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29-617 (3) BP-2022-0674 775 BURTS PIT RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-617-001 CITY OF NORTHAMPTON Permit: New Build PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-0674 PERMISSION IS HEREBY GRANTED TO: Project# 2022 NEW HOUSE Contractor: License: Est. Cost: 425000 BACKYARD ADU'S LLC 116643 Const.Class: Exp.Date:07/13/2025 Use Group: Owner: LLC EMERSON WAY Lot Size (sq.ft.) Zoning: Applicant: BACKYARD ADU'S LLC Applicant Address Phone: Insurance: 247 COMBS RD 207-252-9893 04WECAN6MGS BRUNSWICK, ME 04011 - ISSUED ON:06/15/2022 TO PERFORM THE FOLLOWING WORK: NEW SINGLE FAMILY HOUSE WITH ACCESSORY DWELLING UNIT POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.VV. 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: • Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I1' Fees Paid: $1,030.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RFC The Commonwealth of Massach etts F/V E, Board of Building Regulations and tam -rds `10/ , , C ALITY I'., ;ol Massachusetts State Building Cod , 78g .FAT ' B CIP(9 E �k , � Building Permit Application To Construct, Repair, R , -coolish a Revis d Mar 2011 q N One- or Two-Family Dwelling � Mnt�o iNc ' C r�This Section For Official Use Only k/7 q°F�o�ioAi t� Building Permit Number. 6P" aq.2'u 79 Date Applied: / Building .,S , • Official(Print Name) Signature Date g SECTION : SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 775 BURTS PIT ROAD,NORTHAMPTON 29 ^BD p / 7 1.1 a Is this an accepted street?yes X no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: SR Single Family with ADU 17321.5 See Plot Plan Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft)-SEE SITE PLANS- 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❑ Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Emerson Way,LLC Northampton,MA 01060 Name(Print) City,State,ZIP 150 Main Street,Suite 310 RMM@HPMGnoho.com No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction 12 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify. Brief Description of Proposed Work2: Construction of new Single Family Home with Attached accessory dwelling unit. Construction will be Modular construction built over a conditioned crawlspace. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $387,500 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ 13,500 0 Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing $8,000 2. Other Fees: $ 4. Mechanical (HVAC) $ 16,000 List: 5. Mechanical (Fire Suppression) $0 Total All Fees: 1 Check No. ,1/0 I Check Amounhl 1)0 30Cash Amount 6. Total Project Cost: $425,000 0 Paid in Full 0 Outstanding Balance Due:_ SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-116643 07/13/2025 Austin R Gregory License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 47 George Street No. and Street Type Description Portland,ME 04103 Unrestricted(Buildings up to 35,000 cu. ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 207-252-9893 austin.gregory@backyardadus.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 203349 10/06/2023 Backyard ADU's LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 247 Coombe Road, austin.gregory@backyardadus.com No. and Street Email address Brunswick,ME 04011 207-252-9893 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 0 No .0 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 Austin Gregory, Backyard ADU's to act on my behalf; in all matters relative to work authorized by this building permit application. Richard Madowitz 5/15/2022 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 contained in this application is true and accurate to the best of my knowledge and understanding. Austin Gregory,Backyard ADU's 5/15/2022 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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.) 1950 (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count 12 Number of fireplaces 0 Number of bedrooms 6 Number of bathrooms 2 Number of half/baths 2 Type of heating system MiniSplit Number of decks/porches 0 Type of cooling system MiniSplit Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton J140- 4 Massachusetts t ' DEPARTMENT OF BUILDING INSPECTIONS r 212 Main Street • Municipal Building Northampton, MA 01060 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: Valley Recycling, 34 Easthampton Rd, Northampton, MA 01060 The debris will be transported by: Name of Hauler: Backyard ADU's Signature of Applicant: �_ Date: 05/15/2022 The Commonwealth o fMassachusetts Department o flndustrial Accidents rft ,. Office o flnvestigations war 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Backyard ADU's Address: 247 Coombs Road, City/State/Zip: Brunswick, ME 04011 Phone #: 2072529893 Are you an employer? Check the appropriate box: Type of project(required): 1.® I am a employer with 3 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 working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑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. Iam an employer that is providing workers' compensation insurance fir my employees. Below is the policy and fib site in firmation. Insurance Company Name: The Hartford Policy#or Self-ins. Lic. #: 04WECAN6MGS Expiration Date: 10/07/2022 Job Site Address: Lots 4, 6 and 8, Burts Pitt Road City/State/Zip: Northampton, MA 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 herebycertijy under the pains and penalties o fperµrythat the infirmation provided above is true and correct. Signature: )(�� a� Date: 5/15/2022 Phone#: 2072529893 Official use only Do not write in this area,to be completed by city or town o ffcial. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: AR® CERTIFICATE OF LIABILITY INSURANCE DA7E(MMIDD/YYYY) 03/30/2022 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 Kristen Jenkins NAME: Paquin&Carroll,LLC (PaHicNNo,Extl: (207)283-1486 ! No): (207)283-4258 260 Main St E-MAIL kjenkins@insurancepc.com ADDRESS: P.O.Box 356 INSURER(S)AFFORDING COVERAGE NAJC# Biddeford ME 04005 INSURER A: Berkley Aspire 32603 INSURED INSURER B: • Chris Lee,DBA Backyard ADUS,LLC INSURER C: 247 Coombs Rd INSURER D INSURER E: Brunswick ME 04011 INSURER F: COVERAGES CERTIFICATE NUMBER: 22-23 GL 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 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 PAD CLAMS. INSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAMS-MADE X OCCUR PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A CGL 0162726 03/24/2022 03/24/2023 PERSONAL&ADV INJURY $ Excluded GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X PRO- 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICERMIEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 Proof of General Liability coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ` Commonwealth of Massachusetts ► Manufactured Buildings Program -Plan Identification Number Assignment Name of Manufacturer Professional Building MC Identification Number Systems, Inc. 221 Third Party Identification Number 02 Project Title 103892 Use Group Two Family BBRS\OPSI Identification Number 0 12 5-2 2 Review Required All plans are reviewed by MA and a BBRS Number assigned when approved Date: 03/ 18/22 Manufactured Buildings Program From: Syno Tell Manufactured Buildings Program Re: Confirmation of Receipt of Building Plans & Assignment of BBRS\OPSI Identification Number (BBRS\OPSI I.D.Number) The Board of Building Regulations and Standards and Office of Public Safety (BBRS\OPSI) has received your building plans for the referenced project and has assigned the identification number noted above (in the block marked BBRS\OPSI I.D. Number). This number has been assigned for purposes of internal tracking methods. This number shall be used in reference to this project and on all future correspondences, inquiries and plan revisions. Thank you for your cooperation with this matter. Send all correspondences,inquiries and plan revisions to: Office of Public Safety&Inspections-Linda Shea 1000 Washington Street,Suite 710 Boston,MA 02118 Linda.shea@mass.gov Bbrs\forms2\manufacturedbldgplanid-06/2018 #, 1: 't_i ccN - 1c3(iig3 7 ,- , , q ' _ ,.<' <,f IUUA6znnv .r` s � rmmotAi�s -iai burl' .!— E < 4 t i 5. .r -< � pti ,/ bk+y% k.f - ;,�e €' rir�6sHc=.3 6(rrll fJ} _ t \ 0 ,\ ,, , \ ji, <„,_.................,.. : /^ ".„,, .Op C„ I... 41 ,...., .,..6,#, ' ' , ," 0. Z 2 �. l Hlda: ` a� d I4.'' \c` °',$Rj` �'��\ \1 Hxws�i tresai ! .. ,"`c. '' ��'', s'`'� 1 sew 3z,Pn, 4.0. 4 crc,.raN»��a.^'"__" I Eirl t� t •�Y :; ' Rom., _� _ �4 \ �� " -' '�' � REVIEW ONLY 77 1 5 ;� � , ,3ti\ , .' ;. ��. Date: 3/7/22 /, ti v �°, PFS CORPORATION � i - ,,,\ •77,E Bloomsburg, PA 1 r£ .� .�`'� P 1 i "Ti3 t t .zt�rs F. i',' 1 _ raryxe.�.as,�� _..COP19134,1421 PROPEWYCA'OAtviAHr AC