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36-252 (3) t I i e lilt" NO x , r i � 1 1 ,t .b- - -- 1 =— W y CTi ' ? i Icr .. t s, nn i -r� I :+ . { f t ' 1 k r am L �-jt� 3 M t Cr .as+� s j i 1 f• r rn CO) + y oo � 1 I CA At L-A i � g l� i � t i O S -4- rn oy .r.-t-_ t , w+.yr t l Xv i7, ` I r- CA _ 1 r t _ f it OD cr W _ f O W � m s� o rc_ ' f e ' I r n —,_4 45 co co o - 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 parkine) #of Parking Spaces Fill: (volume&Location) y A. Has a Special Perm it/Variance/Finddi�ng ever been issued/for/on the site? IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW O YES 0 IF YES: enter Book Page; and/or Document#. B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained ® 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 © NO 0 IF YES, describe size, type and location: E. Will 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 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. { - � €Qe�T3rfinente�e Qnly- -� Cibj of Northampton Statcts Q Me-sm Building Department CttlDpuewa �e 212 Main Street Sevtte $epttAuiiafr[Irt - Az } S Room 100 TvaferMt 61'AuaRibti � � Northampton, MA 01060 �vo sets otstrrxcturaLPians» . phone 413-587-1240 Fax 413-587-1272 L'tpfSitePla`ns �� _ APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION-1-SITE INFORMATION: 1.1 Property Address: This tectforrta be compCeted�b�affic> _- 3 V —ol�l AJA done OverlagDrsfnct SECTION:2-PROPERTY OWNERSHIPIAUTHORIZFD AGEi T 2.1 Owner of Record: at2_r2Y �a u t.3 Z� 3 IM Ai? W lZ VD L- 0 P, A Name(Punt) Current Mailing Address: Telephone Signatu 2.2 Autho 'zed A ent: r Name(Print) %�' Current Mailing Address: G� 001,Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building �U _(A Y Building,Permit Fee 2- Electrical (b}Estimated Total ® Construction.from(6) 3. Plumbing Building Permit Fee ,5_p O 67 4. Mechanical(HVAC) 5. Fire Protection 6_ Total=0 +2+3+4+!5) d 0'00 1,,Check Number This Section-For-Officfalalse Only -- '.Dale Building Permit Number:. Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2008-0436 APPLICANT/CONTACT PERSON HOWARD R PAUL ADDRESS/PHONE 355 MIDDLE ST AMHERST (413)253-3698 PROPERTY LOCATION 203 MAPLE RIDGE RD MAP 36 PARCEL 252 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction: REMODEL KITCHEN&BATHROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 059242 3 sets of Plans/Plot Plan THE FOL ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 Commissio Permit DPW Storm Water Management 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. { BP-2008-0436 GlS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Pernut: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2008-0436 Project# JS-2008-000643 Est. Cost: $105000.00 Fee: $525.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOWARD R PAUL 059242 Lot Size(sq. ft.): 439084.80 Owner: NAULT HARRY Zoning: SR Applicant: HOWARD R PAUL AT. 203 MAPLE RIDGE RD Applicant Address: Phone: Insurance: 355 MIDDLE ST (413) 253-3698 Workers Compensation AMHERSTMA01002 ISSUED ON.1013012007 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN & BATHROOM 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 10/30/2007 0:00:00 $525.002284 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo ��� 1 1 RM x 'err�+ +� �`X33? � "ua�r"" '� ,IM WK M �.�h City of Northampton GAS INSPECTION LABEL . APPROVED Date_ ; , XIM Gas Inspector ✓ } r eM*r ,. W� R FIRM— t k w 4t a rug r 203 MAPLE RIDGE RD BP-2008-0436 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block:36-252 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category BUILDING PERMIT Permit# BP-2008-0436 E'roiect# JS-2008-000643 Est. Cost: $105000.00 Fee: $525.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Lase Group: HOWARD R PAUL 059242 Lot Size(sq.ft.): 439084.80 Owner: NAULT HARRY zoniw.' SR Applicant: HOWARD R PAUL AT: 203 MAPLE RIDGE RD Applicant Address: Phone: In-itra ncn. n–L 3 55_Tvt1 7F-°='t (413)253-3698 _ — Workers Compensation AMHERSTMA01002 ISSUED ON.10/30/20070:00:00 TO PERFORY1 THE FOLLOWING WORK.-REMODEL KITCHEN & BATHROOM POST THIS CARD SO 1.F IS VISIBLE FROM THE STREET Inspecior of Plumbing Inspector of Wiring D.P.W. Building Inspector Undergrouad: Service:, Meter: Footings: –Rough: P4 thA House# Foundation: - Driveway Final: Final —r' a / /0 rkFmali'5-ot 1 0 9, 1f RPM Rough Frame:(��t, Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Find-S— cj✓P6 moke: Final: Olt o6ttZIOY L.0-44S THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu a cy ae Si nature: FeeType: Date Paid: Amount: 10130/2007 0:00:00 $525.002284 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo � ��ie 1°dmrreo�nruecz��t �✓T/�a�aczc�ivaell6 Board o.Building Reguiations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 112760 Expiration: 4/22/2009 Tr# 129285 Type: DBA H.R. PAUL Building and Design HOWARD PAUL 355 MIDDLE STu AMHERST, MA 01002 administrator a`' - j�e 1:>omnearuueacifz vq l�cL.lJCtc�iccdP 6 " BOARD_OF BUILDING_REGULATIONS License: CONSTRUCTION SUPERVISOR umber: CS 059242 Bi r*hdate: 03121!1957 Expires: 03/21/2008 Tr.no: 16910 1 a Restricted: 00 HOWARD R PAUL 355 MIDDLE ST AMHERST, MA 01002 Commissioner - Cr fir z1 IIz#1 ��IZ mt 3 ass ach ITS effs 3 ems= DEPP?ZTA,fENT OF BUILDI.G INSPECTIONS INSPECTCP 212 Main Street • Munic:ipal B wilding \` Northwnpton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as 1-.1s/her construction suv-: .-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 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/footinos (before back--fill). sonotube holes (before pour), a rough building inspection(before work is concealed) i-nsulatioh inspection (if required) and a_fin.al_buildina 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 occupancv 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, 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. y Date Address of work location The Commonwealth of iVassachusetts Department of Industrial Accidents Office of Investigations e 600 Washington Street Boston,iM4 02111 www.mass.gov/dia Wormers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Ai licant Information Please Print LefTiblv Nalne(Business/Organization/Individual): Address: City/State/Zip: hone.#: r �g �5 F2. you an employer?Check the appropriate box: Type of project(required): I am a employer with 4. ❑ I am a general contractor and I employees(foil and/or part-time).* have hired the sub-contractors 6. ❑New construction I am a sole proprietor or partner- listed on the attached sheet 7. emodeling ship and have.no employees These sub-contractors have S. ❑Demolition Lrequired.] r me in any capacity. employees and have workers' [No rs' comp.insurance camp. insurance.: 9. ❑Building addition 5. 7 We are a corporation and its 10.❑Electrical repairs or additions 3. eowner doing all work officers have exercised their11.❑Plumbing repairs or additions workers'comp. right of exemption'per MGL 12.❑Roof repairs equired]t c. 152, §1(4),and we have no employees. [No workers' 13.7 Other comp,insurance required] 'xny app ican a c necics oox must also ria out the section below showing their workers'compensation policy-inforaatiotr. - 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.artached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contmctors.have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site information. Insurance Company Name: 4V,.1;7�64 N L D — Policy#or Self-ins.Lic. m: Expiration Date: 2S 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 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DT A for insurance coverage verification. I do hereby certify er the enaldes of perjury that the information provided above is true and correct �ienafure, Date: zn Phone : L6. Othe only. too not write in this area,to be completed by city or town qqz-ciaL Town: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone 7: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su rvisor: Not Applicable ❑ Name of License Holder: License Number� f 2 V/12 Address Expiration Date 4 s-3 . 16 Signature one 9eRe isfeced tfonie'Tni° ueiient.Coir! er�. •- �u° Not Applicable ❑ G (/I Company Name Registration Number 0 Address Expiration Date Telephone ff � / SECTION 10 WORKERS'COMPENSATION=INSURANCE AFFIDAVIT(K GL c-.152,f 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...... ❑ ly 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 1083.5.1. 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-vear 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 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows FAIteration(s) Roofing ❑ Or Doors C-1 Accessory Bldg. ❑ Demolition ❑ New Signs [p) Decks [M Siding[a] Other[0] Brief Description of Proposed Work: hA7 Aiteration of existing Uediccm Yes No Adding new-bedroom Yes ~"�—No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roil -Sheet sa !f tVew house~aei!ciI acfdit[6>t6: i Rios �r�EO pf"�fe aCFai it g 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? Firepiaces 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. III s cons ruc on wi i es -- 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"B E CO LETED. WHEIt OWNERS AGENTORCONTIZACTORAPPLiES FOR BU" ILbk6,.PERMIT ; I R lZ Y N oa V LT— as Owner of the subject property hereby authorize to act on Vll�,ner If, in all matters relative to work authorized by this building permit application. /-) //I / o -7 Signa re Dale I, as Owner/Authorized Agent hereby de fare that thb statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under+ a pains and penalties f periu Print Na e Signature of Own A nt Date