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29-477 ' � "� ' 'gym 5 A i } r-. C 7 o k iI 1 . d V CP Ici N 0( v Vy� ry . tip v x N -r � s_ s n r, t r li x tj - r __ r . � 4 a•� S 3 A` P 6 3 U 0 S± ' C N u L L a US W 7U / . at o v ._._.,..�._.._.._._..�.....--�v.._..�_.._.�..------- 6 - --- -__--: nl ri � �lrs t _ s s r I' 4'. I � l � v !°fir G' C ' N r i s i C E ♦ t/v 1 I, prorse Beck .. v i i I - N81°26'15"E 1.- 283.31' - 172.04' - 111.27' s O zN� Q W W _ z +1 pZUO CC r't C/) W��� ��� z �n (r Q Q Lv LLJ OUNW ;—Zz � cr WAY C7 n- z� ro O Q�p zz��� U m��Y N Q �Ym -J J Q �W�oo N -oz z oo U 0) ww0wz oz W M m� LL, vLO Z00 NO �� O JQ � 00 ce ap uj WTpz W zo°z � Q J Q tom CC CL QWc3 W f LLJ mCLM p Q OL 2°0 � Q).to joi" `n�-w� Q ti� Cr- CD ro zQ R��OO\ oo o z Lit m Q r. Q m a 142.82' h� \ 07.5 —S81°26'15"W co Lij m p 0-q LL il\ N O M za:ct W m 1 �n � z Qp z o 51z O � CL (V O o O \` \ �\ i � O N Po°L >� N� \\ r� �o � a2�• £ mss �--09 ,25 p0 O � T� 2 8 OP ?A a5 a ° �•G6 '" R PPE 350' -- '39.72' 's 1300, 1\0 - --S79°00'58"W �R LPN nU� P i 4'CItAMPJ, •� $ Gxfv of Xart4ainptan z � � �assach�ssrtis - DEPARTMENT OF BUILDING INSPECTIONS /= INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as i:is!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 fanzily 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 inspectionlif 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. G. e �l �t/ (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 , — `f Address of work location (1LIf1J of �YarIlJtilllpfoll ��[SS FC{7nSiSIS DEPARTI,fENT OF DUIiDMG INSPECTIONS 212 Main Street ' Municipal building Northampton, 1fass. 01060 WORKER'S CO3MTENISA770N INSURANCE / +F :1Nr1.T i e b JA) _ \."ith 2 principal place or busiress/r :;idenc, ------- -----------_. .ice_ �----- -� '----='- _--- do hcl-Cby Ccr-L ly- ll:lC _11C 5-111)s ;:.nc l)C it l i1C.; Oi 7C;�ti1 i1li+.: I iiR� c'lII eIIlp!O�'Ci prOVlCllilg t};,, i0110'..'iP.;; •:OI.;CrS GOIT9I)CI]S;?UOn GO\'CI'2�'C ?0' ?Il}' cinployces working on alis job: - (Lnstirz*rG Conprm') ^c_c,?"tr-tb^r) -- r� irijaa D2.c) I ?Gl a sole provIitlor y(n°1�1 C-Oil'i�C'Cf hOII: 0`:�De (crCle OIIei 2IIG ::2\': :'utcl th—, COiI`dciorS (Name of Contactor) ins_ :)cc Cer 'c?i-; ?Zus LYr) :a.,,c-: Date) (I,la.mc of Coi) ctor) - (71� t nc Com��,:\vPe!ie,' Ntrcer; :r .,:ii,a Daze) (I"Tame Of Coatracto, __ ) ._._ 1 1_. ') �In; sic CozL; ��;iYelic. Nur1) r ^x� n._ -a.:) t'Name of Cont-.-actor) -- j sz)ranct Com7:_:3y Polity Nl mb�=r) - (F:;:� -:Tic- Date) (e.lL,Ci a[i•±itimzl i::[�:�;X;r-.a^.•.7:.�-.....c..:CK--a::CK:r-_.-.... � _eli CC.::-......') i O i iull t: pole p ol>rict )i is?1 i ha't'e ' ., no c oil fo n1l L\ � NOTE:plcnac be nt+-qrc tii.:.i�• not uicce lh:a throo u1i,3 in,%%.L. e^pioyes ur�.tr ..c %C7,(G1 1 152 h mco,\-acr`or a L•ccn=Cr p:ra:i:: IcS11 etztXiz of an c=ployor u)ur tLn lL'o etc Cos xrrition!,cL'^• I undcrrtnnd thL a copy of t}i cis t= r_.y fo faw vciot to t?»fYSxi t ^,of Ir�u riJ M� :o CfLc o of 1::n,r+-' for U. oov�S�vaillciioa and tlt:t L•ihirc to:-a_:co r_g-c ui 3 r:c"JM 25.A of MG1,152 can lid to tba i nfi.•rition of r yi_1 p:r�Ir_a using of a fur of up to S 1_500.0,0 a &'rr i fr:.•.•r� �( to cr: .r,j cvi) rsv2tin in uc fr in cf n S. For dcp--:!at u.c only i } SECTjON'8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable Name of License Holder License Number Address Expiration Date Signature Telephone Reg 5tere -f 6fff UZI morovernerit"Contracto R , � Not Applicable J� 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...... O 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.Aperson 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 acccptable 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 Sicynature SECT ON EAT N—lf f- ROPOSED 1NORK(check:ail applicable) w --it644 pok :- New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs Dec 1,s J Siding[ ] Other[ ] Brief Description of Proposed Work:;/ Alteration of existing bedroom Yes�i, No Adding new bedroom Yes No Attached Narrative D Renovating unfinished basement Yes No Plans Attached Roll D• Sheet 0 5a ���lew�hou""'s��nd�or�>a dit�on "to x sti'n:g�°t�oustng.,::comp�e� fi'e��laowin�: 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. 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 Nc 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 'S1©N7a' ak1fNR AUTHORIZATION TO,BE GO_MPLETED 1NHEN OWNERScA�ENT�OR'CONTRACTOR APPLIES'FOR BUILDING PEFMIT I. as Owner of the subject property hereby authorize to ac; or my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 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. "ame r ignature of Owner/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 J / Building Department Lot Size 1 ! 16c,"ii Frontage Z Setbacks Front r 0 -FF 30 Side L: _R: 3Q fT L:l i.;+ R: 30fF (� Rear s / Building Height �- f 3Q - T Bldg. Square Footage ;o as % _ Zoe Open Space Footage % (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 ,✓ DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO V DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs is 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 V IF YES, describe size, type and location: ;O -« City of Northampton _ . Cu4 1 Building Department I 212 Main Street ' p Room 100 ° orthampton, MA 01060 a pfione 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION This section to be completed by office - 1.1 Property Address: Maps Lotr Unit I marts (�f Al Zone Overlay District Efm-S't.District lb District- SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Burt-) �;f Name(Print) Current Mailing Address: ! _� /3.1 SRS g7.3 2 Telephone Signature 2.2 Authorized Aaent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building a (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) ✓ 3 Q r. -Check Number " This Section For Official Usa Only Building Permit Number: /��/ Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Ow*' File#BP-2004-1251 APPLICANT/CONTACT PERSON BRIN MICHAEL F ADDRESS/PHONE 601 BURTS PIT RD FLORENCE (413) 585-8753 Q PROPERTY LOCATION 601 BURTS PI RD MAP 29 PARCEL 477 001 ZONE SR (�t� THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: CONSTRUCT 16 X 23 &7 X 12 DECKS 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 Co ssion d X00 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. #W 601 BURTS PIT RD BP-2004-1251 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-477 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-2004-1251 Project# JS-2004-1892 Est.Cost: $3000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot size(sg. ft.): 79714.80 Owner: BRIN MICHAEL F Zoning: SR/WSP Applicant: BRIN MICHAEL F AT: 601 BURTS PIT RD Applicant Address: Phone: Insurance: 601 BURTS PIT RD (413) 585-8753 O FLORENCEMA01062 ISSUED ON.6111104 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 16 X 23 & 7 X 12 DECKS 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: FeeTyDe: Receipt No: Date Paid: Check No: Amount: Building 6/11/04 0:00:00 1559 $50.00 212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo