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36-159 (8)
BP-2024-1658 1112 BURTS PIT RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-159-001 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-2024-1658 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 5197 BRYAN HOBBS CS-083982 Const.Class: Exp.Date:05/02/2026 Use Group: Owner: KWASNEY MICHELLE D Lot Size (sq.ft.) Zoning: WSP Applicant: BRYAN HOBBS REMODELING LLC Applicant Address Phone: Insurance: PO BOX 1535 (413)775-9006 ECC60040011332023A GREENFIELD, MA 01301 ISSUED ON:12/16/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ER I ZATI ON 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: 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: ("P Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner (Q71 Department use only City of Northamp n - Status of P rmit: Building Department Curd Cut/ riveway Permit � ti t 212 Main StreEDEC 1 6 ewer/Se tic Availability � .� k � J S i7 4 Room 100 1 Water/Weil Availability L�f— Northampton,:'MA 01060-_ Two Sets of Structural Plans o r.7 ..��..,,; phone 413-587-1240 LFax 413-587 i 72''. TOI/Site Plans APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: ^� S l2� Qi Map Lot Unit ll Zone Overlay District_ Elm St.District C13 District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: hoows,.. ‘( ,),,p, f)QA4 T-iy\-s n e AQZ hA Name(Print) Current Maifi Address: Telephone Signature 2.2 Authorized Agent: � rD ln 1 S" Grec n sa tQ 1`t - (Prin Current Mailing Address. � ln� y WI)S^ 96 •4c) ature 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 Fe,t I 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) S1.1(11 . Check Number 36p `a. This Section For Official Use Only Date Building Permit Number: 0- / /O`er g Issued: Signature: -7Vd —tL /Z./ r f/ Building Commissioner/Inspector of Buildings Date (r)Ci -icyA EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n ' Addition ❑ Replacement Windows Alteration(s) ❑ Roofing n Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs tO] Decks f0 Siding [DI Other'0 ,-V f;h+Larlt Cs ao, Brief Description of Proposed Wj St Cat trf.0 eS,.,���U�n\ttih r (u us, Z�'P"1L1►1. hikh e! ,, Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following a. Use of building . One Family Two Family _ Other h. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? c. 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 I, , as Owner of the subject property hereby authorize to action myJ_behalf, in all matters rel Live to work authorized by this building permit application. Signature of Owner Date I, ?jYZ tO,r N. \--A, .l,`•` , as Owner/Authorized Agent hereby d Clare that the statements and information on the foregoing application are true and accurate,to the best of my know edge and belief. rSi n^ed undeer the pains and enalties of perjury. Print Name Si nature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: \ Not Applicable 0 Name of License Holder/ Yl (\ �1J�� / 7� l b 1C)c _ �' License Number Z ‘E3c 6rQetl 11 . \-IC) 0\ a \3, N. o Address Expiration Date 7-7 ApIla4HGV‘ Telephone 8, (Watered Home Improvem nt Contractor. Not Applicable 0 mp Name Registration Number dress Expirati n ate i gc\ ji . ) 0 (J,!i2-- Telephone '7L17 71 (-Mi., 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 0 • THE COMMONWEALTH OF MASSACHUSETTS • • Office of Consumer Affairs and Business Regulation 1000 Washington street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 196045 BRYAN HOBBS REMODELING,LLC. Expiration: 06/25/2025 P.O.BOX 1535 GREENFIELD,MA 01302 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date, If found return to: TYPE:LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street-Suite 710 196045 06125.,2025 Boston,MA 02116 BRYAN HOBBS REMODELING,LLC. BRYAN HOBBS 576 LEYDEN RD gecia,.m' . .;tedgft" GREENFIELD,MA 01301 Undersecretary Not valid without signature Commonwealth of Massachusetts Construction Supervisor Division of Occupational LicertSure Unrestricted-Buildings of any use group which contain less than Ooard of Building Requiatloas and Standards 35,000 cubic feet(991 cubic meters)of enclosed space. C8.083982 . r a(pIrea:Oa1021202g BRYAN G H013BS ' •' !• : P O BOX 16 :.t :• I "' GREENFIEL A 04302' • 2' i wi MOY LVil0• 0 dO • Failure to possess a current edition of the Massachusetts State r .d Building Code is cause for revocation of this license, Commissione' \ Contact OPSI:(617)727.320D or visit www.mass.govldplfopsi • 'q The Commonwealth of Massachusetts Department of Industrial Accidents • �,x .; '=:2 Office of Investigations i' Lafayette City Center r� l $' 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.gov/dia 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/Zip:Greenfield, MA 01302 Phone #:413-775-9006 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 7 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' p tY 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 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 employees. [No workers' 13Kgther weatherization 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. tContractors 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AIM Mutual Policy#or Self-ins. Lic. #: ECC60040011332024A _ Expiration Date: 10/20/2025 Job Site Address: 1 1\C� ' ' - City/State/Zip: �\�qf")(Q , )" 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 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 c y under the pains and penalties of perjury that the information provided above is true and correct. Signature: C_ W Date: \Z Phone#: 413-775-9006 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `� 10/01/2024 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 have ADDITIONAL INSURED provisions or 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 NAME: Alera Group,Inc. PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C.No): 8 North King Street E-MAIL adina.edgett@aleragroup.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A. Selective Insurance Co of The Southeast 39926 INSURED INSURER B: A.I.M.Mutual Insurance Co. 33758 Bryan Hobbs Remodeling,LLC Evanston/XSB INSURER C: PO Box 1535 INSURER D: INSURER E: Greenfield MA 01302-1535 INSURER F: COVERAGES CERTIFICATE NUMBER: E>.p 08/25 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 CONTRACT OR 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 ADDL SUHR" POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) `(MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS•MADE OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 A S2289042 08/04/2024 08/04/2025 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE $ 2,000,000 POLICY PRO 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG S OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) S A OWNED SCHEDULED A9105300 08/04/2024 08/04/2025 BODILY INJURY(Per accadenl) $ AUTOS ONLY X AUTOS X HIRED ONLY X NON-OWNED AUTOS ONLY PROPERTY DAMAGE (Per accident) $ A Underinsured motorist BI $ 20,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 _ A EXCESS LIAB CLAIMS-MADE S2289042 08/04/2024 08/04/2025 AGGREGATE $ 2,000,000 DED RETENTION S $ WORKERS COMPENSATION X STATUTE PER ERH AND EMPLOYERS'UABIUTY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBEREXCLUDED? Y N/A ECC60040011332024A 10/20/2024 10/20/2025 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 -DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ Pollution Per Occurrence 250,000 C CPLMOL121333 01/19/2024 01/19/2025 Aggregate 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it 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 I r ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton �� '" s s s-c, Massachusetts �4.,/ � .e ;� % , c d4 ,.4' ' DEPARTMENT OF BUILDING INSPECTIONS y. n 212 Main Street • Municipal Building J�;.,, c1, •/t! Northampton, MA 01060 �'' CEO \- 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:D\ F_.44-10An,tvo-un Zx kCA 1QM-eh, J v t The debris will be transported by: Name of Hauler: USY J(' \.e_ Signature of Applicant: • , \•- Date: i zl9l Zy