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31C-061 23 HIGGINS WAY BP-2019-1413 GIS#: COMMONWEALTH OF MASSACHUSETTS MV.-Block:3 1 C-061 CITY OF NORTHAMPTON Lot:- 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-2019-1413 Proiect# JS-2019-002285 Est.Cost: $371750.00 Fee: $1540.00 PERMISSION IS HEREB Y GRANTED TO: Const.Class: Contractor: License: Use Groin KENT PECOY & SONS CONSTRUCTION INC 052589 Lot Size(sq.ft.): Owner. KENT PECOY&SONS CONSTRUCTION INC zoning: Applicant. KENT PECOY & SONS CONSTRUCTION INC AT. 23 HIGGINS WAY Applicant Address: Phone: Insurance: 215 BALDWIN ST (413) 781-7008 WC WEST SPRINGFIELDMA01089 ISSUED ON:7/24/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT NEW SFH WITH ATTACHED TWO CAR GARAGE 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 7/24/2019 0:00:00 $1540.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner NWC� File#BP-2019-1413 APPLICANT/CONTACT PERSON KENT PECOY&SONS CONSTRUCTION INC ADDRESS/PHONE 215 BALDWIN ST WEST SPRINGFIELD (413)781-7008 PROPERTY LOCATION 23 HIGGINS WAY MAP 31C PARCEL 061 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 NEW SFH WITH ATTACHED TWO CAR GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 052589 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 Demolition Delay Signature of Building Official 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. W'V'V-q jWJL-1 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 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 Map _ Lot _Unit 23 Higgins Way, Northampton, MA 01060 Zone Overlay District LD`4- S" Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Kent Pecoy& Sons Construction, Inc. 215 Baldwin Street,West Springfield,MA 01089 Name(Print) Current Mailing Address: 413-304-3879 ��— Telephone Signature 2.2 Authorized A ent: 6A krog + 5015 ron. AM. al-5 6A1d w1%i N WeCj Sin nabeU' *III Name(Print) I Current Mailing Address: �QIDWj y16-30Y-.3899 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $312,800.00 (a) Building Permit Fee 2. Electrical $20,850.00 (b) Estimated Total Cost of Construction from 6 3. Plumbing $19,750.00 Building Permit Fee 4. Mechanical(HVAC) HVAC Only $18,350.00 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 EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 [-4,82q--fC— Frontage 48' ---- -- -- ---- Setbacks Front Side L:0 R:= L:= R:= 0 Rear �_� 31' Building Height 30'__] Bldg. Square Footage C=� % 1794', I 6/o Open Space Footage % _ (Lot area minus bldg&paved —� �� 2635 parking) #of Parking Spaces r -, F4 Fill• - -- - - i (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW 0 YES O IF YES, date issued:'; IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW © YES O IF YES: enter BookL- I - Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW © YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained © , Date Issued: C. Do any signs exist on the property? YES Q NO O IF YES, describe size, type and location D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO O IF YES, describe size, type and location: C 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 O NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Q✓ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs (O] Decks [p Siding[0] Other[O] Brief Description of Proposed Construction of new single family wood home with two car attached garage Work: Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes x No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family X Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? Yes d. Proposed Square footage of new construction. Dimensions e. Number of stories? 2 f. Method of heating? Forced Air Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Yes Masscheck Energy Compliance form attached? Yes h. Type of construction Food i. Is construction within 100 ft. of wetlands? Yes X No. Is construction within 100 yr. floodplain Yes—)(—No j. Depth of basement or cellar floor below finished grade 9 ' k. Will building conform to the Building and Zoning regulations? X—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 1, 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, K� W. Peca�t 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 Dp^ennalties of perjury. D Print Name Signature of Owner/Agent Dat SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Kent W. PeCoy License Number 215 Baldwin Street, West Springfield, MA 01089 CS-052589 Address Expiration Date zz, A-" -t �_ 413-304-3879 09/16/2019 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name I Registration Number ftttby -f Son Coo 4rur--6 r-,C• 107367 Address I Expiration Date 151!4�d Telephone c}�5-,g05/-3899 07/30/2020 Q1689 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....... No...... ❑ City of Northampton i `y SSC A�" Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 7yJ�� Hca 212 Main Street • Municipal Building Northampton, MA 01060 Fee Calculator for Residential Properties Location: Lot 5 - 23 Higgins Way, Northampton, MA 01060 Square Footage Amount Basement @.20 1348 sf $269.60 1 ST Floor @ .50 1348 sf $674.00 2ND Floor @ .50 1014 sf $507.00 1/s Floors, Finish Attic, Garage @ .20 400 sf $80.00 Deck / Porches @ .20 47 sf $9.40 Total: $1 ,540.00 City of Northampton _ sus-'� �'•!c� Massachusetts c y I'� DEPARTMENT OF BUILDING INSPECTIONS y 212 Main Street • Municipal Building Northampton, MA 01060 rfYn 8�,�4 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: New Construction—Single Family Home Est. Cost: $371,750.00 Address of Work: Lot 5—23 Higgins Way, Northampton, MA 01060 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 Owner 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: Iby 719 ply for a building permit as the agent of the owner: her 1 b Kent Pecoy & Sons Construction,Inc. 107367 Date 1 Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts !<< .c .it DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Northampton, MA 01060 rslly-�j�g0 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: Lot#5—23 Higgins Way, Northampton, MA 01060 (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: USA Hauling—5 Shoham Road, East Windsor, CT 06088 (Company Name and Address) ,5/,5) 11q Signature of Permit plicant or Owner Dat 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 Industrial Accidents a I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leaffily Name(Business/Organization/Individual): Kent Pecoy&Sons Construction, Inc. Address: 215 Baldwin Street City/State/Zip: West Springfield, MA 01089 Phone#: 413-781-7008 Are you an employer?Check the appropriate box: Type of project(required): 1.[Z]I am a employer with 20 employees(full and/or part-time).* 7. ❑✓ New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.M I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 1 1.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.C]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§](4),and we have no employees.[No workers'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: Borawski Insurance Policy#or Self-ins.Lic.#: WMZ8008006823 Expiration Date: 06/30/2019 Job Site Address: Lot 5-23 Higgins Way City/State/Zip:NorthamptonMA 01060 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 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 certify under the pains and alties of perjury that the information provided above ' true and correct Si nature: L!/ Date: S 3/ / Phone#: 413-304-3879 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#: A ® DATE(MM/ Y) CERTIFICATE OF LIABILITY INSURANCE 08,30,20,82018 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 INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Irene Balise NAME: Borawski Insurance PHONE (413)586-5011 FAX (413)586-7973 A/ No xt• AIC No 88 King Street,Suite B E-MAIL ibalise@borawskiinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC q Northampton MA 01060-3257 INSURERA: Netherlands Insurance 24171 INSURED INSURER B: Peerless Insurance Company Kent Pecoy&Sons Construction,Inc INSURER c: AIM Mutual 215 Baldwin St INSURER D: INSURER E: West Springfield MA 01089 INSURER F: COVERAGES CERTIFICATE NUMBER: 7/1/18-19 All Lines REVISION NUMBER: THIS IS TO CERTIFY THAT THE 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 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLISUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYVYV LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISEST 7 Ea ccurrrence $ 100,000 MED EXP(Any one person) $ 5,000 A CBP8780556 07/01/2018 07/01/2019 -PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO FX LOC 2,000,000 POLICY POTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED BA8781850 07/01/2018 07/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLA LIAB X1 OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LAB CLAIMS-MADE CU8783651 07/01/2018 07/01/2019 AGGREGATE $ 5,000,000 DED I X RETENTION$ 10,000 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ C OFFICER/MEMBER EXCLUDED? NIA WMZ8008006823 06/30/2018 06/30/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) to -45- - 11?3 H,i � ; 0--:> IA�j CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 125 Locust Street AUTHORIZED REPRESENTATIVE 'n/ Northampton MA 01060 `/ Y ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ®� Commonwealth of Massachusetts s ` Division of Professional Licensure Board of Building Regulations and Standards Construction'Supervisor CS-052589 E-Xpires: 09116/2019 KENT W PECOY e b 216 BALDWIWgT WEST SPRINGFIELD MA0108x9' Commissioner Construction Supervisor Unrestricted-Buildings of any use group which contain less than 36,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpi �/ Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation KENT PECOY&SONS CONST. INC. Registration: 107367 Expiration: 07/30/212 020 215 BALDWIN ST WEST SPRINGFIELD,MA 01089 Update Address and Return Card. SCA/ 0 20M-0507 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. if found return to: Reaistr�tIon Expiration Office of Consumer Affairs and Business Regulation 107367 07/30/2020 1000 Washington Street-Suite 710 KENT PECOY&SONS CONST.INC. Boston,MA 02118 KENT W.PECOY ,Q CGQ -- 215 BALDW IN ST � WEST SPRINGFIELD,MA 01089 Undersecretary O alid without signature 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: 23 Higgins Way,Lot 5 Inquiry Made By: Pecoy Companies Dizaree 413-304-3879 (Name) (Telephone Number) Date of Inquiry: 4/4/2019 Fire Line Irrigation Domestic x Number of Units: 1 Type of Units: Type of Ownership: Single Family x Private x Apartments Condo Multi-Family Rental Commercial Applicant to fill out the above) Municipal Water Main in Front of Location: Yes x No Existing service to site? Yes x No Size of Water Main: 8 Material: Ductile Iron Age: 2017 Approximate Static Street Pressure: 65 PSI Flow Test Conducted: Yes No x (If flow test conducted 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' - 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 mi o orking days n n. -All work sh c for ort m Water Department specifications. a r Superintendent) (Date) *Water Entry x ($1,250) Domestic *Meter $ 450 *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 availablitiy is for a new construction,it must be hand delivered to the Building Inspector *Fees will be charged based on current fee structure at the time of entry application (� 1 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: 23 HIGGINS WAY, LOTS Date of Inquiry: 04/04/19 Inquirer with contact info: PECOY COMPANIES 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: Domestic Tie In: ($1,250) Subdivision Tie In : ($2,500) Tie-in to Private Sanitary: ✓ $- N/A Tie-in to Existing Sanitary Service: $- N/A Comments: City Requires 6" cleanout installed at City Property Line Note:If this availability is for new construction,this form must be hand delivered to Building Inspector. A corresponding"sewer entrance fee" shall be paid prior to making any connection to the municipal sewer system.Arrangements of such installation shall be made with the Northampton Streets Department with a minimum of 5 working days notificaiton. All work shall conform to Northampton Streets Department specifications. Date: L j Is//A Sewer Dept. Foreman a *Sewer Entry$ i USTor *Fees will be charged based on current fee structure at the time of entry application