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22D-010 File #BP-2022-1048 APPLICANT/CONTACT PERSON:FERRARI STEPHEN E& ESTHER D RALSTON 103 RYAN RD FLORENCE, MA 01062 PROPERTY LOCATION 103 RYAN RD MAP:LOT 22D-010-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out -Fee Paid $327.00 Type of Construction: ACCESSORY DWELLING UNIT New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 'RESENTED: Approved j Additional permits required (see below)PLANNING BOARD PE plIT REQUIRED UNDER:§ ���' 6.1) TIa 1BL Of 1kS%S Intermediate Project: i Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Penn it With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW WaterAvailability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay TANSigna re of Building Official Date 1Y-1-1 (9.- Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. RECE The Commonwealth of Massachus- s Or FO J. 140, 0 Board of Building Regulations and St. dar 4 202p ICI ALITY a Massachusetts State Building Code, 7:0 C fiaT O U E F Building Permit Application To Construct, Repair, Ren�vat@�®p lr R ised ar 2011 One-or Two-Family Dwelling ant°^'' ti+a o� �s This Section For Official Use Only Building Permit Number: 12741— ). 3---10q$ Date Applied: Building Official(Print Name) —Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 103 Ryan Road 1.2 Assessors Map& Parcel Numbers 22D 10 1.1 a Is this an accepted street?yes X no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 2.9 Acres 99' Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 66'Exist. 24',17' Exist. Over 100' 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private❑ Zone: Outside Flood Zone? Municipal El On site disposal system 0 Check if yes SECTION 2: PROPERTY OWNERSHIP' 2.1 Owneri of Record: Stephen Ferrari&Esther Ralston Florence,MA 01062 Name(Print) City,State,ZIP 103 Ryan Road 413-588-8975 Florence,MA 01062 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied x❑ Repairs(s) 0 Alteration(s) D Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2:_Build out new one bed 8,000. :cessory Dwelling Unit in existing second floor space. Work to include minor rough electric work,new Heat Pump HVAC system,insulation,finishes and finish mechanical work. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 28,000. 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 5,500. ❑ Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing (Finish only) $ 8,000. 2. Other Fees: $ 4. Mechanical (HVAC) $ 8,200. List: 5. Mechanical (Fire $ Suppression) Total All Fee10- Check No. Check Amount: 7 Cash Amount: 6.Total Project Cost: $ 49,700. 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town,State,ZIP Telephone SECTION 6: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 Q No .0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S 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. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Eeectro• Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) 900 (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) 728 Habitable room count 3 Number of fireplaces 0 Number of bedrooms 1 Number of bathrooms 1 Number of half/baths 1 Type of heating system Electric Mini-Split Heat Pump Number of decks/porches 1 Type of cooling system ° Enclosed Open 0 3. "Total Project Square Footage"may be substituted for"Total Project Cost" r ` City of Northampton o �i F:,o S`s SjC �'>" : Massachusetts ? '<<: A f * ;. • DEPARTMENT OF BUILDING INSPECTIONS s 212 Main Street • Municipal Building . p.� Northampton, MA 01060 j'SNi, Cv' CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: Valley Rrecycling, Northampton, MA The debris will be transported by: JMT Services Name of Hauler: Signature of Applicant: AI-- Date: CITY OF NORTHAMPTON SETBACK PLAN MAP: 22D LOT: I0 LOT SIZE: 2.9 Acres REAR LOT DIMENSION: 350'+ REAR YARD SIDE YARD See attached Site Plan SIDE YARD FRONT SETBACK FRONTAGE • City of Northampton ,,/ ''1r Massachusetts �? -�- '� A ` i DEPARTMENT OF BUILDING INSPECTIONS' 212 Main Street • Municipal BuildinqFs Northampton, MA 01060 �tiskw 301 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, Stephen E. Ferrari (insert full legal name), born 5/ 3/1952 day, year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requi -ments of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a proje t or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeown•rs'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 ' 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110. ' .1.2: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on w ch there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accesso 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 home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent t 't I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or vork involving construction, reconstruction, alteration, repair, removal or demolition involving any activity r.: lated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this 0t4 day of 4 v9 U S , 20�? '_1 FiJ (Sign re) The Commonwealth of Massachusetts Iii = Department of Industrial Accidents ire- amor$ 1 Congress Street,Suite 100 k.i t� Boston, MA 02114-2017 4-.1 wow nzass.goiVdia 11 urkers'Compensation.Insurance Affidavit:Builders1Contractors!Electricians/Plumbers. '1'(l B4:FILED WITH'fiIE PEKill'1-1l C AUTHORITY. Applicant 1ufortnalion Please Print Legibly Name(Business Organization indttitlual): Stephen Ferrari Address: 103 Ryan Road City/State/Zip: Florence, MA 01062 P}tc,tic #_ 413-588-8975 Are yea an employer?Cheek the appropriate bus: Type of project(required): 1.Q I am a employer with _.___.____empluyees(full andhor part-tin').• 7. CI New construction 20 I ant a sole proprietor or partnership and have rat ernpk►ytas working fur me in B. :1 Remodeling any capacity.[Nu worker.'comp.insurance squired.] IAIJ ICJ I ant a Iturnaawner doing all work myself.[No worlt►Ts"con".insurance required.)` 9. C] Demolition 4.© I ant a huan.x►wnT and will he hiring contractors to conduct all murk on my property. I will 1 Q 0 Building addition ensure that all contraclurs either hate asulten,'compensation insurance or are sole I I 0 Electrical repairs or additions prrprieteus with no employees. 12.0 Plumbing repairs or additions 50 I ant a general contractor and I have hired the sub-cuntracturs listed un the attached.him. These sub-contractors}use employees and have workers'comp.insurance. l 3�Roo repairs tt.EI We an:a corporation and its officect have exercised their right of exemption pen MOILc. 14.DOther 1 S_',*1(4),and we have no employees.[Nu workers'comp.insurance required.] 'Any applicant that checks boa at must also fill out the a ctivat bcluw showing their workers'compensation policy information.. +homeowners who submit this affidutit indicating they arcdoring all work and then hire outside contrat torsmust subunit a new affula'.it indicating suxh. IC'untracturx that check this box must attached an additional sheet showing the name of[lac sulo-ctxntratinxs and;fate•N ln-lber to nut dose aulrhes haw cunpluyec3, lithe sub-contractors have ctttpluycos.they rust pit*idctheir Nit miters-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: Policy#or Self ins.Lic. #: Expiration Date: Job Site Address: City/StateiZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under NIGL i. 152,§25A is a criminal violation punishable by a fine up to S1,500_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 S250.00 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 pliers and paterltie".t of perjury deaf the information provided above is true and correct Signature: Dail_ Phone#: Official use only. Do nru write in this area,to be completed by city or town official City or'Town: PermitWLicense Issuing Authority(circle one): I. Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: