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42-165 (6) ✓f� pp ie �n��ama�uue¢�i BOARD L OF BUILDING REGULATIONS icense: CONSTRUCTION SUPERVISOR Number: CS 046013 Birthdate: 04/14/1948 Expires: 04/14/2005 Tr,no: 12007 Restricted: 1 G MICHAEL F BROAD PO BOX 94/36 BRIGGS RD .. SHUTESBURY, MA 01072 ° Administrator FOUNDATION PLAN N CONTINUOUS FOOTING o � o � 24°X24"Xt2"FOOTINGS 6'-3" 6'-3" 3-2X10 BEAM POCKET O 3-2X10 BEAM POCKET l9 5-2 1/2" 6-2 1/2" 4'-ii 1/4" 4'-li 1/a° 3'-8 1/2" TOP OF FOOTINGS SHOULD MATCH FOUNDATION FOOTINGS M SCALE: 1/8"=l' ^ J t� t.. pT goo -ity of NorthalliptIL z �118SEACltIlSttt3 r _ DEPARTMENT OF BUILDD�,YG 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 visor. T he state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two fam►nmily _ 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 iegulations. 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 p oper permits and 'nspections are made k�� c�- I — J _ understand the above. (hoM4 okne r/residen '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 l� 1 F E Cfj'ZI-�3 of tTrf Iju111ptoo .63 a 3s a ch ncct Is* a DEPARTMEIJT OF BUILDf),,,C INSPECTIONS 212 Main Strcct Municipal Building Northampton, Mass. 01060 I , I WORKER'S COYTENSATION MSURANCE AFFMAVIT AU t 6j-�r r (ficrnsxlper•cn�tfcc) witb a principal place. of businessfresidence at: — - �1 LJW C- jjj (Phone. s') (,e (sn t/a t}/statcr�p) do hereby certify, under tlic.pztnt a od penalties of pefjury, --hpi I - I ( } I am an employer providing die followine!worlccr's coinpcos:do, cove age for [fly elnpfovecs NvorUng on tills job: I i (instiran=Corer ) (PcLic:Nu--ter) (r;pir�uor, DzL) i O I am a sole propretor, general contractor or homeowner (c cie one) and have hired the contractors listed below who have the followi.a workees cot's.' Jen_tadon okie - Q p s- i ('1 11 2c 0- Conl acior) (IriRfanc:CoinpanyiFo6c !-"LLMLGr) tt_Y Jtr 1 it? t�alC) (Name of Conraaor) (InsJrznee ComDaa}y1'o!ic_� Nunc^r) (—Ea-Dirzdon Date) I - - i (Name of Conuaeto:) (Insurance Compan)•/PoUc- Number) (Expirzden Date) (Name of Contactor (tosuran Comcaay/Policy Numbs) (E��imdoo Darr) . (aBS.cb:ddi�oCSl c5cC.tj acocia_-y to mcvcLiafoctn.3 on pertsiains b all ccm-_LV:s) . I O I am a sole proprietor and have no one wori,3ng for me- ( ) I am,a home owner performing all the Nvork myself: +I NOTE:plesc be eR 17e(fi,•`F c bemcO.-O=ut-ea-mPlaY Per oat w do¢- cs.aj-Da c rc au waric as c d..crL.Z of itot mete than t'so��i�in 11-bb the isomeo we rt d.or oa tSx pvv z�purtca tyeen t c Do(gr�..Uy co=al.-•cd to be civloycs and=the�o i a.p=Lx,•m Act(GO 52.n 1(5)x,�pLi=too by a bomooaaa fcr a 6=r—_or permit n_y c%4dmoc Lbc legs!a=^,• of.=¢ployx under dto WoAY -C,ompea--6i Act I 1 uad"'ad th.e a Dopy oltbi.mtcmcn may be foe vid•d to the(} mm¢of 1n�asriJ Acoe-=z'OfG—oC kau+ooa foc tS. oovc1�6-v if tzlioa and that L•ika'c to—'CO--aSo track zocioa 25 A of r.(OL 152 cta tcLd to tba impost ioa of c imioA pco-%wcs 0—iSS�of a Gnc orup to S 1,500.00 andJor imp of up to Doc yr=c.od ci%-U pcuahua is dx form of a Stop Woric Ordcr and ri=of S 100.00 a dy Pi La rat Far daps a,= ,r u,c ont7 Permit Numb= i.fap: Lot Sti-- >LU c of Lic-scclPcrmiucc — Cate -- SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: c Cs in Lit, License Number B 1A ((q / Address Expiration Dat Signature Telephone 9:Re isered l�tonieirt ravemer► Cofttractar Not Applicable ❑ Company Name Registration Num er - - Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE;AFFIDAUtT(M:G:L.-c 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 fiable 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 r ! SECTION 5--DESCRIPTION OF-PROPOSED WORK(check allagulicable) New House Addition ❑:. Replacement Windows Alteration(s) Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding[0] Other(E I Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No . Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll Sh — a. Use of building:One Family Two Family Other b. Number of rooms in each family,,uwwnit��: 7812 Number of Bathrooms c. Is there a garage attached? V A) _ ^� d. Proposed Square footage of new construction. © Dimensions e. Number of stories? (44--, )(— f. Method of heating? CL.^. Fireplaces or Woodstoves _Number of each g. Energy Conservation ompliance. 1_ 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 Yes No j. Depth of basement or cellar floor below finished grade -7 ' k. Will building conform to the Building and Zoning regulations? JL"I" Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION`Ta-OWNER: J Section 4. ZONING All Informatioh 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 c Lot Size Frontage - L Setbacks Front I Side L:+ R: L= R:' Rear Building Height '' - -- - f Bldg. Square Footage j % Open Space Footage % (Lot area minus bldg&paved t �-- parking) #of Parking Spaces Fill: r 'A � (volume,&Location) •"W A. Has a Special Permit/Variance/Finding ever been issued for/ the site? N0 Q DONT KNOW 0 YES IF YES, date issued:' J4'r93 -2-,Oz IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page; and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Date Issued: C. Do any signs exist on the property? YES NO Q 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 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O , NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r x mpton City_of Northa p Wding Department ; } `212 Main Street Room 100 e ry nnr t t ctJ Northa pton; MA 01060 e e o `i L phone 413-58 -1240 Fax 413-587-1272 k?t�s �r W.. APPLICATION 110 GORSTRUCT,aALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE'INFORMATION This sectron to he #!PO !i b office 1.1 Property Address: ,�//V Zone" Overlay Distract.� "`„Fr1Ftt S �IStr�Ct - SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: t Q[ob 2— 2 Na (P rat Current Mailing Address: K�tJ �t� Telephone Sig ature 2.2 Authorized ent: TZ Z� N m (Pri Current Mailing Address: Sign t Telephone SECTIO43-ESTIMATED CONSTRUCTION COSTS Item ~ Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building �p� (a)Building Permit Fee 2. Electrical (b)�� _l (b)Estimated Total Cost of V Construction from 6 3. Plumbing 0 Building Permit Fee 4. Mechanical(HVAC) V 5. Fire Protection /0) �✓ 0 6. Total=(1 +2+3+4+5) 0 Check Number This Sectio6For.Official Use Only Date Building;Permit Number Issued; s.�a Signature: i Building-Commissioner/Inspector of Buildings Date File#BP-2005-1040 APPLICANT/CONTACT PERSON Pioneer Valley Habitat for Humanity ADDRESS/PHONE P O BOX 60642 FLORENCE (413)586-5430 O PROPERTY LOCATION BLDG#3 -840 WESTHAMPTON RD-LOT#2 MAP 42 PARCEL 165 001 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: CONSTRUCT FOUNDATION ONLY FOR SFH/W ACCESSORY) New Construction N n Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 046013 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF TION 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 Co ssion Signature of Building Official Dat 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. BLDG#3-840 WESTHAMPTON RD-LOT#2 BP-2005-1040 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:42- 165 CITY OF NORTHAMPTON Lot: -001 Permit: Buildim Category:ry: BUILDING PERMIT Permit# BP-2005-1040 Project# JS-2005-1428 Est.Cost: Fee: $315.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: 513 Contractor: License: Use Group: R4 MICHAEL BROAD 046013 Lot Size(s4.ft.): Owner: Pioneer Valley Habitat for Humanity Zoning: SR Applicant: Pioneer Valley Habitat for Humanity AT. BLDG #3 - 840 WESTHAMPTON RD - LOT#2 Applicant Address: Phone: Insurance: P O BOX 60642 (413) 586-5430 (� FLORENCEMA01062 ISSUED ON.512105 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT FOUNDATION ONLY FOR SFH/W ACCESSORY) 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 5/2/05 0:00:00 $315.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo BLDG#3 -840 WESTHAMPTON RD-LOT#2 GIs: — COMMONWEALTH OF MASSACHUSETTS Lot:-0 1 42- l bs CITY OF NORTHAMPTON Lot:-001 Permit: BUlidinci Ckk&0-ry-- BUILDING PERMIT Permit# BP-2005-1040 Proiect# JS-2005-1428 Est. Cost: Fee: $315.00 Const. Class: SB PERMISSION IS HEREBY GRANTED TO: Contractor: Use Group: R4 MICHAEL BROAD License: Lot Size(s4 ft L 046013 Owner: Pioneer Valle Habitat for Humanitv z°Wing sip Applicant: Pioneer 'Undey Habitat for Humanitv App l'cant Address AT. BLDG #3 - 840 WESTHAMPTON RD - L.01#2 P O BOX 60642 Phone: surance: FLORENCEMA01062 413 586-5430 In ISSUED ON.512105 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT FOUNDATION ONLY FOR SFH/W ACCESSORY) POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service:• Meter: Rough:2--1^1% R 3 Footings: Rough: fl' House# Foundation:o< �iyla G lhF� Driveway Final: Final:/(,-,7 4-,,,kFinal: 6 K i-LI04106 (jAF Rough Frame: OK 03to106 l,vuf J Gas: Fire Department Fireplace/Chimney: Rouen:°�-�•( 4( Oil: Insulation: ply( d3 29(0� S'TA),/ Final: Smoke: , b +1�3/� L g Final:_al-,( IZ i� Ob Lu�cs THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate Of Occu anc � Si nature: FeeTyue: Date Paid: Amount: Building 512105 0:00:00 $315.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building=C'ommiss?n=-^.nthra •Patil'•