32C-030 (18) BP-2024-0565
17 BREWSTER CT COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32C-030-001 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-2024-0565 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS TO DECK 2024 Contractor: License:
MEGLIOLA PROPERTY
Est. Cost: 4988 MANAGEMENT 110879
Const.Class: Exp.Date: 06/05/2026
Use Group: Owner: CAGO ENTERPRISES LLC
Lot Size (sq.ft.)
Zoning: CB Applicant: MEGLIOLA PROPERTY MANAGEMENT
Applicant Address Phone: Insurance:
PO BOX 686 EIG4914458
NORTHAMPTON, MA 01061
ISSUED ON: 05/08/2024
TO PERFORM THE FOLLOWING WORK:
NEW DECKING AND RAILINGS
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:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: 7
Fees Paid: $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
ygp�rnot 1 F21/1,+�-i
a
The Commonwealth of Massac us tts
Office of Public Safety and Inspec ' ns wqr
�� Massachusetts State Building Code(780 R)
Building Permit Application for any Building other than a neb Two-Family&Milling
PPr
(This Section For Official Use Only) �`NpRfie1/it pt
Building Permit Numbers)'5I2. Date Applied: Building Official: -----/ K MAAsc
ricaie
,, SECTION 1:LOCATION �"�
94lr/7 •,il^Cw3i�f Court- )�PL>�J�@( �8�1��
No.and Street City/Tgwn Zip Code Name of Building(if applicable)
aloe e,�Pi
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair ja Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No ❑
Is an Independent Structural Engineering Peer Review uired? Yes 0 No 0
Brief Description of Proposed Work eo k 1 O ol d de c .n4 t re ��.�-e 44.
tpee<
eg# x S+t'ok o
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING 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(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 A-4 0 A-5 0 B: Business 0 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❑ I-2❑ I-3❑ I-4 0 M: Mercantile 0 R: Residential R-10 R-2 0 R-3❑ R-4❑
S: Storage S-1 0 S-2❑ U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB ❑ IIA0 IIB0 IIIAO IIIBO 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:
Public 0 Check if outside Flood Zone 0 Indicate municipal❑ A trench will not be Licensed Disposal Site 0
Private 0 or indentify Zone: or on site system 0 required 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 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:
City of Northampton
o��.^..1; s
t
Massachusetts kV . ''••rcr
,� DEPARTMENT OF BUILDING INSPECTIONS 7i
' f�
:_15 �? 212 •Main Street • Municipal Building yO% I.
C.
y.=1.. Northampton, MA 01060 5ii-. �%�0
.s-
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL &
MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS
1. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work (Digital & Hard copy).
3. Site Plan with location of proposed structure(s) and setbacks.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CSL and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (if applicable).
8. Note any Conservation and/or Special Permit requirements (if applicable).
9. Driveway Permit (if applicable).
10. Proof of Water and Sewer entry fees paid (if applicable).
11. Trench Permit (if applicable).
12. Initial Construction Control Documents filled out and signed by the Registered Design
Professional in responsible charge.
13. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton
SECTION 9: PROPERTY OWNER AUTHORIZATION
ame and Address of Property Owner
e.4 c-� c��,t, uC 3 ''uado tuo�. Zr. Sou. . o 10 76
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Title Telephone No.(business) Telephone No. (cell) e-mail address
\ If applicable,the property owner hereby authorizes:
%\f
Name Street Address City/Town State Zip
o 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 0.
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
Ole 5 6(6, en P7 16-4.A-)e fvi-c.t
Company Name L 5 _ ( I O S 1c't c5(.... exp.
Name of Person Responsible for Constru lion License No. and Type if Applicable
1 rc5-- W,\I (L () 1)k c,_-_- f r-e. x,. - zn t Oa"'
Street Address City/Town State Zip
== y'5 5 ,/- 6 zcsv g 47(,..,t@Vi vine man . <<s,,,
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 0 No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ 4 g 8O Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$ .
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ 1GO (contact municipality)
5.Mechanical (Other) $ Enclose check payable to /1 p
6.Total Cost $ lit) S d (contact municipality)and write check number here C.I 'kV' /j/r(
SECTION 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
1 application is true and accurate to the best of my knowledge and understanding.
