36-379 —(Ji/yl f
221 EMERSON WAY BP-2017-0534
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-379 CITY OF NORTHAMPTON
Lot:-32 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: FOUNDATION BUILDING PERMIT
Permit# BP-2017-0534
Project# JS-2017-000870
Est.Cost: $620400.00
Fee: $408.20 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: STEPHEN FERRARI 98877
Lot Size(sq.ft.): Owner: BISHOP DAVID R& PATRICIA M GORMAN-BISHOP
Zoning: Applicant: STEPHEN FERRARI
AT: 221 EMERSON WAY
Applicant Address: Phone: Insurance:
103 RYAN RD (413) 588-8975 O
FLORENCEMA01062 ISSUED ON:10/24/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:FOUNDATION ONLY FOR NEW SINGLE FAMILY
HOUSE - GARAGE REQUIRE PFG AT EACH END
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 10/24/2016 0:00:00 $408.20
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File:BP-2017-0534 OKAPPLICANT/CONTACT PERSON STEPHEN FERRARI
ADDRESS/PHONE 103 RYAN RD FLORENCE (413)588-8975 0 Rift
f
PROPERTY LOCATION 221 EMERSON WAY
MAP 36 PARCEL 379 32 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT Q
Fee Paid OCR'$ .,'
Building Permit Filled out
Fee Paid
Tvpeof Construction: FOUNDATION ONLY FOR NEW SINGLE FAMILY HOUSE
New Construction _ /
Non Structural interior renovations L�rg J( {t/,/��ZQ/
Addition to Existin' A r / ,//A
Accessory Structuregrp K
BuildingersIncluded: a
Owner/Statement or License 98877 '� /Uf Q{V
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INE9RAlrtION 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
• • v
Sig .is il.- _ dal 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.
Department use only
--- •
- } City of Northampton Status of Permit:
•
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
LJ Room 100 WatertWeii Availability
Northampton, MA 01060 Two Sets of Structural Plans
DEPT ofsu.:DWG vr.=:.-cpbrene 413-587-1240 Fax 413-587-1272 Plot/Site Plans
NafiHµGrON,MAGI
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE
OR
DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION /r e/44 , g✓5
t.t Procerty Address: This section to be completed by office
221 Emerson Way,Florence Map_ Lot Unit
Zone Overlay District _
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
David Bishop&Patricia German-Bishop 124 Turkey Hill RD,Florence MA
Name(Print) Current Mailing Address:
�, ( 413-584-4507
(y O-c � t Telephone
Signature 111
2.2 Authorized Anent:
Stephen Ferrari 103 Ryan RD. Florence. MA
Name(Print} Current Mailing Address:
413-588-8975
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Odlars)to be Official Use Only
completed by permit applicant
1. Building 548.900 (a) Building Permit Fee
2. Electrical (b)Estimated Total Cost of
3.500 Construction from(6)
3. Plumbing 26,000 Building Permit Fee �
4, Mechanical(HVAC) es/il,�4
5.Fire Protection -'2.000 �7%
�7
6. Total=(1 +2+3+4+5) 620,400 Check Number c_10/1F
dl� � .da
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Budding Commissioner/Inspector of Buildings D81e
•
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Proposed Required Building
bypa Zoning
This column to be filled'in by
I3uildin(t Dzparzm-nt
1.1.111.11S 40.846 sf MIME
Setbacks Front 55
Side LAO' R:46'
Rear 6
81
-®-
Bldg.Square Footage
Open Space Footage
(Lot arca minus bldg&paved 34,56. 84%
,arkins)
4
A. Has a Special Permit/Variance/Finding ever been issued�for/on the site?l_J
NO 0 DON'T KNOW O YES
IF YES,date issued: 08/11/2016
IF YES: Was the permit recorded at the Registry of Deeds? (�
NO O DONT KNOW O YES V
IF YES: enter Book 128386 Page 45 and/or Document N 00017807
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW 0 YES (3
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO Os
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 0
IF YES, describe size, type and location:
E. WII 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 0 NO 4
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New Nouse n Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. n Demolition n New Signs [CA Decks [C Siding [O] Other[G7]
Brief Description of Proposed
World w�„a,�o„wnym tCtV _ca„kaw•.
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Ron -Sheet
sa.If New house and or addition to existing housing• complete the f911owinq:
a. Use of building: One Family X Two Family Other
I): Number of rooms in each family unit: q Number of Bathrooms 3 5
c. Is there a garage attached? Yes
d. Proposed Square footage of new construction. 3083 sf Dimensions 105-8”x 48'$" irr. T
e. Number of stories? 2
f. Method of heating? Air Source Heat Pumps Fireplaces or Woodstoves Yes Number of each '-
g Energy Conservation Compliance. Masseheck Energy Compliance form attached?,,,,,,
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes K No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade7'
k. Will building conform to the Building and Zoning regulations? X Yes No
I. Septic Tank City Sewer X Private well City water Supply X
SECTION 7a-OWNER AUTHORIZATION•TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Patricia Gorman-Bishop as Owner of the subject
Property
hereby authorize Stephen Ferrari, FCM Smart Build
to act qvl my behalf,in all matters relative to work authorized by this building permit application.
t
Signature of Owner Date 0 - I - r 0 J Fj
I Stephen Ferrari _ ,as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing appiication are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Stephen Ferrari
Print Name
�' •rte �. /0 ,j. 44
Signature of ner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License KohlerStephen Ferrari _ CS-098877
License Number
103 Ryan Road, Florence, MA 01062 5/23/2017
Address � v Expiration Date
f �`-YY2a't'v 413-588-8976
Signe a Telephone
e.Registered Nome hnorpvetnent Contractor Not Applicable 0
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-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
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-necuoied Dwellings of one(I) 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 108.151.
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 he,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 Officialthat 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
The Commonwealth of Massachusetts
Department of Industrial Accidents
L1i5;"_1 Office ofInvestigations
'�1= •;It 1 Congress Street, Suite 100
-- =i= Boston,MA 02114-2017
r-
` www.mass.gov✓die
Workers'Compensation Insurance Affidavit: Builders/ContractorsiElectricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individuall: Steve Ferrari, FCM Smart Build
Address: 103 Ryan Road
City/State/Zip: Florence, MA 01062___ Phone 4:413-588-8975
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 y*
have hired the sub-contractors 6. Q New construction
listed on the attached sheet. 7. Q Remodeling
2.0 I am a sole proprietor or partner-
These Demolition
and have no employees These sub-contractors have g. emolition
and have workers 9. ❑ Building addition
working for me in any capacity. employees
com . insurance.:
[No workers' comp. insurance p
.
5corporation arid its 10.❑ Electrical repairs or additions
required,] ❑ We are a rP
3.❑ am a homeowner doing all work have exercised their I L❑ Plumbing repairs or additions
myself [No workers comp. right ofe.xemption per MGL I2
[ Roof repairs
insurance required,] ' c. 152. 61(4),and we have no
employees. (No workers' Iy.❑ Other
comp. insurance required.]
'Ann applicant that checks box a I must also ILII out the section below showing their workers compensation policy in4mnation.
'I Intneowners who submit this affidavit it indicating they are doing all work and then hire autsidc contractors must submit a new affidavit indicating such.
<bntracton that check this box must attached an additional sheet shooing the name or the sub-contractors and state whether or not rhos entities have
nnplosces. If the sub-contractors have employees.they mist pros isle their worker comp.policy number.
I um on employer that is providing workers'compensation insurance for ntv employees. Below is the polity andjob.site
information.
Insurance Company Name:
Polies 4 or Self-ins. Ire. 41 Expiration Date:
)oh 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 ofa
line up to$1.500.00 and/or one-year imprisonment, as well as civil penalties in the form ofa 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 rer 'p under the pains and penalties of perjure that nw information provider!above is true and correct
/ 1 /
Signature: y s'- / Date: /V l /( �O��j
/
Phone4: 9( 'S gg-8g7r
Official use only. Do not write in Obis area,to be completed by cite or town official.
City or Town: Permit/License tt
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3. City/Town Clerk 1.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
•
•
MUNICIPAL SEWER AVAILABILITY APPLICATION
Northampton Streets Department
125 Locust Street
Northampton, MA 01060
413-587-1570
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: 221 Emerson Way, Lot 32
Date of Inquiry: 09/29/16
Inquirer with contact info: Steve Ferrari 413-588-8975
Reason for Request: New Construction
Municipal Sewer Main in Front of Location: 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:
Private Sewer availability
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 enterance fee" shall be paid prior to making any connection to the
municipal sewer system. Arrangements of such intstallation shall be made with the Northampton
Streets Department with a minimum of 5 working days notificaiton. All work shall conform to
Northampton Streets Department specifications.
1huwG - Date:
Sewer Dept. Foreman
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:1 221 Emerson Way, Lot 32
Inquiry Made By: Steve Ferrari 413-585-8975
9/29/16
Date of Inquiry: Fire Line Irrigation Domestic X
Number of11 Type of Single Family X Type of Private X
Units: 1 Unit(s): Ownership:( 1 Apart. Comm. P= lCondo
_ Multi-family I Rental
I
(Anolirant to fill out the ahovel
Municipal Water Main in
Existing service to
Front of Location? Yes: No: / site? Yes: No L�
Size of Water Main: Material: �1 Age:
Approximate Static Street Flow Test Conducted: Yes: No: r-
Pressure: If done attach results
Size of Service Connection / Cropper fo CC./h Sfuf0
Suggested Meter Size: S /
mf. t�llrp ()Loc.I 4
gliyikfTh
Comments: The Water Department cannot guarantee adequate waterprressure during peak demand
times at elevations above 320 feet. �,lq fro/ Moet t S i10 I` �l�'Ied �/ '>`J7Z (,
,1 p. /I.ovlttonpfoi . $ewi[F kid' not be lt'rnr.J of) Potvlp Sid 0'1 is o1l
• 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 5 working days notification.
•�,y All work shall conform to Northampton Water Department specifications. /
Water Superintendent Date
Water Entry S 100 Meter S ISO Radio S I 3S
cc: City of Northampton Building Dept. /Commissioner 1
Note: If this availability is for a new construction, it must be hand delivered to the Building ,e('� a,CN"
Inspector.