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17C-201 • J. I . ..._..........,„ . . . ,,... 1 .. . ----. . . . . ., . __.fr_-_--e4.___ ... .., ,,,)fr, . , ..... k O h 4) 1 y JJ y ; fG l S a SA U SAVINGS BANK ,6 U, / M '� S 24, PAGE 141 ` ' S / S-1 �o Jim 4$ _Q S� BW1c 1941, PAGE 123 I y \y �� T B P 3 C0 4 O-L C.Q / �a re 6 /� F P AY O j it . p I _ / 4t a� / c c , ti , " Od LA / s ♦:4����+ 1',';s `v at, s' 4- 44 14‘;'• 1 /1., 1 & . • RICNARO FINCK •ry 4'.! / / / f 3 ' i / '� y j BOOK 4311. r 81. S ri,. ZI N / ` e t k f / = t p GEORGE FA1X ■ " \\ t ' / d; e• q. • BOOK 3633. PACE 310 ■ 1 N/F , n' - 1 ` es +. PAC£ < 1 9 v SEE PLAN BOOK 4. PAGE 24 - '9C".. p �s lire .. . PETER FR '' AGE 1 L o el• se t BOOK 1610, ACE 16 4,„_ ! . laf 3 10 Y 11111 • K T ', _` .. _E/k+ . CP4"S:0N PROPERTY STANDS IN IhE Nom' Of if *' 3001( •999. PAGE 19 HEIRS JF uLFRED AND MARY SPENCER 1 4 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. 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 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/footines (before backfill) sonotube holes (before pour), a rough building inspection (before work is 11 • 1 , • 1 1 . • 1 1 • 1' .., 1 - ..i . 1 1 , 1 " 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 jermits 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 ii i . . . : The Commonwealth of Massachusetts • er*=.2.-----. Department of In dus Accidents Office of Investigations . 600 Washington Street • %-..e.if— Boston, MA 02111 , • ' www.mass gov/dia .... -Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name pusineseorganizationfindivich.0: Address: r - City/State/Zip: . Phone.#: Are you an employer? Check the appropriate box: Type of project (required): / 1.0 I am a employer with 4. El I am a general contractor and I employees (full and/or part-time).* have hired the sub-contactors 6. 0 New construction listed on the attached sheet 7• 0 Remodeling 2. 4 I am a sole proprietor or partner- These sub-contractors have ship and have no employees 8. 0 Deinolidon s ' working for me m any capacity. egrployee and have workers 9. 0 Buildink additicni - [No 'workers' corop. insurance required.] - 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3. 0 I am a homeowner doing all work officers have xercised their 11.0 Plumbing repairs or additions myselL [No workers' comp. right of exemption per MGL 1-1... .. 12.0 Eno' repairs insurance required.] t c. 152, §1(4), and we have no or ,. ..4..,. .4 .... , c, •wO' ...# camp- In suxance required.] - *Any applicant that checks box #1 must also fill out the section below showing their worio:rs' compensation policy information. - - t Homeowners who submit this affidaVit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether-or not those entities have employees. If the sub-contractom have employees, they must provide their workers comp. policy number. lam am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: . • • • Policy # or Self-Ms. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Sectiar 25A 'OfMGL c 152 can lead to the irapOsitiOn of Ciimin:il penalties of a fine up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK-ORDER and a fine of up to 5250.00 a day against the violator. Be advised That a copy of this statement may be forwarded to the Office of H I N Y - ei ti ki ti o iis of the DIA for insurance coVeraie Viiffietitioii '7 _ I do here!, y _certifr under the pains and penaltiPs ofperjury that the information provided abov izje _andiorrpci ............... , .-- Signature: risk: 6 i it Phone #: 4 f 2 --( t e(--in ( i 0. - . Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: ' Permit/License # _ , Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical ,IT pector 5. Plumbing Inspector 6. Other . fr. Contact Person: Phone #: SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : r 1 L L- P ek- X v u License Number '31.-rkS 7 (.I\ F ot060 Z2- Address Expiration Dat y r2- Signature Telephone I} =Reriistere ClorriiiErripiten�ritltt" r4` -ZiaarE Not Applicable ❑ Company Name Registration Number 32- $ -ls 11f 1Zf tt Address -}- /'- Expiration Da e No 1 ci.vv, 1 Uv \ d t 0 60 Telephone¢) 7 Z,Vg421 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 Affe 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors El Accessory Bldg. fZI Demolition El New Signs [D] Decks [p Siding [DJ Other [0] Brief Description of Proposed / / Work: 8 K q w 0.5a ' Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa tt> &Wil aiti — a l c xistiitai6iusii ql cr b i=tici faiaiivina: 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 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 GTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN ;'OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I Z' y- i� , as Owner of the subject property / hereby authorize E_ Y^ I _. C • 1 0. "m to act on m b alf • II matters relative to work aut by this building permit application. r Si to of a Date I 'It'L� �� , as Owner /Authorized Agent hereby declare thalt 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. 6 7„ r'e ci?LC d'i-e-' - Print Name �� ature o • : 1 - be 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 L ot Size .,gi9 j 1 t S e"1-' 1 g .°� _ Frontage "��i25 1 % ° ? i Setbacks Front $ I / D 6 i € Side L: 1 R:' i (LJThR:i�I.J I Rear L ! F Building Height 0 1 I Bldg. Square Footage = = % = i .t Z I -` Open Space Footag % -i (Lot area minus bldg & paved i l , ..- parking) # of Parking Spaces :.tip .3 j 1L ..., Fill: r _ } (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DONT KNOW 0 YES 0 IF YES, date issued:1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Pag ? and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do 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 0 NO 0 IF YES, describe size, type and location: 's 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 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 9 e City of Northampton building Department - 212 Main Street N 2 2 2010 Room 100 E Northampton, MA 01060 r phone 41,1 Fax 413 - 587 -1272 _APPLICATION1 O CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1- SITE INFORMATION This section to be completed by office Property ' Address: J,/ ' L f/ G- 1 Map Lot ' Unit Zone Overlay Dist ct orb s Elm St. District CB District SECTION 2- PROPERTY OWNERSHIP /AUTHORIZED AGENT lei Owner of Record: Name (Print) Current Mailing Address: / 3 S ,f .. Telephone ' —1 Signata ∎rp g „ -- 2.2 Authorized Agent: Y- ; L . i?a � y1 � 3 7- - 6 0 R-- r Pri (Zd o r o {,,s Name (Print) Current Mailing Address: 2t9 42-A-40 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION' COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 3�aod (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) 360 Check Number This Section For Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner/inspector of Buildings Date File # BP- 2010 -1174 APPLICANT /CONTACT PERSON ERIC PAYNE ADDRESS/PHONE 32 BURTS PIT RD NORTHAMPTON (413) 218 -4276 Q PROPERTY LOCATION 5 BRATTON CT MAP 17C PARCEL 201 001 ZONE GB000)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out j a Fee Paid Typeof Construction: CONSTRUCT 8 X 9 SHED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 086442 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO AVIATION 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 Permit DPW Storm Water Management Demolition Delay G 6 /2 C) 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. 5 BRATTON CT BP- 2010 -1174 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C - 201 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -1174 Project # JS- 2010- 001710 Est. Cost: $3000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ERIC PAYNE 086442 — of Size sq. - }: - 1 0367:28 Owner :--- PALUMBO LISA M & GREGORY ERAMO Zoning:GB(100)/ Applicant: ERIC PAYNE - -- - Al ': 5 BRATTON CT Applicant Address: Phone: Insurance: 32 BURTS PIT RD (413) 218 -4276 0 NORTHAMPTONMA01060 ISSUED ON:6/28/2010 0 :00 :00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT 8 X 9 SHED 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: Fina;: (31 C ." ..- ______ THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES REGULATI 1 NS. ,11.° Certificate of Occupanc -4° del° sign ature: 490 . 4 1 . 4 8 / FeeType: Date Paid: Amount: Building 6/28/2010 0 :00 :00 $25.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo .._._ _ ...... _ ......_.