36-273 (6) SECTION°8-CONSTRUCTION SERVICES
8.1 Licensed Construction SuQpervisor Not Applicable ❑fir 1
Name of License Holder: (9 dGr' 17 7 k
License Number
0L,0 311 /0-
Address Expiration Date
Sig ture Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
q S 13�hi S _ 1L)VAhM fDn, 10A 6060 b/)b 114
Address Expiration Date
Telephone �!13 d P 7
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: -`Hom 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 buildine 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
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 [[] Siding[0] Other[EI
Brief Descn tion of Proposed L
Work: ="}[{'en Aezu',ih�, r 81m, �Z I c2 rlh xwi!s it '.,\c t,,de L rfuO /?M.AJ44 �GctS
Alteration of existing bedroom Yes X No Adding new bedroom Yes �_No
Attached Narrative— Renovating unfinished basement Yes XNo
Plans Attached-Sheet
6a.1 :, house and or addition to existing housin 'com lete the followin `:
a. Use of buildin : ne Family Two Family Other
b. Number of rooms in eac mily unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new constructio Dimensions
e. Number of stories?
f. Method of heating? Fireplac or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Ener Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. lain 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 OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, �ti `� �N 4,%C 0. Ann• Ayo, as Owner of the subject
property
hereby a ri �,J-^141 (3' 44f In
to act n m f, in all matters relative to work authorized by this building permit application.
.0 a(7
ignatur of Ownek Date
til lit(f as Owne uthorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my no ge
and belief.
Signed under the pains and penalties of perjury.
(
P ame j
//711q
Sign6ture of Owner/Agent t I 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.
Rear
Building Height
Bldg. Square Footage h" % 1 l
Open Space Footage %
(Lot area minus bldg&paved
A
—parking)
#of Parking S -
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW Q YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES Q
IF YES: enter Book ; Page` and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 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 Q , Date Issued
C. Do any signs exist on the property? YES Q NO
IF YES, describe size, type and location:
L.""......"..""..." _....
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:
_..._".__ . ... _....._ _..__". i
E. Will the construction activity disturb(clearing,grading gx 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.
r;
epartmertt use oily
City of Northampton Status€�f Pemut
1
Building Department Curb C�rive ray em t
1
212 Main Street SewedSepbcAvaitabilliy
&GagQ1t)s tons Room 100 ",04 bit
Etectri�yoYthamPton,MA orthampton, MA 01060 Two Sots of St(uctural Plans
phone 413-587-1240 Fax 413-587-1272 itotarSiefa>is �.
Other Spe�fy
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
la's �1ti��e R1�/, Map Lot Unit
r�r�
I �c�, 1"I�I Zone Overlay District
H 17I���
Elm St District CS District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED?AGENT
2.1 Owner of Record:
M -� rq.,e Ann Mvko ! aq M4a1j Ar'Aae 0-,-entd, 1419 oic a
Nam (P n Current Mai in Address:
Telephone
ignatur
2.2 Authorized Agent: z In t 60 L
Name(Pr i Current Mailing Address:
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
2. Electrical N 5V G (b)Estimated Total Cost of
r Construction from 6
3. Plumbing }( 115- Building Permit Fee
4. Mechanical(HVAC) ' ' C G I
5. Fire Protection �^
6. Total=0 +2+3+4+5) ,� '7 3 Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:'
Building Commissioner/Inspector of Buildings Date
File#BP-2015-0449
APPLICANT/CONTACT PERSON WRIGHT BUILDERS
ADDRESS/PHONE 48 Bates St NORTHAMPTON (413)586-8287(116)
PROPERTY LOCATION 124 MAPLE RIDGE RD
MAP 36 PARCEL 273 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiruz Permit Filled out
Fee Paid
Typeof Construction: RENOVATE KITCHEN& REMODEL ENTRYWAY TO INCLUDE CLOSET
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 84280 �
3 sets of Plans/Plot PlanP�i� e
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION PRESENTED:
A. pproved 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
em ' ' n y
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.
124 MAPLE RIDGE RD BP-2015-0449
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36 -273 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-2015-0449
Project# JS-2015-000829
Est. Cost: $52739.00
Fee: $318.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WRIGHT BUILDERS 84280
Lot Size(sq_ft.): 66646.80 Owner: KANE MATTHEW&ANN MARKES
zoning: Applicant: WRIGHT BUILDERS
AT: 124 MAPLE RIDGE RD
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 (116) Workers Compensation
NORTHAMPTONMA01060 ISSUED ON:1012112014 0:00:00
TO PERFORM THE FOLLOWING WORK:RENOVATE KITCHEN & REMODEL ENTRYWAY
TO INCLUDE CLOSET
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 10/21/2014 0:00:00 $318.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner