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24A-212 Restricted to: 00 00 - Unrestricted 1G -1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code s is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS it • Massachuletts - Department of Puhlie Safet. Board of Building; Regulations and Standard Construction Supervisor License License: CS 13706 Restricted to: 00 GUY R KING 95 RIPLEYRD i i MONTAGUE; MA 01351 1 ' --sj Ex�riration: 7/12/2011 4 ('ommissi4iner { Tr#: 17792 it �, . `# 1 1)— • SECTION 8'- CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone .9T-RegisteredtHorne imp vementaContractor. :, :7 ' . = ' 7 : 1 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 ❑ x > ; .01-12 ' g ",' ' 1 . A °7 wirier � niption 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, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature • • 4 ■ SECTION' 5 DESCRIPTIQN OF.PROPOSED WORK (check all applicable) „ , New House n Addition ❑ Replacement Windows Alteration(s) ,K Roofing n Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [0 Siding [D] Other [D] Brief Description of Proposed �' 4 Work: 1 y olUf 63 - (7 IiinY.Dnisi i' 20arsinE AooPS Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 4 ,, ew ouse:arad raadditton to ez sting} ousinq; compiefe.the:�fal]owrna: 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 . •ed? d. Proposed Square footage of new co tion. I imensions e. Number of stories? f. Method of heating? Fir- : -ces or Woodstoves Number of each ' g. Energy Conservation Compliance. Masscheck - • -rgy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetla • ? Yes No. Is construction within 10' floodplain Yes No j. Depth of basement or cellar flo. •elow finished grade k. Will building conform to t • uilding and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION.Ta .OWNER,AUTHORIZATION ,TO'BE COMPLETED. WHEN =OWNERS AGENT OR CONTRACTOR APPLIES FOR:BUILDING PERMIT 1, as Owner of the subject i At'" property hereby aut i to act on my If, i matters relati 'e,to wok aut opzed by this building permit application. &, � b� K r Signature of Owner Date 1, , 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. Signed � nder the pains and penalties of perjury. 1 G-- fi U n^ C� Print Name \ Signature of Owner. Agent Date 1 Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information b . Existing Proposed Required by' Zoning °,A. \ This column to be fillechn by Building Department Lot Size I ` ' i I I Frontage --� - - Setbacks Front ,,.,, Side L R:` \'L ..J R: Rear R I ``.\ F Building Height E r , Bldg. Square Footage r { Open Space Footage % ..__ , (Lot area minus bldg & paved 1 , parking) # of Parking Spaces • Fill: (volume & Location) a I A. has a Spe al 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 recd>;ded at the Registry of Deeds? NO 0 DONT * OW ® YES 0 IF YES: enter Book ; P age; 1 and /or Document #1 i B. Does the site contain a brook, body of water . wettan' .. NO 0 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtaine. om the Conservation Commission? Needs to be obtained 0 Obta' ed ilk , Date Issued: _ C. Do any signs exist on the property? Y. 0 NO IF YES, describe size, type an. ocation: 1 1 D. Are there any proposed ch ges to or additions of signs intended for the prope . ? YES 0 NO 0 IF YES, describe si e, type and location: E. NiiII 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 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. r \., ._ �``�" fit". ' ® Y J , �` ° �,7 ;'-! ,--• -. . 9a x �_- b - °= City of Northampton a • erfml :� R : t_ Building Department, JUL 5 2012 ' 212 Main Street See ®IG m I � � Room 100 � c� Nort MA 01060 • Two t n — p#413- 587 -1240 Fax 413 - 587 -1272 o+ �e a X44 ��� � t Ot her Speci 4 ,'..-,01:__?,,,,,:. r y • APPLICATION TO CONSTR ALT ER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SIT INFORMATION k _ This sectio to b e comp leted by offic 1.1 Property Address: 1 � L '� ] ,, L f . 425 Y Lot 3i ' � ` S Un %4 Y ` 4 Q D� /r4/11{r'Z� �j�.� one ,Overlay, 11411.-- St . ' .Di s tr i G t . > rxs �' - `CB District SECTION 2 = PROPERTY OW NERSHIR /A UT HORIZED AGE NT 2.1 Owner of Record: Name (Print) Current Mailin Address: ,�1 ► i-E+I S KA pr0,2‘,34.,..12/v 2E �r�cE Signature s a t' G t,, ` ta. i / Telephone (3 - © �' 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3' ESTIMATE CO NS T RUCTION CO Item E stimated Cos (Dollars) to be Official Use Only '''-' permit app licant completed by 1. Building (a);Bulding`PermitFee 2. Electrical (b) C sti Total Cost ofi= Con from (6) 3. Plumbing Bu l i ding Permit 4. Mechanical (HVAC) 5. Fire P rotection , 6. Total (1 +2 +3 +4 +5) tai )r.) (P Check`Number .J r> -- This "S s For Official Use Only `bate ; B .- uliding Permit.Number. Issuetl. " ' �. , ..Signature ' . Bu Co m m issionerllnspe c to r of Buil dings Date • File # BP- 2013 -0102 APPLICANT /CONTACT PERSON GUY KING ADDRESS /PHONE 95 RIPLEY RD MONTAGUE PROPERTY LOCATION 40 ADARE PL MAP 24A PARCEL 212 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out // (3 S/0 � Fee Paid p - . _ . truction: REPAIR PORCH,BASEMENT REPLACEMENT WINDOWS & 2 EXT rr�e OORS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 13706 3 sets of Plans / Plot Plan THE F - OWING 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-. ■.litio. )ela 40 Sig ..re o Bui ding • ficial 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. 40 ADARE PL BP- 2013 -0102 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A - 212 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- 2013 -0102 Project # JS- 2013 - 000157 Est. Cost: $20000.00 Fee: $120.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: GUY KING 13706 Lot Size(sq. ft.): 7884.36 Owner: KAINDL MATTHIAS Zoning: URB(100)/ Applicant: GUY KING AT: 40 ADARE PL Applicant Address: Phone: Insurance: 95 RIPLEY RD MONTAGUEMA01351 ISSUED ON: 7/30/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: REPAIR PORCH,BASEMENT REPLACEMENT WINDOWS & 2 EXT LANDINGS /DOORS 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 7/30/2012 0:00:00 $120.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner