24A-079 (6) 18 RIDGEWOOD TERR BP-2006-0909
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24A-079 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0909
Project# JS-2006-1387
Est. Cost: $3500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: TIM STOKES 139806
Lot Size(sq. ft.): 18033.84 Owner: STEINER LORI
Zoning: URA Applicant: TIM STOKES
AT: 18 RIDGEWOOD TERR
Applicant Address: Phone: Insurance:
20 TURKEY HILL RD (413) 587-9470
WESTHAMPTONMA01027 ISSUED ON:3/15/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
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 3/15/2006 0:00:00 $25.003244
212 Main Street,Phone(413)587-1240,Fax: (413) 87-1272
Building Commissioner-Anthony Patillo
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address: `g Z\(�o‘ DOS 1 zit c.4(
TA 0131. 4 1
L"1 Map Lot Unit
0 10G O ° Zone Overlay District
,,Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: .._
Lostl 5vS70-16lz s Ml-
Name(Print) Current Mailing Address: r 2 I
,. Telephone !� 9
Signature
2.2 Authorized Agent:
c'qZ3 Hi t..c., 72 IA '
Name Current Mailing Address: .1
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item - Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 3 SOO (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) 506 Check Number C #°96�
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
rlf ,
r
Section 4. ZONING All Informatihh 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 ..1
Frontage
i ' j i
Setbacks Front j I
Side L: R: L:j ! R 1 i
1 1 1 • 1
Rear
Building Height 1 I
Bldg. Square Footage j I % 1 I 6 I j
Open Space Footage % r--
(Lot area minus bldg&paved 3 1 ( I
parking) _
r
#of Parking Spaces
Fill: ,
(volume'&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued: I
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book 1 Page, and/or Document#j
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 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 0 NO 0
IF YES, describe size, type and location: j 1
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 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.
SECTION 5 DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ - Replacement Windows Alteration(s) n Roofing n
Or Doors !'Egl
Accessory Bldg. ❑ Demolition . New Signs [dj ' Decks [p Siding[D] Other[I]]
Brief Descr' ion of Proposed _
Work: 7- YU lZ 'j� l�� noa 1M 4 1f.-V)4004 +- —ri ,
Alteration of existing bedroom Yes No Adding new bedroom Yes Xi No
Attached Narrative Renovating unfinished basement Yes/G. No
Plans Attached Roll -Sheet
,. ...;., x-' .:"",.' -. - asp.^ M -.,-. . ;, , ,.
sa:Ff New house-a'Tf'�addi f8fi exestinct=hoasinc cotnDtefe the�folldwmg:
a. Use of..ilding:One Family Two Family Other
b. Number of roo ' each family unit: Number of Bathrooms Z
c. Is there a garage attache.. 0
d. Proposed Square footage of new cons , ion. Dimensions
e. Number of stories?
f. Method of heating? :.laces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck .ergy Comp ance form attached?
h. Type of construction
i. Is construction within 1 ft.of wetlands? Yes No. Is construction within 100 yr. 1.odplain Yes No
j. Depth of base nt or cellar floor below finished grade
k. Will bui mg conform to the Building and Zoning regulations? Yes L
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, La r7.1 7 'i ii.i - ,as Owner of the subject
property ,
hereby authorize i 570
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, , as Owner/Authorized
Agent hereby declare 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
ill /5 Zoo
Signature of Owner/Agent Date
•
SECTION 8-CONSTRUCTION SERVICES +
8.1 Licensed Construction Supervisor: Not
Applicablblle ❑ / �J
Name of License Holder: I Q
l��i-' ^' t/� c P v [�
License Number
Address ExpiratinDate
S4 -
Signature Telephone
9.Registered Home Improvement Contractor ',.? -• Not Applicable 0
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 0 No 0
11. Home 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 homeowuet to engage an individual for hire who does not possess a license,provided that the owner acts
- as su_pervisor.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
resnonsible 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
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- DEPARTMENT OP BUILDf'G INSPECTION'S
212 Main Street ' Municipal Building
1Nrorthamp Lon, Mass. 010G
•
W O RICIR'S C O DTP ENS ATIO N NS URAN A FFII)r1.\T1 r
(li ccnsa'Jpermi tire) _.._.—--
with a principal place of business/residence at:
z cJ 1 ilia VITIMAttiliveY
(phone ) �'7'"`,�$b
` (s t/cityIcwcJip)
do hereby certify, under the pains and penalties of perjury, ha
( ) I a m an employer providing the followine'worker's comp sation coverage for my
employees worng on this job: •
(I`suran Comr„cv) - (Policy Nu_mlr_r) ----- (1=;-piston Dam)
( ) I am a sole proprietor, general contractor or homeowner circle one) and have hired
the contractors listed below who have the following worker's mnen_sadon policies:
(Name of Contactor) (In uranc; Coinoany/1'0Uc-i Nurn t: (r,:pinauon Datc)
(Name of Coomaor) (lns-w- ncc_ Comoan`fl o!ic-' Numcrr) ('iXDimiion Date)
(Name of Conrraeto;) (Insurane; Company/Po(;cy Number) (Expirdon Date)
(Name of Contractor) (Insurance Comcany/Poliey Numb- ) tr.xpimdo❑ Daly).
(nasc h_ddi iocoJ tbcct if ace.y to mctsc<infoc m ri oa po-Lnisinc to.11 ooaTl--o:a)
I am a sole proprietor and have no one worldng for me.
(( ) I am,a home owner performing all thework
p � myself.
NOTE:ple.sc be cw rc thr.l.wl a bcmncywocr]K'bp employ pCi-0II3 La,to m•ir...-„ -.--.:euoar rgair work.ao a d..<tt:oa of
aot mots tb_n tEnac tmrs is t.-hich the bomoowac rcuda or oo the croulado zppurua:ra tbece¢c-r out C.r.:_t1y oocr:d.-cd to tie
employ ,c+c+4,--the wui:cr'a n""p<'---iico Act(GL1152s 1(5)).apptintioa try.bomaowoa fa c li=ar..or pcmit may a-idtoc the
logs1 ctazu or.employer under dso woholt eompemai.cm Act
1 undo Hind tha a Dopy of thi.mtcmc¢t m.y be r«w,u den to the[ope,toxr¢ar 1ndur.ia1 ,c aecaa offioo of Irv+r.00e for tb
0o ra-kSt t'LriE=ioo And th_t Liltzc to saaut\Dovc-rasc tracks soetioo 23 A of MOL 152 ma lgzd to the irt7 ;Rion of c-iminsl Pre lrio
ooasisiag of.floc of tip to S 1.300.00 artdlor icrrpriacracoaat of up to ooc yt=-.r end civil pr.,tup to 6c form of.Stop Work Orde cad a
fig of S 100.00 a day tpirmt me
- For d�.ata�lt u,c only
Ul) Permit Number
_ 3/ci
Map: Lot . 4
Signare of Licro aril
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tu
• CrxfEr of Nrirtipintp1art 1 z __
�In= 11,
P.-7'4. pyl►•'�•t jI 1834Acipisetts : Si --l,e
1`�"'�"=- DEPARTMENT OF BUILDING INSPECTIONS �4
\tar if'
INSPECTOR '212 Main Street • Municipal Building
_ sue:
Northampton, MA 01060 .
e'
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supc:,' 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 i egulations. 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 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.
Date
Address of work ,/A 31 U
location .6
.
-7 ) SQOO
25- ' oOOO
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