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24A-070 (3) 64 RIDGEWOOD TER. BP-2017-0711 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Bloek:24A-070 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c-/42A) Category_Porch Enclosure BUILDING PERMIT Permit ft BP-2017-0711 Proiect# JS-2017-001174 Est, Cost:$21550.00 Fee:$140.00 PERMISSION IS HEREBY GRANTED TO: const. Class: Contractor: License: Use Group: Homeowner as Contractor 9S„Size(sy. ft.): 15071.76 Owner: MCCORMICK MEGHAN Zoning:URA(100)/ Applicant: MCCORMICK MEGHAN AT: 64 RIDGEWOOD TER Applicant Address: Phone: Insurance: 64 RIDGEWOOD TERR {508)736-8658,() NORTHAMPTONMA01060 ISSUED ON.:12/2/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:ENCLOSING EXISTING FOUNDATION FOR LIVABLE SPACE POST THIS CARL) 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 It Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: il: Insulation: Final: Smoke: Goal: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeTvpe: Date Paid: Amount; Building 12/2/2016 0:00:00 $140.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2017-0711 19-e (- 111���***""" APPLICANT/CONTACT PERSON MCCORMICK MEGHAN11-: £ E t ADDRESS/PHONE 64 RIDGEWOOD TERR NORTHAMPTON (508)736-8658 Q LopZkrPROPER (S OOD TER MAP 4AI PARCEL 0Y 70 001 ZONE 64 WUURA(10O)1 &GS � rift), , THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLS. OUT Fee Paid 4i{I►,. Building Permit Filled out �tS Fee Paid r Tvpeof Construction: ENCLOSING EXIST!' UNDATION FOR LIVABLE SPACE New Construction Non Structural interior renovations Addition to Existint Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INPWORMATION PRESENTED: V 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 Demolitio] ieiay �W / • Signature of Buildi o OfRcia 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. / � \ City of Northampton yriYitafI�, r ti. � l ` / Building Department qtp,� + itt4, - ' -t: -� 212 Main Street X; -A1 1 r t, ri.b `A^�i 7, ,$ / / Room 100 S+lr3r.}"t I� ttio'ai . Northampton, MA 01060 yj;,t 'i I-Fgiirroi r ygw: K- ,„p !°/ phone 413-587-1240 Fax 413-587-1272 �-r"-�--_ s '..14::', :j* ffif. v-v .1,i ,.,�,.'. A— ICATION 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 IICS'r--\ r-Pii:kd l..k_M Oa k C.--c-c- Map Lot Unit V\fr<Z\l",arny)-Cry 1 'MAdO b Zone Overlay District Elm St District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 21 Owner of Record: w. ! �- Name(Priv Current Mathng Addre\. 4* .4 . t. 4 t r /%„hWe Telephone Signa ure 1 ,-mail: (Ylee ori,;,ae.-meghan t3rDc mu,l ,Crw. 2.2 Authorized Agent: J Name(Ann* Current blaAng Address' Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 0/ et coo 2 Electrical (b)Estimated Total Cost of "ar$:72), Cb Construction from(6) 3. Plumbing Building Permit Fee `.`t-2-50, at) 4. Mechanical (HVAC) G. Fire Protection 1 30-bia•DC7 / , /n 6, Total=(1 +2+3+4+b) V eTha o' Check Number oZ l 9(! I yN t This Section For Official Use Only Swirling Permit Number: Date Issued: Signature: Building Commissionerfnspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomptete Information 44 Existing Proposed Required by Zoning This column to be tilled in by Building Department Lot Size ,=i_ 4, k _ E__±501.3_ ._i r t Frontage I / ._... J 7 __ __ Setbacks Front ET_61 ' - ' Fi Side L: R:I 2L L:b i R:i_ZII -- Azar. 50ai CSLLJ I_1: Building Height I _._J Bldg. Square Footage L_.. 1 h_ Open Space Footage _ _ % _ .— (Lot area minus bldg&paved f, _.� i � `.__1 L_--J parking) — #of Parking Spaces L i Z I___ 1 Fill: f I (volume&Location) -- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW YES O IF YES, date issued:I I "�"'^'"fffT'" IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW fat YES 0 �.I IF YES: enter Book I I Page and/or Document#, I 8. Does the site contain a brook, body of water or wetlands? NO Q, DON'T KNOW O YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained CD Obtained 0 , Date Issued: 1 E C. Do any signs exist on the property? YES O NO Cti IF YES, describe size, type and Location: I D. Are there any proposed changes to or additions of signs intended for the property? YES © NO ota 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 wilt disturb over I acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION QF PROPOSED WORK(Check all applicable) New House n Addition Replacement Windows Alteration(s) n Roofing (371 Or Doors D Accessory Bldg, ❑ Demolition ❑ New Signs [D) Decks [0 Siding it(]] Other ilk Brief Description of Proposed Work: A rxGttl`o1'vul 'E 5c a5 �C�.r c. CVW >LtL Ltli'fs Sda oa Alteration of existing bedrom\J Yes Adding new bedroom Yes -t No Attached Narrative Renovating unfinished basement Yes "f No Plans Attached Roll -Sheet se If Nevi hoiise and or addition toTexisting ilousinq, complete the following: a, Use of building : One Family Or Two Family Other (} C' b. Number of rooms in each family unit:_a__ Number of Bathrooms dam= c, Is there a garage attached? (,(i /5- r - d. Proposed Square footage oftt new construction. ' ;��✓ _Dimensions _5" a Number f stories? I f. Method of heating? (rt Mt encl.m Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction -C-Ca 1, Is Is construction within 100 ft. of wetlands? Yes fNo. Is construction within 100 yr. floodplain Yesc* No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? sr.- Yes No I. Septic Tank_ City Sewer _ct- Private well City water Supply or SECTION 7a•OWNER AUTHORIZATION -TO BE COMPLETED WHEN. OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT , 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 of Owner Date (-\eO\.r CSC Crrcav:iCtL ,as Owner/Authorized Agent hereby are that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name, Signatn of nt Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder' t cense Number Address Expiration Date Signature Telephone &nai 9.Registered Honie hOprgvement Contfactgr, ;, ,_ 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....... O No.._.. ❑ 11. - Flome 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 We 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 cm structs 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 be/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,duringand 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 Signatures -jt r..GCi L _/ 7(/jam/ City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: Lc Ll cc)-C\ cC a ,oc k; C The debris will be transported by: foo - e(V(`t cvv\i L- Cir/Or af:Znav The debris will be received by: \)cfj k-u06 Building permit number: Name of Permit Applicant “'\>ar\ 111 Co-c- -N« is tO- 11-al-/(o L Lill '601-t L•, Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations it o"t1 Congress Street,Suite 100 =aim Boston,MA 02114-2017 .: www.mass.govfdia Workers'Compensation Insurance Affidavit Builders/ContraetorsfElectriciansfPiumbefs Applicant Information Please Print Legibly Name(Businffesss,/Organizzaattiioonlndividuaf;_Meek\-`x4\ �C Cc'c�\i cre Address: CR tv` t'-�-�h t�-e.c•r City/State/Zi : ex _A la D Phone #: G D6- /L,J� Are you an employer? Check the appropriate box: Type of project(required): I.❑ i am a employer with 4. [] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8, t Demolition working forme in any capacity. employees and have workers' 9 Building addition [No workers' comp, insurance comp.insurance? required.] 5. [3 We are a corporation and its 10.0 Electrical repairs or additions 3_4§V I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required]t c. 152,§1(4),and we have no employees. [No workers' 13,❑Other comp. insurance required.] 'Any applicant that checks has it must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit his affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractor and state whether or not those entities have employees. If the sub-contractors have employees they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#:_ Expiration Date:_ 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 MGI.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 fonn of a STOP WORK ORDER and a fee of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si aturg:4 .6 n §-1, f— �l? �,/ MIA ��/ � ` �,N.f.G,—..._ Date: �—... Phone#: �. I "- ,`.. Official use only. Do not write in this area,to be completed by city or town official. City or Town:_ Permiur icense f? _ Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton __may - s . /y„$"� t Massachusetts �s .- << I -y:.41 '� ~ ew b G • (q af4;_� DEPARTMENT OF BUILDING INSPECTIONS Z �I ,� E r " 212 Main Street • municipal Building _. Northampton, MA 01060 ,...1.•P INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HI _. WN t. _NEMPTION ACFNOWLEDGEMF 1tT 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 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/footings(before backbit. sonotube holes.te efore . •..r a Toon i •till•in• 'nspection (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 in-pections 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 P_ELY the project until such time as the proper permits and inspections aremade `� I, '\�? C\\ ‘0tC\ 'rnec.fi,Cs^. ( C understand the above. (Home ow r +resident's signature requesting exemption) I will call to schedule all lre�quired building inspections necessary for the building permit issued to me. Date / 1 '- Q \- 1VJ Address of work location t; t'-)Ymk CVt CC-Ce-S\ 1 F c C C V-\C C "i'Y� ) j 4 Olde. c ) • Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"-_every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MOL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfomance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. if an.LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Deparbnent has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the penninlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permib/icense applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call, The Department's address,telephone and fax number The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 7"el.#617-727-4900 ext 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 7-2013 www.mass.g'ov/dia N soi 4- -F _ To __ ISrF1 Tied -7 / 2nd FI, w/0 eck glob o& peck licit .21c >T ) E (,,KuntaidsTiaLe A ( 4-' aor Dj� 'EtCIFVAq bra ftTi p70 1!e ern((5ed 341 -> Sale. c)r.vc J y N 1 1 1 I I I y oRX6 � e'oc "/a 2224'3771y ryWt. NeW CGnsir n Innyt C ii4f To HAcUay WisJo"' i-rch rgp „ -- --- — O`Ve 11-30 EAST Ae Sty. 0"416 " >4-r of is ' V r Lii �1 Li 1 -- ts_c% 6,4 LJ5g...? � I Ir- �c. 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