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29-249 $ � aNtassacl�useiis ',' of Narthalliptall h DEPARTMENT OF BUILDING 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 its/her construction sup<:%-'Sor. Tlie 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 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 ��ttn}rap . 3�i3tlt rllR6(tti• ra OEPARTMENrT OP BUILDD)\C INSPECTIONS I 212 ATain Strect Municipal Building Northampton, Mass. 01060 WOMCER'S COAfPENSATTON L`lSURANCE AI FMAVI-1- , (liom .^cJPcrmittcc) principal place of business residence at: I : 2gl �, _ � Y /I T6 �1�- (phone') —y4 do hereby certify, under the.pa_ins and pelialties of perJury; Dial (�J 1 am an employer rovidin^ the followine %vorkcr's cocnocnsa� v ` P a � o co e.,.�c, for Intl' • eluplovecs worldng on this job: G C, J d Conr�cv) (Pclic: ?\u 2 r) (r:pirrior,D2t`} i - !' O I am a sole proprietor, general cootz-aaor or homeowner (c c?e pee) and have hired the contractors listed below wbo have the follo iflg worker's cot nenszt'on pc cies: ([+tllll: O CO„_^Ci0') (1[1R rant^ Coinpz i)-Pi c6 q- N'uxn-C:) (N:.mc oC Cooezclor) (insaranec Comoa.aviPoUc; Nunc^r) (Ex-Dir.6on Date) (Name of Conuaaor) (Iancranc: Comn.ao)-/Poliq• Nambcr) (EspiM600 Datc) (Name of Coatrdctar) (IIISZ1faIl Comr�y/PoLcy Numbu) (Ex�itadon Darr). (Laaa�_d:i oc�.l�ea.if acees.-�•cc a�cu�iaf«�u�on pertnaains tv..11«er_e.o:z) . { ) I am a sole proprietor and have no one worldog for me. ( ) I am.a home oNVUer perforr=o all Lhe work myself. !! NOTE:pl=sc be ew7rt I>:c at Je betaeo,vcn u bo C=Pjay pc-sops to ba=A=U==crca;a uo Cr rrpaa work on a d..c -g of apt mcco tea t'aee t�.s is which the bomoo wrr residcs oc ca the g uo6 iPpurtc^...,tbern c ooe C-_re-.Ily oeesdercd to be emPloyes une'c the--rkcr,c=*- -+:oa Aa(GL152-u 1(5))�apptiaDoa by a botneoave fQ a bcyc cc pa=ray--,denoe d-- jIcgxl n,,.,of ea=Zployar u.odcr dap Wockxec Coeap.omatioa AcL I wade nand tha a oopy of this mt®ent may be foc- -d.d to tbo pop.s of In&szricl Al dcaiY OIL-of,6_--O-On ror th. covcr>b`c rc'iratioa :td th1 C-_dmc to sc=='covcny un&r section 25A of MGL 152 na led to the ian7os oa of cimiasl Pcalllic ooas.L.mg of a fsoc orup to S1 500.00 usdfor lamest oCuP to ooc yt=end cva Pavtia is tic ro(m of a Siam Woric Ordcs Lad L ftua 0CS100.00 t dsy tptinv tnc For&P.rta+"�u,e only Permit Number pan{Ctrs � 1.,{ap- Lot Signature of Liccnscc/Pcm6a SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ]� Not Applicable ❑ Name of License Holder: eo ti �J n�'Y✓� License Number X) - Address Expiration Date Signature Telephone 1��? CT6 0� --� c — 9�Reistered`Home-Cinproiemen ntContFacto ; A= Not Applicable .❑ Company Name Registration Number �7g/ E� 1oo5./z z�- Addre�s� /' y� Expiration Date Nb te,7k4 M 7-0 DJ /�1 Telephone s�� r�/�7 le , d-O©Z SECTION 10-WORKERS'COMPENSATION'.INSURANCE AFFIDAVIT(M.G.L.c.1'52-,-§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 buildin ermit. 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 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 ' r SECTION 5 DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks (p Siding Of Other[0] Brief Description of Proposed l/ Work: ZA)S -'J�� �� A)� ' Sl.!J' )4- Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ba If'.New Elyorrse arld,or a�d� iorl"faexis tncclousmc;wC mp e 41 Fr a 0W M: 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 stones? 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.ALITH.ORIZATION�-T.O BE,COMPLETED-WHEN OWNERS-AGENT OR CON TRAGT0R:A/P�PLIES,FOR:BUILbiKG:.PERMIT as Owner of the subject property a hereby authorize L— 2 cUiN J A4/0 to ac on m alf, in all matters relati a to work authorized by this building permit application. Signature of Owner Date J J, AkI I, zss W L r /2,A✓J 7 as-QMr/Authorized Agent hereby declare that the statements and information on 1he foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. W., nJ A-- Print Name Signature of 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 bldg&paved #of Parking Spaces (volume&Location) A. Has a Special Perm it/Variunce/Fi riding ever been issued for/on the site? �� �� NO �,��� DON70NOVV �~� YES �~) IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? ' �� NO �� VV DONT KNOW YES IF YES: enter BuohF-- Page and/or Document#� ' v��x-� x�� ^~� B. Does the site contain obrook, body uf water orwet|unds NO �~� 0ON7KNOVV YES �~� IF YES, has permit been or need tu be obtained from the Conservation Commission? Needs tubeobtained �~\ Obtained �-� Date�~� �~� ' . C. Do any signs exist on the property �� ��� YES x�� NO �~� IF YES, describe size, type and location: —' D. Are there any proposed charges tooradditions of signs intended for the property? YES 0 NO 0 IF YES, describe sizo, type and location: E. Will the construction activity disturb or filling)over 1acre or isVpart oia common plan thow0distudbnvor1aore? YEGK } NO � ) =� �� IF YES,then a Northampton Storm Water Management Permit from the DPW is required. __ n De CJS Q�1 a -4qity of NorthamptonCatttof � l' Buildin De ' - _ 9 Department p !?12 Main Street ^ r Room 100 r Northampton, MA 01060 eQVrU * phone 413-58T-1240 Fax 413-587"-1272 ! Otf►e��Slxec� x ' �`� �� ��'`� �` �� , APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION,1--SITE"INFORMATION 1.1 Property Address: This section to be'com_et b office Af Lot Unit t' o fc x)c U-;, ),14 4—' Tone OverFaYD�st�rct ? - SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: CIA a /.Es es Name(Print)~ Curren M fling Address Telephone _ Signatu e v '7 S SJ 2.2 Authorized Agent: Name(Print) Current Mailing Address: 7 Signature Telephone SEGTION2-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building aJ (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=(I +2+3+4+5) a C7 Check Number This Section For Official Use Only_ Date _ Building Permit Number.' Issued: Signature: Building Commissioner/inspector of Buildings Date •s. 118 OVERLOOK DR BP-2006-1254 GIS#: COMMONWEALTH OF MASSACHUSETTS Man:Block: 29-249 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-1254 Project# JS-2006-1857 Est. Cost: $5068.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin_ B & R Siding 100465 Lot Size(sg. ft.): 16727.04 Owner: HAYES CHARLES J&GWENDOLYN A zoning rJlta Applicant: B.`& R Siding L. Anpliervir Address: — "— - � � - - Phone: Insurance: 781 Bridge Rd. (413) 586-4167 Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON:512212006 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL VINYL SIDING POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector )f Plumbing Inspector of Wiring D.P.W. Building Inspecto. Underground: Service: Meter: Footings: Rough:; Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Deuartmeat Fireplace/Chimney: Final: Smoke: Final: alL e61-L 114 6"jS THIS PERMIT MAY BE REVOI(ED BY THE CI'aOF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULAT[ S. Certificate of Occupancy Signature: _- FeeType: Date Paid: Amount: - Building 5/22/2006 0:00:00 $25.0020369 212 Main Sheet,Phone(413)587-1240,i'ax: (413)587-1272 Building Commissioner-Anthony Patillo