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29-073 L ..Crzt-r aaf Nart4anlptan z �1835ALlrTTB[tt9 - Ott y, DEPARTMENT OF BUILDDJG INSPECTIONS /? INSPECTOR 212 Main Street • Municipal Building V S Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to act as i:is/her construction sups-:1sor. The state defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be, a dine or two fanuTy- 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-buil mg department for the City of Northampton wants-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 regulation. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfillh 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 occupancv 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 understand the above. (Home owner/resid is signature requesting exemption) I will call to schedule all required building inspections necessary for the building peimii - issued-to me. _ Date 12,-1 3-© s Address of work p location �4 � �o9K Die,, r F co pate r * (a l vro� R 4�tVJ-t p)• y / / et� ��.�a Rril a-true• _ _ a DEPARTMEIJT OP BUILDr\10 INSPECTJOJ°S - 212 Alain Street ' Municipal Building Northampton, ATass. 01060 I WORICEIZ'S CO3MMENSATTO.N MS CE ?.I'I U)/VIT i ccnsx/pr;m�ttcc) Vl,ith a principal place of busines residence 1: - -- 8 LD rove (sum t/ci tylaal clri P) jdo hereby certify, under thc.p?ins and penalties of penury, i — { ( ) I am an employer providirl- the following livoricei's cotnocasaoo,,i coverage for lily emplovecs Nvorong on Lius job: l , Corer zy) (Polic: l:� r) _ :pirtSon D2i) I am a sole proprietor, general coau-acor o homeowner r%.e One) and have hired t_he consaciors below wbo have the follot Jep_s non pokles, (t+MC of Co =c-,0r) (Itin mitt c Coi pa y/lIouCi (Namc of Contactor) (lnssran= Comp mviPoum, \urac_r) (Li-Diction Dale) { (N,2me of Connamo,) ozs u-anc Company/polscy N;imb r) (Expir--46on Datc) i (T'2mc of Contramor) (Lctsuran Comp any/Pobcy Numb:.r) ( xpir-joa Darr). (acscb ?�ocai ca.if accc�-}•w c c?uc�iarbl m oc P=lx-;a�io.11 Doc-.ra-a) j ( ) I am'a sole"pFOprietor and have no one working for me. ( ) I am- ,a home owner performing all Lbe work myseif: NOTE:pi=-%c be ew are tx v;Jc ..b�employ pc soar ev a= c�-r�ao a rc^aa wort an.d%,<L -;,of aot mote tin t'ro L-arj is%rich the bomoawvc resid"or oo the p-ou06 tbeev Wt ox —lly oc--d=cd to bc ci0-r-s ua' the--k=Az a=•>r- c.Act(GLi152,=I(5)�_pptin6on by.bomma-Dcr fcr a Gc_or p---mit=y c.•idmx cbc lcpi c_^„of ea e:-ploye aadcr d. Wockt .Coa*. ..L o /,ct_ � ►uaa�._,e dur x aopy of tisi.cat.�nx m.y�roro.enisd w t�Dc�.lmcat or ta�.:s;�n�dcc�osv�or la�...am roc the i cov—a vcrTic3tioa ead ittat L-.ikac to sc=rc tovern-e uodc==ion 25A o ),(oL 152 Qa 1-d to the i=Vosi6oa of aimiaai pc=1 is of a Gm of uP to S 1500.00 indtor tm{sisooza-o1 oCup to Doc yr=r a.ad c%ti1 pca.tia it)tx form of.Stop Word Ord:read, r=of S 100.00 a day tpl= For dcp PCttnit Numb= IAi R Sisnabm-c of Lic=r-scc1Pctm c DKe 1 r } w SECTION 8-CONSTRUCTION SERVICES t 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 3:�Ttea�erMa et Not Applicable ❑ Company Name Registration N um er --— -- Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE"AFFIDA jr(KG:L.c.'152;t,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...... ❑ RPM"MU 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"shalt 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 notresultingin-Death)of the Massachusetts General Laws Annotated,you may be liable for p_erson(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 'i 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 [[3] Decks [C] Siding[O] Other[❑] rief Description of Proposed Work: fNSTrru_+4TlON ___b Alteration of existing bedroom Yes No Adding new bedroom Yes _ No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet sa.l'�N`ew`Io>t�se��nc�Of�a�di�topr�O�extstil�c�:�to�slncl�complete.�fhc�Tfawlnq: 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 y 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-T6, 3E COMPLETED .WHEN -T OWNERS AGENT.OR 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 T �� 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 Name f Signature of Owner/Agent Date = n Section 4. ZONING All Informat-i6h 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 bIdg&paved #of Parking Spaces (volume,&Location) . � A. Has a Special Perm it/Vuhmnoe/Fi nd i ng ever been issued for/on the site? NO 0 DON7KNOVV 0 YES 0 � |F YES, date issued: IF YES: Was the permit recorded ot the Registry ofDeeds? NO 0 0JNTKNOVV 0 YES IF YES: enter Book Page and/or Document# | B. Does the site contain u brook, body of water orwetlands? NO �~� DO07KNOVV �~� YES IF YES, has a permit been or need to be obtained from the Conservation Commission? - Needs tmbeobtained �~� 0�tm�ne� /-� Date v�� �,� ' ' 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 v~~« NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb grading or filling)over 1acre or isdpart ofocommon plan thow@\disturbovor1aore? YES NO `—�K 1 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton Building Department +raP r � ` 212 Main Street Room 100 � Northampton; MA 01060 -� phone 41.3-587-1240 Fax 413-587-1272 «�r APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1 Property Address: This section to be cor)0teted byoffu:e I�h• � - ��t s uw ., ��oR p.re� M�. 0 roG 2 Zone Overiay°D'-tn Elm-S Disfrict ct SECTION 2-'PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name P i t�l�%fir' Curre t Magi Ad e s Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SEGTION 3--ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building D (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. Issued: Signature: Building Commissioner/inspector of Buildings Date 38 ACREBROOK DR BP-2006-0648 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-073 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0648 Project# JS-2006-0949 Est.Cost: $2850.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq.ft.): 13460.04 Owner: HOWE THEODORE J&EDNA Zoning.URA Applicant: HOWE THEODORE J & EDNA fib':-3B-ACRE.BRT:.)K DR - Applicant Address: Phone: Insurance: 38 ACREBROOK DR () 586-2949 (� FLORENCEMA01062 ISSUED ON.1211317005 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL PELLET STOVE 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: 0� 5-Tff o THIS PERMIT MAY BE REVOKED BY THE/eITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL IONS Certificate of Occupancy Si nature: FeeType: Date Paid: Amount: Building 12/13/2005 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo