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29-407 (4) O��t1AMP�O Grzfp of Wort4aimptan � r Z �836AC}'liSttt6 � DEPARTMENT OF BUILDING INSPECTIONS /? I INSPECTOR 212 Main Street * Municipal Building Northampton,MA 01060 � I HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCNIR 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." I 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 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 A✓r + r ��� �� eti C!izf�t L�f �1jLTZ-�1J�-i11r�fLT11 �. A 6 'il«sanrfinsrlla ' m DEPAt2TMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Bui!tling Northampton, Mass. 01060 WORICER'S COMPENSATION INSURANCE A�F F ANTIT ti:rith a principal place of busincss/I �:`dence at - (siTC:UC]ty .ttazjr do llcrcby Ccr<iiy; Ilzl<i :r dic pals and pcn�hies of perjury, :flat: I am an employer pro`idin- tile 101.lov."InQ %vort_cr`s CoI pc.,lsaUon covcm2 !,C for my elnployces working on this job: (1=drancz: Compain) (Pc i c:Nl tuber) --- (ExTirdRnn Data) x I am a sole proonc-o :enera conic er o: llosleo��ver (C" cle one) and have hirt_-cl the contractors hste� below -,vho ii the ` - ;i;� ,%,oFkc,2S coi tnssa aon 0!iC.eS: (1:(IiIIC Of COnL'!CiGr) (1IISL'-,'1C Cvlt?^-::ir:�G!tCf 1111jT1i) iT r' —T'-- b `i z` (Name of Coutrctor) r iMD. ate) (Namt of CoatmClor) (ills 3I1CC (_O 1^.1];i%i�0!; j 1VUSi?In 7) ( :,-:: G L.ab) - (Name of Cont actor) —- (Ins ratla° Cemr J-.yr'olicy Numb,:-r) (1:::ri ::ie. Date; i l � I iIITi it ;;UIC 1)1-Upr1CCC)i idi1Q ilc V, Il0 OIIC', ..'OI"�.lii` tOr rll�. ,) I ?iP, L? 11Ur1?e iiCi.Grl111Ii�-- all i_. 'v. iii"S lf. NO fr::plc u be aria c t!s:.�•]c k c<;co«zr-a c;pl Ix a :ancc a:c"n dm cr:- -t xr 11 cr z�«cl!i not tzxce th n Ilxroo nits in 1c{ Gt the r=:,�=or a; -:c rx t Cersall y cr a l cc sc cc p-1:::: Irgal rtatua of an Qnployor candor tho Woricclt Coz.;>orr-ation A.ct. I and—it.wd tha!a co,y of tlii ctatci.cc!nuy bo forw:vc!od to tf»IY_Siortawz:of Ind Off--of for tlx covcm&c vcrifiC:iioo and that L-.dart to:metre 000=1-370 ut- seci m 2SA of?•iGI,151 cw Ie.d to tlx impositim cif pc:, l=a Cocnisting of a fim,of up to S I-500.100 a:-r&'(Y i^:t zisr.Zx:1 of::p to cr.-}-_r e:.1 civil perulticz in n, fc,nn of a S!c '.y'crx Lt of 5100.00 i dsy Fcc d;cat zraYal u.e tidy Pcrinit N!tultr,,r / / c7J �ti1a-zt! 1,4)t � idill to rc 0 f :•icc:r;c:JPr. iaiac., .777777M r!�ol S ION:S.ERVICES! 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder 0 A-- o 0 / 5 13 License Number 9 9,, /34 zoos wcm Address J Expiratio Date 103- 2cic �f32y Signature Telephone r e ereawmmnt vemerw- nt;a:cto: Not Applicable ❑ Company Name J Registration Number Address E ira ion Date Telephone SECTIOI 10<WORKERS' COMPENSATION 1NSlJRANCE.AFFIDAVIT(M,G=1_.•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"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 fer 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 S GT� INS � Oi��F�PROP�OSED�IVORK� ch ck*�lYa I+ca�b�le�� ' +�. Sois. _ .... .. ... �.. .n"�,""»u."'�ar ':. Fik -�•'�.' -::`���,il..:Cn.. � .:°44xE? 'S:,&: .:,:.3: � .r. New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ j Decks [ ] Siding[ ] Other [ Brief Description of Proposed Work: Jr;�+t,�r ivy loo s `Try r, k� �e�,�b f5r �i�c1c. 134 1 /��►i s Alteration of existing bedroom Yes_mac No Adding new bedroom Yes No Attached Narrative D Renovating unfinished basement Yes No Plans Attached Roll 0 •Sheet 0 a�'fNe�nr""� �e'�d o �.a��itfon to exs�in�housr'ng`:"`c-omp�lez e 1i`ef�law�t'ng: 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 SECT]©I7 fl ERA L1HORIZATION 70=BE COMPLETED YYHEN QWtERS�3 E 0� ONTRACTOR APPLlESrFOR BUILDING PERMIT F I, A eL3, r-ec X 1 IR as Owner of the subject property hereby authorize Q AIV l , T7-S' t.(l( tf_t to ac. on my behalf, in all matters relative to work authorized by this building permit application. 