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Quick Open Space Calculations Coverages
56 Bradford existing
Lot area existing proposed Garage existing 576
105551 2052 2152 House existing 948
Accessory existing 0
Open Space 8503 8403 Driveway existing 528
total 2052
Open % 80.6% 79.6%
Zone GI new 0
Req'd I 20% Shed new 100
new 0
total 2152
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 owaeonstmction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
_regulations The inspection process rewires that the buddi ep artment-be calledzo
inspect work at various stages, which include foundation /footings (before back
sonotube holes (before pour). a roueh 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
pits -in con }unction,.to -the_buildin . . permit issjed,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
understand the above.
(Home owner /r d 'dent's iguature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
--- -Date
Address of work
location /r64 &col Si-.
NQ ✓fiitto, fry) pill lomf�
,\ -------fire-Common-wealtit-ofMassachusetts
--------=-='.- Department of Industrial Accidents
171 ........,- . ....,., 2= 1 fr,
A. 7--lo— ., Office of Investigations •
1.7"--:1 .
600 Washinaton Street
---
Boston, MA 02111
-v..mass.gov/dia----- -
_
- Workers' Conapensation Insurance Affidavit Builders/Contractors/Electricians/Plumber
Anolicantlfiformation _ Please Print Legibly
Name pusine
( ---64114-91
Address: ' ‘ . 4 . 6 r7A A Apr-el S4
_
o toto
Cit N o v i- k a wte &I') A4t. Phone #: IliS - -523q9
Are you an employer? Check the appropriate box: Type of project (required): I
1. 0 I am a employer with 4. 0 I am a general contractor and I
6. 0 New constniction
have hired the sub-contractors
employees (full and/or part-time).*
listed on the attached sheet 7. 0 Remodeling
2. 0 I am a sole proprietor or partner-
These sub-contractors have
ship and have. no , -nployees 8. 0 Demolition
working for me in any capacity. employees and have workers'
9. Ei Bundin addition
[No workers' comp. insurance - comp..m.sur
-Ace
doxl ir required.1 .
3 I am-a-hortteowner-doink
myself [No workers' comp.
insurance required.) t 5. 0 We are a corporation and its 10.1_1 Electrical cal repairs or additions e
___o_faems_haveUercis .0 - ■
-
sight Of exemption 'per MGL 12.0 Roof repairs
c. 152, § 1(4), and we have no —1-1---Q-P-lurnbingzepairs or additions
employees. [No workers' 110 chher
comp insurance requiced.j
*Any applicant that checks box #1. must also fill out the section belowshowing their workers' compensation policy information. . ,
t Homeowners who submit this affidavit indicating tiaey are doing all work and then hire outside contractors must submit anew affidavit indicating such.
ZContractors 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 lithe sub-contractors have employees they must provide their workers comp policy number.
lam 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-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 reqtured Inkier Section of MGL c. 152 Can lead to the imposition of criminal Penalties of a
fine up to S1500.00 and/or one:year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a Frnf.
of up to S250.00 a day against the violator. 15e 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 cci- n .."/- -,, e p , its and penalties ofperjury that the infornunion provided:above is true .and_Ct _
Sitmature: grAirrella , - DaM: 9 0 .
m.
Phone #: AT.11
1 - Official use not wrde in thikarea, to be comp - ed , y city or town °Aida
- _ City or Town: Permit/License # .
Issuing Authority (circle one):
T - L---Board of Health 2. Building Department 3. City/Town Clerk 4. E 5. Plumbing Inspector __ ___ _
6. Other
.
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
. , . .a i 1, 1a s :' C:. i. P. ii ic. -, , fi, AP ' n°,1111"1.'1 a'b Not Applicable ❑
Company Name Registration Number
Address Expirati Date
Telephone lf �"_ ,, ..
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 ❑
. O y et zxenwtion
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, Sta d Local oning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all aaolicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors D
Accessory Bldg. Er Demolition El New Signs [D] Decks [D Siding [D] Other [D]
Brief Description of Proposed I
Work: (0 X/ 0 S )1 I iv b t ei
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
I i.i. LIFi'VIt. 'Iiiiti . !'.°). ?3 a • L....1.9_ v■ ffi.ie • I1 a ® " 8 . 0. a ":.ol wn!:
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 constru '•n. Dimensions
e. Number of stories?
f. Method of heating? fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Massc - ck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction ' hin 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 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
/
I, J e: 1 ( till , as Owner of the subject
property ,J J .J �j
hereby authorize T e teir (v► dl
to act on my behalf, in all rs relative to work authorized by this building permit application.
/ 1 loci
Signature of Owner Date
I, j� Ljll , as Owner /Authorized
Agent hereby declare that the temen on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
m, r
Print Name A
Signature of Owner/ VFW Date
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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
Lot Size � �t O 5A-vo,tz
Frontage
Setbacks Front
Side L. , R: ! 1 ..
t
Rear \
Building Height
Bldg. Square Footage % 20
Open Space Footage c( . % `� e
(Lot area minus bldg & paved
parking)
# of Parking Spaces
o `
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW ® YES 0
IF YES, date issued:.
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW YES Q
IF YES: enter Book { Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES Q NO r4
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q 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 Q NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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I; � \'':', � of Northampton
City „z � � � � t 4A t r y
y , -- Building Department
�� � 212 Main Street � � � � .
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lorthaknp MA 010 E 3 � A
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p h o ne41.� 1240 Fax 413- 587 -1272 ,�, , -' ��
CATION TO CONSTRUCT, ALTER, REPAIR, REN OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address:
This section to be completed by office
6 F3 ri d f .Si _
Map Lot Un
No/ 1I ci wi - 1 /V14 4 l 6 d Beane, O w ir ay District
St. DIstrlct CB D istrict
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: / of Q6 e mC�1 bet,f .5 i� ✓ud 1V ( f" _ /1(0 ,�L►a 01,4 hrl / ��t4
Name (Print) J Current Mailing Address:
Telephone
Signature ..,
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Estimated Cost (Dollars) to be Official Use Only
completed by perm app lic a nt
Item
/1. Building e I a (a) Building Permit Fee
✓ 2. Electrical (b Estimated Total Cost of
3. Plumbing
Construction from (6)
B ui l ding Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total= (1 +2 +3 +4 +5) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2010 -0136
APPLICANT /CONTACT PERSON LARGEY MEG & CATHERINE JENNINGS
ADDRESS/PHONE 56 BRADFORD ST NORTHAMPTON
PROPERTY LOCATION 56 BRADFORD ST
MAP 24B PARCEL 080 001 ZONE GI(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
R
Fee Paid / d i5C2C-
Tvpeof Construction: ERECT 10 X 10 SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN 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 Commission Permit DPW Storm Water Management
Demolition Delay
'''.- ;1/#'./7/,, 0 ; , -
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.
4 4
�aa # BP- 2010 -0136
GIS #: COMMONWEALTH OF MASSACHUSETTS
f' 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 -0136
Project # JS- 2010- 000160
Est. Cost: $1300.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 10149.48 Owner: LARGEY MEG & CATHERINE JENNINGS
Zoning: GI(100)/ Applicant: LARGEY MEG & CATHERINE JENNINGS
AT: 56 BRADFORD ST
Applicant Address: Phone: Insurance:
56 BRADFORD ST
NORTHAMPTONMA01060 ISSUED ON:8/7/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: ERECT 10 X 10 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: 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 8/7/2009 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo