Loading...
29-603 (2) 82 STONE RIDGE DR BP-2017-0257 GIS#: COMMONWEALTH OF MASSACHUSETTS Map-Block:29-603 CITY OF NORTHAMPTON Lot: -001 Permit: Building Cateourv: Stairway BUILDING PERMIT Permit# BP-2017-0257 Project# JS-2017-000443 Est.Cost: Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Peerayo Noummano 109541 Lot Sizeisq. ft.): 84070.80 Owner: Randy Kaplan Zoning: Applicant: Peeravo Noummano AT: 82 STONE RIDGE DR Applicant Address: Phone: Insurance: 809 East Washington Road (413)212-4149 HI NSDALEMA01235 ISSUED ON:8/30/2016 0:00:00 TO PERFORM THE FOLLOWING WORK: Create separate stairway to storage attic 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: Rouse# 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: FeeTvpe: Date Paid: Amount: Building 8/30/2016 0:00:00 $65.00 212 Main Street.Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner A CE[VF i+r^` Dcparrrerro only ..� r. �� Glt `j of North rnpton S'a us of Pei nlr �uildlnr Department 'r. AUG � A cut CUJEn cxa P rznr _Hc - AU 25 %(`�!4 212 Main Street II52 Spic /vatabtll . rI Room 100 I,; nNell4 rtllabnity I Dan orauun:, — Northampton, MA 01060 '(no Sols af,vh ucm al Plan.,.'= rvoa APFLICATI(iPl TG { __-8`one 413 587-12A0 Fa. 4'13-587-127,2 fillodSl !e t r a - �� I CONSTRUCT,ALTER,R� AIR, RENOVATE OR DEMOLISh A ONE OR TWO FAMILY C WELLING I SECTIONS SITE INFORMATION I 11 Property Address, Tets sectioffto be cornpIcted by orrice !J ( . 2 M p -Ldt Uri' Sib C tc C. 6ic • p(��° 2' Ton ^Overray Dstrtc4- '- tO )C� Ls._ 6 4Elm..t ti rror Cs-District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Reocrd: //``�� ..._ ",° i e C ft ♦ 2'2 S4ffe _ pI L f 11010oce C ? Name'•rim0 / Cuserr malice Address': , a. /. Te1eP Io -- .0. _ 7 S— mm '� I ure 2.2 Authorized A.entf II cl mm Isla t n1:' TekltA.tain ea cess /I —�.rrr/ ul '� 'ZIP L ( xed' �E' phone ,ins_ ► ,.SECTION 3-ESTIMATED CORSTRUCTiCN COSTS _ _ Ifem completed Cost(Dollars)fo be Official Use Only completed by permit applicant - 1. Builainp ; t �} �� (a) Building Permit Fee i 2. Electrical r' G I (b)Es meted Total Cost or I Construction from(6).... 3. PlumbingI g Permit Fee '�s 4. Mechanics/ h'VAGj I I 5. Fire P,rotectec ...5-g,Total=(1 `2 +3 +4+F) Building Permit Number: r —e77—1 � ,Check Number This Section For Official Use Only Date 135OG: Signs[ore: Bulk p Ceeimeeicner/ specisror Puddings Dale 1 °4 . EMa/' 14 - ! 1' �jr ��1 , 1 tilt '_: 1 r Section ZONING heermetam Must ea Com e -fifiemfi Can fie De ed Due To Incompbete tctematon E%1sting J Proposed Required by Zoning This column toile.filled in by Building Department Lot Size . , _ . Frontage _ ___ _ .._ Setbacks Front Side d. -- F t `_ 2= Rear —i. ._ -: Buicrg Height —"" Bldg.Square Footage Open Space Footage rZat az a minas bldg&paved ........... K of Parking Spaces ----_ ---" (volae,e&Lesocun) A. Has a Special Permit/Variance/Finding ever been issued(for/on the site? NO '0 DONT KNOW 0 YES l„ IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? 1 NO 0 DONT KNOW 0 YES IF YES: enter Book '- Pape andior Document K B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES EC IF YES. has a permit been or need to be obtained from the Censenratiort Commission? Needs to be obtained Obtained Date Issued: I C. Do any signs exist on the property? YES BD NO 0 IF YES, describe size, type and location e. D- Are there any proposed changes to or additions of signs intended for the property? YES COR NO i. IF YES, describe size, type and location E. Will the construction activity disturb(clewing wading, exavation, or filling)over 1 acre oit part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. I SECTION 5-DESCRIPTION OF PROPOSED WORK Ichock ail acslieable} New Nouse Addition ❑ Replacement Windows AReratico(s) Mas Roc1ing in Or Doors I 1 Accessory Bldg. 1 I Domolilicn U New Signs t0] Decks (CI Siding lD] Other 117) Brief Dee iption of Proposed ]] Work. VUNyn4e C- 'NA' .4--- P.c y1)174Ir t« CA.ck Alteration of existing bedroom aYes No Adding new bedroom Yes ' No Attached Narrative Renovating unfinished basement Yes _No Plans Attached Roll -Sheet 6a If Nevu.hou=_e and oraddd'.ion toettisilha 0ititisona c©rnplete the folov>!ir r a. Use of building: One Family V Two Family Other b. Number of rooms Sn each family unit' 7 _ Number of Bathrooms 2 c. Is there a garage attached? i,,,,_ d. Proposed Square footage of new construction. ,./ Dimensions e. Number of stones" 1 ,_ Method of healing? ;alto , t}_)Chfik—^r Fireplaces or Waodstoves .Number of each g. Energy Conservation Compliance. Messcheck Energy Compliance form attached" h. Type of construction L Is construction within IDD Ft.of wetlands? Yes No, Is construction within 100 yr. Boo:1plaln Yes No j. Depth of basement or cellar door below finished grade k. Will buildino conform to the Building and Zoning regulations? '4 Yes No i. Septic Tank, City Sewer �. Private weltCity water Supply L� SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, t , a r . \r,4Dl(tr\ as Owner of the subject property omit hereby au r raze - ref CNS Cel 1 . , r (Y .. F to signs myallgrim rola a 3 nse+h'{ binding a flon. ng permitpA 7 S—I(e+ �r f aT 7 rte'# t R ,, / _ f_!@9_ �, N i, ...i.-:41----r--- --v as Owner/Authorized Agent Wr.•'a the-alements and information on the foregoing application are true and accurate,to the best of my knowledge and be. Signed under the pains and enaltiesfof perjury. t_1!lIR�� [.) ♦ - a _ i tea rfArea �_ 2,j 2 nerFAgenl Cate / SECTION 8-CONSTRUCTION SERVICES §,= ei oomisen Ca Heider Swoon/Mon:p�ror: D r V6J.'15 Me^tit r� is sP e1irzbic i NotA 1 sit .... umber `S� ,a <F gad-. E,Ip-fit Dale _ � � _.r i_ �lephuae- 2 2- 9.Renistem,,d Home hnoovementt consactor. - Nat Applicable F JJ Company Name Registration Nu nber A Less Expiration Date } ;n ,SGke; ( k...� �Telephone cp 7 /7 L/ SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§2$C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application, Failure to provide this affidavit will reedit in the denial of the issuance of the building permit _ Signed Affidavit Attached Yes..,.... E 11- n Fiume ovpnes Exemptioaa'' The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such hcnneowncr to engage an individual for hire who does not possess a license,pt ovidcd that the owner acts as supervisor.CYIR 780. Stith Edition Section 1003.3.5.1. Definition of 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,attained 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. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Oficial.that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on theiob site All be required from tame to time,during and upon completion of the work for which Sus pern itis issued_ Also he advised that with reference to Chapter 152(WorkersCompensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,Von may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the Stale Building Code,City of i Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated, Homeowner Signature ..... I I G'.-:w. The Commonwealth ofMnssrzchs,sz '.a' , 7 Department ofPrsdl?sOia1 Aceiderts `- .'4- ytY oficeoj'hwestaerrrtsofs.s If F , " c Gro Wash/mg—tom ."J'iPeg fP,O : .; !Boston, MA 02111 www.P"€i 3f5ngovldivi Workers' CotmLpetinaLMout II,ramar'rance AM&It: T>,'o Hoc iCtort actorAIIIec1-;i2ea.tssiklu ber:s Annaten tt Information Fame Prusud 1(.,ean£dly —..... . ..... lName (Busies /Organizatio7ndiv;dual): CIL"jv a,� - t . Address: %CI c F iIho n{i , ., ._ Ci /State/ZiP i _„14,1e _ Phone ) L L , Are you am employer? Cheek the appropriate box: Type of project(required): am a generacontractor I Ie am aeemployer4.with (' --i I l and I o Neve construction employees (full and/or part-time),* have hired the sub-contractors — 2.(J I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contactors have g. _—Demolition working for me iu any capacity, employees and have workers' comp. iusnrance.+ 9. L Building addition [No workers' comp. insurance required.] 5. _ We are a corporation and its 1 o.L Electrical repairs or additions 3.1 Iam a homeowner doing all work officers have exercised their ] I.[( Plumbing repairs or additions myself [No workers' compright of exemption per ivIGL 12.11 Roof repairs insurance required.] 9 c. 152, §1(4),and we have no 13. Other employees, No workers' .....— comp. insurance required.] *Any applicant that cheeks box#1 must also fill out the section below showing their workers'compensation policy information. 'Ho meowners who submit this affidavit indicatting they are doing all work and then Jura outside contractirs must submit a new eC=lat indicating such. 'Contractors that check this box must attached an additional sheet showing the num of the sub-contractors and state whether or not those entities have employees. lithe 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: C1Liti/(�I'1 Policy #or Self-ins. LK. #: t I ( jist �- Expiration Date: �- i Job SEte Address: L. .I fil� C1ry/StatelGtp���(�ti e n c..� 1'' (.ti is C Attach a copy of the workers' compensation poke},declaration page (showing the policy number and expiration date), Failure to secure coverage as required under Section 25A of MGL, c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be fonvarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifj erre pain ,,. .penalties ofperjmy that the information provided above is true and correct Signature: f t Date: qzj} � p l 7 Phone#: "t f 99 24 z. tf`,_`fi-t Official use on)c Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority(circle one): I. Board of Health 2.Building Department 3.City Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other IContact Person: Phone#, City of N- a t aitp ton of r l ,, f`ii A =IT OF L D N 'T NS �jY�, 'r �d /L 212 Mail: Strest ann 2 1=iac �. Nosthamoton� o Ma .T 61050 A ,adst INSPECTOR Louis Hasbrouck Chuck Miller Building. Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780GMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footinas (before backfill). sonotube holes (before pour), a rough building Inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department require, these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location City of Northampton 212 Math 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: S'10/\E atck2 C) IOL-0z The debris will be transported by: ( r e !LAG,. The debris will be received by: Lja- S Building permit number: Name of Permit Applicant 9e 9e ILH � �J M��A,O ZS Date — Signature of Permit Applicant A� CERTIFICATE OF LIABILITY INSURANCE D TEWOD16 ) 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: H the certificate holder is an ADOMONAL INSURED,the policy(ies)must 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 _Mr Customer Service Department GnelaTmp Insurance Services IPAKPONfh EMI. (800)920-4125 (8001980-r 107 EAIMLcertificates@premieragencyservices.c m 3234 Grey Hawk Ct. _._ 115UREIRg1 AFFOROINGCOVERAGE_— AMC* - Carlsbad CA 92010 INSURER Proferred Contractorss.__Ina Co. 12497 INSURED INSURER ACE American Ins CO 22667. Peerayot Roommano, INSURER C: DBA: Hilltown Builders INSURER 0: 809 E. Washington Road INSURERE: _ Hinsdale WA 01235 INSURER F: .. COVERAGES CERTIFICATE NUMBERGL/WC 16-17 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. WR AODUAmpSUO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE wvn POLICY NUMBER IMMOD/YYYYI I IYWof/YYY' UMne X COMMERCIAL GENERAL UABILT' DACH MAGE TORENTE _ „_S 1,000,000 A , X CUaMSMACE OCCUR 1IDANAGES(E a mane _ 50,000 FREMISEs(Ea owmm,cel 3 N PCIC5025-PCM64315 4/19/2016 ]64/19/2017 1 MED EXP(Any one person) E 5,000 _ ' I P~ERSONAL s AEU INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: j 1,000,000 RO- GENERAL AGGREGATE E J11 POLICY JECT LOC PRODUCTS-COMP/OP AGO $ 1,000,000 I I OTHER: S AUTOMOBILE LIAyLm 'COMBINED SINGLE UMn $ (Ea accident) — ANY AUTO BODILY INJURY(Per person) S ALL AUTOS OWNED SCHEDULED BODILY INJURY(Per amMAJ I HIRED AUTOS 1 AAUTOWNED OS I PROPERTYaccident) S --- I S UMBRELLA UAB H (OCCUR I EACH OCCURRENCE S_ EXCESS UAB I CLAIMSAMDEI NIN AGGREGATE S - - - DED RETENTION$ S AND WORKEPLOY COMPENSAIVry TION X 19TRTT1E.I.. I24"- • ANY PROPRIETORPARTNEREXECUTIVE Y/X OFFICER/MEMBER EXCLUDED? 111,AB REL EACH ACCIDENTIS 100,000 llimidatory In NH) 1118792 5/7/2016 5/7/2017 !EL DISEASE-EA EMPLOYEE S 100,000 II w 0wL used I DESCRIPTION OF OPERATIONS below EL DISEASE-PODGY LIMIT S 500,000 I DESCRIPTION OF OPERA/KRIS/LOCKTMee/VEHCLES(ACORD 101,Additions,Romany Schedule,may S attached If more apace Is required) Verification of Coverage *Subject to all policy terms, exclusions and conditions* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Verification of Coverage THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Dave Pike/SSCHOC _ � � - `-- )" i ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) fl/p/rd l/2�t9 S 4at°"( / sT ,2V 4tL/ f i g7 CO A 1) 04XeteX v� I , . 1 I l I , I I f 1 1,- I ; 1-- ' ' 1 I ( 7–_,—.1 , i ,1;, k