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36-326 tolleiiik 1 1 -_ ��� r __ i - ■ -_ t _.. • l.. _- -_ -_ -_ C T I j i T 1 { 7— 1 it 1 } —'- ! — t J ,— i. - I. 1_ T_ r , I 1 I I 4 I : r z j il _ - t I 1 + - rt ' —r i t � 1 a * + ' I I 4 1 � } I I t A ,, , ,,__,. _, 1 „ , f _,_ , ..„.. , + , , . , , , 4 , , , + _,N. 1 I I i I 1 I i ; I ; I ' 1 , , � -F f i -] 1 i 1 —17 H--- + 1- , _ I I C'' I 11 ___ , , , , , T - fi 1 I f __ . I I 1 Nj - ■ N Ni :., 2 ... 24 ` ( N „.; , „,.....,, r. 1 i h. "0/241 i'i- 2 -2N24''.'.0-',IIDC:VVI-S24:',0 t 4 ts 1 i i KI ■ •,, 1'41.,) I 2 2/1 L. -PZ EP '. 9 . L 9 S), ,.....) , I i . . . . 6 t,,Z.;rl.............. . .. s. i 1, 4 1 i 1 X . / ..7 .) ) 2 '. . --- .' ' i ■ 1 ■.6 l' <4 0 < : ..2`10 i 1 -... 7. s 1 Q ., = L.+ ' 2 ;0 . , , ....,.... ) 4■1 s .„ . , . . ‘.. '' . \ . , , . . / . / . . , . , .. , . , . , .. , 1.1,- e"' ti ///07t-( / / 14"/ C-2)A-6,..„--,A,J 4e)/,4 4 /4---//7e//za "7 71 ( 7- „...2 4 -7 ie'6.ef / -, e:. -5 7 4") . 7,.(7"//' r 3 Z-4"-Y e/.:› • /f'/ 7 • „,<:- / 5 c: / it Z Fe-4. iuc-77 , e „ (7 4 , /ill /v 6 G C - ? - / • , � Cr #� �a�z #1#nitort _ __0 _ WI Att. jia a ssachnsetts w _ : � '�""� DEPARTMENT OF BUILDING INSPECTIONS 1 _ ` 1 /, INSPECTOR 212 Main Street • Municipal Building 7,- Northampton, MA 01060 . 0" HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as Lis/her construction sups .': sor. 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 . • M -- -- * * 't 4 431. ) 1 *'• fik 4 Gifu_ f o Xartilaiiipfon ,--, 3 % .40 - 11,,, i ..€t•5••rip,,,u.•• - - -- ._ =_.= -- e _It . -- - ._-- = i • , • • c • • =-_-_-= ^.1 4..a. DEPARTMENT OF BUILIDDG INSPECTIONS , •=..... , 212 Main Street ' Municipal Building Northampton, Mass. 01060 W °RICER S C ONIT EN S A'110 N IN SUIZAN CE AFFIDAVIT . " Oic..._--ri.rtcir./...nnittef,i,) with a pan cipal place of busine.ssiresidence a:: 3 c-,..?• cif> 4-t /3 C. C C I A. /7 4: - 1 /) /1 /1.- C /6: 3 ,i ( ) ,.) _,,, V73 ._). co •;(, / y (StTCCLiCi ty, do hereby ce,r tine i di r,2 pains :Ind penalties °I perjury, t.hat. (>) 1 am an employer providing the fc worker's compensation cove.ra.,.:,e For Inv employees working on this job: //3500 Z . 6 . to66. - (lasu_ranc,:t Coraparn,') (Policy Number) (Expiration Date) ( ) 1 am. a sole pronrittor, general co:it , ,t , : - nornecv•nner (circle one) and have 'aired the contractors listed below -,-, have the following, workers cornoensaton poltc:es: (Narne of Contractor) (lasur Corntyam,./Policy 1-slusnb (Ex:rntaon Date) (Name. of Cortracor) 11nsurance Cona: Nurnber) (12):Diration Date) — _ (Name of Contractor) (I Dal rallCZ C 0 a_i' y PO 1 i L Ni lunber) ;,E.Nrataon Date) (Name of Contractor) (Insurauc-z Com7;_ NumbfL (Exr Date) (r:ttach 2-ckiitiecls.1 s!......-ct :"•,,,,--- tr... • , ..----'...,', :71:2:-.., ( ) 1 1.111 a s,o1c, proprietor au Li have 110 one, ;odin i for me ( ) 1 am a home owner Derforinit?: al! he 'ca: in ''''''''''''' NOTE: Plc,tsz l' aWata tha - .v . :it:1c bccoco..t%).,-;; tNt.r3 c:: P-7 to ,'.) .7 co cr trpttir ,,, :y. ,..-.: t ttvot.111:-.; not 12)0re Ihzu thump unit, in t t..h,c 1-,.:-.-,.....vto•=- Ta CX Caci • S.'. r •_•..=:.'s a:alLairtar-a111 thm-cto t.rt n,:t ucostally o:.::::cf calploya-3 unct.e_t the wcti(ce:. crs,.._-:-.-._-..ttli co /ct. (GI_ I f I (5)), , r7 , : .- - . ) ,- ..- - ,-. by a klotncowncr for :. Lc c- lcsal rt2..tuz of c-n muploya under ti.to Worker'. Coatp-trr.....tion Act_ 1 un.c1c.--sttuld the a copy of this riatc: zalay bo fovot.rt_1,3 to W-' D-tit of I.:J.1_14.6,i Azde,o-113' °Mc- .f 1, . - -'''''''' f°' ti' covcrIgt vcrifi.lioa ariLl thz.t failure 10 .aaCZIra COTr.gt, un& icci 25A o f mCL, 112 can 1,1 tz) thc imposaial GI cr Pcr- coalistErlz of a fin of up to S1.500.00 im:Vor ir.tpri:oczn:_-:-.1. of up to cr. yz.,..r tr4 civil peruitics in ti.c form of is Sc' \VoTi"- 0rti•t=7 ar-d a nr= or s 100.0{3 I dly tztturt1 m7... _ For 64.17....funelfsi u.c cc 1 y i - / 4 ,...,.....____,_.... ,....,__ - 2_ / i 3 ,), 3 Pcr rnit Ntunly2s () M.-,1•,) _ ____Lnt _ . , .gnaturt of r.icr...-n!-,e11)(-..rnr,t1,:,:. 1– •1 .,- ____ • SE CTj,ON 8 CON R S E RVICES 8.1 Licensed Construction Supervisor: ,/ Not Applicable ❑ up Name of License Holder : 7/ 'f /'-' W. 2/6-- // N ve. / / License Number g 6 v � ,� o'et' C(/ , ( -7 z ,> /1l.i-- 0/7S%3",' Address Expiration Date /7 ),...*„.___:____ Signatur Telephone 2. /2 S /t/ e : - 'ere;11 tii" ',hi r.®irerrren -. •on Facto` : � R,.� . V Not Applicable ❑ 7 P( /7. 2 / &' /✓s /(7 �j` z-ii c , 701. K w r / 00 / 3 3 Company Name Registration Number j e,,, szi e,: c c• / /'fi %7' /E"? " L / /c Address Expiration Date k 1/r3�y''Z: Telep ne tECT10.N=io ' COM INSURANCE-A •(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 A No ❑ c " o f e1Q - ®s „ 1:4' ISii :4 - 611' 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 I _ • SECT ® SION ©FPROPOSEDtWORK ch a -� • a`Iica �Ie�fi �. sr U"" �.�'�- . • - ^r ; Raa. '.. .. > a x; s�. ate._ " .,. = "�t^ .,... x"'^... New House ❑ Addition ❑ Replacement Windows Alterations) Al Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: AN) S .- �G« ,,, k; ��, /,,� Alteration of existing bedroom Yes x No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes .0 No Plans Attached Roll 0 - Sheetg &a - , A o -1-.i • o- l ition hire' �n h.ou ring, comp :e tl e" fol7awl:ng: a. Use of building : One Family / Two Family Other b. Number of rooms in each family unit: 7 Number of Bathrooms 3 c. Is there a garage attached? y� "3 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. 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 SECT O 13YlINE DTHORIZATfON TO B'E COMPLETED WHEN 01rYNf>A �GGONTRACTOR APPLIES °FO BUILDING ;PERMIT E 1.1)//V - 46/Y6, C- , as Owner of the subject property hereby authorize L- (2/7 5 /7. / 4� - 7~ - 7i i, S/C7 to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date (' t- /7 A ��^ �'' S /e/ , as Cwner /.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. d- ' (h'L' (/ ICS r.u Print Name 2 --/ 3/3 Signature of Per /Agent • Date 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 Frontaa e Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage vo (Lot area minus bldg & paved parking) # of Parking Spaces • Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T 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: „. ' • - , F 7,---77- 7PW --- ,4 77 FT4f - Trii47-ffiFi .• - ' '':.' '''''''''''2'-'-';.' -- - ' , ia4 k , . City of Northampton 3 2.0\3\ Building Department 212 Main Street , ONG l'''''Poc.1060 Room 100 Nid41lt:. '___ - ,___,-..„,-;_-•,_:,,, -:::,,:„ P tio fnIAP. Northampton, MA 01060 '''' .L■,'” ( ' - ' --- -,-.,', phone 413-587-1240 Fax 413-587-1272 r ,**-9:t WEr: . ,.,- ; _ . ,,,,.. , ( APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ON Dti:: H:0:L::-:;.::.-'4.----.; ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION . 1 .1 Property Address: • -"- ''''' .4/.0'7 . = -,-,‘ ,- ,,,,, -;.-,,, " -.."' ..,;.„4-',. „4'rk ' -,;FP' = ' ' ''k; ■ ;;:: N 'T=Ati*Fg4;'SSV .. 2 9 C r rz 6 / .-‘4.4.v... ■ e u)-)cc / /4- e` /e 4. 1-- .z-z ..41,---",.40 ,„ •,,,', - pi/it.i. , -4 ,,,,, .ii.,'4 , -1- , ; - ;<:' , 5-',---. , ..A,... t. ' .: 4". i'' , - s -,- ',4: '-', ,743..., .,. iiesst‘Dis'fi -:', trk no, SECTION 2 - PROPERTY OWNE RSHIP/AUTHORIZED'AGENT 2.1 Owner of Record: .. t rg /7-z- ...) /4..4 -I '2 2 ,...,, c.R_ ,,,, Name (Print) Current Mailing Address: )- - ) 5' S '1 / ( ,,, e_..... 4 ....,,,._,,,,.. ,:.., , ..._ — Telephone _ Signature 2.2 Authorized Agent: / C (7 1 ) . , - ; // 2 , - - , . , . , ,, i %)6 C C i l e 74.77:,, fr . - z j ) c,, c e; a Name (Print) Current Mailing Address: ? / c% 3/ : 0 c---'-e Signature Telephone -- tECTioN. - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use 'Only completed by permit applicant _ 1. Building c / eFOO (a) Building Permit Fee 2. Elecfical (b) E.stirnated Total Cost of / 6 c — Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 1 5. Fire Protection 6. Total = (2 + 2 + 3 + 4 + 5) / 3 0 0 0 .f,c- Check Number gg *7K This Section For Official Use Only Building Permit-Number: Date Issued: :- S ignature : __ , Building Commissioner/Inspector of Buildings Date File # BP- 2013 -0755 APPLICANT /CONTACT PERSON JOHN ZIEMINSKI ADDRESS/PHONE 8 WOODRIDGE CIRC HATFIELD (413) 247 -9014 PROPERTY LOCATION 224 CARDINAL WAY MAP 36 PARCEL 326 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 7( ! Fee Paid ` U Typeof Construction: CONSTRU T BASEMENT KITCHEN RFS?21 Cart 0IJ MUST 136 Rape-450 New Construction Td Ct t l yf Of O'CC.UP Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 017889 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION 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 Date° Sig ature o Building Official 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. 224 CARDINAL WAY BP- 2013 -0755 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 326 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2013 -0755 Project # JS- 2013 - 001302 Est. Cost: $13000.00 Fee: $78.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOHN ZIEMINSKI 017889 Lot Size(sq. ft.): 18730.80 Owner: LANGE RAY & ELAINE Zoning: Applicant: JOHN ZIEMINSKI AT: 224 CARDINAL WAY Applicant Address: Phone: Insurance: 8 WOODRIDGE CIRC (413) 247 -9014 Workers Compensation HATFIELDMA01038 ISSUED ON:2/15/2013 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT BASEMENT KITCHEN - RESTRICTION MUST BE RECORDED PRIOR TO CERT OF OCC 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 2/15/2013 0:00 :00 $78.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner