29-603 (4) 82 STONE RIDGE DR BP-2017-0754
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:29-603 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2017-0754
Project# JS-2017-000443
Est.Cost: $19500.00
Fee: $126.75 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use G oup: Homeowner as Contractor
Lot Size(sq.ft.): 84070.80 Owner: Randy Kaplan
Zoning: Applicant: Randy Kaplan
AT: 82 STONE RIDGE DR
Applicant Address: Phone: Insurance:
82 Stoneridge Drive (860) 869-1575 0
NORTHAMPTONMA01062 ISSUED ON:12/72/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:FINISHING ATTIC INTO BEDROOM
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 12/12/2016 0:00:00 $126.75
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File F BP-2017-0754
APPLICANT/CONTACT PERSON Randy Kaplan
ADDRESS/PHONE 82 Stoneridge Drive NORTHAMPTON (860)869-1575 0
PROPERTY LOCATION 82 STONE RIDGE DR
MAP 29 PARCEL 603 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLOSED REQUIRED DATE
ZONING FORM FILLED OUT 46
Fee Paid ?_.(' .
Building Permit Filled out !`wn
Fee Paid
Typeof Construction: FINISHING)ATTIC IN C : "a'OOMI,
New Construction
Nan Siructurot interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owned Slat r ent or Lic Ise
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION PRESENTED:
pproved 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
a )clay
414 r _ 1
( :ui i : O 'Mal 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.
�+ Department use only
�El-rE!VPD
e City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
- 5 " 212 Main Street Sewer/Septic Availability
Room 100 Water/Wel 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:«r��, � �j This section to be completed by office
P, 5 /a"'r'"t- R�1je 1u �+(�t Map Lot Unit
ptc i'C, /W O/66A Zone Overlay District
Elm St.District Ca District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: R A. ri Its
/ ,
Name(Print)
AS°. S Current Mailing Address: Putt Cnrire1 LI Telephone 913 /^"-) 'l � y ,., "2 C� .�n
Signature t
2.2 Authorized Anent:
Name(Print) Current Meiling Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building fere) (a)Building Permit Fee
2. Electrical . ?� (b)Estimated Total Cost of
Construction luso(6)
3. Plumbing 1 3 C Building Permit Fee
4. Mechanical(HVAC) L•'
5,Fire Protection �y //''''
6. Total=(1 +2+3+4+5) )/ 1"f 0 0 Check Number 6/400 /au .75
This Section For Official Use Only
Building Permit Number Date
Dated:
Signature:
Building Commssionerfinspador of Buildings Date
Section 4. ZONING All Information Must Be Completed, Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This volume to be aged in by
Building Depsrancnl
Lot Size
Frontage
Setbacks Front
Sada L: R: 1..: R:
Rear
Building Height
Bldg- Square Footage ,o
Open Space Footage
(Lot area minus bldg&paved
Parking)
#of Parking Spaces
Fill:
_(volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO a DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES O
IF YES: enter Book Page and/or Document
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O 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 O NO O
IF YES, describe size,type and location:
E. NFII 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 O
IF YES,then a Northampton Stone Water Management Permit from the DPW is required.
RECTION 5-DESCRIPTION OF PROPOSED WORK(check ae applicable)
New House 0 Addition ❑ Replacement Windows Alteration(s) Q Roofing ❑
Or Doors 0
Accessory Bldg. 0 Demolition ❑ New Signs [D) Decks (O Siding
gni Other
Brief Description of Proposed
Werk: pti/V) cn i N 6 /9-77C //v/ l) '/1✓D(24
Alteration of existing bedroomYes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ea.If New house and or addition to existing housing,complete the following:
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?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
t Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of constniction
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
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION la-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
,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
/
- •
as Owner/Authorized
Agent hereby declare that the - -Mem:n -n. Information on the foregoing application are true and accurate,to the best of my knowledge
and belief,
Signed under the pains and •enalties of p
Pant Nam ,� /
Signature of Owner/•!eent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Narrrcaf Lkense holder
License Number
Address Expiration Date
Signature Telephone
8. :,m;.- _. a . w^ • • + ,no 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.
Sued Affidavit Attached Yes 0 No ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwelines of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
i; si.ryi:.t Ci _L780 ixh Ldi ' fun 10.3
Definition of Homeowner Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,oris intended to be,a one or tin 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 mat be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall be
responsible for all such work performed under the building mer mit
As acting Construction Supervisor your presence on the job site will be required from rime to time,during and upon
completion of the work for which this permit is issued,
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for ,m, ance with the State Building Code,City of
Northampton Ordinances,State and Low. Zonin• aws and Sti e s usetts General Laws Annotated.
Homeowner Signature ,r
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste 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 properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A
Address of the work: 92 9'a{-e R 196 J J ftafrze<< -
The debris will be transported by: 041. /OR ) 9-* C .12f1 0-f/Ak1r-
The debris will be received by: i-/th tT IN? l C 1 }-1
&
Building permit number: / /�I fI
Name of Permit Applicant /C-4\X I W 5 JZ �" vii'
Date Signature of Permit Applicant
City of Northampton
�
Massachusetts e+sc•
IN X f
d f
it A1/2 4 DE'ARTIraS OF BUILDING INSPECTIONS 2
.�
212 w+� Street N,minipal Building
IrArgt
Northampton, to 01060 ^J'yY‘ry
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTIONA 'KNO D EMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her I
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 caned to inspect work at various stages,which include
foundatlon/footi ys (before backfill). sonotube holes (before pour).a rough building inspection
.. More workis Cote: :. • 'ts :..or bsoection (if required)and a final building inspection.
The building department requires 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
pennit 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 m de y/�,;
I, /e owner/
s g"cu"-e understand the above.
(Home owner l ident's signature requesting exemption)
I will call to schedu a all required building inspections necessary for the building permit issued to me.
Date fi . ,3 /E+
Address of work location 9 a 106 r PP
The Commonwealth of Massachusetts
Department of Industrial Accidents
W_Beeyt Office of Investigations
_i41- 1 Congress Street,Suite 100
Boston,MA 02114-2017
www.massgovldia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lenibly
Name(Business/Organization/Individual):
Address:
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box:
Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(Nil andtor part-dme).
s have hired the sub-contractors 6. 0 New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g_ ❑Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance] 9. ❑Building addition
wired.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3 I a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
self [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] c. 152,§1(4),and we have no
employees. [No workers' 130 Other
comp.insurance required]
"Any applicant that cheeks box di must also fill out the minion below showing their workers'compensation policy information.
t H meowve,s who submit.this affidavit indicating they are doing all work and then hire outside contractors must summit a new a ffidatii indicating such.
IContmctors that check this box must attached an additional sheet showing the name of the sub-convectors and state whether or not those entities have
employees. If the sub-ecmiractors have employees,they must provide their workers'comppulley number-
._.
Iam 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. Lie.#: Expiration Date:
Job Site Address: —City/State/Zip:
Attack a copy of the workers' compensation policy 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 forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify it - e andpenahi• r perjury that the information provided above is true and t.
Forrec
Signature: Date' r-/
` ^-}
Phone#:
Official use only. Do not write in this area,to be completed by city or town official. r..
City or Town: Permit/License#_
Inning 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#:
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Northampton, MA 01060 c—S}rn,vp '---:, 4 , o, — ,
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