35-113 I C)
1, 4%, /ip
Cily
]cmc
lwllt k—Itudal
In[ ti1-J.111"li.111 A 'll[
ill hv-,-Fvf�w—lild IlIxl,-;t Il'ut
Ow -il-qwl.11
11 -%-put IlIvrit"Ill It,;,Contract it,111-11 re-illspktutioll III-111t,jolt,Illmle Depot(leternlialv%11-1 it
perform its 'I'le to:I-.0110111'al prol"ith Hit,Itu ntc,ill icilv,!"l-runs or Lek—a.....wort 'equilt-41 to
cum piel, liltij"ll,wl uuI i—hided in the Spe"SI-1 or I -Ilravl. D11-:11011,11 F PAYMENT I IPTIONS
•RA V AN 10 1
i.tq.
3,(D L9
ON 0 1 1 N Cfili,A-11..111 lull .ill),c
\[inluuun 2581.ul 4(-I-d (111(.4 illm
I ,, I)A,.
"I'Allild ji"ll Ill I-A
DIA"ON.CON11111F,I ION i'w Ow(Ivp.v il illdl. 11"1
Mll.m 11DUCAllillorizatma Colic,
Final P:,)wo,1
.:l Wv A 11 hil lmxt will oilliple6oil t 11A pX "W.
it .m 1 mid 11,1111, i1.ttvnnlrr
ilily .ilwlii illl�;l plci 111.1111, 111"i')t1v wl.-nwill
I I'.-A l'oll 1) lfi��
I Xll,
ill a
JZ
ou!•i"; ho ifflc,'-!;:t opi lit 1c
;-cp i!
11-1),IIL
clqA pirti'm i)t 11; "mi f 1 :w, 6 1, cov'nl,
11.7 1;Olt loje il
,I .;v vi:l
,:i- lo lni,illi�thi n! I!,( bu�ia,
iu zwthl. I h,
..1!��� I
ti rl 1.a 11
I IN :it l tA%: P 1A,I v1l Nid 'I C 1 11 1�1 1 11 11;. t I I IA
I X 11 12 1 1 k I
I I-A 11 F t t'l I I
!Vv I I I it A, 1"1.1 Ml \1I I NI v,i I W I)1
\Nl;1 1: Affl
(W", AN I) vl;0 Ai 1 1l I 110i.T I lj�p(yj
k v s\( I
: 1 1 PFP(11T IM J
\1'1
cl -450ja euuu egE :So 90 06 2nd
Gl ify of Xart4aniptrrn L r
1�835ACli llSttt9
DEPARTMENT OF BUILDING INSPECTIONS /=
INSPECTOR 212 Main Street • Municipal Building
Nordi,wripton, MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as l:is/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 fanxily
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
�ILA04 p .
CrI 3 of TnrflJa�11}�fflll _
B ~ E �Z asa RC}(nsrtra'
DEPARTMENT OP BUILDD\10 INSPECTIONS
212 Main Strect Municipal Building
Northampton, Maes. 01060
«'OTUCCR'S COAZT'ENSATTON III'SURANCF- AF=AVFJ-
(li Ccn SCC/p' trli tier)
v.Ith a principa place of business/residencc zt:
J (phone--) e 3()D l % 519P
(sa VLity g2ir_'rip)
do hereby certify, under the pains and penalties of penury.; hai
( }� I am an employer providing the following worker's cornocnsE-:ion cove Ike for Inv
etuplovees \vorlang on this job""
v C-0(0- --- )D-7
!, (Ls>stir-� r : i zrc)np:n ) (Poke: Numb-r) (rp
O I am a sole prowrietor, general coouactor or homeowner (c c:e one) and have hired
the contactors fisted below Tybo h.2ve. the follo%ving workees com?ePs2tion policies:
I .
I
(`+IIIDe of GO:?C^CiD") (III5UrzncC_ Cornpa.rl)-iPrbci NIumh—) �XJIlJt3^P, l�alC)
(Name of Contraaos) (Lrlsarz = C-omna v1?olic- Nunccr) (Ex-D ton Date)
(Name of Contractor) (I.nsurancc CompanyRoUcy N:1mbu) (Expi;z600 Datc)
(Name of Contractor) (Lasurancc Compaay[Poliey Numbs) (Expui-Jtion Darr) .
(mach zddi�odl cScct.if ax�rz_t•tn c�esutL iaformn.�oO prrta�to all ooa7er_o:s)
{ ) I am a sole proprietor and bave no one work-ing for me.
( ) I am.a home owner performing all the work myself.
NOTE:plcsc be na-arc d".wjz c bomcoµ=M wbo carploy pcsom to cU -• ccr,_—zt oo c rgair worX oa of
ont mac then tfzv-,s is whh the bomoowo=raid.=oc oa the V oundr zapurtc++•*+tbcao L- Ooc C ez y oc=_&an w Lx
eixploycr ante the kxS ds oexpc s do Ar (GLt S2 n t(5?� a4ptin.600 by n 6amroav�fc n liC�v a perrar+ray e id-aoc the
Icp1 r.-=of as c=;Aoyx under dw WorUec Co¢Rom.lioa Ao-
1 uadcrsza,ad r>�a a Dopy oC chi.mt®aar may be rar�.urded to tb•Pcpa.rtm«orlodattsial,,ceaaba'Offioo ar 4aur.noo tar t>b
comer se veilasiOO n:16 th1 L-um to Legate tov�cider s0c oa 25A of h(oL 152 ew ied to the imPOSitioa cdc-imiosl pau$io
o o o:L!a ora f l o c orup to sl}oo.00 artdror impriyoam=y orup to Doc year end civil pmaltio is the form Ora stop work Order nod a
fig of 5100.00 a day apima mc_
For dcp.rura=il u.c Drily
PC.rMj11`ttt.II]bC7 -
9 __ Lot
Si o L"tc=rsccfPCrmittcc to j
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
iitracto , A Not A Pp licable 0 1' rn aie eentg–n
M4D_1JOEIE 156 RJ try
Company Name Registration Iqumb e
Address Expiration Date
Telephone *4 9321,
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G.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....... EF- No...... I7
9 P11-1
I
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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [[3] Decks [p Siding[0] Other[p]
Brief Description of Proposed n��I
Work: ( I rl-7
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa f dew-GzOClse:ar c of dltlor> ayxjs ma-:1iOr sera ROO�rptete die 1 �nr�ng:
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
L 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'COMPLETED WHEN
OWNERS IAGENT OR CONTRACTOR APPLIES.FO.R..BUILDING PERMIT
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.
D�
Signature of Owner Date
as Owner/Authorized
Agent hereby declare t at the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under a pains and penalties of perjury.
I 2_
Print Name
Signature of Owner/Ag nt 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/Vahunoe/Fmdi ng ever been issued for/on the site?
NO 0 DON7 KNOW 0 YES 0
IF YES, date issued:!
IF YES: Was the permit recorded at the of Deeds?
'
��
NO �� DON7 KNOKNOW YE3
IF YES: enter Book Page and/or Document#| |
'
�� ��
B. Does the site contain ubrook, body of water o,wetlands? NO x���� VV �_�DON7KNU YES �_�
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs tobmobtained x�� Qbtminmd �~� Qmtm |s Issued:
��v �~� ' .
C. Do any signs exist on the poopert �� ��y? YES �_� NO k~�/
IF YES, describe size, type and location:
'-
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre nrinitpart ofo common plan
that will disturb over 1 acre? YES ��K ) NO ���)
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
\ '�City of Northampton s' � � � t�`�
Building Department
MAW
212 Main Street r MAE
oom 100 -`
g Ngrtha ton, MA 01060
S�Q phone 44.3-587-1240 Fax 413-587-1272 tx
4PfOG kTIOWTO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION-1 -SITE.INFORMATION
1.1 Property Address: s
7h", dab, 'to i compCeted byaffice
�_ Mai dot r iJgtt
24ne� O�erTay3rs€oct
Ehrl £ istrec£ CB DisfncL '
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Addres
Telephone
Signature
2.2 Authorized Agent:
Name(P' t Currenf Mailing Address:
- y®( 4735 QZ73
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 (b)-,Estimated'Total CostW
Construction frorn. 6
3. Plumbing 3dilding'Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) r Check Number °
This Section-For Official Use Only
Building Permit'Number. :
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
� S
34 CAHILLANE TERR BP-2007-0309
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 - 113 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2007-0309
Project# JS-2007-000468
Est. Cost: $4529.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sq. ft.): 9931.68 Owner: NEWDOME LYNN R
Zoning: SR Applicant: HOME DEPOT AT HOME SERVICES
AT. 34 CAHILLANE TERR
Applicant Address: Phone: Insurance:
345 GREENWOOD ST UNIT 1 (508) 341-9401
Workers Compensation
WORCESTERMA01607 ISSUED ON:911912006 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 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:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 9/19/2006 0:00:00 $25.0014906
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo