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29-608 47 STONE RIDGE DR BP-2016-1014 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-608 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-2016-1014 Project# JS-2016-001718 Est. Cost: $38842.00 Fee: $252.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin INTEGRITY DEVELOPMENT & CONSTRUCTION INC 90514 Lot Size(sq. ft.): 83591.64 Owner: O'CONNOR CHRISTOPHER K& SARAH J HEIM zonjagL Applicant: INTEGRITY DEVELOPMENT & CONSTRUCTION INC AT. 47 STONE RIDGE DR Applicant Address: Phone: Insurance: 110 PULPIT HILL RD (413)549-7919 Workers Compensation AMHERSTMA01002 ISSUED ON:2/17/. 016 0:00:00 TO PERFORM THE FOLLOWING WORK.REMODEL KITCHEN, MUDROOM & 1 WINDOW POST THIS CARD SO IT IS VISIBLE FROM TIDE STREET Inspector of Plumbing Inspector of Wiring D.PW. Building Inspector Underground: Service: Metier: 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 CI'T'Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy signature: FeeType: Date Paid: Amounit: Building 2/17/2016 0:00:00 $252.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2016-1014 APPLICANT/CONTACT PERSON INTEGRITY DEVELOPMENT&CONSTRUCTION INC ADDRESS/PHONE 110 PULPIT HILL RD AMHERST01002(413)549-7919 PROPERTY LOCATION 47 STONE RIDGE DR MAP 29 PARCEL 608 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATI N CHECKLIST NCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 60 Building Permit Filled out Fee Paid Typeof Construction: REMODEL KITCHEN, MUDR0024& 1 WINDOW New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 90514 3 sets of Plans/Plot Plan THE FOLLOWING 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 Commission Permit DPW Storm Water Management UomMltl�"Dr.Lay Sign e of Building Official Date Note: Issuance of a Zoning permit does not relieve a appli'cant'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 tho strict standards of MGL 40A. Contact Office of Planning&Development for more information. I r ,♦ 1 ti City of Northampton Building Department \y 212 Main Street Room 100 hampton, MA 01060 413-587-1240 Fax 413-587-1272 x � tee„•, ��.,,���y� .E�,�.;. `;� �, APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION-1 SITE INFORMATION 1.1 Prope Addr : i This section to be completed by office M p Lot Unit Li 06i-Ci(k 1 A Oi) 66Z Z ne pverlayDtstnct E St,District': CS.t3�strTct SECTION 2-PROPERTY OWNERSHIP/AU tHORIZED AGENT 2.1/Owner of Record: J} nAfst7 Name(Prin � CWrrent Mallin Address(j } ----- Telephone +' Signature 2.2 Authorized Agent: Name(Print) G Orrent Mailing Add ss.:I Signature ' iephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be OfFcial Use!pniy completed by permit applicant 1. Building "?a (a);Building Permit Fee J r 2. Electrical :.:,bJ Es11 timated Total:Cost of Constructiortfrom 6 3. Plumbingtoll Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For:. c9aVuse Oril Date 'Building Permit Number: Issued: Signature: 9i Building Commissionerllnspector of Buiidings # Date I ' ^ ` D x 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 Rear Building Height Bldg- Square Footage % Open Space Footage % (Lot area minus bIdg&paved #of Parking Spaces (volume&Location) A. Has aSpecial 9ermt/Variamce/R ever been issued for/onthe site? �� �� NO «���/ DONTKNOYV ��/ YES �_� IF YES, date issued: IF YES: Was the permit recorded atthe Registry ofDeeds? 0NO KNOW 0 YES IF YES: enter Booki Page and/or Document# �� B. Does the site cont�nabrook, body of*mternrvvetiandsJ NO "�� DONTKNOVY v�) YES IF YES, has permit been or need to bpobtained from the Conservation Commission? Needs to be obtained �� Obtained �� �� Issued: «�� �~� ' . C. Doany signs exist onthe property? YES K l NO K_M }FYES, describe size, type and location: D. Are there any proposed changes to or additi ons of signs intended for the property? YES 0 |FYES, describe size, type and location: E Will the construction activity disturb(clearing,gradingvabon. orfilling)over 1acre orisitpart ofocommon plan that vA|idi�m,bover 1 acre? YES K ) NO �� |FYES,then oNorthampton Storm Water Management Permit from the DPW is required. ` �� i SECTION 5-DESCRIPTION:.&PROPOSED WORK tcheck ail a plfcat le} i New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C7 Siding[0] Other[Clj E Brief Descriptio o,p f Proposed "J Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes No Attached Namaf�'wwee Renovating unfinished basement Yes No Plans Attached-R911) -Sheet_ 6a�[f�e�ni��io�i�s�aaiXr�or artd��ian�o���Cst�rxcihlours�r►�°��aEtT�r�'e�e��h���ollt�'u�li�r+ : 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. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATItON TO:BE COMPLEFEb OWNERS AGENT OR ONTRAC'FORAPPLIES FOR B.FILDING ERMIT C_c n..1 c f as Owner of the subject property hereby authorize J�` �� to act on my behalf,in all m tters relativ tow authorized by thp building permit application. Signature of Owner Date Ar-1 f6, 6 h as Owner/Authorized Agent hereby declare that the statements and information on the forgoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name j` [ ! 2c l 6 Signature of Owner/Agent Date I SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction S ervisor: Not Applicablea❑ r� Name of License Holder: (o p < tti �i t License Number Addre Expiration Date 91 Sign)We Telephone RetiisteretlHonteiiietraVetteitf.Ciinracar zx � s A Not Applicable ❑ Com an N e Registration Number Iel 2�r� 17 Address Expiration Date Telephone Ll 7414 SECTlk7N 10-INaN2KERS'COMPENSATiQN INSURANCE AFFIDAVIT jM.Q.L.a 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 build' g pen-nit. Signed Affidavit Attached Yes....... No...... ❑ � ���� 00 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 Iicense,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 r i T The Commonwealth ofhfassachusetts Department of Industrial Accidents . Office of nvestigations 600 Was4ington Street i Boston,MA 02111 M www.m4ss gov/dia -Workers' Compensation Insurance Affdav t: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bIv Name(Business/Orgmiiationjiudividual): r � Cv } a, Address: _1ko City/State/Zip: f t"S ti otoc2 Phone.#: '113 " "9` 7 i g Are you an employer?.Check the appropriate'box: Type of proF"eed,.*. � L�I am a employer with Z 4_- ❑ I ata a general contractor and I 6. ❑New errplayees(fall and/or part time).* have hired tete sub-contractors2_Q I am a sole proprietor or.partner- listed on the;attached sheet 7. ❑Remoship and have m r.n-rloyees These sub-csrttcactars Isave. .8. ❑Demoton wart-ing for-mein any capacity ?IoYsard1ave workers' _ 9 ❑Btiildmg`a�dztiazi No workers'comp;insurance _. COUP. - require(L] 5. Q We are a co oration and its 10.❑Electacai repairs or additions officers have m=6ised their 3.Q T am a homeowner doing aIl work .. 11.Q Phrtabing repairs or additions myself[No workers'comp. right of exemption per MGL i2: Roof repairs 1(4),insz��ce required.]t c. 152,§ and we have no 13. (?cher employees-[leo workers,. ❑ comp.hw=nOe regiiaed}. *Any applicant-that checks box#1==also SII out the section belowshowiug dzit n(odcers'compensation policy inib oration_ t Hoauawners who submit ties affidavit:ffidicating they are doing all work and the rare outside contractors must submit a newaffidavitindicating such. Tconttactors that check this box must.attached an additions]sheet showing the next ofthe sub=contractors acid state w6the oruot=those rdties have employee. If the sub•contractors have employees;they must provide ftir workers'comp-policy number. _ 1 am an employer that is-providing workers'compensation insurance for my employees. Below is the policy and job site information. M insurance Company Name .' 1 t i N Policy#or Self-ins.Lic:#: w h7 i o a oc 6z ! 20) Expiration Date.- Job ate:lob Site Address: City/Stafe/Ztp: -_ .. Attach a copy of the workers''comp. on policy declaration page(showing the Policy innmber..and ea ]ration date). _ _ Failure tosecure coverage;as regiureci'imder.,66&i'2 A of MGT c:p 52,6 lead tct]lie irimpositzari of Penalties of a fine up to$I;5©0.00 and/or one.-year.imprisonment,'as well.as civil ponalties in the form of a STOP WORK-ORDER and-a fine of up to$250.00 a day against the violator Be advised that a copy of I his statement maybe forwarded:to*Office.of 7nvestiaati6ns ofcovee verification W I do hereby certr under the airs and penalties ofper?ury that'the iltformatonprov` av�uizue_auiLcorrect Si tore Date.- t 1'-�� i Phone#: %3` C�i 7-iff _ �� . Oficial use only. Do not write iii this area,to be completed by city for townOffu a1 City or Town: Permuit(License# Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk .4.ElectricalInspector 5.Plumbing Inspector ]. 6.Other Contact Person- Phone#: S 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 persons)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 DIuLAY the project until such time as the proper permits and inspections are made L 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 Date Address of work location