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29-516 ¢'SttiAAfP�. O O �} ti$ rite of Nazt4aiilptan _ r £GT ASSAC�TTSCffB DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building '>a Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CNlR 108.3.4 to act as his/her construction sup(,: , isor. 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 insaected. 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 owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location R (riff of Norf11alliptol_l DEPARTME1JT OF BUfLDI?','C INSPPCTIONIS - 212 Alain Strcct Municipal Building ' Northampton, Mass. 01060 WoMaIRIS C O NIEP 1 N SA S7_O N -EN S UI-,4—N CE A ITIMM)VI-I' --- %VILb ap'nncipaJ place of business/residence at: ��'f/��l L 6 ►� � (phone:') ( d •/sta�cf�p) do hereby certif)r, under tbc.p?-ins and penalties of pequry, --hal (/am an employer providing the following %vorkcr's comncnsaoo, cove�2gc for Illy etuplovees working on this job: ,419150,V �y4U1'1�s lv c�,�3/ /%��y dry OS-,O " p% (La.Tu-n= CompaL--,) (PCUcr NLLUr_r) (T=:•pirzdbr, D=) O I am a sole proprietor, general contractor or homeowner (c cie one) znd Lave hired the contractors listed below who have the follo%viog workers cocoen_saaon policies: (N amc Oi Cont: nor) (In ur-3ricc Coinpan)-/PGUc-; ?,,rudn_r;) (r`;71Tdu^ I�1IC) (N2mc of Cona2cior) (b s -ancc CompanvfPolicy Nunn-:r) Dale) (Name of Cotm-aci ) (Lasu nc: Compan)-RoUq- Namb-zi) (Expir000 Date) I (Name of Contmaor) (Insurance Comczay/Poky Number) (Ex-p radon Datc) . (nnscb:.4 U4�.001l trca,if acoc--u V cD a�c!u�iafCCw Ca p,,6�to.11 r' { ) I am a sole proprietor and bave no one wor'dng for me. ( ) I am.a home owner performing all the wank, myseff. NOTE:plea be cMjx tt,•. +1 Jo bcc,=+,m—bo crnplo),pctionr w do easr o c rgair wcr-k ao.d—a'-Z of twt tnoc-c tb--z c -Div in ubeb Lb.bocmowvc r=do or oa the pvL a we C==-DY cn=-&-rc+d 10 t catployca un?—the Sul rss c==pCy=Act(GLt 52-=1(5)�c.ppUaDOO by a bomco—o=far c licxx_cc pcnait try ni& —the lc- naau of na c=ployx under drn Worlco!c Coarpam�lux I-ad--d th+t:oopy of tbi,to=—.d m y b.ror—aj•d.d to tb.Dep.:ruama erinduu;al ne --Offi—of In-++ for Lb. cova-xs r=Zatioa a-d U-- L-il=c to,==cov=z uodcr=c6cc 25A of hiQL 152 c.Ind to the i-=?x oo cdcriminA Pea'lli° eoosisIu of a frac orup to 51300.00 a AVd oCup to ooc yc r e.nd ci%i1 pmshio i.tx focm of.Ssop Wori;Ord=tad t rum O(S100.00 t d:y tplalt tnc For dcy.rsa>•�u,c only . permlt Ntmbcs L Lot Sip�Ziurt of Lia�scc/Pc - u e J 4 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: f /�j Not Applicable 11 Name of License Holder: ,& /'V L nA bl� ' License Number ►,1 4-12 Address Expiration Date /Ja 7,C) k) Signature Telephone ��. �: ° x• `�" Not Applicable ❑ 9 Iteaisle e'�ii�=`F'tbmet`ifil3r emerit Contractor�Y= PP Company Name Registration Number ?. 4,orill 2 Address V Expiration Date A Telephone-, SECTION 10-WORKERS'COMPENSATION INSURANCE..AFFIDAVIT"(M.G1.c.-152,..§25C(6)) Workers Compensation Insurance affidavi must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildipig 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-owner-parcel_ofland 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 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 Iiable 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofi Or Doors E] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks ([] Siding OK Other[O] Brief Description of Proposed ^- r /I Work: �J S !—� 1 v l yU 7� �w Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet s ` " WUN,, `RrarT� ion X1111n:g_,.cilisma c'a 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--Ta=OWNER AItT•,HORiZAT ION,, TO BE OMP4EGED�WHF�t - OWNERS'AGENTOWC,ONTMAMR APPLIES_FOR-BUILDING PERMIT lQ dJ Jll✓9 (-- Jy/�� as Owner of the subject property 11 hereby authorize � W/Ai [.__ to a y behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 1, 6,�jLl�/ J'l� /chi fir✓ 69404w/Authorized Agent herehy 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 Name < Signature of Agent Date ' Section 4. ZONING All Information 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 Frontage Setbacks Front Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bidg&paved ' #of Parking Spaces (volume&Location) A. Has a Special Perm it/Vurianue/Fmdi ng ever been issued for/on the site? eN NO 0 DON7KN0N YES 0 IF YES, date issue& IF YES: Was the permit recorded at the Registry ofDeeds? NO � ) __ IF YES: enter Book Page and/or Dooument# �� �� B. Does the gtacontain a brook, body nf water orvvet|ands? NO v�� DON7KNOVV �~� YES �_� IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs tobeobtained /~�` Obtainad �~� Oate �ssuad�. �_� �~� . C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YE3, describe size, type and location: E Will the construction activity disturb grading,excavation,or filling)over 1acre or is it part ofocommon plan that will disturb over 1acre? YEG (��} NO K��) |F YES,then a Northampton Storm Water Management Permit from the DPW iarequired. De a etuse=d ^A� City of Northampton Siatt, tia 1� _ y B011ding Department 212 Main Street Room 100 re �` � ,.",'Northampton, MA 01060 00 rtk13-587=1240 Fax 413-587-1272 " � APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION1.-"SITE"IN FORMATION ,�' 'Thas:secfion tb be completed=6y office 1.1 Property Address: * , 7m�iL��strrcY xC> DrstG pct".ct` 'T.. SECTION2-PROPERTY"OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: / / ug am rint) Currer�Wilipg Addressv P )CTyya0— Telephone Signature 2.2 Authorized Agent: 15P-) � �O � Name(Print) Current Mailing Address. Si nature Telephone SECTION-3-,ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building E (a)Building Permit Fee 2. Electrical (().Estimated Total Cost of Construction;.from..6; 3. Plumbing Building Permitfee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) U 6 `.. Check Number This Section For OfficfaCUseiOnl Date. Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 4% 8A.'40 26 TARA CIR BP-2007-0391 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-516 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A/ Category: BUILDING PERMIT Permit# BP-2007-0391 Project# JS-2007-000578 Est. Cost: $4500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: B & R Siding 100465 Lot Size(sq. ft.): 8886.24 Owner: SCHMITH DONNA M zoning:URA Applicant: B & R Siding AT. 26 TARA CIR Applicant Address: Phone: Insurance: 781 Bridge Rd (413) 586-4167 Workers Compensation NORTHAMPTONMA01060 ISSUED ON.101612006 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL VINYL SIDING 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 10/6/2006 0:00:00 $25.0020583 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo