24A-024 (12) 89 RIDGEWOOD TERR BP-2005-0326
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A-024 CITY OF NORTHAMPTON
Lot: -001 • PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A)
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2005-0326
Project# JS-2004-1190
Est. Cost: $10000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Czze(sc.ft.): 5009 40 Owner: VOSS P_ n:(IL_n SUSAN E
Zoning:URR Applicant: VOSS PAUL B & SUSAN E
AT: 89 RIDGEWOOD TERR
Applicant Address: Phone: Insurance:
89 RIDGEWOOD TERR (413) 584-1184 0
NORTHAMPTONMA01060 ISSUED ON:
TO PERFORM THE FOLLOWING WORK:FINISH 2ND FLR ADDITION & DORMER, MOVE
NON-BEARING WALL TO ENLARGE BATHROOM
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: •r, ' r�' ;, ,g`Rough: House# Foundation:
`^;, • ` / :r/ .,;,t61 Driveway Final:
Final: / —I C^(i inal: vim. //IA .
P,,,/ Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke:_ C ti3 Final: 6K 0t/13 fcm CO Al S
THIS PERMIT MAY BE REVOKED BY THE TY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGU TIONS.
...444ert
/1/
Certificate of Occupancy Signature: 44.24/4
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 60414 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
i#641 4):?(/ -
File#BP-2005-0326
APPLICANT/CONTACT PERSON VOSS PAUL B&SUSAN E
ADDRESS/PHONE 89 RIDGEWOOD TERR NORTHAMPTON (413)584-1184()
PROPERTY LOCATION 89 RIDGEWOOD TERR
MAP 24A PARCEL 024 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out jf '`�
Fee Paid ///7 7/"/ 13`�
Typeof Construction: FINISH 2ND FLR ADDITION&DORMER,MOVE NON-BEARING WALL TO
ENLARGE BATHROOM
New Construction
Non Structural interior renovations
Addition to Existing
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
INF9RICIATION 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
Signature of Building f fficial 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.
Department use only
j'!1^ ��y+,rr7 Cit of'lorthampton Status of Permit:
Hr s) [ `S
.. \l `u I Department Curb Cut/Driveway Permit
2 Main Street Sewer/Septic Availability
Ft ,om 100 Water/Well Availability
h
SEP 2 0 , Norttla ton, MA 01060 Two Sets of Structural Plans
phone 413-5j87-1240 Fax 413-587-1272 Plot/Site Plans
L i Other Specify
ni i i -,,I1,'er+F ITIPNc
APPLICATION TO.-G6NSYRUCTr 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`;` 12' 1 Se t,`vc ) Tef( c Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
.�it ✓✓ S ��l 12.c 2' Iecti
Name(Print) ,, Current Mailing Address: -
�f/ Telephone / S p V �Id G
Signature O
2.2 Authorized Agent:
— I V f
Name(Print) Current Mailing 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
2. Electrical I (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) Check Number
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Informatibf•t Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
J Building Department
Lot Size A I I "��tA il ' —
Frontage
Setbacks Front I ! !
Side L: R:1 L: ' R:_
- 1
Rear
Building Height •
Bldg. Square Footage i i , % 7-7
Open Space Footage %
(Lot area minus bldg&paved i i I 1
parking)
#of Parking Spaces
Fill: ' i
(volume-&Location) —
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
N0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page. and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO ` ► DONT KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission? '
• Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO NCY
IF YES, describe size, type and location: I
D. Are there any proposed changes to or additions of signs intended for the property? YES Q N0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,gradi •,ex .vation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q , NO
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) Roofing n
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[0]
I I
�''`"" (Li le IA-lea 2 GC r` ����u.ol�) rksv/. p4a4/0,- �(�w ��--( 'I ,1 . t, ovorit
Brief Description of Proposed
Work:
Alteration of existing bedroom Yes )( No Adding new bedroom Yes No ell-` 11 tr°vim.'
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa If New house ndor=adtl tion to existiriq housing, comp lete7the4811ovuinq:
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 AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
2
I, r �` U�,S S ,as Owner of the subject
property
hereby authorize F`- " 1 S
to act on my beh If ' matt relative to work authorized by this building permit application.
Signature of wner 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
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES +
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: �,r
License Number
Address Expiration Date
Signature Telephone
S.-RegisteredHomelmprayement_Contractor. *' M - ' _ 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 0 No ❑
•
11 dome*OwnerExeniption
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 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 Loca nin Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature /`�✓'��
r
•
•
•
_-ctwtno i..
qe -��'`� (riff of orf!1 uipton _1 -
: 67 E �tasancllrttrfla'
DEPARTMENT OP BUILDD'G INSPECTIONS •
212 Main Street Municipal Building
Northampton, Mass. 01060 r s
WORKER'S COMTENSATION GNSURANCE AFFIDAVIT
•
•
-- -
(Ii ccasxipermi ttcc)
viith a principal place of businessfresidence at:
(phone')
(scr=ici ty/sralda p)
do hereby certify, under the pains and penalties of perjury, dial
( ) I am an employer providing the following'workcr's compensation coverage for my
employees worng on this job:
•
•
(Lasuranc Conpzry) (Pclic: Nu r) (t ;-pinal°n DaL.)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the cone actors listed below who have the following worker's comnen_saiion po icier:
(name of Contrac or) (In2ranc; CornoanyiPoiie; Nun-be) -- CE.:pi,-duon Date)
•
(N-.mc of Contactor) (insurance Comoaa`vPolic Number) (7.4iraon Date)
•
(Name of Con>saao,-) ansurancz Company/Potic)• Nacabu) (Expirydon Date)
•
(Name of Contractor) (Lasurancc Comczuy/Policy Numly`r) (Expirtioo fiat).
(acuc'J=d,"1it`.00J c'..a if acCc.ry to,x du&tnforat._i ea pci .ci to.11
( ) I am a sole proprietor and have no one woridng for me.
(K) I am.a home owner performing all the work myself.
(�NOTE:P1=44 be awuc the..-tric hcmcowocra who splay peons to do rc^a,, a wont on a dwtth E,of
ant moat t1_a L`zo_amitr to which the hamoo oa-rarridn or ea the prouacS oo( ooat'd.—oi to be
eirplayes t+lr_the Act(GL!152=1(5)1.afptico ioo by a bomcoaae fca a lice_a pcmit e.-idmce the
las3.1 alaiu of as=ployor oar:er dho Wort.a o Compo.-o.o' a/.ct
I uolesi.ad th.t.copy of tbi.mt.®est m.y bo for-++urd.d to tbo pope or t of Ina.s.iJ Accident'Off oo of u-ooe for th.
covai-Sc vai6c=tioo sod thst Ut37r to seauc'eovcrtsv track soc tioo 23A of MOL 132 can I 4 to the imposition of eimios!pcasliic
corn hag of a rux of up to S I OO.00 and/or imp-iyo<of up to cot yt r rod dvU p-o•Ilia to rbc form o(.Shop Wont Ordc aad
fire o(S 100.00 a thy again t me
For u.c only
Permit Number
•Map: Lot„
` "S gnaturt of Licauoc/Pccrniuc:r Date -- .J
45t1AMpTO _#_--
�� (!f of Xart11&ntv.IIn i.. — /.
;- .., yl`kV.W"ear . OAassachicsttts Mt::-1jL1
DEPARTMENT OF BUILDING INSPECTIONS , _ :
INSPECTOR 212 Main Street • Municipal Building '`o,,44=S
,
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sup .- 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 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 DELAY the project until such time as the proper permits and inspections are
made
OA 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
location
,-
1/1---V r--. 1-v/q-a-�g - .,
\ ,
,i7/y/-s-1/ i,4 ;.,v //I--1 -) Aoz. t4-4/,06 //
/ k-"7d�s1/04 9-+7 o
�, -� i v�I. -- ? `
s Il 7 - �/7 > rrr1)
____.------ i
4_,-1,i0 pil_ \ 0 ..r.o-7,,iaI
1 toa/y \
\ 111, WI --.....,,kii
7
,4 i
at \,
rioz 5-145 1 \
1 IP7r-t'lhis 9)
I --,0 oir Is 1� 9
- SJ' 1fe.5 ''`7
a _ `
a C
A ry)r '7/VP"VV1 \ .,7
✓ 7i