36-388 Est Cow 5435000.00
Fee: $1790.30 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: GREGORY QUILL 105857
Lot Size(sq. ft.): 11586.96 Owner: GREENMAN JAMES&CATHERINE
zonine: Applicant. GREGORY QUILL
AT. 176 EMERSON WAY
ApplicantAddress: Phone: Insurance:
23 E HADLEY RD (413) 695-4195 WC
HADLEYMA01035 ISSUED ON.818/1018 0:00:00
TO PERFORM THE FOLLOWING WORK.NEW WOOD FRAMED SINGLE FAMILY HOUSE
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 Skmature:
FeeTvve: Date Paid: Amount:
Building 8/8/20180:00:00 $1790.30
212 Main Street Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Dale
Building Permit Number: Issued:
Signature:
Building commissioneranspaclor of Buildings Date
RXemaYJ Coyv. -
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Most Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This Mourn to be filled in by
Building ncWa nt
Lot Size
Frontage k o C(q
Setbacks Front d,S
Side L: I S ' R: I S L:- R:
Rear 5,0
Building Height ay
Bldg. Square Footage Zy SSS ;kS
Open Space Footage r %
IWi arra mina bldg&po,ed 5,d- 1u 1J
nror
N of-Parking Spaces y
Fill:
(volume&Lw:utiun
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Qi DONT KNOW O YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES l
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 6 DONT KNOW O YES l
IF YES, has a permit been or need to he obtained from the Conservation Commission?
Needs to be obtained l Obtained l , Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs Intended for the property? YES O NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,azca on,or filling)over I acre or is it part of a common plan
that will disturb over 1 acral YES 0N
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S-DESCRIPTION OF PROPOSED WORN Icheck all applicable)
New House Addition ❑ Replacement Windows Alteration(s) Roofing r70
r Doom ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks iO Siding[O] Other[a
Brief Description of Proposed p
Work: WoOA /I V 0 p_ }T1n'� homes
Alteration of existing bedroom_Yes -/No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement `Yes No
Plans Attached Roll -Sheet
e■.N Now houlto it d or addiflon to exilitinahousing. om a fol o if :
a. Use of building;One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? Y
d. Proposed Square footage of new construction. a y S Dimensions X49 '- S" X C o I
e. Number of stories? I I/X
I. Method of heating? "04 vfak g0 L �Fk VA C,_ Fireplaces or W oodstoves Q CSS _Number of each
g. Energy Conservation Compliance. �.. Q� L Masscheck Energy Compliance form attached?
h. Type of construction W O d d_
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 1 I
it. Will building conform to the Building and Zoning regulations? V/ Yes No.
I. Septic Tank_ Cay Sewer I/ Private well City water Supply
SECTION Is-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, --�QWt Q S 11 Y--VD VN M a Ip. ,as Owner of the subject
property
E
in —myto work authorized by this building p it of tl.n./f'O�wirer p Dene
I, l7tt/Q_l{ t 1 41 Lt �I ,as Owner/Authorized
Agent hereby deciare(]hat thestatements end information on the foregAg applicabon are true and accurate,to the beat of my knowledge
and belief.
Signed/under the pains(and penalties of perjury.
11YQG l� U \ 1�
Print Name /
31
Signature FOw AB Date
SECTION S•CONSTRUCTION SERVICES
8,1 Licensed Construction Supervisor, Not Applicable ❑
Name of License Hold er: G-� re A a)U l k1 LSf R — 10 5'r-3r)
License Number
L 04 -a9 - 15
Address E Aire w Data
C41�h (n9 S L119 S
Signatures Teleph e
Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,¢25C(8))
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 builtlin permit.
Signed Affidavit Attached Yes....... No...... ❑
City of Northampton
•'r( Massachusetts
DSPARTd6N9' OF BUILDING ZNSPSCTZONS i
212 win St .t •Municiyl 9uila.g
eo[tha ton, MI, 01060
Debris Disposal. Affidavit
In accordance of the provisions of MGL c 40, 554, 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 property licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
b1(o E v- .'p � � )ft
�
(Please print house number and street n e)
Is to be disposed of at::
Vak1P 4C C.11ha LaS�I�G�O�GV\ 1�Cpm 1IUC \dN �61
(Please pnot name and location ta2kity
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature ofApplicant ner 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 Commomvealik of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-1017
www.massgov/dia
Wm.i kers'Compensation Insurance Affidavit:Builders/Contractors/Electrlcions/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information (� 1 Please Print Lealbl
Name(Business/Orgmi.tioMndividml): t2,cmeyv,\A_ `Q V�yLlf�
%
Address: a-3 �N d`4J r E- 1 ..ot _Met 01 O3'
City/State/Zip: Phone#:J 1 a 1 -y ( q
Are you;mtmploya.?Check tbe.pproprbn boa: Type of rofect(required):
L❑lam employer with conloyceslfalland/orpen-timet• 7, . 'ew construction
a snit proprietor or partnership and have no employees working for me in g_ ❑Remodeling
' anyc.'eiry,IN.workers'mmp"rommna required.]
3.❑l out a homeowner doing all workself No workers'co t q. ❑Demolition
my mp.InSUfan<C required]
to 10❑Building addition
4.❑
ensure
homcownttamt will hehiring contractorsnconductallwmkce or me sole
. twill
nsurc that all contractors cithttM1ove workcl%rnny¢naaliun insurance or meanlc IL❑EICCtrICBl repairs or additions
,.Oct.withno employees. 12.❑Plumbing repairs or additions
5.0 1 am a lameml eommcmr and 1 have hind the sub comrxmn listed em the attached sheet a
ricaf subcommemm have employees and have workers'comp.imurenae. 13.❑Roof Pairs
6.[]We arc ac tinnaml its Omecrs lurw exercised their right of 14.❑Other
uannm b P Per MGL<.
152.410),and we have no employees.[No workers'romp.insurance required.)
•.Anyapplicam thm checks box#1 must also till out the scroon below showing t1%srwmkers compctuation policy information.
r Nnnunwners who .limit his audition indicating they are it.,.,all wnd and then hire outside contractors must submit a new amdavtt indicating such.
tContract airs that check this box must attached an additional shm showing the time of the sul contmctom and state whether or not those a it..have
employees. Ifthe sub-contractors have cmplayccs,they must pmvtdc their workcn'comp.policy number.
I am an employer that is proRding 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/Stale/Zip:
Attach a copy of the workers'compensation policy dec ation page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§2 A is a criminal violation punishable by a One 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cerrdfy under the pains and penalties of perjury that the information provided above is true and correct
Sienatiom [ A l
( 11 , Date,
Phone#: (-'�, Ll, j 9
Official use only. Do not write in this area,to be completed by city or town i ffeciat
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CttyTown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
Home Energy Rating Certificate Rating Date:
Projected Report Registry ID: Unregistered
�".flx .
Ekotrope ID: ICXAW98d
IndexHERSO
yo., So,er HLR�sco,e 176 [merson Way, Northampton, MA
5 3 '11- more Irsit R-lat' 'emar�Veraqe USA,01no
Rosemund
Your Home's Estimated Energy Use: This home meets or exceeds the
Use[Motu] Annual Cost criteria of the following:
Heating 73.0 $2,180
Cooling 0.8 $37
Hot Water 13.0 $388
Lights/Appliances 30.3 $1,324
Service Charges S0
Generation leg.Solar) 0.0 -$0
Total: 117.2 $3,928
Home Feature Summary: Rating Completed by:
+.r.� Home Type 5ingle famliy detached Energy RahrJafed Woods
Conditloned Floor Arca; 4,400 s4 It RESNETO,78Z4%1
e"arwr Number of Redroomz 3
Name Rating Conipa":Pmv House Energy Cor�suitin
Primary Heating System: Air Con •VlOr,-El 96 AFl1E 479 West 5t Sure 105,Amherst MA 9
rm Primary Cooiing Sysitm: Air Conditioner.EtecYric•57 SEER
aehrt ce
Nome loo Primary Water Heat ng Water Hearer.Propane•0.95 Errargy Factor r••+::
# Houseu,luaesz 3ACH50 Riling GrovidohEnergy Raters of MaSsa<htuetis
n VeoUlation. 75ACFM,30DW,rfts r x",
x ! Duct Leakage to Outs•de 50CFM25
nYNw Above Grade WRs: R-19 .„r,
Cellla¢ Auk,R48
n dan•mType OValue:0.280,5H5C:0.290
eery o Fou.dafiYlon Walls: R13
ssaM � Jdred Woode((.t lfied Energy Rater
Digitally signeh 1.20/18 at t 1E31 PM
• • i
ROSEMUND-176 Emerson Way
1 ST FLOOR 1865 0.50 $ 932.50
2ND FLOOR 620 0.50 $ 310.00
GARAGE 644 0.20 $ 12880
BSMNT FINISHED 0 0.50 $ -
BSMNTUNFINISHED 1865 0.20 $ 373.00
PORCHES 170 0.20 $ 34.00
DECK 60 0.20 $ 12.00
TOTAL FINSIHED AREA -SF $ 1.740.30
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: 176 Emerson Way,Lot 44
Inquiry Made By: Rosemund LLC/Marie Quill 413-695-8795
(Name) (Telephone Number)
Date of Inquiry: 7/18/2018 Fire Line _ Irrigation_ Domestic x
Numberof Units: 1 Type of Units: Type of Ownership:
Single Family z Private x
Apartments_ Condo_
Mull-Family_ Rental_
Commercial
IAppficanttofill out the abowel
Municipal Water Main in Front of Location: Yes_ No j/
Existing service to site? Yes No
i
Size of Water Main: Material; Age: 212/9Approximate Static Street Pressure: '� '35 pSl Flow Test Conducted: Yes No Y/
(If flow test conducted attach results)
Size of Service Connection: Suggested Meter Size: _ 4 0111
Comments: The Water Department cannot guarantee adequate water pressure during
peak demand times at elevations above 320'
AQ� I Reivalfe mai,
- 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 within a
minimum of 5 working days notification.
-All work shall conform to Northampton Water Department specifications.
7-zy-1P
CWater Superintendent) (Date)
Water Entry x($1,250) Domestic Meter _ $ 160 Radio Read 150
($2,500)Subdivision (fee to be determined)
(Includes fire line if required)
cc: City of Northampton Building Dept/Commissioner
NOTE If this availablltiy is for a new construction,it must be hand delivered to the Building
Inspector
ti
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: 176 Emerson Way, Lot 44
Date of Inquiry: 07/18/18
Inquirer with contact info: Rosemund LLC. Marie Quill 695-8795
Reason for Request: New Construction
Hooking into City Utilities
Municipal Sewer Main in Front of Location: Yes ✓ No
t'
Size of Sewer Main: g Material: V'(— Age:
Depth of Sewer Main:
Length of Sewer Main:
Size of Service Connection:
Type of Service Connection:
Domestic Tie In: _ ($1,2//50) Subdivision Tie In : ($2,500)
J
Tie-in to Private Sanitary: $-N/A Tie-into Existing Sanitary Service: $-N/A
Comments:
City Requires 6"cleanout installed at City Property Line
Note:If thisavaRabimyisforMwcmft ctian,tllt5formmnatbe LanddeNTseredie Butbring Inspector.
A corresponding"sewer entrance fee"shall be paid prior to making any connection to the
municipal sewer system.Arrangements of such installation shall be made with the Northampton
Streets Department with a minimum of 5 working days notificaiton. All work shall conform to
Northampton Streets Department specifications.
Date: yak/I i'
Sewer Dept. Foreman
Sewer Entry$- b4 _
ACORO® CERTIFICATE OF LIABILITY INSURANCE D"0712418'`Y'
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 INSURERS),AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
IMPORTANT. N the certificate,holder Is an ADDITIONAL INSURED,Me pollcyjip)meat have ADDITIONAL INSURED provisions or M endorsed.
If SUBROGATION IS WAIVED;subjectto Me Mms and condltions of Me policy,certain policies may neulm an endorsement Aatatemem on
Nola certldkax,does not eo1rM right;to the eeRMcab holder In IMF of aoch eRdoleemelld 1,
R.UCER IMME
: TIRE'RenOM00n
WvUMrSGRnnellPHdIE Er: (413)586-0111 Me. (413)5866481
xo
B NORh King Street LAWRES., narcsongvebbenndgdnnell.comINSURERn1AFFOROINGCOYEMGE NAIL.
NOMelnpWn MA 01080 BinINSURED Rosamund,LLC uoGngo'CUlll 23 East Radley Road Hadley MA 01035
COVERAGES CERTIFICATE NUMBER: EXP 512019 REVISION NUMBER:
THIS IS TO CERTIFY THATTHE 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 MICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCWSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
RRI
LIR TMPEKWBWIAMCEsyno
P.UCYNUMBER UUM,
COMMaIKW.tlL'aWL WaILITY EIGVOLCYAtWENEE a 1OW.00d
CVJMSMADE OOCCUR PR EMISESEeowmanM 5100,000
MEDEXP An —Ponunl S 5,000
A CIP353708 OSI25I2018 OSR62019 PERSONALaAWINJUm Is 1,0oD.D00
GEMLAGGREGATE LIMITAPPLIES PER GENERALAGGREGWE S 2,000,000
P D'--o- LOC PRODUCTS COMEOPAGG $ 2,000,000
OTXER $
AUMMUDER.MA-s-TV PRIED I LELIMIT E
ANYAUN S
OWNED SCHEDULED eODILYINJURY 1PxeruMnO S
AUTOSONLY AJ706
HIRED NONI EO R PER MA E e
AUTOS D`ILY AUTOS ONLY Memde
S
DMBRFLLALIAa IX:CLR FACRCCCURRENCE S
EXCESS UAe CWMSMAOE AGGREGATE $
DED RETENTION$ S
rROPPERS COMPENSATION PER "-
MIo13NLf)EERe'ILMYIF
I'M
sTNruTE FA
ANY PROPWETORIppRTNFRi£%PCUTIVE ❑ NIAELEAGIM.CJCEW S
OFFICERMEMBER EXCLUDE09
(Wnesay In NM) E.L.DISEASE-EAEMPLOYEE $
Mm4a uMnr
DESs CRIPTION OF OPERATIONS CeIcw EL DISEA6E-POLICY UMIT $
DESCRIPTIO!OF OPERATORS I LOCATORS/VEHICLES(ACORO RIM,MMa NMl Renu Schedule,My W maxled xenon AMM Is MI
CERTIFICATE HOLDER CANCELLATION
SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
TNE.E%RIEAAON DATETHEJrsOF,NOTICE WILL 13EDF1NFIEEDRi
CIyUNrndMmpiGn ACCORDANCE YATHTHEI)OLILY PROM90NA
210 Main Street
AVIXORIFEO REPRESENTATIVE
Nonhampton MA 01060
®1888.2016 ACORD CORPORATION. All rights neerved.
ACORD 25(20161 The ACORD name and logo are Registered marks of ACORD