29-067 CD f
a
Rd d *,'o
e-
� s
5
o �
s
x'
� s
s
61
V
1
11t!
r
o
O
N R'
-- —� W
v u G1
�_ '�•>
Ck
fj
T` OCr
Jul 07 06 04: 23p (4131 567- 5000 p. 1
97/U/I:i9bb n3:n-1 41Jr7CLIAO -- - -- - --
i
hi
Nj
IQ
i
r =
� � I
N-1 R r
CAP- c i
F
4 O
s
Q
m
rl
� ! �- Q
co im
in
\.9
�° 4
C ,
¢StSMIP�.
CI ify of Xorthaillpton 7 (�
.�„ .►�. 1I I-1
DEPARTMENT OF BUILDING INSPECTIONS /?
INSPECTOR 212 Main Street • Municipd Building
North<,unPton, MA 01060 ,
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CNlR 108.3.4 to
act aS his/her construction sup,.: ,- ;or. The 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
F ti lLI1�7 L7I (11MIalliptall
o DEPARTME14T OP DUILDr\C INSPPCTtOtdS -
212 Alain Strcet Municipal Building
Northampton, Mass- 01060
WOMCER'S COl,/IPENSA TON MSURANCE Al=- AVl-j'
(Ii ccvs Pcrml ttcc)
%VI h a pi-Mi cipal place of business/residence at:
Vk`5 (phone-!) ^(�/
do hereby certify, under tic-pains and penalties of pefiury.,- ha
is
( ) I
an an employer providing the following %vork&s cofnoens-�Io❑ coverage for lny
emp10yecs worUng on tilis job:
(Inn-n=Com= v) (Polio Ku-a cr) -- (r:-pirtiorr Date)
O I am a sole proprietor, general contractor or homeowner (c Cie or!e) and have hired
the contractors Gsted below vybo have the fOUO�, ing workers cocpen-Cation policies:
i
0- Co:unci07) (Inn!ranc„ Coinpan)-Pi obci N fumhC:) (i?;>IiJL^1 bate)
(Name of Contractor) (bIS"-L anc: Comoaati/Po!.ie Nulncrr) (Liois,(ion Date)
(Name of Coamclo;) (Insura= Compan)•/Pouq- Numbu) (Espirtieo Datc)
(Na-Me of Contractor) (Iasuranc—c Comrany/PoUcy Numixs) (Expirrtioo Datc)-
(nIISCb=dutocsl r5cd,ifnccaa�•to mc?ucL i7for��oa perainans a all coc7-1•.a:s) .
{ am a sole proprietor and have no one worh3ng for me.
( ) I am.a home o%vaer performing all the work myself.
NOTE:piece tx nVr1rC i+_.�t Jc 6cmcavvcrs v•,o cc�loy pcsam w do rt,as work ova d,,<n-g of
G-0'most Cheer tl roe tmta is Wb-h the bomoo-v rand.a oe the s6 xgpurtenr�tbere c ax occsid=od to be
cxployc-s unC:the- S cr`I 0=*—. ca Act(GLl r-{ inaoo try a bomco.-=fcr=Ucz.a permit rtr--rd—tbc
Ic•gn.!nssu oCaa¢•r,loyor under du Workdr Coaspom.ation Act
f uodcst+ad Chad a copy okbia mtcm.=may bo Coy--xeud.d to tbo poputm ,of Indusr;cl v ndr�tJ Off ou o(Gu none for th.
covoge vcif c=%ioe and th1 L iliac to swuc to�ern ands=clion 25A of MGL 152 m lad to the impos oa of aimiazi peaz -
cooss.;.i�of a r=orup to s 1 Soc.00 arldi c oCup to cog ye:r god cvj]pm,tio is dx form of a 5'snp Work Order and
C=of 5100.00.d_y tpiaa Mc.
For d�'�-,i u,c ody --•-----
permit Numtar
l.3p.—_ Lot
S, �3� E.
curr of LicmtsccJperm.iuc:. •
i
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: 1"u 1�.•` \mil✓t Ll V� d ti 2 9
License Number
l r-ew y�✓ i t u�w. r� ► I� l9�aon2
Address ,r // Expirati n Date
`C V
Signaf6re Telephone
g Reaisteted"1Janeliipra�ententiCotFacla � � � Not Applicable ❑
Company Name Registration Number
l)A[zl aA 0'7�
Address Expira ion Date
C
3,_Telephone
SECTION 10 WORKERS'COMPENSATION INSURANCEAFFIDAWT'(M.G:L.c.152,,§25C(6))
Workers Compensation Insurance affid it must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buil ng permit.
Signed Affidavit Attached Yes....... Id 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
x
SECTION 5--DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors C]
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding(O] Other(E]
Brief Description of Proposed
Work: rOY1 u`d2 is /ZC�,KFd+-M
Alteration of existing bedroom Yes No Adding new bedroom fi' Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a-[f N'ewr oase and �ctc�ifr'el>eta ezistiii railsrrt rimi
. �
.,
~
. ^
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 T
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume&Location)
A. Has a Special Perm it/Vuhunce/Fmdi ng ever been issued for/on the site?
NO 0 DON7KNOW K J YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
'
NO K )
IF YES: enter Book Pug and/or Documont#
B. Does the site contain abrook, body of water orwetlands? NO 0 DON7KNOVV 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained �~� Qbta�nmd v�� ��tm Issued
�-� �~� ' .
C. Du any signs exist on the property? YES 0 NO 0
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,gradingexcavation,or filling)over 1 acre nrinitpart 4e common plan
that will disturb over 1 acre? YES ��� l NO �l��
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton
Building Department HMO, t ea �erau �
212 Main Street
ewer�eprara Ik
Room 100 1 ate ki A tta i ��
01 � ?a° & °
Northampton, MA 01060 �Setsottcuctrr►aliRn� x
phone 413-587-1240 Fax 413-587-1272 Pfas� Ptans a
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
Thissectro to he completed b affice
n
1.1rP�ropertV Address:
G-c aMap tat unit
`dew
Zone OVerFayr Qtstrrct
EliirSt Distr[ct G�Distrrct
SECTION 2-PROPERTY OWNERSHIP{AUTHORIZED AGENT-
2.1 Owner off Recordk;,� �^ i L L L� -7 V',L rc, r� �PVi/ t �C.In�aC
Name(Print) Current Mailing Address:
(0,,A Telephone
Signature
2.2 Authorized Agent:
fq7 ST 5-Fab
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 �"° (b7 Estimated Total Cost of
Construction from: 6
3. Plumbing C.�a Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) OOV % Check Number
This Section:For Official Use Only
Building.Permit Number. Issued:
Signature:
Building Commissioner/inspector of Buildings Date
File#BP-2007-0028
APPLICANT/CONTACT PERSON Mark R.Daviau
ADDRESS/PHONE 121 Brewstwr Street SPRINGFIELD (413)796-1716
PROPERTY LOCATION 7 GILRAIN TERR
MAP 29 PARCEL 067 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
VBl uildin Permit Filled out
Typeof Construction: Convert Garage to Bedroom
New Construction
Non Structural interior renovations
Addition to Existing
AccessoEy 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:
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 Commission
d /a G
Sig Wafture 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.
�'� �"� �' !`t X2.8 �,q���
rJ�
� � �,
---;
- __
7 GILRAIN TERR BP-2007-0028
GIs#: COMMONWEALTH OF MASSACHUSETTS
Ma,o:Block: 29 -067 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category'Non structural interior renovations BUILDING PERMIT
Permit# BP-2007-0028
Proiect# JS-2007-0043
Est. Cost: $18000.00
Fee: $75.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group: Mark R. Daviau
Lot Size(_sg. ft.): 11761.20 Owner: BOOTH RICHARD A
Zoning:UKA Applicant. Mark !~C. Qaviau
AT. 7 GILRAIN TERR
Applicant Address: Phone: Insurance:
121 Brewstwr Street (413) 796-1716
SPRINGFIELDMA01119 ISSUED ON.7/10/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:Convert Garage to Bedroom, hardwired smokes in
whole house
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: 7 p 6 House# Foundation:
vvs/t Driveway Final:
Final: Final e/l 6 � Rough Frame: k 7 2�) e
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: Q H 19—L/-oz,
THIS PERMIT MAY BE REVOKED BY THE C Y OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy signature:
FeeType• Date Paid: Amount:
Building 7/10/2006 0:00:00 $75.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo