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29-145 z Z $ 'Massachusetts DEPARTMENT OF BUILDI7,,G 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 .•-ei:_,or. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one dr twofami 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 backfll), 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 I understand the above. 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 ¢�twtn, f a e (rii� of orilia111}�toil = �Z csanch ntrtla' w Q DEPARTMENT OP BUILDO?G INSPPCri01.'S 3 212 Main Street Municipal Dudding Northampton, Mass. 01060 WO U<z. R'S COIfPENSA`170N GNSUR kNCE AI7MAVI-1- i (liccnsxJperrn ttcc) ���tll principal place of business/residence at: --- ---- - _. (phone;') (surr..dcit—/s=1zjp) i do hereby certify, under the.pzin� a�d penalties of pc 'ury, hal ( ) I atn an employer providing die foljo%Ving'%vorkCr'5 cotnocnsZ�on Covc zgc for 1ny employees wortDng on this job: I i (La7Lr�c Corr ) (Pelic'.Nu_mbcr -- (T,pirtioR mate) ( ) I am a sole proprietor, general contractor homeowner (ci-ie one) and 1?ave hired the coco-actgrs lister+ below c�ho have the foilo� ' Q worker's �oep_�6on pokles: (I+II C Oi CQTI^Ci0") (IRRlr3ttt COIrloany t�obc—,- NIU_GLC:) �tiJlr'd QR I�aIC (N:me of Coamaor) (LII-7waza: Comoaawpoljc `i`mcrr) (E.\D rim ion Date) I � � ; (Name of Conlraclor) (Insuranc; CompUylpotic)' Numiu) (Expimtioo Date) (i�'zme o!Contractor) (Insur-aacc Comcaay/PoUcy Num zi) (Eapirtioa Dale). (aa1r.�1:.ddi�oc71�cd,it nccaal•w a-,c?uc�•iafocmt�oa pcz,-icing to.0 ma✓-_CLO:. ) O I am a sole proprietor and have no one worlong for me. I am..a home owner performing all the work myself: NOTE:pl�sc be coryt ifi*• vt le 6cmco�orris u-O Icy G�om w do c cc c=.r�-m r m air,.rorc oa a d..clJ_g or not mere tb_n t ao tom-is�a'acft the bomoo vvcr rnido oc oo the Qouad,�purtcnsl tb, o LT nor�r� ity occr'd=d to tic cmplo)-=une'-e the�Vzk--�->-,ila Act G L! n t 3 ( )} ppU=Ecrc by.bom.noa-=kr a tics_a pe.^ait n_y c%•id=cc ebe IegsI elaase of m c=loyx under dw WOcicdl Coonpamatioa AoL 1�. tba a oopy o!thin==--=oaay be rot-,vord.ed to the per¢or j d.a W Aeodr�Y OQioe of I�ur•ooe for the covenb<vcrif c31iOn aefd llt:i t-iliac to to=m covcsn�t¢)dc 3=joa 23 A of MOL 1 S2 on Ied to the imposaioa of aimin.�t Pcm%Wc ooaicsrxtg of a rrae Of trip to S 1300.00 andloe oCup to cuc y=cad cjjj pmaluO to ex form of a Stop Wait order and a rta:o of S 100.00 a day aVja.A me For uiit UM - onty — PCTRlIt Httult7CS N'bp." Lot ' Stp�tuze of Lia nscrJpctTtuttcc 'Ie -- "J SECTION<8-CONSTRUCTION SERVICES 7 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone °'a j2tSWjM2 Not Applicable ❑ 9.:.Re°°"' sterec`ht�ome<Im"'`r'orrement:Contraeto Company Name Registration Num er - -_- Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCEAFFIDAVtT(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...... ❑ g `WIN 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 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 Massachu etts General Laws Annotated. Homeowner Signature r s m SECTION 5-DESCRIPTION OF-PROPOSED WORK(check all!applicable) New House ❑ Addition ❑:. Replacement Windows Alteration(s) ❑ Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [0] Other[0] f rief Description of Proposed Work: 9r- P_ ,s CO..� Alteration of existing bedroom Yes No Adding new bedroom Yes No . Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ', , �'• ,. . e,.*rxr 6a.{€rNeW=Mouse.andvorad ian a�eaccs l c -fiorxslnc�.._eotnn et he atto rng: 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 AIITHORIZATI.ON-TO BE COMPLETED. WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING_-PERMIT 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 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. Prin ame G GlC Sign ure of Owner/Agent Date aim. 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 (— Side L:= R:' L:' R:- Rear Building Height r Bldg. Square Footage % ` i Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume'&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? N0 0 DON'T KNOW Q YES Q IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES Q IF YES: enter Book Page= and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES Q 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 Q IF YES, describe size, type and location: s D. Are there any proposed changes to or additions of signs intended for the property? YES NO 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 O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton rStace h� ? Building Department 6 212 Main Street sure e tr r tl Room 100 a a iii iii''�i ♦i LV Y 3 `4' t� Northorripton; MA 01060 Tuvases©�St��;feral�pt�s � �.�,. � � � ��„ phone 413-587-`240 Fax 413-587-1272 Rfof�Sktea�n� � � � Y" APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION b 1.1 Property Address Thts.sectlori to e completed bxo ce , O ,5'jn r v r-c �� �'.R Map dot U n+t �y1 o��� t ///'i4 Z"one —�Overlay Distnet n EI'm 9t 151stnct CB Distr►ct Y SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED'AGENT 2.1 Owner of Record: {- N%e ii 74. U t?XdJ a/e-'z- Name(Print) Current Mailing Address: Telephone j–pz y' t�7 Signafure 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 (a)Building Permit Fee 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+4+5) Check Number This Sectiotr For Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings-- Date • File#BP-2005-1070 APPLICANT/CONTACT PERSON SCHNEIDER KENNETH A&ELIZABET ADDRESS/PHONE 70 SPRUCE HILL AVE FLORENCE (413)586-0487 Q PROPERTY LOCATION 70 SPRUCE HILL AVE MAP 29 PARCEL 145 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Vk- Fee Paid Typeof Construction: REMOVE INGROUND POOL&FILL 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 F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 Commis 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. 70 SPRUCE HILL AVE BP-2005-1070 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29- 145:. CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2005-1070 Project# JS-2005-1459 Est.Cost: $3000.00 Fee: $15.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 43995.60 Owner: SCHNEIDER KENNETH:A&ELIZABET Zoning.URA Applicant: SCHNEIDER KENNETH A & ELIZABET AT. 70 SPRUCE HILL AVE Applicant Address: Phone: Insurance: 70 SPRUCE HILL AVE (413) 586-0487_0 FLORENCEMA01062 ISSUED ON.5 116105 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE INGROUND POOL & FILL 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 5/16/05 0:00:00 $15.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo