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29-254 (3) •V i �I I' I Cr 1 r I 6 1 Y JJ i 0 $ � �tassac3�asrtfs DEPARTMENT OF BUILDIJ,,TG INSPECTIONS INSPECTOR '2112 Main Street 0 Municipal Building ' Northurnpton, MA 01060 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::,z'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 fame 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 buildkin­g 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 occupanev 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-tome Dates Address of work location r �0 Pf �\Tc rfljulllpfoil � w a DEPIJf T.4EIT OP BUILDr7;G INSPECTION'S 212 Main Strcet ATunicipai Building j Northampton, ATass. OIOGO I ' WORICCRIS COi1IPENSATZO.N MSIJT-Z_A.NCE A=,,,' VTJ.' i 01 cc sx/permictcc) a principal place- of businessfresidence at: -- -- i (phone-') i (sUcity/ atr/ap) do hereby certify, under ttie.pa-ins and penalties of per-Fury, thal { ( ) I am an employer providing the following lworkcr's comoens_n;ior. cove ale for Iny emplovczrs worUng on ties job: i (Lsuranc Com=-%') (P olio: Nu--air) (r:-piroor D2L-) O I ate► a sole proprietor, general coa=aor or homeowner(c cie one) aDd have hired i the con -actors listed below T-qbo hive the `oUoltivS workeds comoep_t2 ion policies: (c amc 01 CO_'-r naor) (IRRI3t1C COIi1D1r]}'/t�GIIC'i }�tuIlZ=ri) r`:7LJ'?QR�.11C) i (game of Concrmor) (Irsur-anec C.omoa-av/Po!im Nunc_r) (i.%—D am ion Date) (Name 01 Con>saelo-) (I»u-anc: Compan}-/PoUcy Numbu) (Espir000 Daic) I , (Name of Contractor) (Ins-u=c_- Comean-y/Poli(-y Nu.mYrs) (Expi muon Da1c). I (atI3Ll:�.:oc�1�cC.ifnc�_-y w ax!u�iafora�oo pctniaaa�to.13 ooc:t�-�) ( ) I am .a sole-proprietor and have no one wor'dng 1.5or me. II am,a home owner perforTning all the work myself. NOTE:plesc be ev[yre[fi,•..;i}e hemeu�xa uto employ pc onz to eSo r� -. r�c rcy^z.ir—ark on of noc mote tea t'ro tats is-inch the a oe a'.p-oua6 [� --Uy occ^d-ni w he citployc-s uz/--the A=(GUI 52=1(5)),=ppG:=ioa try. 6omcoQaa f='G�-'v or p_-mit 2r clv Ic-F..l a_^ of a e=-ploys uo&r dre WoAcec Comp�valio¢heL i I I uDdcr.-ud iha n wpy oC th'v GaLCmmi mny be f«'-�.vded to the Dcpartmrse of In�+SriJ Ac�idaa.�'Off oc or lra++r•aoe for th. 'i o,ve�-c veirGtioo rad 11u L-iliac to sa�srz toverese uo3c yoetion 23 A of}.tr�L!52 as Irk to the iz�ioa of eimia+!pe>;a1Sia masiryzgofa fine of up to 51300.00 rzrx i=PrLooco=or up to ooc yr=-e.ad c;%-a p..rji is BSc roan or•Stop Wort Ord-end fim (S 1 00.00 s d y LPI=tzx u.c only _ Pcrmjt Numb= i i Lot K Sigaat nr of Licaascc c 4 * ` SECTION 8-CONSTRUCTION SERVICES 71 8.1 Licensed Construction Supervisor: Not Applicable 11/ Name of License Holder: a�'3 ttYS ref q 3 ©!44 ' License Number Q / 77-2-- �G Addres Expiration Date Sig tune Telephone 9:Re is°tere� fiomerri rovement Contracto :' Not Applicable ❑ Company Name Registration Numum a—�-- --- Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE'AFI#IDAVIT(KG.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-vear 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 hirc 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 r ' y i r.: SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House F_� Addition ❑ Replacement Windows Alteration(s) Roofing F-1 Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [E3] Decks [M Siding[O] Other[d] Brief Description of+,Proposed W. Alteration of existing bedroom Yes No Adding new bedroom_ Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa 7 'evi► ouse an&6%2'd ao E xti wing 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. 1. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNERAUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENTsOR 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, 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. Print Nam 1` Signature of Owner/Agent Date Section 4. ZONING All Informatibri Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning gi This column to be filled in by A Building Department Lot Size C3 P,H a B1. Frontage 4� iI Setbacks Front Side L: R: f Rear Building Height Bldg. Square Footage % � Open Space Footage % (Lot area minus bldg&paved L s parking) #of Parking Spaces Fill: _. (volume'&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW U YES IF YES, date issued:, ! IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW 0 YES IF YES: enter Book { Page; and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T 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: 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 r NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. � ��� 2 .Depa ezatuse.��iiljr• � ��>�� �', City of Northampton f a r tailding Department � '212 Main Street e Room 100 _- �"�' � Jam., t"'� -vY^},�: k'�• , i-.t Northampton; MA 01060 ara! x h 41i-k7,-1240 Fax 413-587-1272 *WL1CATI0W b �1 TRUC7�,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1.-SITE INFORMATION 1.1 Property Address: This sectton to be completed by office Map mot t Uni# Zone Overlay x3tstrict nistFl tij lm St o strlci _ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT. 2.1 Owner of Record: Jam Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item y Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building�,,r (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 Section For Official'Use Only !Date- Building Permit Number I Issued: Signature: ' Building Commissioner/Inspector of Buildings Date .. :b i File#BP-2006-0184 APPLICANT/CONTACT PERSON POWERS JAMES&LINDA ADDRESS/PHONE 109 GLENDALE RD FLORENCE (413)584-4204 O PROPERTY LOCATION 85 OVERLOOK DR MAP 29 PARCEL 254 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction: ERECT 8 X 8 SHED 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 INFORMATION PRESENTED: proved 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 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. 85 OVERLOOK DR BP-2006-0184 GIS#: COMMONWEALTH OF MASSACHUSETTS Map.-Block: 29-254 CITY OF NORTHAMPTON Lot:-001 Permit: BuiIC{Inq Category: BUILDING PERMIT Permit# BP-2006-0184 Proiect# JS-2006-0278 Est.Cost: $750.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES POWERS Lot Size(sg.ft.): 15812.28 Owner: POWERS JAMES&LINDA Zonine:UFA AA licant: POWERS JAMES & LINDA AT. 85 OVERLOGn QR Applicant Address: Phone: Insurance: 109 GLENDALE RD (413) 584-4204 0 FLORENCEMA01062 ISSUED ON.813012005 0:00:00 TO PERFORM THE FOLLOWING WORK.-ERECT 8 X 8 SHED 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: 6i,- Driveway Final: f Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: n/e- THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy- Si nature: FeeType: Date Paid: Amount: Building 8/30/2005 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo