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36-152 (4) BP-2021-2209 32 WOODS RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-152-001 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-2021-2209 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 3281 BRYAN HOBBS REMODELING LLC 83982 Const.Class: Exp.Date:05/02/2022 DONNELLY WILLIAM M &L ANN & ANDREW Use Group: Owner: DONNELLY TRUSTEE Lot Size (sq.ft.) Zoning: SR/URA Applicant: BRYAN HOBBS REMODELING LLC Applicant Address Phone: Insurance: PO BOX 1535 (413)775-9006 WC90572270 GREENFIELD, MA 01301 ISSUED ON:11/29/2021 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION 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. Signature:g G,,etil f 1 • Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner • / V / V/ The Commonwealth of Massaause 8 -Q F Board of Building Regulations and'Standa'reD,s.� �� , UNI PALITY Massachusetts State Building Code, 780'C k'/o SE t�nT�r in Building Permit Application To Construct, Repair, Renovate Or lib . Revi ed Mar 2011 One-or Two-Family Dwelling 1060°41s This Section For Official Use Only Buildinga., Permit Number: S -Z I-� � Date Applied: // 1,..z1.„z, Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 11 ropte rt;Address: 1.2 Assessors Map&Parcel Numbers 1.1a 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 Recor t on Ani'l ame(Print) City,State,ZIP 3- We .x1 ►z 4) y13--5ma- M1ots No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units OthereQ_Specify:Li ( '1,P,(12 cr% Brief Description of Proposed Work: �r J, 9" n biota) ( i 1<j - aik Cl cor, '' k � 1,� Ct1�t�dl,�Kak J Ss�i Z" p SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ 3 3bi i b"4.. 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:S Check No.)1441 Check Amount: LA6. Cash Amount: 6.Total Project Cost: $ ] ts 1. �� 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 06 3p t �a tyvao I" g License Numberi Expiration ate Name or CSL Holder eFLn 1 Jc- List CSL Type(see below) U No.and treet Type Description U Unrestricted(Buildings up to 35,000 Cu.ft.) Ma R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances (413-11 c 90:31a tnRlbrgon, 16L.Q I Insulation Telephone Email addressg.tryvAc4ry, D Demolition Registered Home Improvtpaent ContractoilH10 Mal C to)Ala3 t L.J�J� HIC Registration Number Expiration Date Company Name or HIC Registrant Name 16�x 1535.-- ir&lbr ,,hdobs e 5 ' . and St i'>z. Email address n cLtEt _013�� 413.71g.— .9�x�' 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 .a.... No ❑ SECTION 7a:OWNER AUTHORIZATION 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 fined in this application is true and accurate to the best of my knowledge and understanding. a.,, u 11\)(121 a Pr Own 's or Authorized Agent's Name(Electronic Signature) ate 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" Sr Permit Authorization mass save Form SowWis through enerq).tfrzeonc, Site ID: 4309901 Customer: WILLIAM DONNELLY I, William M. Donnelly , owner of the property located at: (Owner's Name,printed) 32 Woods Rd Northampton, MA 01062 (Property Street Address) (City) 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: WILL/4M DONNELLy Date: 11 / 03 / 2021 ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: iLl2\ a0e1 Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 Fcr Cffi:e Use Only Document Ref:NUHWK-9EPS8-W5NEF-LXZVU Page 6 of 6 • Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC BRYAN HOBBS REMODELING,LLC. Re 96045 Exxppiration: 0iration: 6(25l2023 P.O.BOX 1535 GREENFIELD,MA 01302 Update Address and Return Card. 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: Registration Expiration Office of Consumer Affairs and Business Regulation 196045 06/25/2023 1000 Washington Street ',Suite 710 BRYAN HOBBS REMODELING,LLC. Boston,MA 02118 BRYAN HOBBS 576 LEYDEN RD 4•/+ k• GREENFIELD,MA 01301 Undersecretary Not valid without signature Commonwealth of Massachusetts `�Ir11j Division of Professional Licensure Board of Building Regulations and Standards C onstrstcticart&wervis©r CS-083982 Expires:05/02/2022 BRYAN G HOBBS 26 OAK ST GILL MA 01354 t , rJ i Commissioner _J'tl6;. l;. ...U.` 44.. The Commonwealth of Massachusetts Department of IndustrialAccidents , r , •Office of Investigations �;iy Lafayette City Center `,. .7-,, 2 Avenue de Lafayette, Boston,MA 02111-1750 t'1,;c•• www.massogov/dea • 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/Zi•:Greenfield, Ma 01302 Phone#:413-776-9006 box: . prat . .. Are you an employer?Check the appropriate Type of project(required): 7 LIE® I am a employer with 7 4. 0 I am a general contractor Audi employees(full and/or part-time),* have hired the sub-contractors 6. 0 NOW construction 2,0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. Building addition (No workers' comp.insurance comp.insurance.t required] 5. 0 We are a corporation and its 100 Electrical repairs or additions 3.E] I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions • myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no ' weatherixation employees. [No workers' 13.1 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. Contractors 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. lam en employer that is providing workers''compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Selective insurance Company — Policy#or Self-ins.Lk.#:WC9057270 Expiration Date:10/20/202.2 • rTh Job Site Address: (,t c_IS K ) c}t City/State/Zip: I\r 1-earn 30 Ftk 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 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 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 her tO under the pains and penalties of perjury that the information provided above is true and correct. i gore. ' Phone#: 413 775-9006 Official use onty. Do;tot write in this area,to be completed by city or sown official. City or Town Permit/License# Issuing Authority(ch one)t 1OBoard of Health 2 Building Department 3DCity/Town Clerk 4.®Electrical Inspector SElumbing Inspector 6E:Other . ....'- .oat. A CERTIFICATE OF LIABILITY INSURANCE DA8i4/DDIY Y) kV—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 Adina Edgett, CISR NAME: g Webber & Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C.No.Extl: (A/c,No): 8 North King Street E-MAILss: aedgett@webberandgrinnell.com ADDRE INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A:Selective Ins Co of S Carolina 19259 INSURED INSURER B:Selective Ins Co of America 12572 Bryan Hobbs Remodeling, LLC INsuRERc:Selective Ins Co of Southeast 39926 PO Box 1535 INSURER D:Evanston/ XS Brokers INSURER E: Greenfield MA 01302 INSURER F: COVERAGES CERTIFICATE NUMBER:Exp 08/22 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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE n OCCUR DAMAGE E PREMISES (TO(RENTED 500,000 Ea occurrence) $ S2289042 8/4/2021 8/4/2022 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES I I r J O- I IES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n PR LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED A9105300 8/4/2021 8/4/2022 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ Underinsured motorist BI split limit $ 20,000 X UMBRELLALIAB OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$ S2289042 8/4/2021 8/4/2022 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? y N/A C (Mandatory in NH) WC9057270 10/20/2021 10/20/2022 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below Bryan Hobbs is Excluded E.L.DISEASE-POLICY LIMIT $ 1,000,000 D POLLUTION LIABILITY CPLMOL105179 1/19/2021 1/19/2022 PER OCCURRENCE $250,000 AGGREGATE $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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 /J (W /Grinnell, CPCU, CIC h.!L --i'-- )') ©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 y % Massachusetts ,?Y _ ,,c r . �: .\ p� w. t/ ... t DEPARTMENT OF BUILDING INSPECTIONS �� Y; �t �` 212 Main Street • Municipal Building y D tr Northampton, MA 01060 'rS ••• 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: (jf k9 kaAA SC- 4W`,, .& 3-----t The debris will be transported by: Name of Hauler: CO.. (6\ct LA,....—,,S\e___ st.c., r Signature of Applicant: < 1- b Date: 1111ko).DO )