24A-024 (15) 89 RIDGEWOOD TERR BP-2002-0679
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A-024 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: shed BUILDING PERMIT
Permit# BP-2002-0679
Project# JS-2002-1095
Est. Cost: $400.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group:
Lot Size(sq. ft.): 5009.40 Owner: VOSS PAUL&SUSAN
Zoning:URB Applicant: VOSS PAUL & SUSAN
AT: 89 RIDGEWOOD TERR
Applicant Address: Phone: Insurance:
89 RIDGEWOOD TERR (413) 584-1184 O
NORTHAMPTONMA01060 ISSUED ON:1/31/02 0:00:00
TO PERFORM THE FOLLOWING WORK:ERECT 12 X 3 1/2
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:OK
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIO OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupan Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 1/31/02 0:00:00 329 $25.00
212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo
File#BP-2002-0679
APPLICANT/CONTACT PERSON VOSS PAUL&SUSAN
ADDRESS/PHONE 89 RIDGEWOOD TERR (413)584-1184 0
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
Fee Paid c 5o.1? ,'15,` 5
Typeof Construction: ERECT 12 X 3 1/2
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 FOL OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
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 Commis
'.1,‹—te --X7 ----- / (/7/2_00 _____
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.
M • 1 ,
Department use only
r silty of Northampton Status of Permit:
l E : ilding Department Curb Cut/Driveway Permit
I '12 Main Street Sewer/Septic Availability
t��' 2 9 2002 Room 100 Water/Well Availabilit
� JAN y - _-
art ampton, MA 01060 Two Sets of Structural Pians
q�o413-5:7.1240 Fax 413.587-1272 Plot/Site Plans
_____._
�nn1���� 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:
O 2 t d � /9 Lot Unit
c�¢t,�,«,C I i°l� Map
Neil.1-1A kv--p
hoo /I N Oio�S 0 Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
P v1 v SS S0, -c P/° �'i a .lcl (eSS
Name(Print) Current Mailing Address:
/g/ //e/Ii. Telephone
Signature s S -1/
- l i g g
2.2 Authorized Agent:
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 1i 4 00 (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) Check Number S
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size 1l Ce
Frontage
Setbacks Front / �!
/ `J
Side L: R: 4 L: R:_
Rear
Building Height 51
Bldg. Square Footage 30
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO ) DON'T KNOW
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 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House 0 Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. 4' Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: UJ(!U
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes — No
Plans Attached Roll ❑ - Sheet U
ss , f Nerti lions Ta'nd O relit o RO ex4is thyl allot';,eel"mp1'e e" tl a 0ollowing:
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? .41\J !
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? NA
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck 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 _
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 , as Owner of the subject propc
hereby authorize to a,
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
f'L ) I ' S } , as Owner/Authorized Agent
hereby decl e 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.
Vary ` OS.
Print Name #.,
12-9 /07--
Signature of Owner/Agent Date
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
0 = ii liil Y Cii Dili ._ ; u ywte, E � N of Applicable O
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 affid
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes 0 No 0
ll: ome Owner Exemp u i
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)famili
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner act.
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 faun
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 m4v be liable for person(
you hire to perform work for you under this ermit.
The undersigned"homeowner"certifies assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances, State and c to ws d State of Massachusetts General Laws Annotated.
Homeowner Sign
ature ✓/�
....
B.-.4 0.a B j�lassachasctts' _` " g
•"'W y:'— DEPARTMENT OF BUILDING INSPECTIONS Malt
__t4r
' . 212 Main Street ' Municipal Building
Northampton, Mass. 01060 imp'
WORKER'S COM 'ENSATrON INSURANC : AFFIDAVIT
I,
(licenseeJpermittee)
with a principal place of business/residence at:
- (phone#)
(btiect/city/state/rip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
- (Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
f.
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(anach additional sheet if nor.-,..ry to include infoemarioa pertaining to all ooatracton)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ persona to do ma ire pnonrr construction or repair work on a dwelling of
not more than throe units in which the homeowner resides or oa the grounds appurtenant thereto are Dot gcerally considered to be
employers under the worker's car tion Act(GL152.ss 1(5)),application by a.homeowner for a liccase oc permit may evidence the
legal status of an employer under the Worker's Compeosation Ad. •
•
I understand that a copy of this statement may be forwarded to the Deportment of Industrial Accidents'Offioo of Insrrrenoo for the
cover-ago va-ification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S 1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
firm of S100.00 a day against tan.
For dal use Daly
Permit Number
Map{ Lot#
JAN 2 9 2002 [19
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