32A-195 (2) r,
1r
i
r
i
r � i
N,al
t a
n
U
\NO1N�e�p60S
�OF g0\I�ON,MP
pENOR�HAIA
r
vk r F
ALI
q
u I
�8358Ch1iSttt6 -
<a 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 his/her construction super,'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 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
ti �i,xftr xzf1Lt� t1 �t»t tc1tt
� 6 Ji1ccsacElrtsctts • —
UEP AI R TlvfENT OF' EUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
Nv0r,TCE,R'S CO3'Y1TENSA'I10N 1NSUIZANCE A_TFIDAVI.T
- -•..�-; ------(Levy.:^:;'rr,m;tree)
�:rith a prMc]pal place of buslressJresldcuc� -.
d0 11cl i b j' CC L1I}%, lla:' 1" L11C' 1)::il1S 3ii7 1)Cil i i S Oi iCr)lll�%, Ilfl__
I am ari ernployel' providing the fol]O'.V1Iit_ % oi- cr-S C0II1PC;1s�UO13 CoVCI-1.11C or III},
e]ilployees working on this job:
(InsuanG Corsp�ny) �.e c.Number) ---- (E=pirdoa Date)
1 a.a1 a sole proprietor, gen°ra l homeol•-Veer (Clide one) and 17ave 'Hired
t.11e contractors fisted beiov :,to 1,:- ,- the oil` L, �Ockers c-ot pence`Orl ofic es:
(Name of N=bcr) Date)
(Natne of Conm,.c,,o-) (71ts]r_nce Co _.::`vPe!ier Nlmrrr) (I3 r tiny:Date)
(Name of Coatacior) (lris:]-sl:cc Cott;"n"'t io!;C. N17II1tfIr) '.X, r:i:'`- 1:ate)
-
- (Name of Contractor) — (laslra is e (E;:r17,no n Date)
76�.^.(:.]Gl-`-C�-ii:1 CC:11 S'Y�t:..._'... _., ..ri..�.: ....'Y":1"..t:�='._.... 'li.:(._.__-...•\
1 211T1 t. �OIC f?IOj)C1 LJi i'.i.�� !1a e 110 OIl
c�
NOlfi:hlc uL=n acLs:•ti :]clr'<;<o :ra w•�r_pf , nd :roc ::anc ar:c_rwmct:ct:.t. �«cl!i g ..
not uxce tti-n dirce t:niu in%,il:c'i u a;L`- _:.�_ ,•_t s'Lhcde a c rx4�c>fally ccr:::r:c :o It
ca'.Ployc3 (GiA 2:z!(Sl). y a hotaro«
local ctazuc of an cnployx under t::n WorkoeS Coi,wr a:ion�.cL
I rind-.-st. d that a copy of thii etat=: --r:..y bo fc,,N iod to t!'r IY-Snrtair U of Ind�trie]Mal : C;iaa of i:::+-�r�:n for t!x
covctigc valfic_tioc and th_t f_ilurc to ut)J•::s4a61Xl25A of MOO 152 can Ic_d to tic imPOSiticvt of r. 1 ptt nl:a
comizting of a fur_of up to S 1.500.00 an cc m:Pr v:�-I;,- of::p to en-}- r.:.i evil --Ulna in''c fcnn of 1 S!c- `;v` Y C} =t:A s
frn o[SIO.2.CO I dsy igninst rns.
_ ycr dq=uuint1l u.c cr:ly
�1.....�-.. • 'E Ptzmit Numixrr __— ----------------1
SECT30iN 8 CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : ✓ � �'l�� _��l'�� �/'/ �� �
License Number
Address ExpAtion bate
Signature Telephone
ffl � .gem on racto s. Not Applicable ❑
-Re ere- .�m /� _-
Company Name Registrati n N tuber
P2 Address Expira ion Date
✓� ? �✓' Telephone -7,
SECTIQH 30 1NORKERS' 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....... ❑ 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
Y
SE TIOfI»» �S PT ON OFFROPOSED WORK check Ff ` Ircable 4,
� - -
New House ❑ Addition 0 Replacement Windows Alteration(s)-�, Roofing ❑
Or Doors ❑
Accessory Bldg_ ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: r°GriLt'/ t-vl-�t��_ - ' �v _ ��7'�SC 'V AC.;K)O,% -- �G✓i,Cf Fva
6r,
Alteration of existing bedroom Yes _No Adding new bedroom Yes
IS No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0• Sheet 0
6a 1fi l e ouse d or ad i ion=to 0fl§ i R-VK0 n comphe a the foll:o lyk:
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. bimensions
e. Number of stories?
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 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 7aO1NNERAL)THORfZpTION -'TO BE COMPLETED WHEN
OW IERSAAGENT'0 1,CONTRACTQR APPLIES FOR BUILDING PERM17
A .
as Owner of the subject property
here authorize to act on
my b 71 i all maTi s relative to work authorized by this building permit application.
Gr
Sig Mai re 0 n D e
I, l �,1"�t/ /�� JC�F<��t iS � � ��'''� �� ��As�� er/.Authorized Agent
here'6y 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.
Prin e
` r�10 _
SignGreof can er/Age, Date T
w
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 jGf W
Frontage
Setbacks Front ��sE sf
Z ,Pu � I �w 0
Side LCD R: L: UFO R:.7 �J
i
Rear C 5 / , e,
Building Height �
Bldg. Square Footage I %
Open Space Footage %
(Lot area minus bldg&paved ^�� �J
#of Parkin Spaces �� —1
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW 4!5 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 2--S _ DONT 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:
..ofi Northampton k
i +g Department
1 Main Street
' om 100
No pton, MA 01060 :
240 Fax 413-587-1272 '
n
y
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITEINFORMATION
1.1 Property Address: £
ThW section to be Completed by office
I as 3 h ' _nk
a R 3?
Zone OveNay D
_ tsMct
- -1 �ISL ✓i�; ITT 3
SECTION'2-'PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
NM—me(Print) urrent Mailin ddreA:
J �,0 � z Y
Telephone
Si re
2.2 Authorized Agent:
Na (Print)_ Current Mailing Address:
Sig ature Telephone
SECTION 3- 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 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 ytj d
,c? This Section For Official Use Onl
Building Permit Number:/✓ l>S3 3 k Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2005-0338
APPLICANT/CONTACT PERSON COLIN HOFFMEISTER
ADDRESS/PHONE P O BOX 1301 Northampton 584-4665
PROPERTY LOCATION 24 PHILLIPS PL
MAP 32A PARCEL 195 001 ZONE URC
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: CONVERT EXISTING PORCH TO 3 SEASON ROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 078842
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQRICZATION 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
Signature of Building OfficiaV 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.
24 PHILLIPS PL BP-2005-0338
GIS#: COMMONWEALTH OF MASSACH1JSFTTS
Map:Block: 32A- 195
��rT
Lot: -001 PERSONS CONTRAC .
Permit: Building DO NOT HAVE ACCES; City of Northampton
w � BUILDING INSPECTION LABEL
ry
Catego : N d
Permit# BP-2005-0338
APPR VEL7
Project# JS-2005-0446 Inspector
Est. Cost: $8200.00
Fee: $50.00 PERMISSIONL Date_ D q
Const. Class: Contractor: A.Mense: ---- --
Use Group: COLIN HOFFMEISTER 078842
Lot Size(sq. ft.): 7884.36 Owner: FLYNN CHRISTOPHER T&AISJAH T
Zorung:URC Applicant: COLIN HOFFMEISTER
Al 24 PHILLIPS PL
Applicant Address: Phone: Insurance:
P O BOX 1301 584-4665
NorthamptonMA01061 ISSUED ON:9124104 0.00:00
TO PERFORM THE FOLLOWING WORK.-CONVERT EXISTING PORCH TO 3 SEASON ROOM
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:jfJ�j House# Foundation:
Driveway Final:
Final: Final: �, n
J Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:ox
THIS PERMIT MAY BE REVOKED BY THE CI Y OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS
Certificate of Occu anc Si nature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 9/24/04 0:00:00 111 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Conmlissioner-Anthony Patillo