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29-528 *40 �' • I I I I I 1 I : II I I 1 � 1 {jam � • \\ I I r _ ! I ' I I it I 7 - it It- it I f I ; 1 I I I � I I � I � I I I , I I I i I _ I r I I I 1 I I I r I i - I f-- - - , , I ; I I , I I , I i f i " I _ a I I ,. � I i I � I i..._..I I _.I__ ' � - �_. � I�:� a'-• c�! �t}1�� k� S1. _ I i i I I I I I I I I I , I 1 I I I , t I i it f IJ I yA I w (JW E LAT IS COMPILED FROM DEEDS. PLANS AND OTHEROURCES AND X CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECOF BUILDING LOCATION ACCURACY IS NOT GUARANTEED 1` I 't U. Qti MSCF-Gtin iS •� OEN RSNA`�ON.M,�OlCO._. t 4V .,\ IV 1 J �.. - GAGE , INC . & • `: :�** �`` i ,_ t _. _. _____ ...�{.�_.�W.,,� �-�- �--..�_u_.._��..u...x. yf f h .� 4 tt t •� ,.. ..,; t S � i .., r, � i ( l i 'i i ... a�"' ».....� ,...... .,,,._ ti 4 .--t — d .; � ... � �. �� ���� � F �,g, -c .. -. � er '� o ! an A :jR Y,w q .a A.w ky'n� '.#. w {. .. 3. ... �� { ., .:.. a � ... �; i - 9_ _ ._ R. �� �,.``'` 1 Y t "a.. . I i � � � , ;� ( ? _. _ ._� . i � l 4_.., � �"^ _ 1 _ i _ f ` `t �� _. ,.M r ..�� � '�,. ` �_'�- -� '... _I � `fir ��i ...W}�. ,.. ,i 1 ', �j�`"��' ...-.�. . . . �. y a �:._.._r . .__,,_-,1 ! �, _ � Vic—., '.� �' �.*� . � �rt �! 4 � i' - � ,�, ,' ° '. k _ kTA -�' -.� , , �` �._� «, �1� �1 �'iHA1NP7• O O (rzt-r of Warf4amptan z = �833AC1(IISCtt3 " d, DEPARTMENT OF BUILDING INSPECTIONS /= INSPECTOR 212 Main Street • Municipal Building 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 . ;or. 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 I, understand the above. (Home ow er resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date 5 LS 04 Address of work location `?� ry�2D,b✓L�{ � d �iiaasnr}Ittsrlte J-: 1 _ 11EPARTMEN7 Of' EUILDII�G INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORICER'S COiY1TENSATION INSURANCE A`ItMANT1.T 1' ---- ern ! ��-- -------- ---- _- .. _ ---- (liccn�°c%crrmittc�) %frith a principal place of businesslresieenc t. (10 herebY CCfilI1', LI];)cf L11C p%I11S '11"d pCil itICS Oi p(-,r3IIf��, I am -,m ernployer pr-ovi ling tilt covc,:—_C FOr iI7)' cmployces wol dug on t}ils job: (Insu=cn -- Company) t c` Nu?IExr) (rte fir.:don D2tc) I am a sole prounetor, �tn°ra! c-Ci1traC0r honit:O'.viceD �Cucic Oct) aIIG .i'VP hlrtd t-h,', contractors LSted beiovi "rtti0 i': i}It `OL ti,'OrC:?"S 0.0 L7.U°Il Ort n OI:S'.CS: (-Na-mc of Contractor) fps=un,_nc Cor_ri.-tr�:Poi;cJ Tlusntcr) (��: r�=t or. Datc)- (Name of COIItT<CIOr) (1_-lsumn.cz Com:�_.n/Pchc-, Numb--r) (3 ?:D raiinu Date) — — — -------- - ----------- (Name of C aritmctor) ___--h-r--T)_.___ -x r:dc_ hate) - (Name of Contmcicr) — (IcEumnc-z Da(e)- (^tLU11:�It':CY:zI rtst:�:xr�-•.^.._?:�_.;.. :. - ._ - .:c.-._..-... 1 �1iI1 it SOIC i)(U7C1C tJi Yil(I i avc. no -)II' honiC i)�V?IC" liCi:C`i?11I'� 1il i_. ii 11. NOTE:I?IC:SC be not:recce tlL,n t1u'ce unity ir;t�i::c't'��e t..;.--.±;•.tiy�r:_:c::3 u oc::�.: �•-:.� .,r:4r_.r1 L>Gdo cat oz< catploy, -3 u. Set tiv tvcr?,--e:ar - .__. n.r (<iL.S2-•1(S j; a,: .__air;;r' s hntaco,�-cr`:cr e cc pera:i: .rcc t.. Icgal ratuc of an a uployx under tl.n Wcvicla ov;w ikon!.cL I undc,t,nd the a cmay of tt_n cuy tx fcn—xvd:o- to ti»Irtw z c of In�u ricl Ac�d�:Y C;G o of 1:airs r=a for tlx covcrg6c vc ifiGtioc and that um urc to: c CO'---;ut;3c:.cGticn?SA of MCi.152 can lc:Ji to the i-mposition oCc :l pct�l_cs COQ11aILla of a fine of up to S 1,iWcuJ n:��'(?r i^',?r;.;-,-z;c:,of up to rr;} e^.1 Cavil xruttia to t}c I<,nn cC1 S!c-,,';:r=i. =-:a far;oCS1C0.00 a day ar�_in:l m.. . - Foe'ciq%uuzrrtaJ u.c oily l IlI1tY.1 permit N --------------�----� _ �t°I7:1 t1]rC OY :.IC 4 ` . HT SECTjON 8 CONST.RUCTI;6N SERVICES' 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 'Regser"e orn""elmprouement`Contracto ��_ 014 Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTIONIOn WORKER SCOMPENSATION 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...... ❑ 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"homeo,,vner" 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 buildine 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 _.. `: 5ECTION�a_ DSCRIPT10N0 PROPOSED WORK check all a livable Nw New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition[] New Signs [ ] Decks Siding[ ] Other [ ) Arief Description of Proposed Wor : X Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative D Renovating unfinished basement Yes No Plans Attached Roll D - Sheet 6a Ifie"whouse� tid�Dr a1"dii;it�on=�to�ex:ist;ing"H"ous°ing�'comp'lete�the""follow�nt7 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. bimensions 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 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 30VYNER AUTHORIZATION wJ BE COMPLETED!WHEN OWNERS�AGENT OlZ 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 _, as Owner/.Authorized Agent hereby declare that the statemen 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 Name Q r1 �S Signature of Owner/A nt Qfite Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIFD DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This colurnn to be filled in by Building Department Lot Size 15 r Frontage v Setbacks Front afo? 3d Side L: R: L:0 R: /s Rear Building Height Bldg.Square Footage i Q o % � Open Space Footage % (Lot area minus bldg&paved (} S IO parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT 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 _ i/ 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: City of Northampton Building Department 212 Main Street Room 100 el � Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 �. i l` �i v'""t•+ <.�,a r.':T.t � -'.ft,:..3`�Fn'Y..xX�. APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING R' ! - 3 2004 ' SECTION 1-SITE INFORMATION 1.1 Property Address: � � �`� This section to;be completed by office �i Map Lot Cin�t Zone��.A��r�� flirerlay.D�strict_ dm St iDsstr<ct CS D�stri+ct SECTION 2-'PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: r 1 YYl 7` -Yl ,GZ Name( 'nt) Current Mailing Ad ess: . Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED'CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building �-� r 6 (a)Building Permit Fee J 2, Electrical (b)'Estimated Total Cost of Construction from 6 3. Plumbing Building::Permit`Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2 + 3 + 0©. COO Check Number This Section For Official Use Only Building Permit Number. d Date Issued: Signature: Building Commissioner/Inspector of Buildings Date NQ T - WILED FROM DEEDS. PLANS AND OTHER kURCES AND IS NOT UED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. 11LDING LOCATION ACCURACY IS NOT GUARANTEED �_ a.... ►��--�a- ►...._ X38 ��,►.s� ? G. j 7�t� J i i File#BP-2004-1084 APPINT/CONTACT PERSON PARENT RYAN M&KIMBERLY L A6D SS/PHONE 37 GREGORY LN FLORENCE PROPERTY LOCATION 37 GREGORY LANE MAP 29 PARCEL 528 001 ZONE URA/J,;t�¢ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE \ ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid Tvpeof Construction: CONSTRUCT 22 X 12 DECK 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 FO LOWING 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 s— L oa 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. 37 GREGORY LANE BP-2004-1084 GIS#: `. COMMONWEALTH OF MASSACHUSETTS Map:Block:29-528 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-2004-1084 Project# 35-2004-1612 Est. Cost: $2500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Groin: Homeowner as Contractor Lot Size(sq. ft.): 8102.16 Owner: PARENT RYAN M&KIMBERLY L Zoning:URA/WSP Applicant: PARENT RYAN M & KIMBERLY L AT. 37 GREGORY LANE Applicant Address: Phone: Insurance: 37 GREGORY LN ( ) 584-8480 O FLORENCEMA01062 ISSUED ON.618104 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 22 X 12 DECK 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 Shinature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 6/8/04 0:00:00 319 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo