW 'RAwca 1.000,000
sxensLiu
�.SMAOIII 00210042 DSMQO'S 0agM2010 ME 4,000.000
D
NWNW CWFEt1MTQV
AM aMFLDYBIILW,YTY ,
MFIc6q �MBER�pLWre oemM wTM ryy NIA We"67270 Bryan Hobbs Exd, 10000010 10000010 EACH ACCs>OR w0,000
aUWtlemHwn 36ASE.E• 500,000
DE6G " F P I MAY10N LG&A6!- YWRI 00,000
COMMERCIALPROPEATY Buono 1406,004
82289042 04MI2016 OSIMOIC BPP 050,000
"TIDY OF OPBNTIONS I LOCATCNS I VEHICLES D,AGN In.ANR al R4mFM Somata ,may MrGeMC I mom Mom,IF Yeu1Ml
TIRCATE HOLDER CANCELLATION
IHOVLOANYOF THE ABOVE OWRIEEO POLIOMO BE CANCELLED BLCM
THE EEPIRITION DATE THEREOF.NOTICE WILL EE DELIVERED IN
ACCORDANCE WITH THe POLICY PROVISIONS.
AVTNOpC®RVANhOWATIVE ��/I
M- z
0/MA.9nu APnPm. ..
The Commonwealth of Massachusetts
Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR
DEBRIS REMOVAL FORM
Section 105.33.2 780 CMR, Massachusetts State Building Code stater "..... a condition of issuing
a permit for the demolition,renovation,rehabilitation,or other alteration of a building or structure,
M.G.L.Ch.40§ 54,requires that the debris resulting there from shall be disposed of in a properly
licensed said wasta disposal facility as defined by M.G.L.c.I 11, § 150 A."
Data,_rj 178\15 Permit Number 1
Job Location: Z-L 0S\Yt&
Location orFaoiary or WYk Digpul Company's Nama end Addrcas
.4M `I�ik� �p' 44,Johs
9t pain, ppu<ant pant sine