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36-254
53 MAPLE RIDGE RD BP-2022-0109 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-254 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: Porch Enclosure BUILDING PERMIT Permit# BP-2022-0109 Project# JS-2022-000192 Est.Cost: $28500.00 Fee: $186.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: STEPHEN D ROSS 079160 Lot Size(sq.ft.): 106286.40 Owner: SINELNIKOV ANDRE Zoning: Applicant: STEPHEN D ROSS AT: 53 MAPLE RIDGE RD Applicant Address: Phone: Insurance: 36 SERVICE CENTER RD (413) 584-1224 () NO RT HAM PTO N MA01060 ISSUED ON:7/29/20210:00:00 TO PERFORM THE FOLLOWING WORK:enlarge existing deck and make screen room 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: . � 1' • )2 . FeeType: Date Paid: Amount: Building 7/29/2021 0:00:00 $186.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2022-0109 APPLICANT/CONTACT PERSON STEPHEN D ROSS ADDRESS/PHONE 36 SERVICE CENTER RD NORTHAMPTON (413)584-1224() PROPERTY LOCATION 53 MAPLE RIDGE RD MAP 36 PARCEL 254 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out r ,, Fee Paid Typeof Construction: enlarge existing deck and make screen room New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 079160 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: X 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 _ Permit DPW Storm Water Management Demolition Delay 4tetiAL //a Ci Sigtture of Building Official 1 Date Y 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. C iakis E/V/ho �° Jot The Commonwealth of Massachusetts 2 wt Board of Building Regulations and Sian& .k 8 2049) F Massachusetts State Building Code, 780 '°Rccnins^ IC PALITY i.; SE Building Permit Application To Construct, Repair, Renovate Or Qt �? 1is, �n r7o Sevise Mar 2011 One- or Two-Family Dwelling so This Section For Official Use Only Building Permit Number: (dj,44 a'! O9 Date Applied: H4,.., ,,,, , ,7„75 n Building Official(Print Name) Signature SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 53 /nage �i d4e 3Co 2S-9 1.1a Is this an accepted street?yes j/ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided ate/ r C. o23 : 02 Ys ` 1.6 Waterer Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public CII Private❑ Zone: _ Outside Flood Zone? Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 O--wner'of Reco d: /Ce/5`/ Y C/iet/ i'melfh kov f/oren6e , ma.. O/DDc- Name(Print)/ / City,State,ZIP 5.9 maple I df& 60S-3Vg•4/7y/ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building IB' Owner-Occupied ll' Repairs(s) 0 Alteration(s) 12' Addition lI Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': el7 Mir -elt/5h1 deeIC coil/ /72C/ SejW/7 rzem . SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ a7,400 .DO 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ DD 0 Standard City/Town Application Fee //566 0 Total Project Costa (Item 6)x multiplier x 3. Plumbing $ ) 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ \Q Total All Fees: $ Check No.7(,3�Check Amount: '56Cash Amount: 6. Total Project Cost: $ �g15Do ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ��i CS 791 6o �•�s�v�-1 c5-/z pheil a 'D 55 License Number Expiration Date Name of CSL Holder r List CSL Type(see below) U ZG L9erv,ce. C'jn-i-er oaG� No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Norfham/J.6 fr) - o/Dl, b _ R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding // QQ ,/ /g n I / c� SF Solid Fuel Burning Appliances ' ice/' 5 L/. /�lo�Lf SiepdrZs5 QJ Lr) , earn I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /66 P 4/7 ,3 ,� ast 3 0. iTb 55 genera not reetb HIC Registration Number Expiration Date HIC copapany Name o HIC Regis ant Napie Oke viCe.cQ�tE UGcLf Sizioalro66 yahoo,Cam No.and Street Email address Ito tinrfiw !PA 61D6d i3•5-60/e?y City/Town,State,ZIP' Telephone SECTION 6: 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. SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN CONTRACTOR OR OWNER'S AGENT APPLIES FOR.BUILDING PERMIT I,as Owner of the subject property,hereby authorize k.V{p • RD to act on my behalf,in all matters relative to work authorized by this building permit application. .�.itee) 7ai)'aI 9L( ' ignature Date SECTION 7b:APPLICANT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. I tra •r//Owner's Agent/Owner Signature Dat 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.niass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF NORTHAMPTON SETBACK PLAN MAP: 3(0 LOT: Z. LOT SIZE: 1 OG,286 Cb 2•4r4 Acee5, REAR LOT DIMENSION: 3C-IC3t REAR YARD t 2851 SIDE YARD ± ' SIDE YARD 21 r Oroseb . 23' + 28c)t FRONT SETBACK FRONTAGE I S I. 14 ' I-Akc'L v-k'1GE ' -o A 400.00 212.00 -I 700.00 590.45 520.00 115.00 '�� 590.45 300.00 i 0.00 700.00 520.00 36 -2 ; = 35 ' tom z86 4' '2.34 i5 534.57 �'2.34 4.19 534.57 - D . Yo h 8 z- ;lt ►, ` Rs 177.74 't,X SST w G cvu�v►c� 36 - ,vU 217.74 ,,. 3, _r .110.00 -+ ' - - 1. 464.86 ,i.:: 150.00 17.00 ______--_----464.86 ',-..< 00.00 • ' - 6 _t 6 1 140.00 ..? 175.00 - 150.00 �� 175.00 .. : =�- -- 118.42 600.00 a► = =64.23- - P 200.00429.71 180.00 60. �.=y36 -255 .ki 'o.00 \_____;:i - . - - = . 10.00 `"429.71 126.00 : -- _..=%y 155.00 494.02 \ :- - - _-32.74 : 36 -260 - = _ . -: - 96.00 71.16 75.00 150.00� . - 494.02 - 150.00 96.0 1 .16 :fib = = �= -. 211.57. 200.00 200.0 36 -256 -- 8 . j- • = �- = = -. = ' 407.44 - 217.17: - 'c:,. X - : "scams-: LoG, 28C.. )(' Tk N cc \Ous Z k 47 b o\. .,u,Ac`t: 4, Soo d) i s-ri, 2 1 2- t1 5H�fl Eck sTk l 6o --COT,-L 9,1 113 Gout � E to ` °I P fzoeo D Gc3vt2,kCc� °�' o EXt Sz to cav�,eM . 1 3 14 P ec a' b i b` 6e, �i � 452 tp The Commonwealth of Massachusetts t'' = Department of Industrial Accidents — �_ :r_ 5. 1 Congress Street.Suite 100 _' =_i . Boston, .i A 02114-2 0!7 =,,,ti www.mass.gor/din 11urkers'Compensation Insurance Affidavit: l3uiiders/(`ontractors/Ekctricians!Plumbcrs. 10 HE FILED N U I1 11W PERN1I l'IlM;At 1'HORIT1'. Applicant information T ,J Please Print Legibly Name alustncss'organizationfIntlividual):�i '1 _ 1D- 1 6 ' Address: 7z- s--/-,fit-&-� (' 7I ___ v2 City!StatelZip: AVIII.64-` 0`1. 44./- Phone#: V( —1 eel— 1 r z 6( Are yaw an employer?Cheek the appropriate hies: Type of project(required): tot a employe'with _ emplo wes(full and'orpart•timol• 7. 0 New construction 2 a mile.proprietor or partnership and have no employees working fur rose rn,,n, jt. O Remodeling any capacity.[No workers comp.uwurnnce nyumtl.( 9. ❑ Demolition 3.0 I am a horncvswrx-r cluing all work myself.[No workers'corm.insurance twarined.r 10 CI Building addition .1.(,1 am a homeowner and will be hiring czmtr.toor�to conduct all work on my property_ I will ��---rr ensure that all cemtra:ion tither hose workers'compernatron insurance or an sole I I.I Electrical repairs or additions pruprirtors with no canpluyces. 12.❑Plumbing repairs or additions 5f:j 1 am a gets?ul contractor and I have hired the subcontractors bated on the atwctaed sheet 13( `I Roof repairs These wbccmtracturs Iase employers and luxc workers'comp.also/unce.: 1 14.Q Other 6.D We are a cutporanun and its officers have exercised their nght of exemption per Altai.c. --- ------ — 152.§1(4).and we love no ernploy'ecs.(No workers'comp.insurance required.) •Any applicant that clawks bore a I must also an out the sedum helusc show ing their workers.'compensation policy utlunnataun 'Homeowners who submit this at1id:t%rt"ncheaLng they are doing all work and then hue outside contractors mita submit a new affidavit imdieating such. :Contractors that check this bus Hurst attached an additional ahect showinb the name of the svbcuntracturs and state whether or not those entities have employee, If the soh-contractors have employees.they must provide their workers'comp.policy number. I am an employer that is pro►iding workers'compensation insurance fur my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: _ Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation polio declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152. Z;25A is a criminal violation punishable by a tine up to SI.500 00 andlor one-year imprisonment.as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to S250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certl , nder th tii►s-an ...Tallies of perjury that the information provided above 6t ue and correct. Signatu a;(/1 Date: 7 e/2 2 Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): ' I. Board of Health 2.Building Department 3.('ity/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton µY16MNy>,, "'" Massachusetts �Q?- II_ 'le "1 qI 44-1 DEPARTMENT OF BUILDING INSPECTIONS i' 'k 'i 212 Main Street • Municipal Building IA v a \; 'j:'" Northampton, MA 01060 sy•• y%' CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: /A#._: e....e_ _G t....,----- The debris will be transported by: Name of Hauler: ro./Zet•—yct✓CA-C—� Signature of Applicant: - Date: 'f,{ �...N CONSTRAS01 CKELLY ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 41.....----- 6/30/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: AXiA Insurance Services PHONE FAX 933 East Columbus Ave (A/C,N0,Ext):(413)788-9000I(ac,N0):(413)886-0190 Springfield,MA 01105 ADDRESS:info@axiagroup.net INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Mutual Insurance Company 17000 INSURED INSURER B:A.I.M.Mutual Insurance Co. Construct Associates Inc. INSURER C: 36 Service Center Road INSURER D: Northampton,MA 01060 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYYI IMMIDDIYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 8500071119 7/1/2021 7/1/2022 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X yea n LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: EPLI $ 25,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO 1020098280 02 7/1/2021 7/1/2022 BODILYN INJURY(Per person) $ — OWNED SCHEDULED 1,000,000 --X AUTOSRE� ONLY X AUTOS yyN p BODILY INJURY(Per accident) $ X AUTOS ONLY X AUTO ONLY (Perr accide t)AMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS UAB CLAIMS-MADE 8500071119 7/1/2021 7/1/2022 AGGREGATE $ - DED X RETENTION$ 10,000 $ 2,000,000 B WORKERS COMPENSATION STATUTEPER ERH AND EMPLOYERS'LIABILITY WMZ-800-8007507-2020A 7/1/2021 7/1/2022 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ MFFICER/MEMBER EXCLUDED? N/A andatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Proof Of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZ E DREPRESENTATIVE I �?s,- ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD