38B-234 (9) 107.1 30 30 V .....
0 81.7 1
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104.21 214 205
109 78.5 8.5
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109 00 104 78 ....
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7
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225 120.00 88 41 208 170. • 3
so 92 ,2.1:
226 ao
75,1 138.2
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235 ��� 92 31 5: 210 is ao 92
228 ` 12 0
10d 8 106.83 � Q 6 139.2
60 234 eo 229
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115.'115.2 178.
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232 192
70 48
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DEPARTMENT OF BUILDIT;G INSPECTIONS , ` �_L
INSPECTOR 212 Main Street • Municipal Building >o
Northampton,MA 01060 .
1
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sups: 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 anypersonts)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 i dividual trades to secure the permits and inspections as
required can DELAY the ,,ro'-ct until such time as the proper permits and inspections are
made
I, ' .. understand the above.
(Home owner/Tent's signature requ,...ting exemption)
I will call to sche9 .! all required building i pections necessary for the building permit
issued to me , 7 -
Date J--• - /Ocen
Address of work
location 'i L '
�
,-
. 7e.. (-)V'i-')01-1 -7p)/- -7 / .74-
62/060
"? f -
--(:) �. (riir of :arflianll]Jta11 1 �� =
R2 ,�E �1.3.ttchnsrue•
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DEPARTMENT OP I31.111-DING INSPECTIONS , .4k. •
212 Main Street ' Municipal Building _
Northampton, Mass. 01060 ` 'y
r
WORKEIZ'S COMTENSATTO-N L;tSUTtANCE AFFIDAVIT
•L, 4(/(114:[±;. ArA-Mn.)4/6 ....._._.__.
• -
(lies ipermittce)
with a principal place of business/residence at:
- (phone;)
(sor_..1Jcity/statd p)
do hereby certify, under the pan- and penalties of perjury, hal _
•
( ) I am an employer providing the followinnHworker's compensation coverage for my ,
employees wor dng on this job:
(Lsuran Conran.) (Policy Nu_'nDcr) (":-pirntion Das.) '
( ) I am a sole proprietor, general contractor or homeowner (ciscie one) and have hired
the cone actors listed below who have the following worker's couoen_ Lion policies:
-
(i+aame of Co„_^ctor) (In2ranc-e Coinoa_nyfipolic Numk7) ("EL,•pinn on Datc)
(Name of Connaetor) (insurance CompaawPo!ic— Num-D r) (Tia-pir:ion Date)
(Name of Contractor) (Insurancc Company/Poticy Nush.u) (Expirdon Dale)
(Name of Contractor) (f_ surance Cotnrany/Poticy Numbs) (Etipiration Date).
(tt ith• •'.:ocal tto .ifn«—.,.to mc1. inform-'loo r-+-tea to.11 o -_t'_o..a)
( ) I am a sole.proprietor and have no one world.ng for me.
AI am..a home owner performing all the work myself.
NOTE:p1,-44 be c9e4rc tt,,.•. }c boce.nnwners w•bo cazploy pc-1-o=to da r-.1--,---.,--•,o-s, s.:r„oo c rr,•xa •o, on a d••11_z:of
not mote Ls y t.=fl is tohich the bootoownc raid=oc on the p-onodo amp• to , ibeco -' ox c --lly oee:d--cd to be
cirploycs=CI.the...oi:_•.-'7..r -Y-__,.oa Ara(G1.1152=1(5)). pif�7oo by c bomraQaa fc c lip.«p=enis t✓y c.-idmcc c1~
legal ct: u or en c ployor under tho Wod;dt Coo,om.ti Act
I uodc^ss...ad tux a.Dopy of thi.sat®Cos c-y be for-a.arded to the D-cp..-ta m¢of Inez:rich Arc■dc2a'offioe of In=+r•.....for tb.
e - Ycirat4 t atd lhct Liltac to s=ort:lxcvcrrp.-e t',-4c-socion 25 A of MOL 152 an Ic a to chc i os*tion of eintinol pal'hi=
eoci.ins oI of tep to s i Soo.00 srtdtor cr>;sisot000nl of up to oar yr.=aa'1 d ell pm.Fua io the focal of.Stop Work Ord ..od. _
rim of I100. a day tzninIl to
r , t
! .. For 64�='I u.c only
I,' ` /g/ô — }�G'rIIIlt N11.Q]tJCS _ — _ _
r Lot :
Si -
S;!!�! of t i JPc u� Da. •
SECTION 8—CONSTRUCTION SERVICES ,./
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
3Regisle'"red tlomenpio entent Contxaeta' , ": = Not Applicable ❑
Company Name Registrati i Number
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 ❑ No ❑
Hem Q ier eiii s non
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 2(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Dea of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under thi .ermit.
The undersigned"homeowner"certifies . d assumes responsibility for compliance wi r e State Building Code,City of
Northampton Ordinances,State and Lo .1 oning Laws and State of Massachuse eral Laws Annotated.
Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House El Addition ❑:, Replacement Windows Alteration(s) 2 \ oofing ED
Accessory Bldg. ❑ Dpmolition New Signg 1 Je ks Ciding [CD)Other[CI]
Brief Description of Proposed (SUS -I- Cb d&-r* , i MP--Art)k t rt ( j1 f .D 004Z-S
Work: 1J•rre-Q.lae— e..0 443'?n.Us 1
Alteration of existing bedroom ✓ Yes No Adding new bedroom Yes ✓ No
Attached Narrative Renovating unfinished basement Yes kNo
Plans Attached Roll -Sheet
6a�1f1�BW IOIISe4a11Ct i cidif 1QR: O existing fio stnq comp lete etfo of i inq:
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. Masscheck 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 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
SECTION 7a-OWNER AUTHORIZATION-TO BE.COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ,as Owner of the subject
property
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, K F 0 KAII iP 1t ,as Owner/Authorized
Agent hereby declare •.t the s atements and information on the oregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under th- .a.,, and penalties of perjury.
`K -(. ) 14-ti-IkP i 3 Ci
Print Name
Signature o 0 - Agent Date
Section 4. ZONING All Informatibh Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size t2e7 SL I I.
Frontage
I2r_., ' I € i i
Setbacks Front i2.4, 1 i i
Side L:'lO ' R:.- -+ L:' 1 R:
Rear 5?7!
7. ,
Building Height , . . _ 2l 2 .
l
Bldg.Square Footage ij % �
Open Space Footage ��'�? %
(Lot area minus bldg&paved) _ Sir___ ? I i I I
parking)164ti:eiwacy.
#of Parking Spaces �'.
Fill: i Cm1Q .s5 `,
(volume'&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO CO DON'T KNOW 0 YES 0
i
IF YES, date issued::
IF YES: Was the permit recorded at the Registry of Deeds?
NO OD DON'T KNOW 0 YES 0
IF YES: enter Book Page: i and/or Document#'
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0
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 0 NO
IF YES, describe size, type and location: i
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0,
,
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 ,- NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
„4.
Departmeht use
oi ty
City of Northampton Sau7+ e t 1 , . „, �„,
ri 1 -= � 41 Building Department
212 Main Street sew tt •fi ...;_rt.4"M4 3? w :
Room 100
Northampton, MA 01060 M Se; 77,
phone 413-587-1240 Fax 413-587-1272 '1 v; re
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section tahecompleted byoffice
1.1 Property Address:
•
�Z c=.Lty S-�. p o e Untt
A,c Zane �Yerlay D�sfncf
T=►/�-c ` /Y v
o10Co Elms U�strkt CB Distrfct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
I �t t�r All C� JTL amt viii s--r
Name(Print) /4f
urrent Mailing Address: �! sa
� 3 tL�
Telephone
Signature AlliPw'A-
2.2 Authori ent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION`'COSTS
Item ~ Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 2., ) corn. (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
�i edl: Construction"from(6)
3. Plumbing -.7 Q Or:� Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection I 5�
6. Total=(1 +2+3+4+5) S�C7 Check Number 1-?3
013%))06-6°
This Section For Official Use Only
Building Permit Number` Issued:-
Signature:
Date
Building Commissioner/Inspector of Buildings
ei
" cv<tvt — cisr✓1;
p7,1,54 ,1771 /
t;.
52 OLIVE ST BP-2006-0883
GIS#: COMM3NWEALTH OF MASSACHUSETTS
Map:Block: 38B-234 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:. BUILDING PERMIT
Permit# BP-2006-0883
Project# J8-2.006-1356
Est. Cost: 46500.00
Fee: $232.50 PERMISSI011 IS HEREBY GRANTED TO:
Const. Class: Con/racior: LiciAse:
Use Grow: Homecom3r a:. 0 ;aractor •
Lot 3242.24 Owner: 1(2,MPING KATHLEEN.
A PnIzkysin'.. K4 Ai! KAT!- •.EP!
AT. h2 OLR/r ;').E
Applicant Address:
52 OLIVE ST 0 559-7678.0
NORTHAMPTONMAO1C: ISSUED ON:3/13/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:INTERIOR RENO,REPLACEMENT WINDOWS,
ROOFING, SIDING CONVERT BEDRM TO BATH, REMODEL '<ITCH
POST THIS CARD SO IT IS VISIBLE FROM THE STP,EET
Inspector of Plumbing inspector of Wiring D.P.W. Buiaiing Inspector
Undcrground: Service: Mel er:
Footings:
Rough: Rough: House# Foundation:
litiy.fway
3/41/04. 17^10/41
Final:if 1_.,D7 Final: 0 'it
Roug%Frame: ' •
61-ter)ig L
Gas: Fit e Department Fireplace/Chimne),:
•
7 •
T7. /L lc c
Rough: ki r
- •
G"(-- -7(y.004 -'7
Smokes Viklos://ec, Final:et.\ 44.0_
THIS PERMIT MAY BE REVOKT.1 BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS!
Cerlificte Occuagncy
3/13/A03
2i. Main Sdtt,1)1011:'(413) /..1240,Fax:(z!13)5 r.'7-1272
CO' - ijk
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•
•
•
•
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52 OLIVE ST f' BP-2006-0883
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B-234 CITY OF NORTHAMPTON
Lot:-001
Building
Category:. BUILDING PERMIT
Permit# BP-2006-0883 •
Project# JS-2006-1356
Est. Cost:$46500.00
Fee: $2.32.50 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Con/radon License:
Use Group: Homeowner as Contractor
Lot Size(sc. ft. : 13242.24 Owner: KA?vIPING 1'_ATIiJJ EN
7';13 •tnn/kr/ I: K4APts . .774 KATi 1'-EF.
AT: 62 OLlVr_- I
Applicant Address: Phone: Insurance:
52 OLIVE ST 0 559-7678 Q
NORTNAMPTONMA010ti0 ISSUED ON:?!13/2066 0:00:00
TO PERFORM THE FOLLOWING WORK:INTERIOR RENO,RE'PLACEMENT WINDOWS,
ROOFING, SIDING CONVERT BEDRM TO BATH, REMODEL KITCH
POST THIS CARD SO IT IS VISIBLE FROM TILE STREET
inspector of Plumbing Inspector of Wiring D.P.W. Buitding Inspector
Underground: Service: Mel er:
Footings:
Rough// /`'07 Rough: house# Foundation:
Driveway Final:
1
1/0/04 1700 ki4 01111 7' R
Final: Final: ^� _
t7� Rough Frame: (� � �
Z- 3 - p6 A
Cas: File Department Fireplace/Chimney:
+Pd
Rough:8 •� (3� 0 .ant: T ,: . . ` / ( .'. : !_� �`•
fir. .-.—.. y .. ' i.
I �t_ cg 07'l `06 ci)
Final:1/4 g„0? K Smoke viitVegfr Final:Q/S /—��.198,
THIS PERMIT MAY BE REVOKE')BY TIHE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy_
Fee7'yi?e: )r_,te Pai lN__ apt ,,1*
Dui!uiu• 3/136.003.;)03 O.:., :)0 i 33
2i. 'NUR Sole':+t,I';,o,n°(4i:ij d/ 1240,Fax: (4 13)5`..;7-1272
1:iu:ldi:. -
File#BP-2006-0883
APPLICANT/CONTACT PERSON KAMPING KATHLEEN
ADDRESS/PHONE 52 OLIVE ST NORTHAMPTON ()559-7678()
PROPERTY LOCATION 52 OLIVE ST
MAP 38B PARCEL 234 001 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 I ii-J07,5-0
Typeof Construction: INTERIOR gENO,REPLACEMENT WINDOWS,ROOFING, SIDING CONVERT
BEDRM TO BATH,REMODEL KITCH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9CMATION 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 Commissio
............,44,011----7
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.