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36-396 MUNICIPAL WATER AVAILABILITY APPLICATION Northampton Water Department 237 Prospect St. Northampton,MA 01060 587-1097 A Department of Public Works Trench Permit shall be required prior to any construction or connection activity associated with this application. Location: 108 Emerson Way, Lot 52 Inquiry Made By: Steve Ferrari/FCM SMART BUILD 413-588-@)75 Date of Inquiry: 7/28/14 Number of Type of Single Family X Type of Private X Units: 1 Units : Ownership:� ) Apart. Comm p: Condo Multi-family Rental (Annlican to fill nLt the ahnvel Municipal Water Main in Existing service to Front of Location? Yes: No: X site? Yes: X No Size of Water Main: 6" Material: Ductile Iron Age: 2010 Approximate Static Street Flow Test Conducted: Yes: No: X Pressure: 60psi If done attach results Size of Service Connection 1�� Suggested Meter Size: 5/8" Comments: The Water Department cannot guarantee adequate water pressure during peak demand times at elevations above 320 feet. • A corresponding water entrance fee shall be paid prior to making any connection to the municipal water system. • Arrangements of such installation shall be made with the Northampton Water Department with a minimum of working days notification. • rk s to Northampton Water Department specifications. go uttelman, Superintendent of Water Dept. Water Entry$200 Meter$ 100 Radio $ 100 cc: Ned Huntley, Director Note: If this availability is for a new construction,it must be hand delivered to the Buildinu _ Inspector. MUNICIPAL SEWER/AVAILABILITY APPLICATION Northampton Streets Department !" 125 Locust Street Northampton, MA 01060 587-1570 A Department of Public Works Trench Permit and Sewer Entry Permit shall be required prior to any construction or connection activity associated with this application. Location: 108 EMERSON WAY, LOT 52 Inquiry Made By: STEVE FERRARI/FCMSMART BUILD Y13-S98-8275 Date of Inquiry: 7/28/14 Reason for Request: NEW CONSTRUCTION/HOOK INTO ANY CITY UTILITIES Municipal Sewer Main in Front of Location: Yes No Municipal Storm Drain Available: 5 '/2 deep Yes No Size of Sewer Main: Material: Age: Depth of Sewer Main: Length of Sewer Main: Size of Service Connection: Type of Service Connection: Tie-in to Sanitary Main Tie-in to Sanitary Stub Comments: City Requires 6" cleanout installed at City Property Line Note: If this availibility is for new construction, this form must be hand delivered to Building Inspector. A corresponding"sewer entrance fee"shall be paid prior to making any connection to the municipal sewer system.Arrangements of such installation shall be made with the Northampton Streets Department with a minimum of 5 working days notification. All work shall conform to Northampton Streets Department specifications. A 11JAA J Vt� John Hall Sewer Department cc: Ned Huntley, Director DPW Louis Hasbrouck, Building Commissioner 10 ~ ' X7 Flush Steel Insulated Door 3-0 x 6--8 in standard jamb 1 T-2 1/2" 6'-10 1/2" 2 Burgess ESTIMATE 5O0K target working. 23 0781/2014 - General specifications Burgess Exterior Material: Premium Vinyl 108 Emerson Way,Florence Exterior Finish/Color: Standard Colors 06/08/2014 Interior Material: Premium Vinyl Revised: 06/1512014 Interior 1-inish/Color:---White WINDOW&EXTERIOR DOOR SCHEDULE GBG Window Paradigm NC8300 Series High Perormance Vinyl double hung and awning windows ith Advanc d Low E,Argon filled triple g ass with applied Specs: 3-1/2"exterior trim in standard color WINDOWS UNIT ER SILL KEY# MFGR&TYPE MODEL# COUNT I WIDTH HEIGHT HEIGHT HEIGHT Paradigm NC8300 Vinyl w/Transom 3762 2W 1 6-3 5'-7 1/2" 94" 68.75 3 Paradigm NC8300 Vinyl DH w/Transom 3762 2W 1 6'-3" 6-7 1/2" 94" 68.75 4— Paradigm NC8300 Vinyl DH-3652 2W 6-1 1 4 -3 3/4" 94" 53 Paradigm NC8300 Vinyl AWN-3613 1 T-0 1'-2 �-52- 15.25 6 Paradigm NC8300 Vinyl CSMNT-2543 2W 1 4'-0 T-7 1/4" 94" 44.5 8 Paradigm NC8300 Vinyl DH-3252 2W 1 6-3 4'-3 3/4" 94" 53 9 Paradigm NC8300 Vinyl AWN-2916 1 2'-4 V-4 94" 17.25 22 Paradigm NC8300 Vinyl AWN-2020 1 2'-0 V-11 1/8" 84" 24.375 23 Paradigm NC8300 Vinyl DH-3644 1 T-11 1/2" T-7 3/4" 84" 45 29 Paradigm NC8300 Vinyl CSMNT-2531 1 2'-0 2'-7 1/8" 84" 32.375 33 Paradigm NC8300 Vinyl DH- 3248 2W 1 5'-4 T-11 3/4" 84" 49 34 Paradigm NC8300 Vinyl DH-3648 1 2'-11 1/2" T-11 3/4" 84" 49 132 Paradigm NC8300 Vinyl CSMNT-3829 2W 1 6'-4 2'-5 1/4" 84" 30.5 EXTERIOR DOORS KEY# MFGR&TYPE MODEL# COUNT WIDTH HEIGHT Therma-Tru Fiberglass Smooth S-2000 Full Lite LE Glass(U-0.21 Therma-Tru Fiberglass Smooth S-2100 Halfl Lite LE Glass(U-0. Sectional Overhead Door 11/2 1 Burgess ESTIMATE 500K target working.123 07/31/2014 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under"Job Site Address"the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations; 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 7406 or 1-877-M:ASSAFE Revised 7-2013 Fax # 617-727-7749 www.mass.gov/dia The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations tl 1 Congress Street, Suite 100 �r Boston,MA 02114-2017 l� YOyi www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Steve Ferrari, FCM Smart Build Address: 103 Ryan Road City/State/Zip: Florence, MA 01062 Phone #:413-588-8975 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑■ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: 9. ❑ Building addition 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 12.0 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#I 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. I am an employer that is providing workers'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: City/State/Zip: 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 cer fJ under t e pains andpenalties of perjury that the information provided above is true and correct _._ .,. Sip-nature: J/ Date: Phone#: 413-588-8975 Official use only. Do not write in this area,to be completed by city or town official. 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#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: S Tel 14EV Pe-A A A K 1 �! CJ Q 7 8 O 7 License Number to -� Py4N Ra 4J . FuAwc'L," Address Expiration Date vWiQ W3 —SAS K —8 7 Si at a Telephone 9. Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(6))7_7 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...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-vear period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors ID Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks [p Siding [0] Other[d] Brief Description of Proposed rc 0 rr!'I I"_ Work: co Pf v_Z NO 4/ 7-S y S!of �P F cK 12 fife - Alteration of existing bedroom Yes_/ No Adding new bedroom Yes y No Attached Narrative Renovating unfinished basement Yes _'90 Plans Attached Roll -Sheet 6a. If New house and or addition.to existing housing. complete the following: a. Use of building : One Family Vlo� Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? 6 5— i 14 4( la Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. i&­�-'Qe> )P'-"J1V')C4 Masscheck Energy Compliance form attached? h. Type of construction w0 0 i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes 1/`0 j. Depth of basement or cellar floor below finished grade 7 k. Will building conform to the Building and Zoning regulations? Yes L"-'No . I. Septic Tank City Sewer_JL Private well City water Supply^Jl SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES'FOR<BUILDING PERMIT I, A A(A STS as Owner of the subject property A �T hereby authorize ATE hereby r�� 1 to act on my behalf, in all matters relative to work authorized by this uilding permit application. . I - 6/Zs�/� Signs ure of Owner Date as Owner/Authorized Agent hereby ddIclare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. sTEr-P(4GEN FerKA "I Print Na IQ�_L L,4 Signature Signature of 0=01r/Agent Dat Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zonin This column to be fille ,by r Building Department Lot Size y Frontage t fj Setbacks Front 5- 1 Side L: R:, L:l IR: t / Rear 78 Building Height " Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location •" n,n. A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 YES IF YES, date issued: V/6 �dI IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES IF YES: enter Book Page and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES I NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,exca ation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES U NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Dep n City of Northampton Status of Permit ` Buildin De Department I � g p Curb Cttt�GrNewayr 0,10mlt 212 Main Street Sever/5epticAvarlability AUia — � 2011 Room 100 Water/Weli Avtlsbillty L _ rthampton, MA 01060 Two Sets of Structural Plans Alec r c. 'r no&Gas Ins ectio �� r n �rQ 41 -587-1240 Fax 413-587-1272 Pfot/Slt >Pl ri Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office ,d Lam_ 6GAJ II✓1y Map Lot \' Unit li–o A e– ww,I 1.14 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: � A P6A1 GA©y TrA q.4 c&, —✓�4r�q�► �N Name(Print) Current Mailing Address: 1sT ! `-� Telephone Signature - 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only —completed by ermit applicant 1. Building U df o C ' (a)Building Permit Fee 2. Electrical 1 S—Q cr, (b)Estimated Total Cost of Construction from 6 3. Plumbing y� S—� Building Permit Fee 4. Mechanical (HVAC) 1 U C) 6 5. Fire Protection 112-00. 6. Total=0 +2+3+4+5) �(O Q 0 , Check Number _41&&Z This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-0140C b� - , (I K. � Cc r'i , , x APPLICANT/CONTACT PERSON STEPHEN FERRARI rok bf c tr DF(�� ADDRESS/PHONE 103 RYAN RD FLORENCE (413)588-8975 Q / PROPERTY LOCATION 108 EMERSON WAY j i N 1 d C'f.T PACO MAP 36 PARCEL 396 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: / PERMIT APPLICATION CHECKLIST /� ! ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: CONSTRUCT 2 STORY SFH W/ATT GARAGE/PORCH New Construction Non Structural interior renovations V�`G Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 98877 / rl4w 3 sets of Plans/Plot Plan o( THEYOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IVYORMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit 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 Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Del y Signature of Building O ficial 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. 108 EMERSON WAY BP-2015-0140 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-396 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A) Category:New Single Family House BUILDING PERMIT Permit# BP-2015-0140 Project# JS-2015-000244 Est.Cost: $380500.00 Fee:$1300.20 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: STEPHEN FERRARI 98877 Lot Size(sg. ft.): 11848.32 Owner: BURGESS ALDEN&CAROLINE Zoning: Applicant: STEPHEN FERRARI AT. 108 EMERSON WAY Applicant Address: Phone: Insurance: 103 RYAN RD (413) 588-8975 ) FLORENCEMA01062 ISSUED ON.911612014 0:00:00 TO PERFORM THE FOLLOWING WORK.CONSTRUCT 2 STORY SFH W/ATT GARAGE/PORCH/DECK 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. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 9/16/2014 0:00:00 $1300.20 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner