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24A-027 (7) 4 92 RIDGEWOOD TERR BP-2002-1085 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A-027 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2002-1085 Project# JS-2002-1747 Est. Cost: $1500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Harvey Messeck 104545 Lot Size(sq. ft.): 5009.40 Owner: MORINI LOUIS J&SOPHIE& Zoning:URA Applicant: Harvey Messeck AT: 92 RIDGEWOOD TERR Applicant Address: Phone: Insurance: 271 Prospect Street (413) 584-4460 NORTHAMPTONMA01060 ISSUED ON:6/7/02 0:00:00 TO PERFORM THE FOLLOWING WORK:STR I P & SHINGLE ROOF 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: 0 K G•g/-O a. THIS PERMIT MAY BE REVOKED BY THE C Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND RJ? ULATI� O . Certificate of Occupancy - signature: Fee Type: Receipt No: Date Paid: Check No: / Amount: Building 6/7/02 0:00:00 2726 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 92 RIDGEWOOD TERR BP-2002-1085 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A-027 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2002-1085 Project# JS•2002-1747 Est. Cost: $1500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Harvey Messeck 104545 Lot Size(sq.ft.): 5009.40 Owner: MORINI LOUIS J&SOPHIE& Zoning:URA Applicant: Harvey Messeck AT: 92 RIDGEWOOD TERR Applicant Address: Phone: Insurance: 271 Prospect Street (413) 584-4460 NORTHAMPTONMA01060 ISSUED ON:6/7/02 0:00:00 TO PERFORM THE FOLLOWING WORK:STR I P & SHINGLE ROOF 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 6/7/02 0:00:00 2726 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo • De`;artment<use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit_ 212 Main Street Sewer/Septic Availability Room 100 Water/Well 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 1.1 Property Address: This section to be completed by office 9� ' e, , -/ c Map Lot Unit G� WCJo �Ci�"�'� ,. �(/ // ,� /hq p 0(' Zone Overlay District /� Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �I�� -10 p h 1 Alo i-i n , ' ?,„2, ///��� wood . 44-4ja.h�fUQ' Name(Print) Current Mailing Add s: Telephone �� — 0 /1/45✓ Signature 2.2 Authorized Agent: A k ve) F' �w 5 Pe Q cS /gi-Wict h Name(Print) Current Mailing Address: Signature J Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building /�00 J © (a) Building Permit Fee Yii42. 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 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 Requfred by Zoning This olumn to be filled in by B 'ding Department Lot Size Frontage Setbacks Front Side L: R: L: Rear Building Height Bldg. Square Footag Open Spa Foota 'o (Lot area n s bldg paved parking) #of ark' g aces F. 1: olume Location) A. Has a Special Per /Variance/Finiing ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued IF YES: Was the p•rmit recorded at the Registry o Deeds? NO DON'T KNOW YES IF YES: ente Book Page and/or Document # B. Does th, site contain a brook, body of water or wetlands. NO DON'T KNOW YES IF ES, has a permit been or need to be obtained from the Conservation Commission? N•eds 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 ❑ Addition ❑ Replacement Windows Alteration(s) 0 Roofing k. Or Doors 0 Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: 5:6h'I pPi b^ F-oo- ) c� h L �'►_ci 1 h Alteration of existing bedroom Yes Nov Adding new bedroom Yes Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet 0 6a. If New house and or addition to existing housing, complete the following:. a. Use of bu ing : One Family Two Family Other b. Number of room 'n each family unit: Number of Bathrooms c. Is there a garage attache . d. Proposed Square footage of new con ction. Dime ' ns e. Number of stories? f. Method of heating? Firiaces or Woodstoves Number of each g. Energy Conservation Compliance. Masche Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. • etlands? Yes No. Is construction thin 100 yr. floodplain Yes No j. Depth of basement o ellar floor below finished grade k. Will building •nform to the Building and Zoning regulations? Yes No . I. Sept' ank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT . 0 i, ( 64 p- 1 h i , as Owner of the subject property hereby authorize f'//C / M SeC- to act on my behalf i all matters relative t6 work authorized by this building permit application. Signature of ner Date 6 7 0o.2— �%; 311. , as Owner/Authorized Agent hereby declare thatements and information on foregoing application are true and accurate, to the best of my knowledge and belie . Signed under the pains and penalties of perjury. i7 q,-- V ./ P He,. .sec_ Print Namelir , leg77/7, .'61.'4'0.4, . Signature of Owner/Agent Date 10'/0a- SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: 1 Not Applicable 0 Name of License Holder: Cl f V`'y f7 1 v/'e s �C 'c 69 / [ License Number hA? Addr ess Expira ion Date O ESignatur Telephone _ s _ Not A ❑ 9. Regit rripstered Home Irovement Cont: ctor.; , ' , ;�� �, a�,9 ��.����y ��,,,_.,,;r������v r .�,<,�,' Applicable av siIc=7 //esse c_ /'o Company Name //// ,L Registration Number �iospec� $ , /lld► l4v `0 nCo Address ,� Expiration ate �E-1/—Telephone • T/j/.'7` 0 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 No 0 The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(_) 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,Oat 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 . ft.w`-► dill' �Z41 of Northampton a11tpton ^ 9���S�i'~�L et6 jflassaelinsrtts' _:'—' � yy DEPARTMENT OP BUII.DITIG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 ' %i-key WORI{ER'S COMPENSATION INSURANCE AF.F.WAVIT I, F f etSSe_c_. 41S- (li ceusee/permi ttee) with a principal place of business/residence at: • Q 7/, `oSpr• F-at Grp h O/O‘ (phone#) - 11— `14‘.6 (street/city/state/zip) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following workers compensation coverage for my employees working on this job: - (Insurance Company) (Policy Number) (Expiration Date) ( Cam-- CI am a sole proprietor, neral contractor or homeowner(circle one) and have hued Cthe contractors list e ow who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) I e. (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Da.e) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shoe!ifineam:ury to include information pertaining to all contractors) 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 whim hoc who employ persons to do maintmarxr construction or repair work on a dwelling of not more than throe units in which the homoowner wide cc on the grounds appurtenant thereto arc oot generally considered to be employers under the worker's oornpen<ation Act(GL152,sa 1(5)),application by a homeowner for a license or permit may evidence the legal status of an employer under the Worker's Compensation Act I understand that a copy of this statement may be forwarded to the Department of Industrial Accidents'Offioo of tawrnoa for the coverage verification and that failure to secure coverage under section 25A of MAIL 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 fuse of 3100.00 a day against tux. For dq rteamed use only Permit Number j;"://4-- .���...._., gyp# Lot# iaAh Si f LicenseePermittee Late