23A-082 (12) BP-2021-2236
17 MAIN ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-082-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS ('ONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2021-2236 PERMISSION IS HEREBY GRANTED TO:
Project# PLATFORM Contractor: License:
Est. Cost: 5060 FLYE REMODELING 068006
Const.Class: Exp.Date:09/09/2022
Use Group: Owner: EZMJ LLC
Lot Size (sq.ft.)
Zoning: GB Applicant: FLYE REMODELING
Applicant Address Phone: Insurance:
45 SHATTUCK ST (413)772-6203
Greefield, MA 01301
ISSUED ON:11/30/2021
TO PERFORM THE FOLLOWING WORK:
PLATFORM/RAMP
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: QT',. .10
Fees Paid: $100.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
File #BP-2021-2236
APPLICANT/CONTACT PERSON:FLYE REMODELING
45 SHATTUCK ST Greefield, MA 01301 (413)772-6203
PROPERTY LOCATION 17 MAIN ST
MAP:LOT 23A-082-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $100.00
Type of Construction: PLATFORM/RAMP
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
V Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Perm it With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Perm its Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic ApprovalBoard of Health Well Water Potability Board of Health
Permit from Conservatidn Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
4, ► 6b1 11 I 1I 30/
Sign ture of Building Official I I 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 40A.Contact Office of
Planning&Development for more information.
ff___Trs, (_:_,Erv_i___I_L;______f
NOV[ 92O2 '1
The Commonwealth of M+�s
J '
CTIONS
Office of Public Safety and Ins I���ToN MA1SPE 01060
6- c. ._.;
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Building Permit Numbetig P a.l'2.23q Date Applied: Building Official:
SECTION 1:LOCATION
/ % 711,41/1 "ram dii(-232 F&ei\lL-, P *
No.and Street City TrA O dr:),.. Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK,
Edition of MA State de used If New Construction check here a or check all that apply in the two rows below
Existing Building Repair 0 Alteration 0 Addition® Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes /No ❑
Is an Independent Structural Engineering Peer t eview�r ?, / Y ❑ N
Brief Description of • .,.. :. Work Sri 6 X • *l2f- r fl • li- //b I
;TAW
�OP:016ri h/i ra i i al ._. /it /Ile .` .
SECTION 3:COMPL' IS SECTION IF EXISTING BUILDING UNDER OING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(indude basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business ' E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R Residential R-ID R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB ❑ IIA ❑ IIB 0 MA BIB IV 0 VA CI VB 0
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information Sewage Disposal: Trench Permit Debris Removal:
Public 0 Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site 0
Private 0 or indentify Zone: or on site system CIrequired 0 or trench or specify:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
\, SECTION 9: PROPERTY OWNER AUTHORIZATION
N e and Address operty Owner _
/Jd u r'.c Lr 44'1i /7 Y!1,), 5 . /)rz i e Pt A e%fe6 2-
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information: �3 y1Q/- 3 2 J 3
eW 0Y q 1 3 - lE' '//3_ 2/# 2 y 213 matt Y'U ci 14 it'le r1 6s".71404-3/rItt-
Title Telephone No.(business) Telephone No. (cell) mail address
If a licable,the pro er hereby auth
41d 7 Y5-�' �1 0C N Street Address City n State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here D.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
i
an Name
6\
ame of Per Responsible for Constructiona_c.1(ie.c_reNo. and Type if Applicable
Street A dress City/Town State Zip
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes CI No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor -s----
and Materials) Total Construction Cost(from Item 6)=$ ,,1
1.Building $ )/L7L-TD Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate mu fac )=$ .
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum f =$ "" (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ �.47-) (contact municipality)and write check number here aciiJ�
SECTION13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and cur best of my knowledge and understanding.
go vio Y/3- 4,2-4.3Z /
Please P t and svl no Title / Telephone No. ,
..) 'Ygra 4ftl, 40,
treet Address City/Town State Zip Email Address
NI I
Municipal Inspector to fill out this section upon application approval: 4: ° $ 0V Q a
Name Date
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
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r °'` r� Massachusetts` Yt DEPARTMENT OFBUILDINGINSPECTIONSkV .., 212MainStreet • MunicipalBuilding` "Is^—' Northampton, MA 01060
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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:C /��` 7
The debris will be transported by:
Name of Hauler: it-7. ....- irriv606.77,4
.- _„:„______-__,
,41.1.14
Signature of Applicant: �A`► Date: ` `
The Comtnonit eahh of Massachusetts
!�j Department of Industrial.4ceidents
=-j 1 Congress Street.Suite 11/0
Boston,AL-1 02114-2111"
www.mass.gor/dia
11.1Lers'Compensation Insurance Affidat it:Builders/Coatractors'Eketriciam/Plutwbers.
It)BE FILEDV.11ll INE PERMITTING AtrrtnnuIV.
Annlicant Informal- Please Print L.eribly
Name/Boston.t organization Individual _
Address •
City/State/Zip: Phone#:
Are yea lea slimer?Cbrrk doe appropriate tor:
Type of Iect(required):
I.Q I am a cmplus t srih _ cit i oynrs(lull and or Futuristic 1• 7. PE/New construction
? am a sole pruprw-to or runners/or and hat c no employ by%orltru for me an 8. o Remodeling
any capacity.[No worker.'comp.Insurance rryunnaJ.1
30 I am a hrnnwvune-r doom:all Nor o►an rdt.[Nu Nla insurance
n'comp_iurance required""
9. ❑Demolition
4.0 I am a hw ey%men and ionic be homy sc m:mu rs to conduct all work oil my property I wd1
IOO Building addition
m
an ate that all contractors either has%osiers'compensation unuranlr of at MAC 1 I Electrical repairs or additions
prupnetors Nuh rxo amphryeo_ 12.13 Plumbing repairs or additions
sa I am a general eontraewr and I has c hnnJ the subcontractors lusted on the altaehad sheet.
these sub-contractors bus a employes and Face%oilers'comp.insurance.: i3.1:Rootrepairs
14.fl Othci
h.[J%Ie are a corporation and.i otlw.7%haveexaTauaJ their ngbt of exemption per 11N.L e. --- ---------.
1 52. It 41.and w e'has no employees.[No worker.•comp.insurance required.)
•km'applicant that clw.l box n I moo also till out the section below slims on;them workers'compensation policy anlornvtnon
II 'oss nit who submit this atlidasit udaeattn a they an dung all%irk and den hoc outside ce tractors must subnut a new allnlas ai.mlicakng soh.
;1."onlraciors that cheek this boa must attached an addataon-al sheet show my the name of the.uh►.otract rs and slate N hearer or not thus entities has
emrlusec. It tie sub-contractors Fuse employ Les they must pnsudc their workers'evnnp.policy number
I am an employer that is providing worAers'compensation insurance.for my employees. Below is the policy and job site
information.
Insurance Company Name: _
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: CityrState'Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and eipiratioa date).
Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishable by a fine up to S 1.500_00
andd'or one-year imprisonment,as well as mil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day against the s iolator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
cot craw verification.
I do hereby cite rains and penalties of perjury that the information proriele d above is true and correct
Signal // Date /e„2_, t t(j�/
Phone (3 ���f,,
Official use only. Do not write in this arevt,to he completed by city or town official
( it or Town: PermWLicense a
Issuing Authority(circle one):
1. Board of Ilealth 2.Building Department 3.City riown Clerk 4.Electrical Inspector S. Plumbing.Inspector
(,.Other
( ontact Person: Phone#:
Coninionwaalth of Masaaonusetts
1lyDiViki0f1 Of Professional Li6ensure
Board of Euildin§ Rogulatlofis and gtandafds
Construct i (visor
CS.000000 gltpires;00/00/2022
RICHARD E(LYE I.
4/SHATTUCK IT
GREENFIELD MA 01101
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4
Co ififissionor c fv t , ` ` l
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r,0 #####pNtlMJA 0e5./10 lG,04 1.
Office of Consumer Affairs&Business Regulation i
HOME IMPROVEMENT CONTRACTOR
TYPE: Individual
Registration Expiration
134 798 01/22/2022
RICHARD E.FLYE
RICHARD E.FLYE 2
45 SHATTUCK ST. ,,L,,t4.(01/0,,
GREENFIELD,MA 01301 Undersecretary
Policy Number: MPK39735
MAIN
STREET BUSINESSOWNERS COMMON DECLARATIONS
AMERICA
INSURANCE
MAIN STREET AMERICA ASSURANCE COMPANY
4601 TOUCHTON ROAD EAST,SUITE 3400,JACKSONVILLE,FL 32245-6000
Item 1. Named Insured and Mailing Address Agent Name and Address
RICHARD FLYE GILMORE &FARRELL INS AGCY INC
45 SHATTUCK ST
GREENFIELD, MA 01301-1930 525 BERNARDSTON ROAD
GREENFIELD, MA 01301
Agent Phone No. (413)-773-3686
Agent No. 200063
Item 2. Policy Period From: 06-19-2021 To: 06-19-2022
at 12:01 A.M., Standard Time at your mailing address shown above.
Item 3. Form of Business: INDIVIDUAL
Item 4. In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to
provide the insurance as stated in this policy.
This policy consists of the following coverage parts for which a premium is indicated. Where no premium is shown,
there is no coverage. This premium may be subject to adjustment.
COVERAGE PREMIUM
Section I—Property NOT APPLICABLE
Section II—Liability $1,165.00
Inland Marine $72.00
CYBER $43.00
Total Policy Premium: $1,280.00
For Coverages subject to premium audit: Annual Audit Applies
Item 5. Form(s) and Endorsement(s) made a part of this policy at time of issue:
See Schedule of Forms and Endorsements
Countersigned:
Date: LI? I`AP1011 By: t • 0 (it '_
Authoriz' ` - esent:ive
THIS BUSINESSOWNERS COMMON DECLARATIONS AND SUPPLEMENTAL DECLARATION(S), TOGETHER
WITH SECTION III—COMMON POLICY CONDITIONS, COVERAGE PARTS, COVERAGE FORMS AND
ENDORSEMENTS, IF ANY, COMPLETE THE ABOVE NUMBERED POLICY.
BPM D 1 1207
INSURED COPY
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