4 _(0 7J. Signatur 0 ner / Date as Owner;.Authorized Agent hereby declare t at the statemeng 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. Yvn\s,, 5 t✓� Print Name Signature of Owner/Agent Date I i Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by 1 Building Department J f� Lot Size Frontage Setbacks Front I Side L: R: L: R: i Rear I Building Height Bldg.Square Footage % i Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces i i I Fill: (volume&Location) A. Has a Special Permit/Variance/Finding Bever been issued for/on the site? NO DONT KNOW t' 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 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 rC � Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING lah 7"rfw� ������� fc��� �c"ts C� �,ar tg"44- P.*3 SECTION 1-SITE INFORMATION j 'Chrs sect�o toe vomletecbice 1.1 Prouerty Address: s ° , � " + " k sal a a�s�t. a r .am M�a...�"r•W s? S.g s" �swk;+-y5 "p, " �hancs. i '2 SECTION 2=PROP}.ERTY OWNERSHIPJAUTHORIZED AGENT 2.1 Owner of Recgrd: - r� w a2eyr I�Q neS �-' rt r, ec s 0 I055 3 Name(P" t) Current Mailing Address: Telephone �^ Signature ' 2.2 Authorized Aagnt: "h Y\\ S' C � �1 Yak ar y 9 �J ia,kl T� ► 11,4, >►.T 1�� � Name Print) Current Mailing Address: JIO b 4413 Z96 g3z U Signature Telephone SECTION 3-ESTI_.�ATED CONSTRUCTION'COSTS Item Estimated Cost(Dollars)to be Official Ilse Only completed by ermit applican t 1. Building z o ldmg;Permit.�Fee J ' 2. Electrical l �� o (bj,:Esbmated_Total Cost of Construction from 6 3. Plumbing 2- tD Building Permit Fee; 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1-+ 2+'3 +4+ 5) (� �� £heckNurrber a— This Section.For,Official:Use'Ord Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date i I i I File#BP-2004-0735 APPLICANT/CONTACT PERSON DENNIS C PITTSINGER ADDRESS/PHONE 49 BOFAT HILL RD WILLIAMSBURG (413)296-4320 Q PROPERTY LOCATION 81 SANDY HILL RD MAP 29 PARCEL 407 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Pe 't Filled out Fee Paid a Q Typeof Construction: INTERIOR SHEETROCK,DOORS,TRIM,KITCH CABINETS&FLOORS New Constr0tion Non Structural interior renovations Addition to Existing Access ory Structure Building Plans Included: Owner/Statement or License 007513 3 sets of Plans/Plot Plan THE FOLLjOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO A'N'ION PRESENTED: pproved 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: § Findipg 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 Co ssion Signature of Building Official Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requiremgnts 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 rip, 3"�s- s �.„•.�` c " , 3 r a a s gv t n r a� 4 � F- c yr. 81 SANDY HILL RD BP-2004-0735 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-407 % CITY OF NORTHAMPTON Lot:-001 Permit: Building Caategory:te BUILDING PERMIT Permit# BP-2004-073511, Project# 3S-2004-1063�!i Est.Cost: $15600.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DENNIS C PITTSINGER 007513 Lot Size(sg. ft.): 20821.68 Owner: JONES LAWRENCE&BETTY Zoning:URA Applicant: DENNIS C PITTSINGER RD Applicant Address: Phone: Insurance: 49 BOFAT HILL RD (413) 296-4320 O WILLIAMSBURGMA01096 ISSUED ON:118104 0:00:00 TO PERFORM THE FOLLOWING WORK:INTERIOR SHEETROCK, DOORS,TRIM, KITCH CABINETS & FLOORS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: I Footings: Rough: Rough: `,--f 3 —O 4f House# Foundation: ,►' �7 ,�, j�� p,���j� Driveway Final: Final ) Rough Frame: Gas: Fire Department Fireplace/Chimney: I Final: Sm eke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES ANl REGULATIONS R, Si ature•�ZZI 1'e, ' Date Paid Check No: A Dent: R c>l' No s 1{8I0411,00s4}U 3903b©.00 TYX s { F G 2I 2 Main Street,phone(413)587-140,fax:(#13 587-172 x Building Commissioner-Anthony Patillo F r ..