78 Maynard BP AppRenaissance
Builders uilders
PO Box 272, Turners Falls, MA 01376
Phone (413) 863-8316; Fax (413) 863-9712
wwwrenbuild.net
July 26, 2019
Louis Hasbrouck
Building Commissioner
City of Northampton
Building Department
212 Main Street
Northampton, MA 01060
Enclosed is the Building Permit application and a check in the amount of
$4,875.00 for the permit fee on the property located at 78 Maynard Road,
Northampton. Marta Rudolph owns the property. Digital plans with specs have
been email to you to accompany this application.
Please contact me at 413.863.8316 if you should have any questions in regard to
this application.
Thank you,
Donna Flagg
Enclosure
SECTION 1 - SITE INFORMATION
Department use only
Ut
ti.212
!(
City of Northampton
Building Department
Main Street
Room 100
Northampton, MA 01060
Status of Permit:
Curb Cut/Driveway Permit
Sewer/Septic Availability
Water/Well Availability
Two Sets of Structural Plans
I
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:
This section to be completed by office
I
Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print)
Current Mailing Address: [ Q'
am' L26` Wq 1'1CJ
�[
lry
Telephone
Signature
2.22 Authorized Agent:
1
/
Name (PrlK I
urgent Mailing Addr ss:
Lkk3 .
Signature t-. *
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)
5. Fire Protection
6. Total= (1 +2+3+4+5)
'jC)
Check Number
This Section For Official Use Only
Building Permit Number:
Date
Issued:
Signature:
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 f Iled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side
Rear
L:qji R:
L:� �y1R:
EA
L_4]
Building Height
:^ b
4� OLS
1
Bldg. Square Footage
4- �{
Open Space Footage
(Lot area minus bldg & paved
arkin
L_
%
�J
C_
# of Parking Spaces
Fill:__
volume & Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ® DON'T KNOW JC�04 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DON'T KNOW ® YES 0
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 10 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 10 Obtained Q Date Issued:
C. Do Do any signs exist on the property? YES O NO
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
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading avation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO
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 ❑
Addition
Replacement Windows Alteration(s) Roofing
Or Doors 0
Accessory Bldg.
Demolition ❑
New Signs [O] Decks 'ftm—� Siding�o Other [C]j
//h
Brief Description of Proposed ��`a`+ 1 r`} Sf�r`A ��,'d t ( i
1
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
`'? ''
Plans Attached Roll - Sheet ;; , ��,g� ;-, - {, ,h
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family `1 _ Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? �Jb_
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? Zi^
l
f. Method of heating? �Pt,` &+ 4C flofts Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
L 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 E—
k. Will building conform to the Building and Zoning regulations? )!4–� 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
� " a V A - C— )
I, �) as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative two work author'ze by this building permit application.
Signature of Owner Date
LI, � � OP�YAuthorized
Agent hereby de tare that the sta ements and information on the foregoing application are true and a�,rate,e best ofmy knowledge
and belief.
Signed under the pains and penalties of perjury.
XP
Print N e
Signature o OwnerlAgenl Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor..
NotApplicable❑
Name of License Holder'
61 S, J�--
License Number
Address
Expiration Date
9
Signatur
9 Reciistered Home 'Improvement Contractor:
Not Applicable ❑
R g tra�ti'onj umber
Company ame
M �1
Ad es
elephone
Expiration 13ate
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.
I Sianed Affidavit Attached Yes....... X1 I No...... ❑ 1
Renaissance
Builders uilders
P.O. Box 272, Turners Falls, MA 01376
(413) 863-8316, Fax (413) 863-9712
www.renbuild.nc--i
Louis Hasbrouck
Building Commissioner
City of Northampton
Building Department
212 Main Street
Northampton, MA 01060
1, the undersigned certify that I am the Owner of the property located at 78
Maynard Road, Northampton, MA.
I hereby authorize Stephen Greenwald of Renaissance Builders, 390 Main Road,
Gill, MA 01354 to submit a building permit application on my behalf for the
renovations at Ampersand Sprout, LLC.
I agree to conform to all applicable laws of the town and state, and I believe the
work proposed to be in compliance with all zoning regulations and the
Massachusetts State Building Code 780CMR.
Signature of Owner:
Printed Name:
Date:
Northampton, M/\:Assessor Database:
Northampton, MA : Assessor Database
http://iioi-tliamptoii.ias-clt.coiii/parcel.detail.plilp?id=3 IA- 167-00 10
Prope*Search�
pamazm Owner s�er w"�mm s�°c Name:
'
- ' - - 178 MAYNARD RD
,--'Search Reset
Property Detail:
Parcel ID: .c"rd. Street Name: Street Number: Zoning: State !«cm,. Plot:/
------r—'T ------r------- |--- --1--- --- --
31A-167-001 I MAYNARD RD 78 Single Family Residence 0.17
Owner InformationProperty Images:
Owner wame'�xexnmo
_-_�-
FRANK suSUSAN M p^cture,----- -
-
Owner Name:
Year Built:
_z
Owner uName:
| |
i
Street 1:
550 LITTLE RIVER PATH
�
City:
THE VILLAGES
mmm.
FL|
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------
Zip;
-- - -- -
|32162 �
Dwelling Information:
n
_ |
e*�.
- — - -' -- - -
comvsmromAL '
-
Year Built:
`-l
moo
s"te�" =mn. "
- - ---'
�srocco
Story Height:
z.« }
x,m:
wome ------'--
Basement:
puu Sketch:
u,m^Gar Spaces:
o
Total Living x�a.
--'-' — -
1�a
^--
Total Living Area Minus peLx:
zuss l
Finished Basement x�".
n
_ |
28
wsnvom.
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Heating System:
-- --
mxsxorwmEx
|- ' {
Central Air:
No
Fireplaces:
---- -
.z
Rooms:
o )
o°omvmo
_-
s /
Full Baths:
---
z `
-. 1
Half Baths:
-
--
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|
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Valuation:
Appraised Land: $z4s'000.00
---' | �
Appraised Bldg: $z*o'000�uo
— ---- | - - �
Appraised Total: $485,900.00
Out -Buildings:
9
29
28
10
28 1
10
-------|
/
A: 2Fv
61smcift .
B: E FP �
o»cift
cEF9 �
zm^cift
oxn
24 sqft
E: Terrace
zo^cift
| of 7/19/2019, ||:47/\M
Northampton, MA : Assessor Database:
2 of 2
http://northampton.ias-clt.com/parcel.detail.php?id=3IA- 167-0010
Code: Description:
Units:
Year Built:
Sizel:
Size2:
Area:
Grade:
Condition:
RSI
1
1991
1
64
64
C
AVERAGE (Res)
RG1
1
1900
1
240
240
D
POOR (Res)
The information delivered through this on-line database is provided in the spirit of open access to government information and is intended as an enhanced service and
convenience for citizens of Northampton, MA.
The providers of this database: Tyler CLT, Big Room Studios, and Northampton, MA assume no liability for any error or omission in the information provided here.
Comments regarding this service should be directed to: jsarafin@ northamptonassessocus
Fri. July 19, 2019 : 11:07 AM : 0.09s : 10mb
7/19/2019, 11:47 AM
78 Maynard Rd - Google Maps
Go,,,)gle Maps 78 Maynard Rd
Marta Rudolph
https://www.google.com/maps/place/78+Maynard-�Rd,+Noi-thampt.
00
Map data @2019 200 ft -
78 Maynard Rd
Northampton, MA 01060
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78 Maynard Rd
Northampton, MA 01060
89C2+FG Northampton, Massachusetts
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_ City of Northampton
Massachusetts
:T DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 ssb'^••-.»�i%��C
LOUIS HASBROUCK
BUILDING COMMISSIONER Effective July 1, 2015
Phone: (413) 587-1240
Fax: (413)587-1272
Residential One and Two Family Building Permit Fees
http://www.northamptonma.00v/702/Building-Department
Fees for work not listed will be determined by the Building Department
Any work beginning before a permit has been issued is subject to double fees and a stop work order removal fee
Hours of operation are typically Monday thru Friday 8:30 to 4:30, Walk -In hours are closed at 12:00 pm Wednesday
Permit Fees are paid to the CITY OF NORTHAMPTON CHECKS OR MONEY ORDERS ONLY: NO Cash or Credit Cards
Checks or Money Orders Must Be Submitted with the Application or it will not be acted upon
To Be Processed, Applications Must Be Complete and Include ALL Required Attachments
All Applications Are Subject To Zoning Review. The Weekly Filing Deadline is 12:00 pm (noon) on Wednesday.
Building applications - Require a plot plan, floor plans, elevations, structural and energy information as appropriate
Sign applications - Require a photo of the existing elevation and a photo shopped placement of the proposed sign
Applications may be subject to Central Business, and or Historic and Demolition Delay reviews
It is the Owner's responsibility to verify property bounds and conservation issues
COMPLETE DEMOLITION Accessory Structure --------------------------------------------------------------------------------- $30.00
One or Two Family House ----------------------------------------------------------------------- $75.00
NEW CONSTRUCTION All Occupied Floors per sf--------------------------------------------------------------------------- $.50
% Floors, VValk-In Attics, Basements, Garages per sf -------------------$.20
Decks, Porches, Canopies, Porticos per sf------------------------------------------------- $.20
NEW ACCESSORY STRUCTURE Free Standing Decks -------------------------------------------- $.20 per sf, Minimum $50.00
Shed up to 200 sf zoning review -------------------------------------------------------------- $30.00
Shed over 200 sf-------------------------------------------------- $.20 per sf, Minimum $35.00
Tentover 200 sf----------------------------------------------------------------------------------- $30.00
Above Ground Swimming Pool --------- ----------------------------------------$40.00
In-G-r6trn nming Pool ----------------------------------------------------------------------- $75.00
REPAIR, RENOVATION, ALTERATION $6.50 per $1000 of estimated cost (rounded up) --------------------- Minimum $65.
SIGNS Wall Sign for Home Occupation------------------------------------------------------
SPECIALTY PERMITS Roofing--------------------------' - -- - -$40.00
Siding---------------------------------------------------------------------------------------------------$60.00 �LJ
Non -Structural Door & Window Replacement ------------------------------------------- $40.00
Solid Fuel Burning Appliances---------------------------------------------------------------$40.00
Sheet Metal --------------------- $25.00 with building permit on site; Otherwise $50.00
SOLARRoof Mount------------------------------------------------------- -------------$75.00 l
Ground Mount up to 8kw or 100% of demand ------------------------------------------ $75.00
Ground Mount up to 200% of demand ---------------------------------------------------- $100.00 ^�
Ground Mount over 200% -----------------------------Use the commercial rate calculator
OTHER SERVICES Request For Zoning Determination ---------------------------------------------------------- $30.00 \
Home Business Review & Registration ---------------------------------------------------- $30.00
Replacement Permit ----•------------------- -------------------------------$30.00
Contractor Change-------------------------------------------------------------------------------- $30.00
Temporary Certificate of Occupancy ------------------------------------------------------$75.00
Additional or Requested Inspections -------------------------------------------------------- $75.00 .
Removal of Stop Work Order----------------------------------------------------------------- $75.00
The Commonwealth of Massachusetts
ITA Department of Industrial Accidents
Ulf
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumlbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: PO BOX 272
City/State/Zip: TURNERS FALLS MA 01376 Phone #: 413-863-8316
Are you an employer? Check the appropriate box: Type of project (required):
1. [N I am a employer with 24 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors 6. ❑New construction
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub -contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers'
insurance.$ 9. r_1 Building addition
[No workers comp. comp. insurance p' 10.[:] Electrical repairs or additions
required.] 5. E] We are a corporation and its
3. ❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4), and we have no 13.❑ Other
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' compensation insurance for my employees. Below is the poliel, and job site
information.
Insurance Company Name: AIM MUTUAL INSURANCE CO.
Policy # or Self -ins. Lic. #: MCC20020004972019A Expiration Date: 01/01/2020
Job Site Address: ��.QI—Q J�� `J City/State/Zip:' k
Attach a copy of the workers' compensation policy declaration page (showing the policy number and exp ration 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 certrAunder the pains and penalties of perjury thgtlthe information provided above is true and correct.
Phone #: 413-863-8316
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 #:
051
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Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction Supervisor
CS -013302 Expires: 08/17/2019
STEPHEN J GREENWALD a; `
390 MAIN RD
GILL MA 01354
Commissioner -''"
City of Northampton
Massachusetts
� c
DEPARTMENT OF BUILDING INSPECTIONS �
r 212 Main Street • Municipal Building
�J 'a
ue P 4
Northampton, MA 01060 y�y ^•�j�'�
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation ("OCABR") regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes, a contractor must be registered as a Home Improvement Contractor ("HIC").
M.G.L. Chapter 142A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner -occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building" be
done by registered contractors.
Note: If the homeowner has contracted with a corporation or LLC, that entity must be registered.CY
Type of Work: �(iickoV1 1&-a Est. Cost:
Address of Work:
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
_ Work excluded by law (explain):
Job under $ 1,000.00
Owner obtaining own permit (explain):
_Building not owner -occupied
Other (specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L. Chapter 142A. SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT. SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the
Contractor Name
/d6 y9c�
HIC Registration No.
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
fr Massachusetts
a
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building JaCb
.m, Northampton, MA 01060 .ry;..•t�
Debris 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.
The debris from construction work being performed at:
-- �, W �i(,l 1/1 al a A
CL
(Please print house nuniber and street name)
Is to be disposed of at:
rl f
(J .Kj
® (Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.