42-054 (2) Louis Hasbrouck
Chuck Miller
Building Commissioner
Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his /her construction supervisor. 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 backfill),
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
clat7 4if,,La 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 D228 1 2-
Address of work
location 6 a/C- 07/4
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City of Northampton
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I ' TMENT OF BUILDING INSPECTIONS j'
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FEB fGD 12 ain Street • Municipal Building y � a
`' ` 0 Northampton, MA 01060 ssFiy g/01.\
DEPT. OF BUILDING INSPECTIONS
• - - • MA01060
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
Permit Fee: $25.00 Check # 1/ *C
e PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 4 L �jeK - T £4 ;4 L. V
Address: . - 70 �/� 5 % /41,4 -//'T( D Telephone: a 3 73P1...4 a 3
2. Owner of Property: I4L CST G' A1�.L- 0
Address: Telephone:
3. Status of Applicant: )( Owner Contractor
4. Type or Brand of Stove: brhaP$ s'oth) 0,/I/'E -- c ile i i`
If applicant is not the homeowner:
Construction Supervisor's License Number Expiration Date
Home Improvement Contractor Registration Number Expiration Date
All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
5. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge. �,�� �J / �j
DATE: 0 2- 231 l Z APPLICANT'S SIGNATURE (9GC147 • ' c/ QsA?
DATE: o Z Zad ( Z HOMEOWNER'S SIGNATURE a/AV 't/- 4,41.4
APPROVED
DATE: — 2 7.- 1 BUILDING OFFICIA
570 WESTHAMPTON RD BP- 2012 -0750
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 42 - 054 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: woodstove BUILDING PERMIT
Permit # BP- 2012 -0750
Project # JS- 2012- 001327
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 161172.00 Owner: GARLO ALBERT S
Zoning: SR(100) / /WSP II Applicant: GARLO ALBERT S
AT: 570 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
2 CONANT DRIVE (603) 738 -9363 ()
CONCORDN H03301 ISSUED ON:2/28/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL WOODSTOVE
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: Date Paid: Amount:
Building 2/28/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner