23A-082 (11) 17 MAIN ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1799
Map:Block:Lot:23A-082-
001 CITY OF NORTHAMPTON
Permit: Addition
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2021-1799 PERMISSION IS HEREBY GRANTED TO:
Project# BEM-2022-000196 Contractor: License:
Est.Cost: 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:08/26/2021
TO PERFORM THE FOLLOWING WORK:
ADDITION OF TREX DECKING WITH ONE STEP INTO BUILDING
POST THIS CARD SO IT 1S 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:
v • w9 . Cfr.'•1 •
Fees Paid: $I00.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
i.,,,4j
Comm�tntvth f ssachusetts
....,
Office of Public Safety and pections
nr'cicylawNg Co e(780 CMR)
Building Permit Applic iiiin:an d er an a One-or Two-Family Dwelling
(This Section For Office
Building Permit Numbe'nr"A ia / 7/Date Applied: Building Official:
SECTION 1 LOCATION
i- �7: F R-- V pi- r
No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State a used If New Construction eck here 0 or check all that apply in the two rows below
Existing Building Repair 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 Engin ' g P eview required? , Yes 0 No
B 'ef 'p'on of,Pro Work
4D`
/j ,dr.,,r,e -- C' /fit 5/y c (t
SECTION 3:COMPLETE S SECTION IF EXISTING BUILDING UNDERGOING R OVATTAON,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(include 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 All 0 A-5❑ B: Business E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 ❑ H-4 0 H-5 0
I: Institutional I-1 0 I-2❑ I-3❑ Ill❑ M: Mercantile 0 R Residential R-ID R-2 0 R-3❑ 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 ❑ HA IIB 0 MA IIIB ❑ IV 0 VA 0 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:
A trench will not be Licensed Disposal Site 0
Public Ef Check if outside Flood Zone 0 o Indicate municipal required 0 or trench or specify:
Private 0 or indentify Zone: or on site system❑ 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 0 Yes 0 or No 0 Yes 0 No 0
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
Name and Address of Property Owner
gliliA ra. 7/-i4, 1tn /7 Mom-# si ,r/0eVv ( -e, /4 0/6,4,2_
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
OwilPr „if 33Y1. 32.yj 9/3.2,g_ 2Y7 �iMIArcVX'tiri r) ("c (Q ./ e7
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
FZ P. %S 1- 4. 411_1_,At.
r'(3Df
Name Street Address / wn 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 O.
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 .
-* /. /44
ComRan C y.......,
y�ame Ziq 11
Name of Perso R onsib e for Co coon 'cense No. and Type if Applicable
t Address ity/T `m V
to Ip1f 4.02L -sue a7t5 ' 6 / lea
Telephone No.(business) Telephone No.(cell) e- ail
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Acciden must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the' uance of the building permit.
Is a signed Affidavit submitted with this application? Yes No D
SECTION 12•CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$ la
1.Building $ !(Z/129 Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ appropriate municipal factor)_$ .
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $/(AV (contact municipality)and write check number here
SECTIOT(13: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
a licati n ise and agcurat y knowl ge and understanding.
a G�Prrroc � Vi - � Y(3- c,2 8.5i
Please print 4zrd se Title 1 Telep ne o. Date I axii._460 6,- E---- I 1
Street Address Ci /Town State Zip Email Address
____ 14:11
Municipal Inspector to fill out this section upon application approval: r ' JQM� 4 a 1 0
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Policy Number: MPK39735
MAIN
BUSINESSOWNERS COMMON DECLARATIONS
AM
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: $1,280.00
For Coverages subject to premium audit: Annual Audit Applies
Item 5. Form(s)and Endorsement(s) made a part of this policy at time of issue:
See Schedule of Forms and Endorsements
Countersigned:
Date; 1.Thb-ri\
By: ittl
r ' Authoriz Ae resentafive
THIS BUSINESSOWNERS COMMON DECLARATIONS AND SUPPLEMENTAL DECLARATION(S), TOGETHER
WITH SECTION III —COMMON POLICY CONDITIONS, COVERAGE PARTS, COVERAGE FORMS AND
ENDORSEMENTS, IF ANY, COMPLETE THE ABOVE NUMBERED POLICY.
BPM D 1 1207
INSURED COPY
0ommonwP ith of MaSsastU§@tts
®ivl lon Of Fr®feSBI®ftsl LidanaUfa
? Shard Of Building Bagulstiona and Standards
C o nstructt4Atipery isor
CE=060006 tpir44 0g/0012 22
RICHARD E FLYE
41$HAfifiUCK IT
UREENFIELC MA 01 _1
C®rtjmissioner cast 4. `01 Lila
rAt}Suttttttnttteetta pi-,liitkitrrvft&ieAr
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE: Individual
Registration Expiration
134798 01/22/2022
RICHARD E.FLYE
RICHARD E.FLYE � /2
45 SHATTUCK ST. c �
GREENFIELD,MA 01301 Undersecretary
the Commonwealth of Massachusetts
l` - !l Department of hidustrialAceldrnet
I Congress street.salty 100
ir Boston.MA 02114401
t.
3*.�_� WWW.mwS.f.Ral'/dla
11 utlien•t'atttprttratinn Insuranrr.A fidav it:Ruildertit untrattori1:krteirirasiPlumhrrr:
10 fli.1ILII:U N fCN HD.14:1011l'I lit:Airlil tltl 11.
ti slirantIntnrmatinn P1rssatint,j ujhls
Name I Bus a11tKS t liy,il7l/dtlrrll li7klt17kliidlt /� �`�'l12/ /l'7 /V....;/)P.--/4 F i,...7-L'
Address: `j .)2 rfl l-k
City/State/Zip ` ` / a / _. Phone#: yi, 5 -fZ o- 3
Ate yea art errpttnsrrt('Yee►the appeeptWr hat:
Type tl�jrrt(required►:
I.a l m a iployer wiry employees(full and of part-tithe}+ 7. ( t st w kutNctructlon
2 a sole at Berns irship and have tar employees nodose! tut nit us R. CI(ta mutts hnsG
any capacity.l wot►en•romp.insurance mpurnd.1
30 I ant a hom anvtiirr doing all work rinsed.I`t0 wur►aicomcomp.uuurant required.I.
9. 0 Dentolthun
10 El Ilurlding addition
4.O I am a homeowner and%all he honor tmaratiors to conduct all work on my propertk. I ntll
ensure that all contra:ton either lake Mtlete-n"ckmr'aells7anr1 niuutancc+r LW WIC 11.0 Electrical ra.-pairs or additions
proprietors with no employers.
12.0 Plumbing tepatrs or additions
s j9 I am a germ-tal contractor and I lase hoed the suhakmtraclors listed on the anatlaat sheet
U the..:sub-ekmiraclurs hake employees and hake%tater,'savor.insurance. 13.0Rl)llt repairs
14.0(3thet
li 0 VW are a camparar tru and its officers tune etete'ised then ogler of exemption pet MK&e.
I52.11t4).andwehavem apryeir.ISowcriers•antp.irautaresrtaspia�ed.J
•ins applicant that cheeks hoe a1 muse also fall out flit wetson Mon shooing then wuAevt"cutnpensa4un polity information.
li mn...minis who submit Out atfrlaknl indicating they ate deans all wort and then hire outside contenders Mail submit a new attdaait nra a:aliie surely
.t ontraetors that cheek this buss must attic ed an additional sheet showing the nave of the sub-contractors wild stale whether or not those entities lute
curb:owes. if the sub-contractual hake employees they mustjwustde then workers'coin uhes number..
lam an employer that is providing worAers'compeasanan Insurance for my employees. Below is the police and Job site
fsfarstatfon_
Insurance('ontpany Name:
Policy a or Self-iris.Etc.#: Expiration Date:_ - __
Job Site Address: __ _City State Lip:
Attach a ropy at tic workers'retllprasatlea polies'dcrlrratk a page(sbasi►iag the palsy)eambrr aid rtpiration[Intel.
Vulture to secure coverage as required lusher%KIL c_ Ii2.*23A is a criminal violation punishable by a tine up to S1,J00.01)
atui or ogre-year imprisonment.as well as end penalties in the from of a STOP WORI(ORDLR and a tine of up to$250110 a
day against the s.:rotator.A copy of this statement may be forum-Jed to the Otlice of investigations of the DIA tier insurance
cot eta a:verification.
I do hereby c s s and prnakirs of perjury that the lnformallon provided abort la true and torrret
Ic
Official ial use only, bo sat write lit this area.to be completed by city or►oast official
( its or tonic Permit'Lkense#
Issuing. uthoNN (deck dark
I.hoard rot Health 2.Building Dcpatimrat 2.t'ity Aaiun Clerk 4.E lrrtrieal inspector 3.Plumbing Inspector
6.Other
t untatt Pretest Phoneft:
�r:
City of Northampton
�;•` i'\ Massachusetts
if DEPARTMENT OF BUILDING INSPECTIONS
.R .,, F ," 212 Main Street • Municipal Building\ i
' !
— .;"f!4L 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: .'EC-C-(4,1/64/r04r)&49
The debris will be transported by:
Name of Hauler: ���'` �l"C`-'
Zdf
i/�! "
_65.7c.,2 /
Signature of Applicant: AVM AeA Date:
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD /
516: Z' ''-'‘4
) t%4 ,
SIDE YARD 0?` 16 SIDE YARD
J
I
FRONT SETBACK scR
FRONTAGE yQ2 /
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