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22D-120 PAVES DP VE WA,' / / _ r SD j"/ / C AEC rftly EwVA q}.��F> S r El. �0,�.„.i t Ci u .,q o a t' P` � m e — . / �P .�,�V _ mgr , tVA P a / F P-• rm.,— L/04) l�A. HUrn a�lty a I '� CQ Noor fN <VV ' c , N ' pi�Po . V��ouk 6t 9�P! �Pnye \ a 1 CC 9 plan BCo _ J a . 2� �� FT • ,e9 3,1 ACRES ,r. 0531 N e5 ' r TaO,CV 5, 'i8,Page ')F E m $004 N ti 05' W BP-2007-1228 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2007-1228 Project# JS-2007-001958 Est. Cost:$1200.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: use Group: Homeowner as Contractor Lot Sizefsa.R.l: Owner: GOLDSCHEIDER THOMAS PAUL Zoning: Applicant GOLDSCHEIDER THOMAS PAUL AT: 109 RYAN RD Applicant Address: Phone: Insurance: 109-B RYAN RD (413) 586-2869 O FLORE NC EMA01062 ISSUED ON:6/22/2007 0:00:00 TO PERFORM THE FOLLOWING WORK:ERECT 10 X 12 SHED 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: FeeTvpe: Date Paid: Amount: Building 6/22/2007 0:00:00 $25.002094 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo • File#BP-2007-1228 • APPLICANT/CONTACT PERSON GOLDSCHEIDER THOMAS PAUL ADDRESS/PHONE 109-B RYAN RI) FLORENCE (413)586-2869 0 PROPERTY LOCATION 109 RYAN RD MAP 22D PARCEL 12Q 000 ZONE, THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Bui; I Permit Filled out rI +ry Fee Paid ata z' `AsoQS ' Typeof Construction: ERECT 10 X 12 SHED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner Statement or License 3 sets of Plans/Plot Plan THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFATION 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: §_„ FindingSpecial 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 Con ' ion a , 2002 .. 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. _City of Northampton .• a' aan, Ir U I Building Department 212 Main Street i e rs n1:i * *. h =Room 100 ,tlifirtr-t-tharrlit 0,7 Northampton, MA 01060 o}. Pf— TL "x a��,` UJUN1 0hOrie413-58%-1240 Fax413-587-1272T� �'�` �ti: : „t +�Pat�3GATwN TO COttSTRUCTyALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property nnAddress: t1 this section tote wmptetad by office 6Ci h.vd/l Finn O MaP` fat Um[ �kse.,\ce Zone a Overlay District-- �A+SL DISL1c! CB DISMCt SECTION 2-PROPERTY OWNERSHIP/AUTHORIZEDAGENT 2.1 Owner of Record: t —ran Goidscter3�l-"' -, t f7 f—yan 6"L F tCl2AyQ r trig, 0106 Name(print) Current Mailing Address: Telephone J C g6 �'�j6 G1 ._ Signature 1 2.2 Authorized Agent: Name(Print) Current Mailing Address. Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only yompleted by permit applicant 1. Building I./ (a)Building Permit Fee }r )..‘450 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number 6)DB'1 $ This Section For Official Use Only VVVV Building Permit Number Iss te Issued: Signature Building Commissioner/Inspector of Buildings bate F Section 4. ZONING All Information Must Be Completed Permit Can Be Denied Due To Incomplete Information IIIIIIIIIIMIlaillRequiredby Zoning This column to be filled in by Building Department j Iffillna rla raEMEMEMM N I`t Setbacks Front Kole IPNO '- _i ( L _ Side L: _ R: ,,, L. s . R u _ Rear f 1 ®®®® ® ®®®® Open Space Footage ®IEIM®®® (1M area minus bldg&paved MNINIIMIIIIIIIIIIIIIIIIIIIIIMIMIIIIIIIIIII Fill: volume&Warm) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? _.__... NO ©—_ 90PoT-mmev. .D—_—.. YE,,—n-- lF YES, date issued::, IF YES: Was/'the'� permit recorded at the Registry of Deeds? NO `._.r DON'T KNOW 0 YES d IF YES: enter Rook Page. and/or Document a B. Does the site contain a brook, body of water or wetlands? NO © DON'T KNOW T 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 O NO 0 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 cp IF YES, describe size, type and location: h ,r+ E. Will the construction activity disturb(clearing,grading,excavation,or filling)over I acre or is it part of a common plan that win disturb over 1 acre? YES© NO 9 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 D Addition ❑ Replacement Windows Alteration(s) ❑ Roofing in Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [CI Decks [I= Siding[O] OtherjID] Brief Description of Proposed Work: Gila-1)W S{{(D /D �,(O" '� Attaof existing bedroom Yes l/ No - Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes ✓ No Plans Attached Roll -Sheet Ba if i e)kKupse-1 orad litiOn to ezTetin4 tophi;<cornplete N tillowinq: 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? f. Method of heating?rgFireplaces or Woodstoves Number of each g. Eney Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes 'rid-construction wnnm 100 yr. Ouudplain -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 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS 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. Signature of Owner Date I, Oaner/�,uthorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the nest o my knowledge and belief. Signed under the pains and penalties of perjury. ion Ga 1 4,44,,,;dor Print Name 1—Q : ar�_ C/ IAV ?Neal Signature of Owner/Agent Date SECTION S-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: _. — License Number^- Address Expiration Date !— Signature Telephone y 9aR5gYsea'fed,Ho`m4jmpm'v' merit:Gontaktor;,,a;,;",,e„„,,,�. .,, . p, = '„:s Not Applicable 0 \ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§26C(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 0 It -"$Gll1GtkireitSi p11Un The current exemption for"homeowners"was extended to include Owner-occupied Dwe0incs 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 as supervisor.CMR 780. Sixth Edition Section 108.3.5.1. 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,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 homeowner. — Such"homeowner”shall submit to the Building Official,on a form acceptable to the Building Official.that behhe shall be responsible for all such work performed under the bgildine permit As acting Construction Supervisor your presence on the job site will be required from time 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 bath)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 State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature `§ .Q i iiNrr- ,_„ • The Commonwealth of Massachusetts tee_ Department of Industrial Accidents pa—totn =:ta-las Office of Investigations • 600 Washington Street ' ,,� .s�' Boston,MA 02111 www.mass.govfdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organisation/Individual): Address: City/State/Zip: Phone#: Are you an employer?Cheek the appropriate box: Type of project(required): 1.[,� I am a employer with 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. []New construction 2.0 I am a sole proprietor or partner- These on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8, 0 Demolition working for me in any capacity, employees and have workers' 9. 0 Building addition [No workers'comp.insurance comp. insurance.: required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11.[]Plumbing repairs or additions 3K am a homeowner doing all work myself[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.)1 c, 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] ------ - -"•Anyiesst"iranrihat maks box el must also he ode the are bela l howing their workers hompenacto policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such, formation that check this box must attached an additional sheet showing the name of the sub-cont-errors and state whether or not those entities have employees. If the sub-contactors have employees,they must provide their workers'comp.policy number. I am cm employer that is providing workers'compensation insurance for my employees. Below is the policy andfob site information. Insurance Company Name: .... _... Policy#or Self-ins. Lic.#: 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 sec=coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 8250.04 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 under the pains and penalties of perjury that the information provided above is true and correct _..3) Si n,�at rt. �(�, /, e +_""'•,� ...... D. 4 ••�. ._ _. Phone#: Cllr) SRe- ,•2)6a( .... Official use only. lbo 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.Boiiding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone k: s2 �� e ,e Citp of ,liarthttntpfun �(�' .,d�e,l��w�`��.� nsedyins ne I l r{+.� {+S-3' DEPARTMENT OF BUILDING INSPECTIONS 5 / .71 INSPECTOR 212 Main Street • Municipal Building Northampton,MA 01060 " _Y V • HOME OWNER EXEMPTION ACKNOWLEDGEMENT • The State of Massachusetts Slows the homeowner the right under 780CMR 1083.4 to act as his/her construction supe:: Sor. 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 homeowner 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/footings(before backfill). sonotube holes (before pour). a rough building inspection (before work is concealed), insulation inspectionjif repuired) 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 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 I, .1—et-Or.."—.7----2,_ 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___/41761 —j Address of work location ./g / it gA /ic,I'k Quick Open Space Calculations Coverages house existing Li S Lot area existing proposed deck existing I a3,1'A0 drive existing _ I ,6SO shed existing p Open Space 7.10 c7 a shed existing 0 total c1 0 Open % S O shed new ia,o_ new WSP URA Open Space Requirement new 85% total 3, 050