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35-275 (2) L Ll1 of �eL X. Fef VC9�a�� 1 lo.t �v�nw[ t C'aS2 u-A jci 1 f S k,!j I LA V D w � m n - n 13,1k AJ ©��f�fs Li 7y �lo �c�ie � ��Hl►MPJ. �+o-\ Gift' of Wart4au ptan L 855RChITB[tt4 c S DEPARTMENT OF BUILDIT G INSPECTIONS /= INSPECTOR 212 Main Street • Municipal Building 5\,0( 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 his/her construction supc:,,isor. 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 hour), a rough buildinL 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 } E ±i�cssrccilnsrtle ^� m DEPAR'r1.;ENT 01' LUILDING INSPL'C I0Ns 212 Main Strcet ' Municipal Duitding Northamptoll, Mass. 01060 ' NVORICER'S COMPENSATION INSURANCE A fTI A�r1.T (liccn.e:iC!':mittce) �:itll a principal place of busiresslresdcnc _A.1ciS' (strc°UCIt r: :rip) CIO heI-CiDy cci—LII Y Lr7:i 1" tl]C pni-1S i'.iid pcn ?i1C5 Oi pC�1111�, r.ha" I any an eriapioyei- providing tll'C iollov.''it1C '• :)Ct:Cl1S compcns Doll GOVCI :. C iUr IIly employees working on this job: v (Ins—=CZ Cora am') e c, Nu_-1Eyc;) ( j I am a sole proprietor, ge'n°rat (circle one) and t:a.� Hired the conuiaGtors llstei below tl]C. i01C'.'��i;� '��OrKe;S GJ JeIl Oil iOiiG'.CS; (I�(lIIIC Of COr1tI'1Ci0r) (LASE^II C:. COI:'?�`::i1,rPOtICJ 11t1SIl�r) �?': -�•�0'DziC) (Name of Contrctor) -- (1,-Sur,_ncc Comp .,%Tpo iev Nurnb^s) (i D Z lion Date) (Name of Contractor) (Ins ��yc� Co n;;an.;i?olio: Nnmtr�r) -.�;.s�:ion Daie) - (Name of Contractor) — (InEuraric:. Cornr.;y y. Pohcr Nlumb'^r) (attaca i r ( I1IT1 I: sUlc 17rC)pr]C tvi c:Iltl havC no op,3 ''.'.'U!:�_iL 1o1 ?]le- } 1 :1111 a home Cw?1Cr iiCil',`i?11Ii7 al� iI. iL`i' It NOTE plcasc be zmwc t1s:"vL.;3c]xrrco,,Ir-rs . .o csap!.^,,- to c.) -===CC, not utoce than throe uniu i^ u Cc eatployc3 ttr.:vc:i:n,cc^ _.._..-n,'r (GL.S� •!{511 - ._..:ic•;. hn:::m. rr`or a i ccx a p:r......- ... time ._ ltgal riatua of an c=xployer under tL�Wco kc.'.Co,-mwrr-aiion!.cL I undo-st.+..ad the a copy of lh:.ctatcr.s•n:.4y Arcid�:f QIrne of for 11x cove veri5=1ion and th t f.Au:r to in.:;:trot-r M ut 3::cc.iM 25A of M01,152 mn Imd to the impasiiia ctixilis2ing of a rrnc of up to S 1•SOU.CJ n:t.".'c�r i'::prisr.�:.;.1 of::p Lo or.:}--.. ..-.j civil peruitia in do fc-,nn Cr n S!r,,`;.'c*i.C}z._ _^,d L•rn oCSI00.W a day main;!rn-- . F,lkr 111n1`d u.o only i Pcrrnit N t1inb-r _—._.-----.---____-` ------� __ .- r- J!�n1tuCC t) 1.iC�:t:J_:;fi)Cfnl i•.t�:, i 4 !- ' t r=CT QN 8 Cdh7 -TRUCTION SERVICES 771 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : I��U: 1 G le O 6 b b 2t+ RA ji l ,,/�/► License Number 30 c S� �.., l�r,5'7 /'r/' . G;cam 7-28- 014 Address Expiration Date 4--n sy5 sgs, Signature`7 Telephone Regrstee ROSE e mnrouernen't °ontract � Not Applicable ❑ G, <- /-/,^,e- I/ 3 Z 00,4 Company Name << ] L Registration Number mo Address Expiration Date Telephone SECTlOIJ lb WMARS' COMPENSATION!1N5yURANCE,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....... 0" 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 them 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 t EEE`v SECTION =D S fZ P OT+IaPROPOSED VI/ORK check all a I'catle r .�, .•".P.1'T'£''3,4...'s'_'.��i�a?...�a2�3"rtrt.'?, ,.u',<< .a.= Sa :' .. i, :,N!;Y .,v`z„"-� .....: ..+",�'' New House ❑ Addition ❑ Replacement Windows Alteration(s) f� Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs L[ ] Decks [ ] Siding[ ) Other [ ] Brief Description of Proposed Work: I&1124 2 Xy / as Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes No 7,1.1 /`d jYJ r-,* Attached Narrative 0 Renovating unfinished basement T Yes No Plans Attached Roll 0 •Sheet 0 T 6a. ME Ouse dci'ition to ez sung ousing kc ple a tfie foilowrn 2"� '� ° c s °�s a. Use of building: One Family Two Family Other R �/ �/L So$&,Idt..( b. Number of rooms in each family unit: Number of Bathrooms IF/.t(ucv%1 10 e—J c. Is there a garage attached? O, G d. Proposed Square footage of new construction. Dimensions ��„ �.,r,•:�� e. Number of stories? i2 yi2 f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck 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 Nc 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 SEC�TOTI0}A(NERf�UMIZATION =TO BE COMPLETED' WHEtV O YNffS ACENTc0 j'C0NTf2ACT0;R APPLIES OR BUILDING'PERI II ; G��� � � ;rte ►b �Ce.�ne�,/ as wnPr of the subject property hereby authorize l u;�-, 1 �t to ac; or my behalf, in all matters relative to workg authorized by this building permit application. ` &z d ��-v( �2 / 7 G Signa ure f Owner Date g l{ as Owner/ thorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to t knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of wne get Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW ✓ YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: 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— No - IF YES, describe size, type and location: i - OtV,Of'Northampton E_ �t �Bullil+ng Department 2f2', Main Street � � .Room 100 FC6 i 2N;rthanmpton, MA 01060 phone 413-587-1210 Fax 413-587-1272 < APPLICOION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION NT sect�an# be completed by office 1.1 Property Address: M � as � { MJV m 3 � nsw s .'Unit 7q �no� I&.n gyp° OrF 1 SECTION-2-PROPERTY'OWNERSHIPIAUTHORIZED.AGENT 2.1 Owner of Record: J ii M- 'J %A Ark JVlvry "J 11� .���v 7gcy LNnJ -Drr. Name(Print) f Current Mailing Address: 4Aj k 6-ft7-3 l '11, Telephone Signature 2.2 Authorized Agent: /eEu ., 31y Name(Print) Current Mailing Address: SiI9- X6-1 Signatu Telephone SECTION 3'ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official-0se Only completed by ermit applicant 1. Building {a)`Building Permit Fee I i 000, 2. Electrical (4)Estimated-Total Cost of Construction'from T6), 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2+ 3+4+ 5) J Z 580,E -Check Number This Section"For Official Use,0611y Building Permit Number: ,�3/,G>�f Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2004-0806 APPLICANT/CONTACT PERSON Gale Home Improvement ADDRESS/PHONE 319 Pine St AMHERST (413) 549-5951 PROPERTY LOCATION 74 WOODLAND DR MAP 35 PARCEL 275 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: FINISH BASEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building_Plans Included: Owner/Statement or License 060020 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOQ V ATION 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 C ssion L 11,9 Lo Signature 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. a . 74 WOODLAND DR BP-2004-0806 CIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35-275 CITY OF NORTHAMPTON Lot: -001 Permit: BuildlnQ Cate orb BUILDING PERMIT Permit# BP-2004-0806 Project# 35-2004-1195 Est. Cost: $12500.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Gale Home Improvement 060020 Lot Size(sq.ft.): 67953.60 Owner: KENNEDY MARK M&MARY JO Zoning_SR Applicant: Gale Home Improvement AT. 74 WOODLAND DR Applicant Address: Phone: Insurance: 319 Pine St (413) 549-5951 AMHERSTMA01002 ISSUED ON:2120104 0:00:00 TO PERFORM THE FOLLOWING WORK.-FINISH BASEMENT 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 Sip-nature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 2/20/04 0:00:00 2158 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo