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36-271 (2) Aug- 14-02 06:43A P.O1 t � f r� 1 t�F a Y 0 t T 1 w � oc oc -. G c� C JI I N x O i � r f s oe � N kA s 6(7 30 V) v Iry r 4 N N •� A �u -1 ` r �y Milli L S � i O cY /� Y7�� C✓ ' 4 i,J C�O r N N r ti ZO'd VEV:90 ZO-bi-6nd u r Dear. s t i r , .eau T c�EUIPTTnq [Te rci,/ ueT�? a;TS FS W (YAM) V 6V y� S�AOf.L:?adS:A1 `,�,i�i1Q-Illlfl :(O .LiAc15`i.:.21'�.%d.r•;i c3 J-j JUN 2 6 2002 DEPT OF BUIL GiNG INSPECTIONS 0 Ic'60 -j -57 2c -21 ---------- ............ .............. ---------- 05 '0 -1' OF INSPECTIONS N'Lull Sljco :0 1\1 till ic I 1m; BmidlIll, MUST SlLe Plan /Plot Pla,,, buildiiig--, wil.11 scluare footage to propert-v lines: Framing pla;i IF' d[)J)l c3i-)! Filing cl c,a d i e i 'v: -�v C)I I Revie41ed ev:ery �-(j°j Ar E JUN 2 ' of 177 >i-,ry 1'7 oq'TttMIpTO 9 fl L1 7 laf wart 11a111pBall la3a ACtlttS[IIa m DEPARTMENT OF BUILDrNG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AVIT (lice>LSeeJpermittec) with a principal place of business/residence at: (phone#) (streel/ci tY/s-t alrin p) do hereby certify, under the pains and penalties of penury, that ( ) I ,.m an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) � (Policy Number) (Expiration Daze) I a+sole proprietor, contractor or homeowner (circle one) and have hired the contra tr5 tv ve the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) ,, (Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date) (Name of Conti-actor) (Insurance Company/Policy Number) (E)cpiration Date) (Name of Contractor) ansuzarice Company/Policy Number) (Expiration Date) (attach additional dart ifntcc= ,to inc}udc infvcmifioa patuuing to ell ooatradors) am a sole proprietor and have no one worming for me. am a home owner performing all the work myself. NOTE:pleaw be await that while homcowzxrs who employ persous to w maiatcaancS a---, too cr repair work oo a dwelling of not mote than throe units in Notch the ha¢wowncr rtzida or on the grounds appurtenant thatto err oo(grrnrally ooaiidcrcd to be tmploycra under the worker's saticn Act(GL152,ss 1(5)),application by a homoow=for a Beats=oc permit tnay mine the legal statua of an employer under the Worlccls Compamation Ac(_ I un&rs d that a copy of this atatcmmf may bo forwnrdod to tho Dcpartraij of Industrial Acc idzn&Offioe of In,t�for the coverage vcsificaliou and that failure to aeatre covcmgo under sectioa 25A of MGL 152 can Itad to the k9osition of ai mal penalties oomisiiug of a fine up to S1,500.00=Wor imprisotmxut of tip to one year and civil pcnslt C3 in the form of a Stop Woric OrdG and a firm of s 100.00 a day against mr- _..._� r' For dputnaa u Only Pcmtl uIIb Lot# Si of Lic=sec/permjttce e SECTION 8-CONSTRUCTION SERVICES' 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder Licgnse Number /p� S � 5 L� ��•� r S Address Expiration Date 3�- 'rF�� Signature l Telephone Not Applicable cable ❑ZRg9etl1Home te ¢ e mfG , Com m / j Registration Num ber ber e Address // Expiration Date J 3 1� C r.� 41- 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...... ❑ :©� �►� ner��em �tiian 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 buildinil 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_ w SECTION 5-'DESCRIPTI6NOF PROPOSED WORK(check-all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] s Siding [ ] Other [ ] Brief Description of Proposed Work: v Alteration of existing bedroom Yes J�<— No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ fa If"New house`aid or tld'ition:.to existin "" ho"using =°:'corn lete the°followihi 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. �1/ k Dimensions e. Number of stories? f. Method of heating? _ Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck 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 . I. Septic Tank City Sewer Private well City water Supply SECTION 7a OWNER AUTHORIZATION'-TO BE COMPLETED WHEN OWNERS:AGENT;QR CONTRACTOR APPLIES FOR'BUILDINGPERMIT 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 wner Date .(� ,�_ ,� ��r.4� 6`4 A lbre,0 ��v �r�� ,vim, as Own-OAuthorized Agent hereby declare t6at the statements and information on the foregoing application are true and accurate, the best-of-may knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Own_ gent Date 2 ` V Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by r Building jjDepartment Lot Size Frontage O Setbacks Front 15'd Side 68'3, L: AVT" R: ifO L:W R: Rear J s Building Height Bldg. Square Footage ;'wo % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands N0 , DON'T KNOW YES 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 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property?YES _ No IF YES, describe size, type and location: ` Y 1� A-a� of Northampton di ng Department 12 Main Street Room 100 e�ampton, MA 010600g,04 51%01NI7-1240 Fax 413.587-1272 Plot Slte P ----- APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This"sectionao be completed by office 1.1 Property Address: ( Map Lot Unl# Zone Overlay°District Elm St. District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record. Name(Print) Current Mailing Address: 754— 53U _ Telephone Signature _ 2.2 Authorized Agent: J) A ,a }il5 IIb Q�4� Cc��—,f��.�,✓ 935 Name(Print) Current Mailing Address: 4SS 0 L Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by ermit applicant 1. Building (a) Building Permit Fee jZ. �d3 2. Electrical (b) Estimated Tcial 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 b This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2002-1176 APPLICANT/CONTACT PERSON ALBRECHT CONSTRUCTION ADDRESS/PHONE 939 GRANBY RD (413) 532-9880 PROPERTY LOCATION 168 MAPLE RIDGE RD MAP 36 PARCEL 271 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid Typeof Construction: REMOVE 12 X 10 DECK&ADD TO EXISTING TO CREATE 12 X 50 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 050106 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION 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 L Loa 2.. Signature�ofBuilding frcial 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-2002-1176 x COMMONWEALTH OF MASSACHUSETTS 046— : CITY OF NORTHAMPTON °.loc k 3 fi' '� ° � ` Lot: -001 Permit: Buildinl7 Category: Deck Addition BUILDING PERMIT Permit# BP-2002-1176 Project# JS-2002-1884 Est. Cost: $12683.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ALBRECHT CONSTRUCTION 050106 Lot Size(sq. £t.): 94089.60 Owner: EPSTEIN KEVIN G& Zoning: SR Applicant: ALBRECHT CONSTRUCTION AT. 168 MAPLE RIDGE RD Applicant Address: Phone: Insurance: 939 GRANBY RD (413) 532-9880 CHICOPEEMA01020 ISSUED ON:8116102 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE 12 X 10 DECK & ADD TO EXISTING TO CREATE 12 X 50 DECK 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 8/16/02 0:00:00 8257 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo