25A-029 (3) 11 MARSHALL ST BP-2019-0120
GIs#; COMMONWEALTH OF MASSACHUSETTS
Mao:elock:25A-029 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2019-0120
Project JS-2019-000197
Est.Cost$30000.00
Fee:$65.00 PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group: Homeowner as Contractor_
Lot Size(sp. ft.): 8581.32 Owner., MOOS STEPHEN E&SHEILA N
Zonine:URB(100)/ Applicant: MOOS STEPHEN E & SHEILA N
AT: 11 MARSHALL ST
Applicant Address: Phone: Insurance:
16 MARSHALL ST (413) 586-4539 0
NORTHAM PTONMA01 060 ISSUED ON:8/2/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.•CONSTRUCT 2 APARTMENTS IN EXISTING
BUILDING -WORK TO BE COMPLETED ON 1ST FLOOR
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: 08: 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 sienature:
FeeTyoe: Date Paid: Amount:
Building 8/2/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0120
APPLICANT/CONTACT PERSON MOOS STEPHEN E&SHEILA N
ADDRESS/PHONE 16 MARSHALL ST NORTHAMPTON (413)586-4539 Q
PROPERTY LOCATION I(MARSHALL ST
MAP 25A PARCEL 029 001 ZONE URBO 001/ 1
THIS SECTION FOR OFFICIAL USE ONLY: �5 J F100 r
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TvueofConstructiom CONSTRUCT 2 APARTMENTS IN EXISTING BUILDING — I cI- Floo r wOrK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildine Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INATION 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 Stomr Water Management
D molmon Delay
Si c ofTim In O ud Date
Note: Issuance of a mg permit does not relieve a applicanCs 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.
Depamnent use only
CE C / -_ - of Northampton Status of Permit:
• �1t V'C I_V L_UBui ding Department Curb Cuuorivevay Permit
2 Main Street Sewer/Septic Availabiltly
JUL 0 2018 Room 100 WaterlN/ell Availability
3 OR mpton, MA 01060 Two Sets of Structural Plans
Phone 4 3-6 -1240 Fax 413587-1272 Plot/Srte Plans
-c oc rua oink imsaecnous Other Specify
CT,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
/lA' h111Si54AU ST�E1 7 Map 5� Lot t l--;t-q una
NO,4�774,91bl,07VA4 AM 0/661) Zone Overlay District
Elm SL District CB District
SECTION 2-PROPERTY OWNER§HIP/AUTHORIZED AGENT
2.1 Owner of Record:
S �PIIFN E. ` Site1LA Al. Moos /b A�a,'skalik W4+PVJ
Nam (Prim) Curmm irm Add
/// `�6 - 539
" '�7� Telephone
$laa m
2.2 Autlwriad Aaenk
Name(Pant) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed b it a ica
1. Building - 'o-�Cl "° (a)Building Permit Fee
Z Elegripl �/, �t7�• N 7//!Jl/s/ /. (b)Estimated Total t of
Construction from 6
3. Plumbing 3—' v!/V Building Permit Fee d(
4. Mechanical(HVAC) 9t/ jv 8I1/I
5.Fire Protection ✓✓V
6. Total=(1 +2+3+4+5) 1 Check Number
This Section For Official Use Only
Suild mg Permit Number. Date
Issued:
I - -
Building Cama' /Inspector of Buildings Date
" ,Section 4. ZONING All Information Aust Be Completed.a it can Be Denied Due TO i�r:r
Existing Proposed Required Zz
This:eim—.._ s
Building�:=cc-
Lot Sim
Frontage
/80 / i8o '
Setbacks Front
Side L,::-AO R:QAt'Z L:c- O R: o�O
Rear
Building Height
Bldg.Square Footage 8 cep - n% 8 vo r
Open Space Footage %
(wanmuinmbldg&paved Jl(lyo S� Y� r
arkin )
q of Parking Spaces Cy
Fill:
(vowmc&Lnut-o,o ON,�5' ✓VU NE
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES 0 n
IF YES: enter Book %r� sv'� Page � 9 5 and/or Document#�C 7 D��09
B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW Q YES 0
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
IF YES, describe size, type and location:
D. Are there airy proposed changes to or additiorts of signs intended for the property? YES O NO
IF YES, describe size, type and location:
E Wit the construction activity disturb(clearing,grading,excavation,or filing)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO 0
IF YES,than a Northampton Storm Water Management Permit from the DPW is required.
SECTION Y DESCRIPTION OF PROPOSED WORK check all applicable)
v House Addttlon ❑ Repincemsnt.V�dows Alboration(s) Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks Siding[p] Other[EQ
Brief Description of Proposed
Work: Cmta.iLtcc�,Z Q.DIYAt`771-e-'rw� /i7 Q-�t Y/!-ta-C/�1c.(: Isf
Alteration of wasting bedroom Yes k No Adding new bedroom X Yes No
Attached Narrative Renovating unfinished basement Yes _,X_No
Plans Attached Roll -Sheet
sa.If New house and or addition to existina housing, complete the following:
a. Use of building-One Family Tyro Family V—Other
b. Number of rooms in each family unit: 13 Number of Bathrooms_
c. Is there a garage attached? k n-,V
d. Proposed Square footage of new construction. Dimensions
e- Number of stories?
f Method of heating? iz&(..vr-<-r_ 7 .tFireplaces or Woodstoves Number of each_
g. Energy Conservation Compliance. �Ie_S Masscheck Energy Complianceform attached? YE S
h. Type of construction WOC�
Is construction within 100 fl.of wetlands? Yes X No. Is construction within 100 yr. floodplain Yes X No
j. Depth of basement or cellar floor below finished grade /WIVE
L Will building conform to the Building and Zoning regulations? Yes No.
1. Septic Tank_ City Sewer 1- Private well City water Supply A
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
property
Hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Orme, Date
I, F--yLF_LA NOP5 ,as Owner/> a�
Agen"ereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signedr .pams ar)_d }r� of perjury
m N� � CTi—Y�
�7�=7'.tlt=ly�. /L1r,'OS Sri=icN ;1� i�100s 5191��
Signature of Owe,/Agent Date
City of Northampton
Massachusetts
�(
I D212 M.. S OF BUILDING LNSPild Z.,a p
213 Main rthe •aunicipal Builtling
IQ Northampton' MA 01060 a
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
(Please print house number and street name)
Is to be disposed of at:
VaCt�yc� � .�
(Please print name and to ion of facility)
Or will be disposed of In a dumpster onsite rented or leased from:
(Company Name and Address)
SignatutWof Permit Applicant or Owner Date
If,for any reason,the debris will not be disposed of as indicated,the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
\ The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street,Suite 100
Boston,MA 021I4-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builden/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant l f fi Please Print Legibly
Name(Business/Orgmiza5oWindividua0:
Address:
City/State/Zip: Phone#:
Are you an employer?Check Ne appropriate box: Type of project(required)'
I.❑I am s employer with iernpl.,ees(full motor part-time)' 7, ❑New construction
2_FJImnasolepmpdmurorpatmemblpmdhaveooemployeesworking minivan g. ❑Remodeling
any capacity.[No workers comp.insurance required]
G3. I sm a homeowner doing all work myself[No workers'comp,iecomnce u:quind.] 9. ElDemolition
4 1 a homwwner and will be hiring..him m conduct all work on my pmpeny. 1 will 10 E]Building addition
mamsme mat all contraman either have workerscompensahon insurance or are sole 1I.[]Electrical repairs or additions
pmprlemr with no employees.
12.E]Plumbing repairs or additions
5 I am a general contractor and I have hired the sub-contractor listed on the attached sheet.
These s.b antracmry have employees and have wodcars'comp.i 1., 13.ERoof repairs
6.n We are a coronation and its oRcen have exemised loch right ofexempand per MGL a 14.QOther
152,§1(4),and we have no employees.[No waders•comp.insurers nqulred]
*Any applicant deli chmim box 01 most also fill out lie section below showing their workers'compensation policy inPomrtioa.
'Homeowners who submit this affidavit indicating they an doing all work and men hire outside Contrubrs must submit a new affidavit indicating such.
:Cmdactors that ehcok lois fins most attached an additional sbem showing the were ofthc min-- o mm r and state whether or not muse enthies have
employeeslathe sub-cm=cma Imve employees,may must provide theh workers comp.policy number.
I am an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site
information
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Lip:
Attach a copy of the workers'compensation policy 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 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 foe 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
coverage verification.
I do hereby car m elr the pains an ties of perjury that the inform ddim provided above is true and correct
Sienatury - "^' Date
Ph #'
Official use only. Do not write in this area,to he completed by city or town official.
City or Town: Permit(License#
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.City/Pawn Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
SECTION&DESCRIPTION OF PROPOSED WORK(check ll applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doom =1
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Docks [0 Siding[0] Other[0Q
Brief Description of Proposed
Work.