e a l-to-r 1-4 WO- _ ,,, fi 3-5-31 - (z zaz, 07/z'l
Please print and sign l me Title Telephone No. Date
ca b;rr:Q. N-%\l (24Na J ? ..-J-Cvrr) r„h bkCC brews ai •t
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: ��� 5-s�MZy
Name Date
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
S St
.y"F i Massachusetts �.4,• ';
W=
0 1. DEPARTMENT OF BUILDING INSPECTIONS SJ �,�,°
r p 212 Main Street • Municipal Building b. c...'4s^ Northampton, MA 01060 rsYW 3;O°,
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:
V' QGty(-1;
Location of Facility: 50kilk^P.slitfi40.. gaa.J
The debris will be transported by:
Name of Hauler: ii.xe� < <o10, grt-pei
Signature of Applicant:, 4„-5;:---,„„ Date: 5/7l 2tl
The Commonwealth of Afassachusetts
t. Deptn tttrctrt of Industrial Accidents
eS * i.= s; 1 Cuu,,;ress Street,Suite 104
Boston.MA 0114-2017
• K' ►t•ww.mass.gov/din
M ut-kers' Compensation Insurance Affidavit:Builders/ContrattorsfElectricians.'Plumbers.
to BE HIED VI RH THE PEIOtl rriN(:All irttom I .
Aatilicant Information Please Print I.ei:ibis
Name(Business,Orgamzatioc tnd,vidual): f l e I %O i Q `rt,
Address: —79 K.i,,P) 5 t .
City/State/Zip: Po(4"c-,,...1-t-in, Phone g:
Are yilu an emptnyer?Cheek the appropriate hot:
Type of project(required):
1.4 i ant a employe with_ ._._. employees(folk under purl-timei.• 7. O New constructions
.LD I am a sole proprietor ur partnership and have nu employees working fur me in $. 0 Remodeling
any capacity.[No workers'camp.unsurance required]
I:II p Demolition
.CJ I am a homeowner doing all work myself.[No winters'comp insurance regained]•
4.fJ lam a hors:owner and will be hump contractors to conductall work un my property 1 will 10 CI Buckling addition
cmurc that all co ta:tors either have wurters'cXpmper satu.Vr utsurancti ur are sole l I.Q Electrical repairs or additions
prupnaun with nu employee..
12.0 Plumbing repairs or additions
tCi I am a general contractor and I have hued the sub-contractors listed on the attached sheet.
The.. subcontractors have employees and have workers'comp.insurance. I3.0 Roof repairs
6.0 We are a corporation and its sinkers have etenised their nght of exemption pei M(.L c. 14. Other � (#^ r
152.,�1141.and we have no anployeoi.(No*utters'comp insurance required]
'Any applicant that checks boo al mint aLso fill out the section below showing their wooers'compensation policy information
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new of idav it indiwing such.
1Contraetors that check the.box must uttxhcd an additional sheet showing the name of the s b-ronttarters and state w he then or not those entities lu,c
employees if the sub-contractors lose employees.thu."y�must provide their workers comp_policy somber.
ts.. .. .. --.
l am an employer that i.providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: 64006-t✓J $k-. Tys qusevao
Policy#or Self-ins.Lie.t: 'Z ( Z C-k- Expiration Date:
Job Site Address: I > 1 7 kI'f'c� S `-t- City/State/Zip: Po( 1tA)t dl Ole l
Attach a copy of the workers'compensation police declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishable by a tine up to S1,500.00
and or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
cue crsge verification,
/do hereby certi Iv arrde r the pain.and penalties of perjury that the information provided above iiA true and cos t
Siw'naturt: /12/X (--/w j N_ Date: 67 /Z,-:, 2. j
Phone x: y 5- -
Official use only: Do not write in this area.to in completed by city or town official,
City or-town: Permit/License ii
Issuing,‘uthurity (circle onel:
1. Board of Health 2. Building Department 3.Cityllown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
Y �f for work per the ninth edition of the
Massachusetts State Building Code, 7S0 CMR, Section 107
Project Title: Date:
Property Address:
Project: Check(x)one or both as applicable: New construction Existing Construction
Project description:
I MA Registration Number: Expiration date: ,am a registered design professional. and I have
prepared or directly supervised the preparation of all design plans.computations and specifications concerning,:
Architectural Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information, and belief such plans,
computations and specifications meet the applicable provisions of the J.lassachusetts State Building Code. (780
CMR). and accepted engineering practices for the proposed project. I understand and agree that I (or my
designee) shall perform the necessary professional services and be present on the construction site on a regular
and periodic basis to:
1_ Review, for conformance to this code and the design concept, shop drawings, samples and other
submittals by the contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CM.IR Chapter 17, as applicable.
_ Be present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quality of the work and to determine if the work is being performed in a manner consistent
with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
Vhen required by the building official.I shall submit field/progress reports (see item 32)together with pertinent
comments. in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a 'Final Construction Control Document'.
Enter in the space to the right a-wet- or
electronic signature and seal:
Phone number: Email:
Building Official Use Only
Building Official Name: Permit No.: Date:
Note L Indicate with an'7 project design plans.computatto:u and specifications that you prepared or directly supervised If'other'is
chosen,provide a desciptien
Version 01 ul 2013
Appendix 1
Construction Documents are required for structures that must comply with 780 CMR 107. The
checklist below is a compilation of the documents that may be required. The applicant shall fill out
the checklist and provide the contact information of the registered professionals responsible for the
documents. This appendix is to be submitted with the building permit application.
Checklist for Construction Documents*
Mark"x"where applicable
No. Item Submitted Incomplete Not Required
1 Architectural
2 Foundation
3 Structural
4 Fire Suppression
5 Fire Alarm(may require repeaters)
6 HVAC
7 Electrical
8 Plumbing(include local connections)
9 Gas(Natural,Propane,Medical or other)
10 Surveyed Site Plan(Utilities,Wetland,etc.)
11 Specifications
12 Structural Peer Review
13 Structural Tests&Inspections Program
14 Fire Protection Narrative Report
15 Existing Building Survey/Investigation
16 Energy Conservation Report
17 Architectural Access Review(521 CMR)
18 Workers Compensation Insurance
19 Hazardous Material Mitigation Documentation
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
`Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified
must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the
authority having jurisdiction.
Registered Professional Contact Information
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Please follow this link for construction control forms to be used by Registered Design Professionals.
Commonwealth of Massachusetts Construction Supervisor
Division of Occupational Licensure Unrestricted-Buildings of any use group which contain less than
Board of Building Regulations and Standards 35,000 cubic feet(991 cubic meters)of enclosed space.
Const tpl,_ p rvisor
et' 4
CS-110879 x * ' tpires: 06/05/2026
BRET R HAFIL1
8 BIRCH HIL4Ri it 7, a' .,
BLANDFOR[CfA • -• ,
`t'O
f 11
70
LLtrdfl� y Failure to possess a current edition of the Massachusetts State
Building Code is cause for revocation of this license.
Commissioner L.eVe 1..., — Contact OPSI:(617)727-3200 or visit www.mass.gov/dpliopsi
/ 1 DATE(MM/DD/YYYY)
AC L CERTIFICATE OF LIABILITY INSURANCE
05/07/2024
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 Stacie Breck
NAME:
Borawski Insurance (AHONo,Est): (413)586-5011 jArc,No): (413)586-7973
88 King Street.Suite B E-MAIL sbreck@borawskiinsurance.com
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC II
Northampton MA 01060-3257 INSURERA: Penn America
INSURED INSURER B: Employers Association
Megliola Property Management Inc.DBA:Pancione Associates INSURER C: Hiscox Insurance Co
PO BOX 686 INSURER D: Selective Insurance Company
INSURER E:
Northampton MA 01061 INSURER F:
COVERAGES CERTIFICATE NUMBER: 24-25 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 ADDLSUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD wVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1.000,000
CLAIMS-MADE XI OCCL P PREMISES(EatNTED occurrence) 5 100,000
MED EXP(Any one person) S 5.000
A PAC7247679 01/23/2024 01/23/2025 PERSONAL BADVINJURY $ 1.000,000
GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2.000.000
POLICY ri JE n LOC included
PRODUCTS-COMP/OPAGG S
OTHER $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000.000
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
D OWNED X SCHEDULED A9108391 10/29/2023 10/29/2024 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED v NON-OWNED PROPERTY DAMAGE $
X.
AUTOS ONLY AUTOS ONLY !Per accident)
$
J
UMBRELLA UAB OCCUR EACH OCCURRENCE $
—r
EXCESS LIAB CLAIMS-MADE AGGREGATE 5
OED RETENTION$ S
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY X STATUTE ER
v/N 1000,000
B ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA EIG4914458 12/31/2023 12/31/2024 E L EACH ACCIDENT $ ,
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E L DISEASE-EA EMPLOYEE $ 1,000,000
If yes.describe under 1000.000
DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ ,
Professional Liability(PL) $1,000.000
Errors and Omissions
C MPL504344 01/01/2024 01/01/2025 Each Claim Limit $1,000.000
Bodily Injury/Property $50.000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) •" '-' ''va' ''
Job Location 15-17 Brewster court Northampton
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Northampton Building Inspector ACCORDANCE WITH THE POLICY PROVISIONS.
212 Main Street
AUTHORIZED REPRESENTATIVE
Northampton MA 01060 `�z —;
I C
CO 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
From: Qr1,1pe< `I' .r1��-eW-e—` '
To:
Jonathan Flagg
Building Commissioner
City of Northampton •
212 Main Street
Northampton, MA 01060
The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for
construction control in certain situations. In accordance with code section 104.10, I request that you
grant a modification to waive the requirement for construction control of the project at
because the work is of a minor nature,will not affect structural elements, health, accessibility, life or fire
safety, and will be done in accordance with the prescriptive requirements of the code.
Thank you for your consideration. •
Respectfully,