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37-083 (14) 266 GROVE ST-UNIT 31 BP-2020-0140 GIS#: COMMONWEALTH OF MASSACHUSETTS MW:Block: 37-083 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2020-0140 Proiect# JS-2020-000234 Est.Cost: $1326.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BRYAN HOBBS 83982 Lot Size(ssq.ft.): Owner: SMALLEN ANN LOUISE Zoning: Applicant: BRYAN HOBBS AT. 266 GROVE ST - UNIT 31 Applicant Address: Phone: Insurance: PO BOX 1535 (413) 775-9006 WC GREEN FIELDMA01 301 ISSUED ON.81512019 0:00:00 TO PERFORM THE FOLLOWING WORK.INSULATIONNVEATHERIZATION ATTIC FLOOR 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 8/5/2019 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner rjtUt IV Department use only City of Northartpto of P mit: Building Dep rtme t Curb ut/D veway Permit f.- 212 Main reet QV� — 2 20 $ew r/Sep c Availability }, Room 1 0 Wat r/Wel Availability Northampton, A p F U Two ets f Structural Plans phone 413-587-1240 Fax_4.Z3s8t� 'iNsPr f�YdNSite ans MA Ot gQ �fY APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION g�-C v-/Vo 1.1 Property Address. This section to be completed by office Ju .k Lnro' L 5� Map ! Lot Unit Un 3 ` Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: 7Uu 9 Telephone Signature 2.2 Authorized Agent: (� (Pri ) Current Mailing Address: q)2.)- 11 y-9�� Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5 5. Fire Protection r 6. Total=(1 +2+3+4+5) % Check Number �/�f This Section For Official Use Only Building Permit Number: Date Issued: Signature: D-5-Zo) / Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors (] Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding [0] Other[W" Brief Description ofPro osed n Work: 1U" (_kpCin"i.) Ct c F-\tN Y, 0,1T S.[c 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. Signature of Owner Date as Owner/Authorized Agent h reby d clare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Y�o Print Name J Sitriatvre of wner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: L�Ci }�a� S ( - A a I �t-1,14 License Number ess Expiration Date Sig ature Telephone 9. Registered Home Improvement Contractor: 1 r � Not Applicable ❑ C� �d�1�L�� omNa v Name Registration Number Address -1 GLXCExpirat�n Date g Telephone /1S L 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...... ❑ Permit Authorization mass save Form Site ID: 3838021 Customer: ANNELOUISE SMALLEN "iJ,owner of the property located at: (Owner's Name,printed) 266 Grove St unit 31 Northampton, MA 01060 (Property Street Address) lcny) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: Date: l 1 FOR OFFICE USE ONLY INE have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: articipating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office U=e only Rev, 102015 '/Ct� Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC 6045 BRYAN HOBBS REMODELING,LLC. Registration: P.O.BOX 1535 Expiration: 066/25/2/25/2 021 GREENFIELD,MA 01302 Update Address and Return Card. SCA 1 t3 20M-05/17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Reolstratton Expiration Office of Consumer Affairs and Business Regulation 196045 06/25/2021 1000 Washington Street -Suite 710 BRYAN HOBBS REMODELING,LLC. Boston,MA 02118 BRYAN HOBBS / 576 LEYDEN RDlw�K� GREENFIELD,MA 01301 Undersecretary Not valid without signature ®� Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-083982 Expires: 05/02/2020 BRYAN G HOBBS . PO BOX 1535 . GREENFIELD MA 01302 Commissioner " The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www,mass,gov/die Wohkers' Compensation Insurance AMCME1 BUlldere/Contractors/EIec>r(cta s/,Plumbers. TO BE FILED WITH THE PEIMITTING AUTHORITY, Applicant Information Please Print Leei-bly Name (Business/Organization/Individual): Bryan Hobbs Remodeling LLC Address; PO Box 1535 City/State/Zip: Greenfield, MA 01302 Phone 0: 413-775.9006 Are you an employer?Check the appropriate box; I.Q I am a amployor with 7 emType ofroject (required):ployees(full and/or part•time),° 2.❑I am a sole proprietor or partnership and have no employees working for mo in 7. ❑ Nw construction any capacity,(No workers'comp. insurance requiroci,1 8. ❑ R modeling 371 am a homeowner doing all work myself [No workers'comp insurance required 19• ❑D molition 4❑I am a homeowner and will be hiring contractors to conduct all work on my propvm, 1 will 10 ❑ 13 ilding addition ensure that all contractors either have workers'compensation insurance or are sole 1 1. El ctt'ical repairs or additions proprietors with no employees. 5.r7 lam a general contractor and I have hired the subcontractors listed on the attachod oheet, 12•:]P1 robing repairs or additions These subcontractors have employees and have workers'comp insurance. 13.❑R of repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c, 14,(Z 0 her WeathditatlOn 152,x11(4),and we have no employees.[No workers'comp.insurance required I Any applicant that checks box#1 must also fill out the section below show ng their workers'cuntpensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a rcW affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whethel or not those entities have employem 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 i.�Me policy andJob site Information. Insurance Company Name; Selective Insurance Co, Policy#or Self-ins.Lic,#; WC9087270 10/20/2019 ---- Expiration Date; Job Site Address:_ � Glp (�n5 x c� l _7�i City/State/Zip; Attach a copy of the workers' compensation policy declaration page(showing the policy num er and expiration date), Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable b 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 an a fine of up to$250.00 a day against the violator,A copy of this statement may be forwarded to the Office of In covorvestigations f the DIA for insurance a a verification, do hereby undxr the pains and penalties ofperlur)'that the information provided above!si true and correct. l Phone 413-775-9606 Date' Ofykial use only. Do not write in this area, to be completed by city cr town offlcial, �r City or Town: Permit/License Issuing Authority(circle one), — L Board of Health 2.Building Department 3. City/Town Clerk 4, Electrical Inspector S, }dumbing Inspector 6.Other Contact PerRnn! ACOOR"® CERTIFICATE OF LIABILITY INSURANCEDA7, ( ) 18/20 9 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 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 NAME: Adana Edgett Webber & Grinnell PHONErxtj (413)586-0111 A� Ne: (113)566-6481 B North King Street E-MAIL ADDRESS: aedgett@webberandgrinnell.com ett@webberand rinnell.com INSURERS AFFORDING COVERAGE NAIC N 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:Selective Ins Co of Southeast 39926 PO Box 1535 INSURER D INSURER E: Greenfield MA 01302 INSURER F: COVERAGES CERTIFICATE NUMBER:Exp 10/19 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. I T R TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A CLAIMS-MADE X OCCUR PRE a occurrence) $ 500,00C S2289042 9/4/2019 8/41/2020 MED EXP(Any oneperson) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY D JELO2,000,000T OTHER $ AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT $ 1,000,000 B ANYAUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED A9105300 8/4/2019 8/4/2020 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS P $ I Underinsured motorist BI split limit $ 20,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATIONX PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 N/A OFFICERIMEMBER EXCLUDED? Y❑ C (Mandatory in NH) WC9057270 10/20/2018 10/20/2019 E.L.DISEASE-EA EMPLOYEE $ 500 00C If yes,describe under DESCRIPTION OF OPERATIONS below Bryan Hobbs is Excluded E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I 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 W Grinnell, CPCU, CIC C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) City of Northampton Massachusetts ��. DEPARTMENT OF BUILDING INSPECTIONS `^ 212 Main Street •Municipal Building �\ Northampton, MA 01060 ssrh T��^`` Debris 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. The debris from construction work being performed at: (Please print house number and street name) Is to be disposed of at: Q� Sle X\ �C Q/ 4L t (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 'i CM 11-Lkn Sign ure of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed.