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The Commonwealth of Massachusetts
11 ' tl J 117 City of Northampton
Certificate of Occupancy
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In accordance with 780 CMR, Section 120.0 (The Seventh Edition of the Massachusetts State Building Code with 2009 IECC)
this Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified.
Identify Name of Building of Space Within, Building Owner, or Permit Holder Certificate No.
Issued to
Brian Kennedy BP- 2010 -0572
BP- 2010 -0605
Identify property address including street number, name, city or town and county
Located at
22 & 24 Wright Avenue
Northampton, Hampshire, Massachusetts
Use Group
Classification(s) Two Family Residential
This Certificate of Occupancy is hereby issued by the undersigned to certify that the premise, structure or portion thereof as herein specified has been inspected for
general fire and life safety features. This certificate shall allow for the use as herein described and in conformance with any and all conditions as identified below. It
shall be posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate, failure to comply with conditions or, tampering
with the contents of the certificate is strictly prohibited.
Conditions of Use Two Family Home - Safety and Structural Systems must be maintained.
Name of Municipal Date of Final Map /Plot:
Buildin• Official Ch M111er Inspection 05/24/11 - ,•,,, , �••.+
Signature of Municipal Date of
Building Official r r Issuance 05/24/11 39A -014
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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 rocessieg1 Tres 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
-- -- - - - - -- puts -in- conjunction__ to _the_building permitissued,_ 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
a '- ' understand the above.
(Home owner /re is 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 / � , 9 14 f krt / VA
The Commonwealth of Massachusetts
Department of Industrial Accidents
=-, " 1.� E Office of Investigations
t. l 600 Washington Street
t — a Boston, MA 02111
s • www.mass.a ov dia •
-Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/PIumbers
Applicant Information Please Print LegibIv
•
Name ( Business /Organization/Individual):
Address: ,
City /State/Zip: Phone.#:
Are you an employer? Check the appropriate box: Type of project (required):
1.0 I am a employer with 4.. 0 I am a general contractor and I
employees (full and/or part- time).
: have hired the sub- contractors 6. ❑ New construction
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship . M have. no. `n 1oyees These sub - contractors have. 8. ❑ Deraol on
working capacity. employees and have workers'
worng for me in a
Y P ty. 9. 0 Building addition
[No workers' comp. insurance comp..;nsuranre
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
I y6 arm ahomeowner doing-all-work "-
3. o cer aye cised sir _14.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, § 1(4), and we have no "
employees. [No workers' 13.0 Other
comp. insurance requited.}
Any applicant that checks box #1 must also fill out the section below showing their woricers' compensation policy information.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new 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-contractors have employees, they must provide their workers' comp. policy number.
Iam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
ormation
Insurance Company Name: -
Policy # or Self-ins. 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one :year imprisonment, as well as civil penalties in the form of a STOP WORK QRDER and a finee
of up to $250.00 a day against the violator. Ile advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penattiPs of pedury that the information provided above _true andcorrect __- _
i tgnature: 'A ' / ra , Date;
Phone #: ..
Official use only. Do not write in this area, to - be completed by city or town official
City or Town: Permit/License # T -
Issuing Authority (circle one):
I. Board of Health 2. Buikii Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector .. _ _
6. Other . .
Contact Person: Phone #:
A A
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Numbor
Address Expiration Date
Signature Telephone
9..Registered:Home lmprovementContracto . „ ... Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
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 ❑ No ❑
IL , O er. Door
The_current_exemption for "homeowners" was extended to include Owner 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
sort ampton lir.inance , a e an. . . ,, . . . s-General- Laws= Annotated.
/ 472 7 1----
Homeowner Signature ,lam' r--"
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SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition Replacement,Vndows Alteration(s) Roofing El
ry-� Ur Doors L -J
Accessory Bldg. ED Demolition L"! New Signs [0] Decks [❑ Siding [Ilti Other [❑I
Brief Description of Proposed
Work: Pe mut( K rz I- Mills .rns. ,w`e.I Gpd' .j e wiirr 113 / v� f gy-ff /3 l Ro f A +r L3rrc,C ecti col
Alteration of existing bedroom Yes X No Adding new bedroom Yes No
No
Attached Narrative Renovating unfinished basement Yes X No
Plans Attached Roll - Sheet
na:° .'1f.NeW =hOUSe�and :ts� �ldc�E #iort�.to��exisfinq � " ®uslnq,:coiri "ptete the fo�1 "owan+�:
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
SECTION Ta: - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR 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.
Signature of Owner Date
I, , as Owner /Authorized
Agent hereby 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.
Print Name
V / S ' ignature of Owner/ gent Date
A. ,
st e �
Section 4. ZONING All Information Must Comp e e Pe i an Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
/ JM TeRef This column to be filled in by
/ 1 ! V7� n_ „ r1 ,
Lot Size ��` Building Department
/�7�� .. _ .._.. ,,_
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) _ .___.w . ,
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 40 YES
IF YES, date issued:,
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
1
IF YES: enter Book Page? and /or Document # ��� __M___.
B. Does the site contain a brook, body of water or wetlands? NO It DONT KNOW 0 YES
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 4
IF YES, describe size, type and location: :
D. ° Are there any proposes c anges to or a. •itions of signs intended for tom property ? YES 0 NO C i
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 0 NO .p!
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
•
arfase
City of Northampton � � � �
Building Department G�ir��
212 Main Street se. y ftS vSil�ys
Room 100 :` a��`���
_ raptor -MA 01080 ,. �rd
phone 413- 587 -1240 Fax 413 -587 -1272
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APPLICATION TO CON$aRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Address:
This section to be completed by office
/. "V r :sli I Ave, Map Lot Unit
Zone Overlay- District
Elm St. District CB District
SECTION 2 -- PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name ( Print) Current Mailing Address:
1. 9 773
Telephone
Signature '
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - 'ESTIMATED CONSTRUCTION: COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a B uilding Permit Fee
2. Electrical / (b) Estimated Total Cost of
(/ Construction frorn (6)
3. Plumbing Building Permit Fee
/ln®
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 +2 +3 +4 +5) /7 a C7) Check Number `
This Section For Official Use Only
Date
Building Permit Number: sued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP -2010 -0572
APPLICANT /CONTACT PERSON KENNEDY BRIAN
ADDRESS /PHONE 22 WRIGHT AVE NORTHAMPTON (413) 387 -9973 Q
PROPERTY LOCATION 22 & 24 WRIGHT AVE
MAP 39A PARCEL 014 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out � � � , i
Fee Paid , �/
Typeof Construction REMODEL KITCHENS, BATHS,INSTALL INSULATION,VINYL SIDING & REPAIR
FOUNDATION �r,; t 16
New Construction S' 4N5 fl Co P erect r j tvAU ST afi- 3
Non Structural interior renovations C t f NT (d?
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOIVIATION 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
/2/4 /0 9
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.
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22 & 24 WRIGHT AVE BP- 2010 -0572
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 39A - 014 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 -0572
Project # JS- 2010 - 000799
Est. Cost: $12350.00
Fee: $74.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Sizetsq. It.): 6011.28 Owner: KENNEDY BRIAN
Zoning: URC(100)/ Applicant: KENNEDY BRI AN
.4T. 22 A 24 Yv ,1t. HT AVE
Applicant Address: Phone: Insurance:
22 WRIGHT AVE (413) 387 -9973 0
NORTHAMPTONMA01060 ISSUED ON:12/16/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL KITCHENS, BATHS,INSTALL
INSULATION,VINYL SIDING & REPAIR FOUNDATION - UNIT 22 - UPDATE SMOKE & CO DET TO
CURRENT CODE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: po Service: Meter:
Footings:
Rough: 3 —a6 -' /p Rough:/ / House # Foundation:
,�/� ,, ' Driveway Final:
l� I s,l'isl��n�
Final: 4.14 l/ Final: / �p
\ 7 /� nRfdrt Rough Frame: O 0 Lem
Gas: ire De . artment Fireplace /Chimney:
--it
fi��
Bough• ��l1 Insulation: OK 231 (o too(
� t U la
Final: Li -(� - I [I B (, oke: >,, • --¢P"l 2
. - -. Final: ( k J ' 11 cv�
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIO OF
ANY OF ITS RULES AND ' • ]e
Certificate of Occupant Signature:
FeeType: 1 ate Paid: Amount:
Building 12/16/2009 0:00:00 $74.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo