36-369 (3) 163 EMERSON WAY BP-2020-0108
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:36-369 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:ZoningPermit BUILDING PERMIT
Permit# BP-2020-0108
Project# JS-2019-002425
Est.Cost: $587300.00
Fee:$3047.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MATTHEW DERY 064404
Lot Size(sq.ft.): 15594.48 Owner. KENNAMER HAL
Zoning: Applicant. MATTHEW DERY
AT. 163 EMERSON WAY
Applicant Address: Phone: Insurance:
408 HOOSAC RD (413) 369-4447 O
CONWAYMA01341 ISSUED ON.7/29/2019 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT NEW SINGLE FAMILY HOUSE
WITH ATTACHED 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 Sip_nature:
FeeTyne: Date Paid: Amount:
Building 7/29/2019 0:00:00 $3047.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
JGc
= Department use only
City of Northampton Status of Permit:
Building Department 3 Curb Cut/Driveway Permit
212 Main Street = j /Septic Availability
Room 100 Wat /W ell/Availability
Northampton, MA 01060 iTwo ets 'f Structural Plans
\tib 5 phone 413-587-1240 Fax 413-587-1272 Plo Sitetans
Ot er Sp city
/ON
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVAJjfl DEMOLI H A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
Map Lot Unit
163 Emerson Way
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Hal Kennamer 524 Olde Englilsh Lane, Mountain Brook, AL
Name(Print) Current Mailing Address;., . ZZ ) //--
Telephone
Signature
2.2 Authorized Agent:
Stephen Ferrari 103 Ryan RD, Florence, MA 01062
Name(Print) Current Mailing Address:
413-588-8975
Signat Telephone
SECTIOd3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars)to be Official Use Only
com feted by permit applicant
1. Building $527,950. (a) Building Permit Fee
2. Electrical $18,900. (b) Estimated Total Cost of
Construction from 6
3. Plumbing $15,950. Building Permit Fee 0
4. Mechanical (HVAC) $24,500.
5. Fire Protection n
6. Total = 0 + 2 + 3+4+ 5) $587,300. Check Number W
This Section For Official Use Only
p,' r7— Date
Building Permit Number: Issued:
Signature: ' - �y zozz)
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 15,549 sf 15,549 sf
Frontage 80.23' 80.23'
Setbacks Front 26.5'
Side L: R: L:27' R: 19'
Rear 26
Building Height 21'
Bldg. Square Footage % 3181 sf 20%
Open Space Footage %
(Lot area minus bldg&paved 11064 sf 71%
parking)
2
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ® DON'T KNOW ® YES (X)
IF YES, date issued: 8/11/2016
x
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DON'T KNOW ® YES (X)
IF YES: enter Book 128386 Page 45 and/or Document# 00017807
B. Does the site contain a brook, body of water or wetlands? NO (x 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:
C. Do any signs exist on the property? YES ® NO I-
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 (x)
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 [x] Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors E3
Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks [Q Siding [O] Other[d]
Brief Description of Proposed Construct a new one story single family home w/attached garage
Work:
Alteration of existing bedroom Yes No Adding new hedroom Yes No
Attached Narrative Renovating unx ished basement Yes No
Plans Attached Roll -Sheet
6i"I"'W ft Mlles aW or addition to existing housing, complete the foilowina:
a. Use of building : One Family x Two Family Other
b. Number of rooms in each family unit: 7 Number of Bathrooms 2
c. Is there a garage attached? yes
d. Proposed Square footage of new construction. 2810 sf Dimensions 54' x 45' irr
e. Number of stories? one
f. Method of heating? air source heat pump Fireplaces or Woodstoves 1 Number of each
g. Energy Conservation Compliance. HERS rating Masscheck Energy Compliance form attached?
h. Type of construction Wood Frame
i. Is construction within 100 ft. of wetlands? Yes x No. Is construction within 100 yr. floodplain Yes x No
j. Depth of basement or cellar floor below finished grade 7 +-
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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Oc4_11 Weo l a m e,v- as Owner of the subject
property
Stephen Ferrari
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
#M10- /
Signature of Owner Date
Stephen Ferrari 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.
Stephen Ferrari
Print Name
Signature of Own r/Agent Date
SECTION 8-CONSTRUCTION SERVICES �e
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder Matt Derry CS 064404
License Number
408 Hoosac RD, Conway 7/1/20
Address Expiration Date
413-369-4447
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
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....... ❑ No...... ❑
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste 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.
Address of the work: 163 Emerson Way, Florence
The debris will be transported by: J & J and Son, Williamsburg, MA
The debris will be received by: valley Recycling, Northampton
Building permit number:
Name of Permit Applicant Steve Ferrari
Date �� �� �j' Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of IndustrialAccidents
1 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 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 employees(full and/or part-time).* 7. 0 New construction
2.a I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3.Q I am a homeowner doing all work myself[No workers'comp,insurance required.]t
10 Building addition
4.[:]I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 1 1. Electrical repairs or additions
proprietors with no employees.
1_.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1 3.[:]Roof repairs
These sub-contractors have employees and have workers'comp.insurance.
6.f_1 we are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other
152,§1(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'comPenation insurancefor myemployees. Below is the policy andjob site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: 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 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 cern under the p ins and penalties of perjury that the information provided above is true a71 correct.
Si afore: Date:
Phone#: 413-*8-8Pf5
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#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 02-23-15 www.mass.gov/dia
FCM Smart Build Steve Ferrari
Construction Management Services Phone: 413-588-8975
103 Ryan Road Fax 413-586-1832
Florence, MA 01062 ferrari.steve@gmail.com
MEMO
T0: Northampton Building Departmrnt
From: Steve Ferrari
Date: 12/18/19
RE: Electronic Media for BP Application for 163 Emerson Way
CONTENTS OF CD submitted with Buildin Permit Application
File Name File Type Pages Description
1 Kennamer BP App completed PDF 4 pgs, letter Completed BP Application Form
Kennamer Construction Set 12-5- PDF 14 pgs, 36 x 24 Site and Building Plans
2 19
Kennamer Framing Plans from PDF 2 pgs, 24 x 18 Framing Plans& Beam Designation
3 RKM 9-19-19 from RK Miles
Sewer&Water Availabilities PDF 2 pgs, letter fov
from
asvailability forms
4
5 Construction Debris Affidavit PDF 1pg, letter Solid Waste Disposal Affidavit
6 Insurance Affidavit PDF 1pg, letter Insurance Affidavit
1
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: 163 EMERSON WAY
�I
Inquiry Made By: STEVE FERRARI 413-588-8975 ferrari.steve@gmail.com
(Name) (Telephone Number)
I�
Date of Inquiry: 6/25/2019 Fire Line Irrigation Domestic X
Number of Units: 'j 1 Type of Units: Type of Ownership:
Single Family X Private X
Apartments Condo
Multi-Family Rental
Commercial
(Applicant to fill out tbo above
Municipal Water Main i Front of Location: Yes x No
Existing service to site? Yes x No
Size of Water Main: I 8" Material: Ductile Iron Age: 2016
Approximate Static Streit Pressure: 50 psi Flow Test Conducted: Yes No x
(If flow tent conducted attach results)
Size of Service Connection: 1" Suggested Meter Size: 5/8"
i'
Comments: The Wa er Department cannot guarantee adequate water pressure during
peak de nand times at eIgy4tions above 320'
- A corresponding wate, enterance fee shall be paid prior to making any connection to the municipal
water system.
-Arran a such i istallation ll be made with the Northampton Water Department within a
mi ' um of 5 rking s �fic ion.
All work s 1 co fo North ton Water Department specifications.
71 6/26/2019
(urate Superintendent) (Date)
*Water Entry x ($1.250) Domestic *Meter $ 450 *Radio Read $150
($2,500) Subdivision (fee to be determined)
(Includes fire line if re'luired)
cc: City of Northampton Building Dept./Commissioner
NOTE:If this availablit y is for a new construction,it must be hand delivered to the Building
Inspector
i
*Fees will be 4arged based on current fee structure at the time of entry application (�
1
i
MUNICIPAL SEWER AVAILABILITY APPLICATION
Northampton Streets Department
125 Locust Street
Northampton, MA 01060
413-587-1570
A Department of P + lic Works Trench Permit and Sewer Entry Permit shall be required prior to any
construction or connection activity associated with this application.
Lc,Fation: 163 EMERSON WAY LO-r a ,
Date of I�quiry: 06/25/19
Inquirer with contact info: STEVE FERRARI 413-588-8975 ferrari.steve@gmail.com
Reason for Request: NEW CONSTRUCTION
j
ii
Municipal Sewe�,IMain in Front of Location: Yes No
Size of Sewe� Main: Material:, Age:
Depth of Sewer Main:
Length of Sewell Main:
Size of Service Cenection:
i
Type of Service Connection:
Domestic, ie In: ($1,250) Subdivision Tie In : ($2,500)
Tie-into Private Sar}iitary. y $ - N/A Tie-into Existing Sanitary Service: $ - N/A
Comments:
L�
City 'quires 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 seer system.Arrangements of such installation shall be made with the
Northampton Str jets Department with a minimum of 5 working days notificaiton. All work
shall lconform to Northampton Streets Department specifications.
Dater 7 l f
Sewer Dept. For an
j
*Sewer Entry';$
*Fees will be charged based on current fee structure at the time of entry application
I I
City of Northampton
Massachusetts
fi
IIN� DEPARTMENT OF BUILDING INSPECTIONS
1 " 212 Main Street • Municipal Building
tom*^ Northampton, MA 01060 ssyw, 1�
Fee Calculator for Residential Properties
Location � -
Square Footage Amount
Basement @ .20 - �rvtir �f 7Z 2b ' 2
1ST Floor @ .50 79-6d
2nd Floor @ .50
'/2 Floors, Finish Attic, Garage @ .20
Deck / Porches @ .20 7
Total
C.,
16') EMERSON WAY BP-2020-0108
Cl I S#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:36-369 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Catep,om:Zoning,Permit BUILDING PERMIT
Permit# BP-2020-0108
Project ; JS-2019-002425
Est.Cost:$10000.00
Fee: 431.00 PERMISSION IS HEREB Y GRANTED TO:
Const.Class: Contractor- License.
Use Group: MATTHEW DERY 064404
Lot Si7z(sg.'ft.): 15594.48 Owner: KENNAMI-UlAl-
ZoniLi&_ Applicant: MATTHEW DERY
AT. 163 EMERSON WAY
Applicant Address: Phone: Insurance:
408 HOOSAC RD (413) 369-4447 0
CONWAYMA01341 ISSUED O.'V.-712912019 0:00:00
TO PERFORM THE FOLLOWING WORK Z-FA - CONSTRLJCT NEW SINGLE FAMILY
HOUSE WITH ATTACHED GARAGE
F4t*" 011�
.01
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 ft 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 RL
�T
LES AND REGUILATIONS.
Certificate of Occupancy Signature:
FeeTvpe: Date Paid: Amount:
Building 7/29/2019 0:00:00 5431,00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck- Building Commissioner
File 4 BP-2020-0108
APPLICANT/CONTACT PERSON MATTHEW DERY
ADDRESS/PHONE 408 HOOSAC RD CONWAY (413)369-4447 O
PROPERTY LOCATION 163 EMERSON WAY
MAP_3¢._PARCEL 369 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION C LIS
EN , ,OSED RhnUIRED DATE
ZONING FORM FILLED OUT
Fee Paid V11-11 I
Building Permit Filled out
_._____.._.....
Fee Paid
TypeofConstruction: ZPA -CONSTRUCT NEW SINGLE ACHED GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
A_ccessory Structure
Building Plans Included:
Owner!Statement or License 064404
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 Perntit _._.__. 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
/ _......7'Z6-201
Signa ure 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.
r
Department use only
,
City of Nbi-thallrot,
EIV tatus of Permit:
_.
Building Depa @t5 urb C utlDriveway Permit
212 Main Street ewer,Septic Availability
Roomloo ao JUL 2 6 2019 �
- - � a#er ell Availability I
Northampton, MA 01060 wo Sets of Structural Pians
phone 413-587-124+0 F otlSi e Plans
. % Other pecify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address This secti to be completed by office
Map `� Lot (j7Unit
163 Emerson Way
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Ha! Kennamer 524 Olde Englilsh Lane, Mountain Brook, AL
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Stephen Ferrari 103 Ryan RD, Florence, MA 01062
Name(Print) Current Mailing Address: p
413-588-8975 i
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit 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) , �d
5. Fire Protection
6. Total=0 +2 +3_+4 +5) Check Number
This Section For Official Use Only
r
BuildingPermit Number: Date
Issued:
Signature: r` ? t
Building Commissionerlinspector of Buildings Nate
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
Chis column to be filled in by
t3uddmg L)epartment
I.ot Size 15,549 sf 15,549 sf
Frontage 80.23' 80.23'
Setbacks Front 26.5'
Side L: R: L:27' R: 19'
Rear 26
Building Height 21'
B{dg. Square Footage % 3181 sf 20%
Open Space Footage %
(Lot area minus bldg&paved 11064 Sf 71%
atking)
2 6
#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 0 YES (X)
IF YES, date issued: 8/11/2016
x
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW a YES (x
IF YES: enter Book 128386 Page 45 and/or Document # 00017807
B. Does the site contain a brook, body of water or wetlands? NO x DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 Date Issued:
C. Do any signs exist on the property? YES 0 NO (x)'
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 Q
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 0 NO (x)
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 [x] Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [0 Siding [O] Other[CI] �
i
Brief Description of Proposed Construct poured concrete foundation for a new single family home
Work:
Alteration of existing bedroom Yes No Adding new hedroom Yes No
Attached Narrative Renovating un x ished basement Yes _No
Plans Attached Roll -Sheet
sa. 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: 7 Number of Bathrooms z
c. Is there a garage attached? yes
d. Proposed Square footage of new construction. 2810 sf Dimensions 54'x 45' irr
e. Number of stories? one
f. Method of heating? air source heat pump
g. Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. HERS rating Masscheck Energy Compliance form attached?
h. Type of construction Wood Frame
i. Is construction within 100 ft. of wetlands? Yes x No. Is construction within 100 yr. floodplain Yes x No
j. Depth of basement or cellar floor below finished grade 7 +-
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
1, L)6( as Owner of the subject
property
Stephen Ferrari
hereby authorize i
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
Stephen Ferrari 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.
Stephen Ferrari
Print NaG,*,
'
G%
SignaWe
e of er/Agent Vate
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable
Name of License Holder Matt Derry CS 064404
License Number
408 Hoosac RD, Conway 7/1/20
Address Expiration Date
413-369-4447
Signature elephone
9.Reaistemd Home Improvement Contractor: Not Applicable ❑
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. _ ❑ No...... ❑
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: 163 EMERSON WAY
Inquiry Made By: STEVE FERRARI 413-588-8975 ferr4ri.steve@gmaii.com_
(Name) (Telep one Number)
Date of Inquiry: 6/25/2019 Fire Line Irrigation Domestic X
Number of Units: 1 Type of Units: Type of O nership:
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: 2016
Approximate Static Street Pressure: 50 psi Flow Test Conducted: !Yes No x
(If flow test conductfd attach results)
Size of Service Connection: 1" Suggested Meter Size: 5/8"
Comments: The Water Department cannot guarantee adequate water pressu�e during
peak demand times at el tions above 320'
jdl oell
6
A corresponding water enterance fee shall be paid prior to making any connection to the municipal
water system.
-Arran_&e. such installation 11 be made with the Northampton Water Department within a
m' um of 5 rking d s iflIC ion.
-All work s 1 co
fo North' ton Water Department specifications.
f 6/26/2019
(Water 5uperinendent) (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 anew construction,it must be hand delivered to &Building
Inspector
*Fees will be charged Based on current fee structure at the time of entry application (�
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: 163 EMERSON WAY 0`t"
Date of Inquiry: 06/25/19
Inquirer with contact info: STEVE FERRARI 413-588-8975 ferrari. teve ftmail.com
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 14: ($2,500)
Tie-in to Private Sanitary: $ - N/A Tie-in to Existing Sanitary Service: $ - N/A
Comments:
i
City Require 6" cleanout installed at City Property' Line
Note:if this availability is for new construction,this form must be hand delivered t&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 io Northampton Streets Department specifications.
Bate:?;
Sewer Dept. Foreman
*Sewer Entry$
*Fees will be charged based on current fee structure at the time of a `'try application
tl