Alteration of existing bedroom_Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Be.N New house and or addWan to indstingi.housing.complete the foNowina:
a. Use of building: One Family Two Family Other
Id. Number of roams 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? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance farm 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, , as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, ,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
Signature of OwnerlAgent Date
SECTION 8-CONSTRUCTION SERVICES
Not Applicable ❑
81 L' ru
Licensed C nstctlon Supervisor:
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
B.RaNlatered Horrar(mptovenleM CoMraelor. Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 18-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....... ❑ No...... ❑
City of Northampton
� Massachusetts
( c
z
212A in S O 88ZLDZNG 1I Buml, ng 5
10
'l l'! Hein Stxeet Municipal Building 'Cb
MoitLegpton, MR 01060 sdp.:y iso
Massachusetts Residential Building Code
Section I I O R5.1.2
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.
Section 110.R5.1.3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s)
for hire to do such work, then such homeowner shall act as supervisor.
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.
City of Northampton
Massachusetts � 1•- 4c
��, DEPARTMENT OF BOLLDIM rN5PECT10N5 Z
212 Main Stiaat a Municipal B—Id—g
Northampton, !A 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L. Chapter 142A requires that the"reconstruction, alteration,renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: Est.Cost:
Address of Work: // / /i�/1�,U/UJ/' It v
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
Job under$1,000.00
TIOwner obtaining own permit (explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
Date Contractor Name HIC Registration No.
OR:
Notwithsta di /'tg,he abo n ice, I hereby apply for a building permit as the owner of the above property:
Date /vim/� Owner Name and Signature
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Home Energy Rating Certificate Rating Date: 2017-04-24
QMWMaP8* Regi"ID: Unregistered
l'�^ Rating Number:
Index • • Home:
•
55lejmm.,,%,jsit wwwhorsindnx.com :o an averag�l J S.home Moos
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Your Home's Estimated Energy Use: This home meets or exceeds the
Use[Motu] Annual Cost criteria of the following:
Heating 5.5 $290
Cooling 0.4 $20
Hot Water 9.3 $202
Lights/APPllil 13.0 $683
Service Charges $60
Generation(eg.Solar) 0.0 30
Total: 28.1 $1,255
Home Feature Summary: Rating completed by:
Homelype: Apartment,and unit Energy Ratmal Mayna!d
bnldonW'locr Ares 970s f•.. WS-NET10:9463452
)JI Nqmoetdaedrao.^ 2
Patiag Compe7Ty0'.;S u HERS cne:ry F1T;cier_y
P17ary yeaitn 4isct-- Ai..,xurcE nx r ;4,q.-t-, -.�_`f
' Mn,, ,00 PI'ar/uooing$s a-.. A� wumeea . ,'gyp Sec .c LSIoiR
PrimaryWaterHeating: Water Heater.Propane•097Energy Factor Rettig PraridenEnergy,Raters of Massachusetts
'0 House Tightness 3A0150
Duct Leakage to Outside. 0CFM25
Above Grade Walls: R-20
TM'M0"" Calling: R-59 �
Window Type. U-Value 0.280,SHGC 0.270
m Foundation Walls: WA
r"° o
Arlin Maynard,CertiRed Energy Rater
ws.a
Home Energy Rating Certificate Rating Date: 2017-04-24
ReglstrylD: Unregistered r�a6a
Rating Number.
Index a . Home:
51 the mot�vi�etgy effident the home.Tu jr462 Builder:
earn nior,visit ,ww.hu,ind,� c�rn :,,,,r fw Moos
Your Home's Estimated Energy Use: This home meets or exceeds the
Usa[Mato] Annual cost criteria of the following:
Heating 5.5 $208
Cooling 0.3 $15
Hot Water 9.6 $210
Lights/Appliances 12.8 $676
Service Charges $60
Generation(eg.Solar) U -SO
Total: 28.2 $1.249
Home Feature Summary: Rating Completed by:
Home Type ApartmitM end unit En ayy RaaanAdin Maynard
condt6ored Fimr Area: 940.it. KcNEt IQ9463452
%mirex:t Senimmt 2 Rating Ltxupaay:NiS&HFp5 Ernergy EfflcieM.y
t Primary Haac:rg System: Air Sr�nz Heat Pump•Seem-13 HSPF
: ya Pnma7y Cnoiing Syst,= Air Sa:rce Heat Pump•Ee nc-22 SEER
Pdmaty Water Heaeng: Water Herter•Propane•087 Energy rector
A Ratatg Pravidar.Enetgy Raters ofMassac
Houserightness 3ACH50ME
Duct Leakage to Outside: 0 CFM25 r
s
Above Grade Walls: R-20 � :
^a•a^� Ceiling: N/A
Wintlow.TypType. U-Value:0.290,SHGC 0.270
m Foundation Walls WA
a Adin Maynard,CertiRed Energy Pater
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. a-
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: 11 MARSHALL ST.
Date of Inquiry: 03/07/17
Inquirer with contact info: Sheila Moos, 16 Marshall St, Northampton 586-4539, 320-3529 cell
Reason for Request: Conversion of existing garage and storage building to 2 apartments.
Municipal Sewer Main in Front of Location: Yes �/ No
Size of Sewer Main: Material: Age: 91 y
Depth of Sewer Main: $
Length of Sewer Main: S S
Size of Service Connection: 6 _
Type of Service Connection: QVL tv M<h.
r_Tie-in to Sanitary Main: Tie-in to Sanitary Stub:
Tie-in to Private Sanitary: Tie-in to Existing Sanitary Service:
Comments:
City Requires 6" cleanout installed at City Property Line _
Note:If this availability is for new construction,this form mustbe 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.
l^ '4_ Date:
Sewer Dept. Foreman
Sewer Entry $ Q
MUNICIPAL WATER AVAILABILITY APPLICATION
Northampton Water Department '
237 Prospect St
Northampton,MA 01060
413-587-1097
A Department of Public Works Trench Permit shall be required prior to any construction or
connection activity associated with this application.
Location: 11 MARSHALL ST.
Inquiry Made By: Sheila Moos 413-586-4539 413-320-3523 cell
(Name) (Telephone Number)
Date of Inquiry: 3/7/2017 Fire Line_ Irrigation_ Domestic }_
Number of Units: 2 Type of Units: Type of Ownership:
Single Family_ Private__
Apartments X Condo _
Muli-Family_ Rental ?_
Commercial_
(Applicant to fill out the above)
Municipal Water Main in Front of Location: Yes_V� No_
Existing service to site? Yes_ No
Size of Water Main: _� Material: CT Age:j(y /
Approximate Static Street Pressure: ^' 100 pS'r Flow Test Conducted: Yes No (/
(If Flow test conducted attach results)
Size of Service Connection: � CoPPe4" Suggested Meter Size: �rll
Comments: The Water Department cannot guarantee adequate water pressure during _
peak demand times at elevations above 320'
l / cencvI int , s" 44P
- A corresponding water enterance fee shall be paid prior to making any connection to the municipal
water system.
-Arrangement of such installation shall be made with the Northampton Water Department withi.i a
minimum of 5 working days notification.
All work shall conform to Northampton Water Department specifications.
(Water Superintendent) (Date)
Water Entry$ 0 ..00 Meter S IqO.400 Radio Read$ 13S.00
cc: City of Northampton Building Dept/Commissioner
NOTE:If this availablitiy is for a new construction,it must be hand delivered to the Building
Inspector
r
a'
I �h '
CITY OF NORTHAMPTON, MASSACHUSETTS
DEPARTMENT OF PUBLIC WORKS
125 Locust Street
Northampton, MA 01060
413.587-1570
Fax 413-587-1576
Fax 413-587-1576
Donna LaScaleia
Director
ASSIGNMENT OF HOUSE NUMBER
Street: Marshall Street
Assessors Map: Map 25A,Lot 29
House Number: 11
Date: March 6,2017
Remarks: Address assigned to an existing building lot on Marshal Street. The number
assignment was requested by the owner for permitting purposes for the
conversion of an existing garage and storage building to two apartments.
�— David K.Veleta,P.E.
City Engineer
cc: ✓Central Dispatch 'Board of Health
vWater Division /Tax Collector
✓Sewer Division Xatiional Grid
Streets Division ✓Verizon Telephone
✓inspectors -Comcast
,/Assessors -Columbia Gas of Massachusetts
'Police Department ost Office(Northampton)
✓.fames Thompson(GIS Coordinator) Post Office(Easthampton)
VP egistrar of Voters ✓School Department(Joy Winnie)
✓MasSGIS ✓Address Management Systems
✓Applicant/Owner: Sheila Moos
16 Marshall Street
Northampton,MA 01060
M o=NwabaaV.mMl Str I t Marshall Svt