38C-010 (6) MUNICIPAL SEWER/AVAILABILITY APPLICATION
Northampton Streets Department
125 Locust Street
Northampton, MA 01060
587-1570 y
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 Grove Street A,B,C,D 2 Bldg's 4 units
Inquiry Made By:
Steve Ferrari 413-588-8975
Date of Inquiry: 11/4/15
Reason for
Request: Existing location turn into Condo's 4 units
Municipal Sewer Main in Front of Location: Yes T No
Municipal Storm Drain Available: 5 '/2 deep Yes _ No
Size of Sewer Main: Material: Age:
Depth of Sewer Main: S,�C4.
Length of Sewer Main:
Size of Service Connection: U jet L< i4/tr v `y 061
Type of Service Connection: e, w A/F( I i A.1 G 70 -�� -
Tie-in to Sanitary Main Tie-in to Sanitary Stub
Comments:
City Requires 6" cleanout installed at City Property Line
Note: If this availability 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.
John Hall /
Sewer Department
cc: Ned Huntley, Director DPW
Louis Hasbrouck, Building Commissioner
1MUNICIPAL WATER AVAILABILITY APPLICATION
Northampton Water Department
237 Prospect St. Y
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 Grove Street, A,B,C,D
Inquiry Made By: Steve Ferrari 413-588-8975
Date of Inquiry: 11/4/15
Number of Type of Single Family Type of Private
Units: 2 Bldg's Unit(s): Apart. Comm. Ownership: Condo X
4 units Multi-family X Rental
(Annlicant to fill out the shovel
Municipal Water Main in Existing service to
Front of Location? Yes: x No: site? Yes;x No
Size of Water Main: /d Material: Age: /93
Approximate Static Street � .- Flow Test Conducted: Yes: No:
Pressure: If done attach results
Size of Service Connection / A re 4.,4
Suggested Meter Size:
Comments: The Water Department cannot guarantee adequate water pressure during peak demand
times at elevations above 320 feet. /r(/ �O/�lm"lle-ls DCtOJ /IC "-e
FaJP�r rrD �tfu- �i�ce�, � /A��lsf �� B. ✓A�ix"�
• A corresponding water entr ce f 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 5 working days notification.
• All work shall conform to Northampton Water Department specifications.
Gregory R.Nuttelman, Superintendent of Water Dept.
Water Entry$ Meter$ Radio $ 00
cc: Ned Huntley,Director )W.00 �'� $ 54 0.
Note: If this availability is for a new construction,it must be hand delivered to the Building
Inspector. O
',•smbl\admin'i Perin its\Water Appl.icationVater Availabiiity.doc
UC
(SUBJECT TO ATTACHED CONDITIONS I & 2)
Permit No. D08-16
Conditions: Driveway Permit
In lieu of plan approved by the City Engineer I agree to the following added conditions:
1. I will contact the Department of Public Works and have an inspector check and approve
the graded gravel base prior to paving to insure compliance with slope and location;
2. I further agree that if in the inspections, any of the permit conditions are not met that I
will at no expense to the City remove and replace the driveway as directed by the City
Engineer.
By:
Petitioner Signature
Name: Steve Ferrari
Address: 103 Ryan Road, Florence,MA 01062
413-588-8975
Note: The Public Works Department recommends that you provide a plan showing the
proposed driveway with grades and location in the future to avoid possible expense
which you will incur by not getting approval of actual plans in advance.
For Commercial and Industrial applicants, a plan showing the proposed driveway with
grades, location and Planning Board permits are required.
Cc: Building Inspector
0
° Permit No. D08-16
CITY OF NORTHAMPTON, MA
DRIVEWAY PERMIT
Date: 11/4/15
Check#:
FEE: $250.00
Proposed driveway must be staked and address and/or lot number posted. Public Shade Trees
are protected by MGL Chapter 87. Do not cut, trim or remove any trees on City property.
The undersigned respectfully petitions your honorable body for: A NEW CURBCUT
Permission to install a driveway at: 108 GROVE STREET, UNIT'S A,B,C,D
Fifteen(15) foot maximum width from street line to property line. Gutter drainage not to be
disturbed. All drainage shall be directed off the driveway surface to adjacent land and not on the
existing roadway. The first one hundred(100)feet of the driveway surface shall be paved as
soon as possible if the grade of the proposed driveway exceeds 3%at any point in the first one
hundred(100) feet. Homeowners will be held responsible for any costs to the City of
Northampton in the event of a washout of this driveway. City is not responsible for culverts
installed under driveways in City layout. Code of Ordinances §350-8.8 providing standards for
private, individual driveways as most recently amended, must be followed.
By: Steve Ferrari/FCM SMART BUILD
Telephone: 413-588-89
i ature:
Proposed Location Inspection -Z-
Gravel Base Grade Inspected By:
Final Approval:
Edward S. Huntley,P.E.
Director of Public Works
Cc: Building Inspector
C O Inv %—Urn 'tuicweucc" uJ 1V1U33uv""3V163
c�cil Department of IndustrialAccidents
u v Office of Investigations
I Congress Street, Suite 100
Boston,MA 02114-2017
wwH.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.❑ I 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.❑■ 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 or me in an capacity. employees and have workers'
g Y P tY� 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' 11❑ 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.
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 certify der the pat_s and pena 'es of perjury that the information provided above is true and correct
Si nature: �'? g Date: f r`
Phone#: 413--888-8 7
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: C S - v� tiv 7
License lber
Y Q �QC Q�� o,✓ �. 1�)4 3 1-1 0 7 01 b
Address Expiratio Date
L
Sig ature Telephone
5.Reaistered Home Imorove rent Contractor: Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 1'0-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 buildi g 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-year 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 lIff Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [❑ Siding[[3] Other[❑]
Brief Description Pgposed �� �, � t lC� a -�.
Work. 9 N C
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family_ • Other
b. Number of rooms in each family unit: (49 Number of Bathrooms
c. Is there a garage attached? ilk_/y
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply_
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 'J✓L)d e 1f O /Z_ as Owner of the subject
property 1 FL-7R y�
hereby authorize l�C- r` '`
to act on m behalf, in all at r lative to work authorized by this building permit application.
Signature cf Owner Date
as Owner/Authorized
Agent hereby declare 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.
Print Name ---
11L
Signature o ner/ gent l5ate
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size ,,.° .Gl.
Frontage
Setbacks Front .
Side L: .. R: L: R:
Rear
Building Height
Bldg.Square Footage % ly��
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW YES
IF YES, date issued: l'�'//6//1
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book ! I'll0 � � Page, � �. and/or Document# �-n q
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued: Z Aj
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 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
"1pep&rtrriehttAse.only
C-` of Northampton Statta of Perrrit
ing Department Curb CuVDriveway Permit
x Z f3 � 2 Main Street SewrlSeptic Availability
oom 100 Water/Well Availability
ton, MA 01060 Two Sets of Structural Plans
'16� `' ' -587-1240 Fax 413-587-1272 Plot/Site Plans
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
108 A,B Grove Street Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
SHOP Development,LLC 43 Winterberry Lane,Florence,MA 01062
Na ) Current Mailing Address:
tiy7zl�✓ Telephone 413-695-3314
Si nature
2.2 Authorized Agent: `� y)IA.) Rd
CAR 4JItT
Name(Pri Current Mailing Address:
Signatu Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2016-0712
APPLICANT/CONTACT PERSON MATTHEW J DERY
ADDRESS/PHONE 408 HOOSAC RD CONWAY01341 (413)369-4447
PROPERTY LOCATION 108 GROVE ST-UNITS A&B -
MAP 38C PARCEL 010 001 ZONE URB(100)
.Jim.
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 FOUNDATION FOR DUPLEX-A&B
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/Statement or License 64404
3 sets of Plans/Plot Plan
THE FOL ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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
D o i)ion e
Signa o Buil g �ciaf Da e
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 GROVE ST- UNITS A & B BP-2016-0712
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38C-010 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: FOUNDATION BUILDING PERMIT
Permit# BP-2016-0712
Project# JS-2016-001194
Est. Cost:
Fee: $281.40 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MATTHEW J DERY 64404
Lot Size(sq. ft.): 24916.32 Owner: SHOP DEVELOPMENT LLC
Zoning: URB(100)/ Applicant: MATTHEW J DERY
AT. 108 GROVE ST - UNITS A & B
Applicant Address: Phone: Insurance:
408 HOOSAC RD (413) 369-4447 WC
CONWAYMA01341 ISSUED ON:1211412015 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT FOUNDATION FOR DUPLEX - A &
B
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 12/14/2015 0:00:00 $281.40
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner