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24A-027 (8) } 92 RIDGEWOOD TERR BP-2004-1031 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A-027 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2004-1031 Project# 3S-2004-1552 Est. Cost: $10500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: B & R Siding 100465 Lot Size(sq. ft.): 5009.40 Owner: CONNOR NORMA Zoning: URA Applicant: B & R Siding AT: 92 RIDGEWOOD TERR Applicant Address: Phone: Insurance: 781 Bridge Rd. (413) 586-4167 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:4/27/04 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL VINYL SIDING 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: Receipt No: Date Paid: Check No: Amount: Building 4/27/04 0:00:00 19272 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo t • w • • City-pf Northampton S atu0l"'P=ra i y�', f 4 ,` a_.e-the. -.` '4 ;'.. 1.z -}+¢.• Z. Ilr : V� c B ntding Department Gurb Ctitve ve � .i 4`� " — 212 Main Street 5ew� se:.te '0aiasir � � h µy Room 100 a er/V�etl,t,va a t A.PR 2 0 2004 Northampton, MA 01060 Sets`of St c`� a ::x � ' 'fi ��" � ,� .,_� - r phone 413.587.1240 Fax 413-587-1272 r ' _ ^ ",°mot ; , 4_ Ptot/Site Rlans Ga.=�T��, -gym-. , `' ".4:-€t"4f 1� f^", x; Other Specrfy =�;:.sx` 4 - �� _ , APPLICATION TO CONSTRUT, 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" 7.2..E , i f7► wv fj� -" Map -Lot Unit /i,�d Y?.-7�4 )r1''I-'6 13 )4 . ©i0 a Zone Overlay.District Elm St_Distr'ic1 CO District :_ SECTION 2 - PROPERTY OWNERSHFP./AUTHORIZED AGENT 2.1 Owner of Record: /Y02 ill/1 670 er N ore— !?6' llo 7�c /h'Z � Name(Print) Curf�nt Ma.1Lifig Address: / N6!2lAAlYn 7'0 1-/ ruI( ✓ 2/1I G) Telephone '— elephone Jr ` Signature �—3 3 3 K, 2.2 Authorized Agent: E 1 J) ij L 13 E.,4/0/ 7 Fi /6 , di lee id6-i-144 -ro Al Ill' Name(Print) Current Mailing Address: t —�-- c.c...... �7. .5`—g .,— yi 6 7 Signature Telephone SECTION...3=- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be • Official'Use Only completed by permit applicant 1. Building Q J�6 d - (a) Building Permit Fee 2. Elecirical (b) -stimated Total Cost of Construction_ ;,.from (6) 3. Plumbing — Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) /0l �� D °—°-"- Check Number /91,97c1This Section:For Official Use Only Building Permit-Number: Date:Issued: Signature: _. I: I Building Commissioner/Inspector of Buildings Date i i r y 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 Frontage Setbacks Front Side L: R: L: R: Rear • Building Height Bldg. Square Footage 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 0 Replacement Windows Alteration(s) 0 Roofi g 0 Or Doors 0 Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding Other [ ] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0• Sheet 0 rialESTMAhonvelandroriarlaiti n b e reek inoi srng 'dbMpletett a "fio`l aw;�ng: 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. 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 Nc 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, '"6le, kyiti CC) A) C) ie---' , as Owner of the subject property hereby authorize �/LW) NJ L ' nA1—/ to act of my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, E LQ) N L /j 24O`f' , as-emser/.Authorized Agent hereby declare that the statements and inforn-fation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Ci1,/4.0..) ry b g ,2Ao Print Name ,i,...77.4.1.-......., ',f--- .1...„.......e7 „2 0 07 Signature of 6wnec/Agent Date F SE4110N By-COIa1STRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : 5:.1-0li A) •8 i 9 r License Number /�6(€1 A v -toy er 0 '07-- 0� Address Expiration Date $"5 `fJi? oai, ,r jet, Signature Telephone Re: s e +' °iaa.= `110.= .ent :on racto Not Applicable 0 IS 941 TC.. 6.4)I & S rN e—. Company Name v Registration Number 73 P--/ -ice IZ-' /6 Address / Expiration Date / OA7kA en" r6 �� Telephone S8- ��/G7 (5 SEG�TION 3 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 the building permit. Signed Affidavit Attached Yes No 0 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 acccptable 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 i 53 (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 t ; .c O��t tAN J'TO — — (i�i1 -_-. b, cam, `e ofc.$e .: \Ta iliaillpfnil 1 _15 r 4 �%lt���r�6 fslcssacftnsrtle o �.A+=' DEPARTMENT OP DUILDING INSPECTIONS •tell_______ 212 Main Street ' Municipal building . Northampton, Mass. 01060 '� as , • WORKER'S COiviTENSATION INSURANCE A..1+1411)AVIT ,_ e r? _ _ with a principal place of business/residence at: - • 48721 Rejiai_e'- LIA y►- oZ &hone':) 3 1� l�7 street/eil)!' iit^.izi P) _ do hereby certify, t,n(Ier the pains and penalties of perjury, that: ( I am an employer providing the followinc worker's compensation coverage for fly • employees woridng on this job: . Li32ry i oTU.//bus Ca woI-3/ � 'a/79/ -0/O I5- A 0J - (Ins dean=Company) (Policy Number) (Expiradon D. ) • ( ) I am a sole proprietor, general contractor or. homeowner (circle one) and have - eci the contractors listed below who have the folio vying worker's coa1pensason polic'e': (Name of Contractor) (Insurance Company/Policy Number) (Exp:ration Hate) (Name of Contractor) r r Number) xr„mtion sate) Com�ir-;1'/Po.tct� �•-. • (Name of Contractor) — (Insurance Coml.any/Policy Number) (ExF. raeea ►ate) (Name of Contractor) (Insurance Company/Policy Number) (Expiration ►ate) (attach additional sleet ifntee nary to i^.clx:e i.=K:nciac.,:--_.::c:e,::sl!rc-r ztu:.,) ( ) I am a sole proprietor and have no oneworking for me. ( ) I am a home owner petforming all the t of k myself. NOTE:please be aware that while hccneow,rre t.;ro employ;r - to do wain'ruaee,w.:-r•.c.:m era repair w•mi:cos d%el!i-:s of not more dun throe uniu in triad'the b7tioxtvc rceit:.=or on the :'_:.is wailer-tat thereto axe not Generally e`•'r:tiered: be employ=under the wa i;et cts .::ticn Act(GL152.3l(5)).ap;•I:z ilea by a het:imMAC:fora lien c cc prs ni:::-.•:-..' n c L.= legal stab's of an employer under tho Wor!cels Consper .ation Act I us.de_-stand that a copy of this etatc act may be forwortlod to the Department of industrial Accidents'Offloe of I:waaee or the coverage vcriticctioo and that failure to ee tre cot:nge under sac iat 25A of MGL 152 can lead to the imposition o;c -oi l per-allies comisring of a fine of up to S 1.500.00 erd/cY in prisrrrr.=of up to cr, yrerr and civil perultiea in de form of a Stc'Work =and a Lrz of S100.00 a day aw.in:l ttr_ . -Far d tt ep—a resYa,Ube orl,y 1 Permit Ntuntx-r .—.-.-______ ______ oO 0 I.f.apll _____Lett . - - 1 y I :F Sitrnaturt:of I.iccnr,ce/Pcrniittee •rat''<'_ / c'�vj_'�aria_ - - 4gHAMPJ. g C�Lxt of 't rtiptinphan 71i t _v • q�-v`I _rY LAG ' fflASSACh IISCtts _ -'_ VA `� ��=ryy DEPARTMENT OF BUILDING INSPECTIONS ,:1,:s i- /_= INSPECTOR 212 Main Street • Municipal Building 5 Northampton,MA 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction super H 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 back fill), 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 location