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24A-026 (5) 95 RIDGEWOOD TERR BP-2003-0256 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A-026 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-0256 Project# JS-2003-0451 Est. Cost: $8000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Usec:iroup:_ Oliver Iselin 039073 Lot Size(sq. ft.): 7492.32 Owner: MICHAEL DEE Zouin :U.1-3 Annlicanr: Oliver Iselin AT: 95 RIDGEWOOD TERR Applicant Address: Phone: Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAMPTON M A01060 ISSUED ON:9/13/02 0:00:00 TO PERFORM THE FOLLOWING WORK:RELOCATE BASEMENT STAIR & REMOVE NON-BEARING PARTITIONS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Servi Meter: Footings: Rough: Rough: House# Foundation: > �� f I's Driveway Final: Finale: l'?/7 /o Final: /d/3//vz__ Rough Frame: _ Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: (9l/ j.1— 702 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occur ancy - Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 9/13/02 0:00:00 1164 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File ft BP-2003-0256 APPLICANT/CONTACT PERSON Oliver Iselin ADDRESS/PHONE 36 Service Center (413)584-1224 PROPERTY LOCATION 95 RIDGEWOOD TERR MAP 24A PARCEL 026 001 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 It Typeof Construction: RELOCATE BASEMENT STAIR&REMOVE NON-BEARING PARTITIONS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 039073 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 7A/o0Z_ 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. i of Northampton 41 ,§ �,� 2002 •ing Department � /'� i ` , M SY 2 21 : Main Street P �� w , � Pc�10NS •oom 100 sr f , NB" NGNSo x0 �OEqx�{proTe413-587-1240 Fax 413587.1272 • F\ >� 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 /? 1 v7 G o.J `.�rC yC,�}c,(T Map Lot Unit Zone Overlay District Elm St. District _ CB District_, :.._ _.... SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: t c14- 4 '7. rz/ OG( o Tesci`y.r� ,� Name P ' Current Mailing Address:_re.Z (2,21 Telephone oignature 2.2 Authorized Agent: _ C� L ✓�[- =t Y-1-/ - _fly jilt v,c ,C;. (4->-r rt Name(Pri Current Mailing Address: �/ J - ( 1Z � Signature Telephone 5EOTION 3 -;ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building y (a) Building Permit Fee 2. Electrical Sl_____ (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 /1f 1 ti54 r This Section For Official Use Only Building Permit Number: O 3 Date Issued: signature: Building Commissioner/Inspector of Buildings Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN �E DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning Af O C.tt A C b-1 1 S A C- This column to be filled in by �� Pl�� d 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 L— 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) [ill Roofing 0 Or Doors 0 Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: /Z1-CC✓}1 Ertl t-viA 1.,.s r -Pr 4 in , Zitw«vv& ti,c� �6✓M,�G Alteration of existing bedroom Yes 'No Adding new bedroom Yes ` No Attached Narrative Renovating unfinished basement Yes ✓No Plans Attached Roll ❑ - Sheet❑ , k+ .:.1 a ¢. o,S � �! �7 �, ..� .1. .= :®J` „wit, 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? . 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 s .�,.7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 6 I � I � 4/1GI�Q / , as Owner of the subject property hereby authorize c7L / J&� �`r� L) to act on m >in all matters r lative to/work authorized by this building permit appli ation. Yk CLC1 9�i z./O 7— Signature of Owner Date Dit/167-7'(-- LiS6-1- '"J , 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 Nam5// Z/0 Signature of Owner/Agent Date ISECTION 8-CONSTRUCTION SERVICES 1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: ©L I ✓6� �cr L. o 15 O tI License Number 3b ' 7)(-vc_- ,,to — O� Address Expiration Date Signature Telephone � ''� : Not Applicable 0 Company Name Registration Num er J. - i �! L/ 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 l- 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 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 Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature • • QittvHpT • b • • a I E (rii� of �clrtl)uittpton 1 �_= • rrttara>tttlncrlls • A•V j... DEPARTMENT OP Lan r c INSPECTIONS • 212 Main Street • Municipal Building \tar — Northampton, Mass. 01060 WORKER'S COMPENSATION INSURA_NCF AF IJ)A\rlT • I (7/. ) ✓.�'�— �,J� Lira (li ccu sc c/permi It CC) with a principal place of business/residence at: • • -- - (phone:-) (strrt/ci ty/stalclzi p) do hereby certify, under the pains and penalties of perjury, that ( ) I a m an employer providing the following worker's coinpensauon coverage for my employees working on this job. (Insur:.n 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 coapencation policies: (Name of Contractor) (Insurance Cornoanynolic 'tomb i) '(Ekpirauon Date) • (Name of Contractor) (Insurance Comoany/Potic-y Nttnoer) (Ext u lion Date) • (Name of Coluractoi) (Insurance Company/Policy Ntun u)• (Expiration Date) • • (Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale) (ettaeh additioeal abed if necessary to induct:informa.noo pertaining to.11 ceo on) ( ) I am a sole proprietor and have no one working for Me. • s•( ) I am.a home owner performing all the work myself. NOTE:ptex b:twat that while bear vcr,a+bo cmpiay pcsons to ifs mioancaz:ec,caw er h cr repair work on a d" l.14E of oat mote thao three tmitr in which tht bornoouver resides or oo the greonei.a,purtenar r the-no an mic ally ooc3 decal to ix employes under the worker's n r. -z,-tied Act(GI-152f3 1(5)),apptiration by a bomnoaaa for a Gezcot or permit tr.ity evidmec the Iega1(wile of CO ecgloyec under tho Wean?'Coeapomai.ion Act_ I undariand the a copy of this mltemcut may be fc-M,ded to the Depart/pad of ...Am id Aradenti OfLoo of bteu a000 for the oovazgt vtrirenioo and tht_t Elkin to soaut coverage tinder soetioa 25A of(dal,157 can lad to the two:Utica of criminal pcnaalticr coati-zing of a Lac of up to S1.300.00 ardor inapriioncocris of up to one year and a ail pemhuo io tic form of a Stop Work Order end fiat,of S 100 •y gainsttx. . 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