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06-006 (3)
N 0 CV CC) C3) 1• s 0 CX) O o O � O r (0) Lf) O 0 Er) CD 0 3 Y: ; LC) 0) N (N N to O c- O N CY) 18 Descriptor/Area A:2Fr/8 FU B 16 silt 8:1 Fr 504 sqft C:OFF' 64 sgfk 21 D:FIJE 432 slift 24 2Fr/B Cs Os o1AMpi. 4 T n . r e Ceti of N�arf1i ttp#att z lop $�� J assactuseffs o- _iT1 mtu b' DEPARTMENT OF BUILDING INSPECTIONS '� 4 INSPECTOR 212 Main Street • Municipal Building '; W 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 supc: . 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 l✓e2✓. 3l 2-07,k, Address of work location cd2 1/4"2'0 2-AJ v/I-4-5 go . Lt c 5 l "AA- O/a5 5 • a; �TttA,r nT` : �O O�e 'R+ tti � ( if af Part I & tptot i = •B `� E Zasaxrlar ' • v.1 i=: ,t Iris Tor DEPARTMENT OP BUILDr1\C INSPECTIONS 212 Main Street Municipal Building V"-- Northampton, Mass. 01060 to WORKER'S COitC'ENSATION -l;tSU1ZahCr_ AFTIIDAv1T (1iccuscJpermittcc) with a principal place of business/residence at: -j)honer') (rtrt /city/statesp) do hereby certify, under the pains and penalties of perjury, that ( ) I am an employer providing the following worker's comocnsadon coverage for my . employees woridng on this job: (Insur.:n= Company) (Policy Nu mix-r) F.-pirauon Daut) ( ) I am a sole proprietor, general contractor or homeoWner (circle one) and have hired the coon-actors listed below who have the following worker's comnenation policies: (Name of Co - co r) (Insurance Cornoany/Pone,- Nun-cc ) CH::ptrauon Date) (Name of Contractor) (1nsuranec Como-any/Policy Nt1-znce.r) ca-pi. uon Due) • , (Name of Conn-an:;) (Losurancz Conran}•/Policy- Nambc.r) (Expiation Date) J (Name of Contractor) (insurance Comcany/Poticy Nt1mb r) (Etptration Da e). (aaa.ch-6c'a J c'vcrs.if arr--•-S-to ecru&iafort. oc pcz7n.iainc to.11 coex-.-cots) • s ( ) I am a sole proprietor and have no one wor)dng for me. gI am.a home owner performing all the work myself. NOTE:plea be ow-arc the.wi Je bcmcowocrr u•1>0 c coptoy pcsons to do r.Ecooc..,• co;.:e,n c repair',art oa.d.•c11_r,of ant mocc tb tt ro_-t Eu is w cb the bocaoowacr raid=or oe the ryou.D42,pvct.ca:ct tbees�-c ax c-m.--2.11y(=TidoD..w be cstploy=o t, the t ok rr n--.-m Act(0 LI52=I(5)},=pptictitioo by a harocosa-oart for:Gc=cx or perm rL-y c.-id=.00c tbo IcEp.l rtzlu of eo=ploy= ooder to Woetior's C.oatpamalioa Act- - I aaoolcrsiaosi tad a co,y of this eatemem clay be fora.urrted to tho D-opa tmca¢of 1..,.6,rrial Aced Off o0 of Itcur.oee Cori the cover, vo ire tioo mod thl EiJt-c to so arc to.ora cc under socsioa 25A of MOL 152 on lo.d to the ispositioo of euninal pccurtics 000aar tq or a rtnc of tap to S 1 500.O0 andtor ixnpriso of up to ooc ycor t od es-ii pm ltia is be focal of a Slop Work Otdc and a rtm o(S 1 MOO a dcy aptiao cia l3 —--- i For '=alu,c only / , f t l tIlJt NitLTJt)Cl t� ,, i 3106 ��P°_- ' of " SiBaaittxc of LiccrzscrJpcctntucz Late • SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Restistered Home Improvement Contractor; 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 ❑ 11. - Home Owner Exemption 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 buildins 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 resp sibility for compliance with the State Building Code,City of Northampton Ordinances,State an, oc.I Zoning Laws d tate of Massachusetts General Laws Annotated. Homeowner Signature L . SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s))Er Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [Q Siding[o] Other[D] Brief Description of Proposed /1\141—A w 7■)e Z 4s D I)a e2-0 AL y2,( 1,014-AArV `) Work: Alteration of existing bedroom Yes �. No Adding new bedroom Yes No‘_„,„ Attached Narrative Renovating unfinished basement Yes ''CNo Plans Attached Roll -Sheet 6a.If New house and or addition to existing housing. complete the following: a. Use of building:One Family )( Two Family Other b. Number of rooms in each family unit: Number of Bathrooms s1' ic. Is there a garage attached? N tt a d. Proposed Square footage of new construction. I!O 5.1). Dimensions [ x !4--e . Number of stories? 2.€ J f. Method of heating? C3 I L. 1+OT A I �- Fireplaces or Woodstoves . �S Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction W OP 010"6- i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes >4. 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 ,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 PL!7 2 F i„ „A,)142 2 ,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. f2er i7__ F -/A CVZ__ Print Name ..j.--. A/6 v 3, 2az'6 `Signature of Owner/Agent 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 141' Lot Size 3775 ACi2(S Frontage )59 1 Setbacks Front 50 I Side L: R: L: 1 Gltt R: �b I Rear Building Height 3 S Bldg. Square Footage / � Open Space Footage /0 14 IAA L (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 0 DONT KNOW YES IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW YES 0 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 beobtained ® Obtained © , Date Issued: C. Do any signs exist on the property? YES 0 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: 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit NOV — a ;,006 212 Main Street Sewer/Septic Availability Y -Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413587-1240 Fax 413-587-1272 PIotSite Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 2 I LA'€. rz.0 ' Map Lot Unit Let 04 i Pi4 A' c 1C7 5 3 Zone Overlay District Eim St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: QETEVL. sit 5TEIpe}/ 1\6 r. iaY-f 42,. SDL If' e021J J/t1A-€ •2-60 L�'i 5/ rii4- Name(Print) Current Mailing Address: S , 57.2 ..�i� 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)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) t j73D Check Number 0-6-0 ,f"5"--J This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2007-0526 APPLICANT/CONTACT PERSON FLINKER PETER A&STEPHANIE J ADDRESS/PHONE LEEDS (413)585-5724 0 PROPERTY LOCATION 502 HAYDENVILLE RD MAP 06 PARCEL 006 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ��Jr' 045e, Fee Paid '--- Typeof Construction: INSTALL NEW SHED DORMER(WORKROOM) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan PLANS 0 k, l 1 6 a 6 A? THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFpRMATION 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 I1 QY/0 � Signature of Building •fficial 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. �t� " +� J2 HAYDENVILLE RD S BP-2007-0526 IS#: COMMONWEALTH OF MASSACHUSETTS 4ap:Block: 06-006 CITY OF NORTHAMPTON ,ot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS 'ermit: Building DO NOT HAVE ACCESS.TO THE GUARANTY FUND (MGL c.142A) 2ategory: BUILDING PERMIT Permit# BP-2007-0526 . Project# JS-2007-000763 • Est.Cost: $3000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 162914.40 Owner: FLINKER PETER A&STEPHANIE J Zoning: SR Applicant: FLINKER PETER A & STEPHANIE J Win_■: J'_ '/ wwi_ :V t.__L . ..� Applicant Address: Phone: Insurance: (413) 585-5724 (). LEEDSMA01053 ISSUED ON:11/9/2006 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL NEW SHED DORMER (WORKROOM) 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: 21 • _:)(4 (N/ Final: Final: i Rough Frame: ( ) L 1( L t�J` i I t(J Gas: Fire Departni nt Fireplace/Chimney: • Rough: Oil Insulation: Ck/-( ( 41 l 5 o I c-A i g Final: Smoke: - Final: K (2115(dCr 1A2(M S THIS PERMIT MAY BE REVOKED BY THE CI ' OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy f ry _Ij'/ Si'nature: r FeeType: Date Paid: Amount: • Building 11/9/2006 0:00:00 $50.004250 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 . Building Commissioner-Anthony Patillo