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29-254 (4) i Og�tU►MP�O z Z �I1844AC}r314ttt4 s « _ cwM` DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR '212 Main Street • Municipil Building Nortliampton,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: 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 -- 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 builcd g department for tie City of Northampton wan ts-any persons)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 fegulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfiM. 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 L 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 I ��tw•rar r • . 2C � 'fit _ (�Ifj) Jif �,Talrfljcd11I:p jcIt - — P � E �ZcsaKCEltssrtfa' �_ DEPART)r4El rr OF BUILDr�\,C INSPEC7fONS 212 Alain Street Municipal Budd;nc j Northampton, Mass. 010G0 t 'OItl IZ'S COi1+II'ENSA`IO.N L'�StTi�'CE AITLnAA,IT (liccns�Jpc;m�cicc) %1.11 th z principal place- of businessIresidence at: - - A/ '' r21 Ot': //1 Am 715 "� (phone-) i — I ( d ty/SZa_ula p) do hereby cerdf--, under die ppint and penalties of pcg'ury, h:i (jI am an employer providing the followine'%�rori;cr's comoensaoon cove age for lay etuplovecs ivoriong on tius job: 6;12 7 =Mc Coo.ran,•) (PoIic: (TExpirz oa Du.) O I am a sole pronricror, general contrac-or or homeowner (c c;e one) and have hired the cona-actprs listed below wto have the following wori;er`s co�pen_�aon pc�!cies: I _ (IN=c 61 ConaT c�or) (Insuranc;Colnpzn)-i-Pobc; :�rL1II1L<:) (Y`:Jlyd 4 1�11C} i (Nzmc of Conczaor) (Irsuuancc ComDam-Rol c- N sac_T) (Ex-pinion Dae) - (Name of Coanaaor) (Lau-mc: CompanyfPoticy dumber) (FELxpirsdon Date) I I (Dame of Coanaetor) (Imnlranc-- ComrzzryRoticy Number) (Expirdon Dalc). (alts b=d s vocal�eee.irnco�.a_^t-w me!vci iafoc�oa Pe'A!njtLr to.0 ( ) I am a sole proprietor and have no one worldog for me. ( ) I am.-a home owner perforrni.ng all Lbe work myself. NOTE:pl.-..be conic c—-tzi7c hnmeawac .ho e=play Pcoei w do cr-r ao a gaa work an a d.,clL:z of ant mete theme d �-qtr is wteh the bomoouzc raid.oc oa t .pm=d. C --Y 0.-c-d.-ui w be c vloycs unG=the Aa(GL152=1(5)).=ppU=600 by.6ommax ftr a lic^v cc pcmit rz:y c'4d-.az trc }fit coast of ea 4loy.r upder tlse WorSco(s Coaspomaxion Act_ ' I uad�ind the.a copy athis c=a===i m y bo forte ded to thn poP.:smcat or Ofnoo or 1=— for th. cO'6* o^c w-iGc=ioa sod tku L-ilrac to xA-='covmse tmdc soesioa 25A of h{oL 152 na Icd to the=PC11 i°a of eimin'l P@'k'a oomi:ag or a fine orup w S 1500.00.ndfcc ixIIpTt}p�or up to ooc yc:r cad c+it Peasftie is t5c form of.SSOP Wort Ode aad. of St00.(?0 a d_y Lpip:2 ay- Foe d4+r,-,--yj—only -----�. Permit Numtxr Lot f S, I k ty-••�t1L`�of 1_If:"TV`^!P� F1f-P r SECTION:8-CONSTRUCTION SERVICES r 8.1 Licensed Construction Supervisor, j� Not Applicable ❑ Name of License Holder: 'y L . '✓ /L• G License Number Address / Expiration Date Signature Telephone - - ,,..�,•r:::r.z.:+.rr....=v.,:� °,rN-: „max ... -.e- '.= pay" a �3F' 9wRe sfecetfiorne fim ravement:` antractoir.,.� Not Applicable ❑ 7-37 le Company Name �}n V Registration um er —- - - �7121-1�'Iqk-)IV16 Expiration Date � � Telephone 7 SECTION 10-WORKERS'COMPENSATION iNSURANCEAFFIDAWT(MAL.c:152,;§25C(6)). Workers Compensation Insurance affidavit ust 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....... 01 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 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 i SECTION 5-DESCRIPTION OF PROPOSEDWORK(check"alt aualicablel New House ❑ Addition Replacement ndows Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding flulf Other[0] • Brief Description of Proposed I 1 nn Work: Z-A) 1�Iv Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa Ci~tVev���io�rse ai�d� �dctiot0�°extstErlct�ic�°s`Inc� �ar�e�et�fh��[a�l�g• 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 AUTHORIZATION-'TO BE.COMPCETE€1 WHEN" OWNERS AGENT OR CONTRACTOR"APPLIES'FOR BUILDING-PERMIT- as Owner of the subject property hereby authorize2�W to act on behalf,in all matters relative to work authorized By this building permit application. 4 Signature of Owner Date —------t--�-------- T31?"4"o as O #r/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 Naipe j Signature oLCWAnr/Agent ' Date . � ~ _ Section 4. ZONING All Informatio'n Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This colunm to be filled in by Building Department Lot Size Frontage Setbacks Front Rear Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume,&Location) ' A. Has | Perm�/Vuranoe/Fndi ever been �suedfor/on the sheY No' 0 DON'T KNOVV 0 YES 0 � IF YES, date issued: | IF YES: Was the permit recorded ot the Registry ofDeeds? NO �~�� � DON-r K.""." 0 .^^ IF YES: enter Book Page, and/or Document# ' �� �� B. Does the site contain o brook, body of water orwetlands? NO v���� DON'T KNOW �~� YES v�� IF YES, has a permit been or need to be obtained from the Conservation Commission? ` Needs tobaobtaioed v�� �bta�nad �~� 0mtm [ssue�' x�� k~�/ ' � C. Do any signs exist un the prnperty �� ��� Y[3 �~� NO v_� IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YE3 0 NO 0 IF YES, describe size' type and location: E. Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre orimd part ufo common plan that will disturb over 1 acre? YES K ) r NO K ) _ ' _ IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r r--- fa mptont r -- -C. Building Dep��, ment SEP 2 9 2c MainSr�et we see r a = soorn 100; r; elt ; � � � , Northampton MA 01060 Se Sti „ gti �1 S87 ?t0 Fa.I413-587-1272 t?tatkSrte 'fans � � s , r Y � T t APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1.-SITE INFORMATION Thrs section to be cdinpr6t6cf b'' f9i 1.1 Propertv Address: _ 5 ©u�f!Z Map Lot Unit N �,./o �`1J C�r!� /�/4-� O © Zone Overlay Drstrict 4 Errttsf E7rstrrct CBDrstErct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: oT IgrnIf 6 haw s /07 G�FNOA lc j)0e.,A)(,v IX Name,{PH Current Mailing Address: Telepho Signat 7o�+0 2.2 Authorized Agent: p �IaL,E;l�'f Ij G Pj f�i��Cj" ) - ��61 ffli Name(Print) f Current Mailing Addr ss: Signature Telephone SECTION'3-ESTIMATED:CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building I f per -,(a)Building Permit Fee 2. Electrical 7 (b)Estimated Total Cost of Construction from 6 3. Plumbing Building,Permit Fee 4. Mechanical(HVAC) ✓� 5. Fire Protection 6. Total=0 +2+3+4+5) ✓ Check Number S— This Sectildn For Official Use Only Date Building Permit Number.; Isssued: Signature: r i Building Commissionedlnspector of Buildings- Date 85 OVERLOOK DR BP-2006-0347 GIs#: COMMONWEALTH OF MASSACHUSETTS MV.-Block:29-254 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0347 Proiect# JS-2006-0510 Est.Cost:$8264.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: B & R Siding 100465 Lot Size(sg.ft.): 15812.28 Owner: POWERS JAMES&LINDA Zoning:URA Applicant: B & R Siding AT. 85 OVERLOOK DR Applicant Address: Phone: Insurance: 781 Bridge Rd. (413) 586-4167 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:912912005 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL SIDING & REPLACEMENT WINDOWS 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: 61L ( �40 U7 THIS PERMIT MAY BE REVOKED BY THE Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL IONS Certificate of Occu anc Si nature: FeeType: Date Paid: Amount: Building 9/29/2005 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo