24A-074 S
44 RIDGEWOOD TER BP- 2011 -0325
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map.-Bloc 24A - 074' CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categor BUILDING PERMIT
Permit # BP- 2011 -0325
Project # JS- 2011- 000532
Est. Cost: $1700.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 7448.76 Owner: SANDLER BRUCE & CAREN
Zoning. URA(100) / Applicant: SANDLER BRUCE & CAREN
AT. 44 RIDGEWOOD TER
Applicant Address: Phone: Insurance:
44 RIDGEWOOD TERR (413) 218 -3017 O
NORTHAMPTON MAO 1060 ISSUED ON :101812010 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSULATE & SHEETROCK DET GARAGE FOR
WORKSHOP
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 10/8/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
File # BP- 2011 -0325
APPLICANT /CONTACT PERSON SANDLER BRUCE & CAREN
ADDRESS/PHONE 44 RIDGEWOOD TERR NORTHAMPTON (413) 218 -3017 Q
PROPERTY LOCATION 44 RIDGEWOOD TER
MAP 24A PARCEL 074 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid VA
Typeof Construction: INSULATE & SHEETROCK DET GARAGE FOR WORKSHOP
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION PRESENTED:
Approved 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
D
Sig a 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.
Department use only
City of Northampton Status of Permit
Building Department Curb Cut/Ddveway Permit
212 Main Street Sewer/Septic Avallability
Room 100 WaterMlell Availability
No ` ampton, MA 01060 Two Sets of Structural Plans
p e,413 -5 7 -1240 Fax 413 - 587 -1272 Plot/Site Plans
hop
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
Aar -TtA Map Lot Unit
Zone Overlay Di
��,, 610�� Z e ve ay strict
Elm St. District CS District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Na a (Print) Current fling A ss:
�S
Telephone
Signatu
2. 2 Authorize Agent:
r kbrucX
Name (Print) Current Mailing Tess:
q13- 212 -3.1`4-
S Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
, completed by ermit applicant
1. Building I ]J► 1 V (a) Building Permit Fee
2. Electrical � (b) Estimated Total Cost of
5 60 Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = 0 + 2 + 3 4 + 5) 60 Check Number 33 1 P3
This Section For Official Use Onl
Building Permit Number: Date
Issued:
Signature:
Building Commissioner /Inspector 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 column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg & paved
p arkin g)
# of Parking Spaces
Fill:
volume & Location
A. Has I Special Permit /Variance /Finding ever been issued for /on the site?
NO DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW 0 YES 0
IF YES: enter Book Page and /or Document # I K B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW ® YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Q , Date Issued:
C. Do any signs exist on the property? YES 0 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 tx qavation, or filling) over 1 acre or is it 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.
SECTION 5- DESCRIPTION OF PROPOSED WORK fcheck all applicable)
New House ❑ Addition Replacement Windows Alteration(s) Roofing
Or Doors ❑
Accessory Bldg. Demolition ❑ New Signs [C3] Decks [[Z] Siding [O] Other [1:31
Brief Description of Proposed '
Work: Vh UMO�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roil - Sheet
6a. 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?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
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.
1. 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
1 , 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 statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Si ned under th pains and penalties of perjury.
rrUC,
Pri me
Signature of Owner/Agent Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
8. Registered Home Imomyemgnt Contractor. 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.
Signed Affidavit Attached Yes....... ❑ No...... ❑
11. - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner - occupied Dwellings 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 he /she shall be
responsible for all such work performed under the building 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 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 compliance with the State Building Code, City of
Northampton Ordinances, St #e and Loca Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature —�
City of Northampton
Massachusetts
.A . N
I DEPARDONT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 s st y yi�"
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 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 /footings (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 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
�Na- c�C�G>r 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 10 9/2 0 1� b
Address of work location 0
The Commonwealth of Massachusetts
Department of Industrial accidents
Office oflnvestigations
600 Washington Street
ulv Boston, MA 02111
www.massgov /dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information Please Print Le ibl
Name ( Business /organization/individual): .
Address: -�
City /State/Zip: - Phone. #: `tip 3 ' 1(& 3 0
you an employer? Check the appropriate box: Type ofpioject (required):.
1. ❑ I am a employer with 4. [] I am a general contractor and I
to foil and/or « 6. ❑ New e:onshuction
emtp yeas ( part- time)• have hired the sub•conbutors
2. ❑ - I am a sole proprietor or partner- listed on the`attadmi shed. 7• ❑ Remodeling
ship and have no employees . These sub - contras have 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers' comp. insurance comp. insurances
Zm:aF l 5. [] ers We are a corporatim and its 10.[] Electrical repairs or additions
3. me�=cotw_ ing all work offic have exexcisod ihcir 11.[] Plumbing repairs or additions
No right df exemption per MGL 12.[] Roof repairs
insurance require&j t ,c. 152, ji(41 and wee have no
eaaployr es. (No wodwre 13.[] Other
comp. .rcquhv&j
«Any ippGaat mat d�ocia b= gt must Ww snout me aodion bdowAwwiag mein waioms' compea"on policy i &faun.
t Homoownas wfio submit mis affidavit imksdpg d ey m doingan wait and d= hire outside ooatcadoa must submit anew affidavit g ai&
t0unbadm dWdw* d& box must aascbed an additiovA dwd ftwing me name ofine rA400hadas and stft Y&Aa orrA base eatities have
aM o vm If the vA c.m aotocsbovempbyasdeymudpmvi&
raw an Employer dwisprovtd v workers' coarpenssdt insumeefor my employees. Below is thepo&7 andjob she
informadon.
Insurance Company Nam:
Policy # or Self -ins. Lic. M Expiration Date:
Job Site Ad&=: • (St}n5tate/7.ip:
Attach a copy of the workers' compensation polky declaration page (showlog the .policy number and eq*zdon date).
Farllm tei am= coverage as required ardor Soodon 25A ofMUL e. 152 can lead to tireimpmt m of cximiaalpeadit of t
hoe lip to S1,S00.00 irod/cr ooe -year ini eoa�e , as well as dvl! p=Wft inli a bad A* 6" WORK ORDER sad a Sae .
of up to $250.00 a day ag&Kftvi iMm Be*hhmd*d seopyofdds eta 'maybe f wardedto the Office of
Tayeestis ona of tiye DIA for 800n.
Ledo Aff&YCdT0 *epdw,=dpMdda ef'p4wy the Wora &kxpnvatdad taleond.aaat
A
_�- 8. 2�.
,
B[SE O O rtOt w sutra, lb . CO/1(P Ai'ION'n O,�CIa�
City or U": Peraift/Lii ise #
Iscutng "Mority (dale one):
:1. Board of Health 2. Building Department 3. City/Town Clerk 4, Eledrieal Inspector S. Plumbing Inspector
6. other
Contact Person: • Phone N.-
. t
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract, of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the Legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct bdidiugs in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the lnsarance coverage-required."
Additionally, MGL chapter 152, §25C1(7) states 'Neither the commonwealth nor any of its political subdivisions small
enter into any contract for the of public work until wcepta* evidence of compliance vft the insurance
requireiments of this chapter have been presented to the contracting authority."
Applicants
.Please fill out the workers' compensation affidavit completely, by c*king the boxes that apply to your situation and, if
may. supply mss) name(sj, address(es) and phone mmhba(s) along with their ce rtificate(s) of
insrrcance. Limited Liabsility Companies C LC) or Limited Lability Partaerships (I.LP) with no employees other than the
members or partners, are not required to carry wodkc a' compensation imtii um If an UC or LIY does have
employees, a policy is requinA Bo advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of ranee coverage: Also be sure to sign and date the affidavit. The affidavit should
be vetucood to the city or town that the application for tie permit or license is being requested, not the D;rartment of
Industrial Accidents. Should you have any questions regardingtine lawor roq*ato obtaina '
no lion policy, please Call the Department at the number listed below Sdf4=td companies ahouid enter their
selfansurance_license number on the appropriate line.
City or Toga Officials
Please be sure that tare affidavit is complete and printed legibly. The Depattmaat has provided a space at ft bottom
of tha affidavit for you to fill out in tie event the Office of Inver has to contact you rcgardinig the appheant.
Please be sure to 511 in do permitilioarse nmaba which wi71 be resod as a rffemace umnbm In adMou, an applicimt
tat roue submit multiple Pemimlicense aPP m; in any given J+ need only ca t ono affidavit iod cads catireait
policy ism (iit'noo &my) and under - Job Site Address" 1 he appliaot should write `sri locations in_(cdy or
town)' A otipy of the aiffdsvit that has been officially stamped or mm d by du city os town maybe piwvidod to the
appliaaaot as of list o valid sfiidaxit is
an file a for fAgw pen nits cr ccom.7A.wwaW&vit must be 511oded each
;yrn., . ttq�a4rccitia�e�obtes: Cooase. arpdmitnotielslod�ot ►basiirem�ocoahmexraal
(ise.
a M bdn[kavxs a idpe oftisd!TQ'f ?b oompl $ s tiff axlt.,`` r• ' ;
IU*fSioe 6f kVO49otioit wfid Mw to drank you fn advance for yahr cooperation and dwdwyvn Lave aggl► epheshons;
pWn do M ht *o S St gi a �. '.� � �y+4�oitac��:; .... o u� _ . � :, .• ..
The Depattrae addr+as, *boneaadfar ...
The Cotllmonwedth ofMassa uset?Ix
• Dq>�tneat of u� - A+ooddotlts : .
" `Oi1�%d'of hlition� ,.
600 ra faft
Tel. # 617 - 727- 4906•ext406.0148774dA SM
RevLed 11 Fax # 617 -727 -7744
. .. arww.massgavldia .
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