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29-536 1 �© o ku i Z owl rl f g'S�'yP7 ,.Gz#p of Warthamptan z = a - �I IIH34ACh314ttf4 - DEPARTMENT OF BUILDII%ZG 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 has/her construction sup,;: .';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 r'.egulations. 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 o► F : a 4_ ____���tand the above. ome owne /resident's signature requesting a emption) wifl-c-a-fl-to—sc-Tiedule all required building inspections necessary for the building permit issued to me. Date ( O w Address of work locationJ� CL n r Crif� �f {crrfl7�ili}�to�i - _ a7 a itch nsclla• _ 4 OEPARTMEN7. OP DUILDI7\C INSP=IOhrS - 212 Main Strcet ' Municipal Building Northampton, Mass. 01060 WORICI;RlS COiNITENSATTOIii MSURANCE AITD�e' .VJT' (liccnsxlperm�fret) llvit i a pnncipaj plate of business/residencc at: -- - (phone:=) (suit/cz ty/SLUG/a P) do hereby certify, under die.pz2in5 and penalties of perjury:, hai ( ) I a rn an employer providing die following %vorkes comocns-n:Jon cove mSc for Im etuplovccs wor-1308 on dlis job: O nnir-mac COM=zv) (Potic: Numbcr) -- (I:•pirrtion Date) ( ) I am a sole proprietor, geoeral conu-aC-Tor or homeowner(cl:de one) and have hired the coao-acnprs listed below who have the folio%vin¢ workers ramperLanon policies: (Namc Oi Conmicior) (InRr-wicc Compan)- ilobci T-,lumhCr) nitc) (Namc of Co0(TaC 0r) (Lns-w--ac;, ComoanN Poky Nu 6cr) (t-piraon Date) (Name of COUMCIoz) Oms u-anee Comp�=)•[Pouq• Number) (Expiradon Datc) (Name of Contractor) (L=ance CompauyPobcy Numb•`r) (Etpim6oa Date) . (aIISch ad�s�ocal c''.eG.ir acaza�•w atcud_inrorovLs oa peru�iain.g w.11 coos-_c.o:a) { ) I am a sole-proprietor and bave no one working for me. I am.a home owner performing all the work myself- NOTE:plc=be Gw-jx,tti u k4�jje t]GmCXJM DCT]-to cimploy p---L4=La dD n= c=--=jao c rcpaa-ank an d,-Jt-j:of Lux mote than t`=r a ua?j is«bleb Lbe bccnoown-rraide oc oc the pouzx!3 rppurtc==tbe�r_-r ooc -.11y oc=-d-c d to t' esLplor-uod-the--v-,z cc=p==Lca A=(GOI52ss 1(5)x,appliunoo by a boa3mava far a lies_or permit may--id—EL- le�Ll ct�[c of-es?loyw under dL waki ec Coospomal-ioo-Ac(- I undests,od)fast a copy of thia mtcm m m y be f----d<d to tbo Dcp-tmcod of A.&—1'office of ham—for lbe eova�lse va if alioa a_'rd olu L•il=to to=ut Fnvcrase uadC 111 t oa 23 A or h(GL 152 c.lead to the L oa of eimiCLA peaa - ooa-3z x of a rmc orup to S1Soo.00-dloc impriaoa�orup to oo,-yczr and ci%il pmsPua in t5c form ora Stop Work Ord-and a _ fun of 5100.00 a day=pri=se tnc PCTMI NumL--r Lot ignatuzr of Li c Ltcc -- 9/fo�oy• SECTION 8'-CONSTRUE PION SERNIGES r 8.1 Licensed Construction supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9 Rea stereortre aoveriienarrtt armor• Not Applicable ❑ Company Name Registration —umber Address Expiration Date Telephone SECTION 10-WORKERS''COMPENSATION INSURANCEAFEIDAVk7 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...... ❑ 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 Stat f Massachusetts Gen ral Laws Annotated. Homeowner Signature w r t p i -- SECTION 5DESCRIPTION OF PROPOSED WORK(check-altapplicable) New House ❑ Addition [�:,: Replacement Windows Alteration(s)� Roofing ❑ Or Doors F—I Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [p Siding [Oj Other[pj Brief Des,sccriiption of Prop fed r o grk-Alteration of existing bedroom Yes No Adding new bedroom Yes No'. Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet L,a^ ,.�., x � �, '..e,�s n r, � ,, -,:�.x ,, : , sad t `N`e1 iouse�an Ua c[ MOD D nc 6ar s�na�„coma ete_fh : o t wrng: 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 7a,-OWNER AUTHORIZATION-`TO BE COMPLETED,,WHEN, OWNERS AGENT OR CONTRACTOR APPLIES`FOR BUILDING:PERMIT 1, �dr�`� yy �r.�C ” as Owner of the subject property hereby authorize c Dc— to act on my-behalf,in all matters rela' o rk authorized by this uilding permit application. Signature of Owner Date I, 9 . c N))i,+6 re 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. Prin7Na e Signature oF9�gent Date Section 4. ZONING All Informatioh 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 NeN, Frontage I Setbacks Front Side L:' R L l R: � L Rear I Building Height - Bldg.Square Footage '— 011'0 Open Space Footage , % (Lot area minus bldg&paved parking) F-7 #of Parking Spaces Fill: r �� (, volume I&Location)i I a A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES Q IF YES, date issued:= IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book 1 Page; and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Date Issued: C. Do any signs exist on the property? YES 0 NO Q IF YES, describe size, type and location: '__ D. Are there any proposed changes to or additions of signs intended for the property . YES 0 NO 0 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 r NO 0 i IF YES,then a Northampton Storm Water Management Permit from the DPW is required. o Norti arnpton u l _l-- B it g Department Main Street X004 t; oom 100 No ton; MA 01060 phone 413 87- 240 Fax 413-587-1272 Rn ;a x ut �; (�h? I�S ECTIONSe pec'f y �,.,�r — �_.ppp_b ,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION j1.-SITE.INFORMATtON_ ` k This section to be completed by office 1.1 Propefir Address: ( \ , Maw Lat � r � Unit Zone . Overlay"Dtstnct I �G.__ O l O to �EImFSt:Distract - C6 D�.stnct SECTION`2-PROPERTY OWNERSHIP/AUTHORIZED AGENT: .1 Owner of Record: t7� Name(Print) Current Mai ` s: Telephone(( 11 1 1�} Signature 2.2 Authorized Agent: e' - Q D • fox l�l A7ha�-ely 1M 1D9 Name(y n') Current Mailing Address: L O A O O Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item - Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant Building 1 O 1)v {a)Building Permit Fee 11610 el 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) Check Number &50 This'Section For Official`Use.Onl :Date Building Permit Number Issued: Signature: ' i Building Commissioner/inspector of Buildings Date q0ile#BP-2005-0302 APPLICANT/CONTACT PERSON PRITCHARD MARIA&DAVID ADDRESS/PHONE 24 INDIAN HILL NORTHAMPTON O 586-7074 O PROPERTY LOCATION 24 INDIAN HILL MAP 29 PARCEL 536 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinp,Permit Filled out Fee Paid Typeof Construction: INSTALL BATHROOM IN LAUNDRY ROOM 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 IN�F�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 q- /Y . Signature of Building Wicial 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. IAN HILL BP-2005-0302 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-536 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-2005-0302 Project# ]S-2005-0116 Est.Cost: $2000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sg.ft.): 7971.48 Owner: PRITCHARD MARIA&DAVID Zoning:URA Applicant: PRITCHARD MARIA & DAVID AT: 24 INDIAN HILL Applicant Address: Phone: Insurance: 24 INDIAN HILL O 586-7074 O NORTHAMPTON MAO 1060 ISSUED ON:9 1I5104 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL BATHROOM IN LAUNDRY ROOM 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• Receipt No: Date Paid: Check No: Amount: Building 9/15/04 0:00:00 518 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo