29-515 (2) 7
v"�
_�
4
0
.�C ?
� �
��
d
y
N t �
f
V�
o
0
y
� r a
�k
..r
f
cant
F
Q
....
. 0
4m
In
eF..
v`
�
5
@ �
\
/
. - --
)
N 67 $\0& �
K & :
+� °� ,s
-
a flj�I�Ii}?fL1 11
Y'` E iiicse,;cf r,r,c(fs iO4
�� Jt
1VORILI�:R'S <'U\1PETMATION INSI.IRANCE ,SIMIDAV"'
1.
�':lih .. � iilClh�•� il��ll'� - �i'�! Ji �h � ...
,10 pC"ill(\' ....._
wl 11
T x'_111 d Sulu I?1mn Ci pum ! J', _t we a Ovs C1rCt�
of
(N'amc: of Cont_
(Name of C,o,1U;aaw) Iltiansna Coln .nypokc�,,
1 gun _:IA
\ .. ii:`r=ill
?IO�IL.I•Ic-u lr nuuc � �:: �'> s ><'�:y,j_ry}> � uu c c. _ Y�rr
not nxvc t]nn ducc u,vtt in u&At A .r:r. r._.. 3 :
cnrto 'csu_t' r0Y,Nwr. _CAcc_-=-a._ni.r
Itsil datuc of an�nloyx under d,n lVhl d�C'o;r.;wri:ioti Ad
I tvudcnttnd tlt+t.copy of th6 uatr_,—!nay];o to 0»[YtnitnxrL oflr.c Iot">c
cove,-q;c vc:&ICrliat nwt 11Lt f•ilurc to :cc vxi:5A(,f MGi,152 can lr_d tot!),,u.: •>>-'.t ,': �-t�—1 Ix:alt:a
comisting oC a 1mx of tip to S l jDD 00 anvm i_:,ti-.-= ::t of up to c:�}'-.:"i civil multin I le All: -:�
ftm CCSI00.00 m-.
04 �O
i of Nortllaii ptaii
r � i �A55ACt'11Sttt8
DEPARTMENT OF BUILDDNG INSPECTIONS
INSPECTOR 212 M;iin Street 0 Municipal Building
Northampton, MA 01000
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CN4R 108.3.4 to
act as iJs/her construction Sul)':_: he. state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or trvo family
d►velling, 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 buildiniz 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/r sident's sign u requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date -7 2, �
Address of work
location -3 C r R e (,E _
� t ,
SECTIONS -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature i Telephone
9 :Registe'r'ed H"o`me"Improvement Contractor - t
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...... ❑
1k1, Home wnerrE-Wffib�ion
The current exemption for"homeowners" was extended to include Owner-occupied Dwellin,-s 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 fo- 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 14 �4M
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all ap licable
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. Demolition❑ New Signs [ ] Decks [ ) Siding [ ) Other [ )
Brief Description of Proposed Work %,,A2 " '
- -- - _— fit-�zz t�.�.��,-�� --�-- .-- 1c - .p
1
Alteration of existing bedroom —____Yes --._. _ No Adding new bedroom Yes __-X No
Attached Narrative (7 Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet t
6a.'If`New h"ou"se:and or addition to'existing housing, complete the following_
a. Use of building : One Family-__ 1,.:o 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 floodplatn __-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_
SECTION 7a -OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
— - v,,
� s O ner of t�ne subject property
hereby authorize _ to aci or
my behalf, in all matters relative to work -Iuthoriz-d by th _; ':wilding permit application.
Signature of Owner Dare
it
_ _ __ _____-_- _, as Owner/Author,zed 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.
Print Name
} - ---
Signatrire of Owne /Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
14 11,.v GACA6Z_ This column to befillcdinby
"ic 1461D Building Department
t UUQa,,
Lot Size
Frontage �' <, A
Setbacks Front _7 t
Side L: L R:__5. 6 ` L: 50� R: v<
Rear
Building Height i
Bldg. Square Footage u" %
I 3U
Open Space Footage %
(Lot area minus bldg&paved 11 4 C� `1
parking)
t
# of Parking Spaces
Fill:
volume&Location) NJ b
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO k 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 X__ vON'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 X_
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:__ _—
_ bDepactrpenttuse'�odnly
-----"'�C —� of Northampton Status 0 Permit
. � }°''�,•xcF`e r�`r� s v fr. �"���5.��'��.{�-y:f �
ing Department Curb Cut/Dr(vewayi, ermit
"1
1 r Mali-,
Street Sewer/Septre'A allatJ(ilt�a�"` s �,
[Room 100 Water/Well Matlafsility � � h �
N rt a lipton, M/a, 0 1060 T,vvo.Sels`ofStrdctural P�1ans� �
' 240 r' ;. 4 ? Piot/Site'Plans ?. '
of$IjIL�ING INSpEt;+� � S
wY
o, MA 01C36fl Other Spec[fy
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: Lot �/�
M ap Unit
1.--- C - - - -
j Zone1111 - Overlay District
E in St. District CB District
SECTION 2 - PROPERTY OWNERS HIP/A.UTHORIZED AGENT
2.1 Owner_of Record:
eon — D q NZVil CK Cl t"ArR__60 _ _3 1 -7 Al?A j_12 c_
_ <.f NSA _ a
2.2 Authorized Ave-nt:
i
SECTION 3__ ESTIMATED CONSTRUCTION COSTS +
7 �� SiIflldteQ Cost <<`UII rr Difir„l Use Only i `
C file bV p milt 2[ ca t — -- -- -
ut ,n, s,an r
l
1. tam t .ra Taal
-i cn t Ilion from 6`
? Building Permit Fee
', {irr, rote C or,
E- for — r - ? + 1 Wreck f�LjinLer
d
This Section For Official Use Only
— -------- -
Building Permit Number: ! Date
Signatt:re: -
Building Commissioner/ nsprctor of thil lings �� ”'
#BP-2004-0093
APPLICANT/CONTACT PERSON DANZIGER GEORGE&
ADDRESS/PHONE 33 TARA CIRCLE (413)586-4181 ()
PROPERTY LOCATION 31 TARA CIR
MAP 29 PARCEL 515 001 ZONE URA
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: ERECT 8 X 12 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 LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN F RMATION 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 Ehn Stree o ssi
)la 3
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.
31 TARA CIR BP-2004-0093
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-515 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0093
Project# JS-2004-0145
Est. Cost: $1600A:W-
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Grot►p� Homeowner as Contractor
15333. l`..r. ..r. r.nrj7Trr..» f:F(?*,2QF&
Zoning:URA Applicant. DANZIGER GEORGE &
AT: 31 TARA CIR
Applicant Address: Phone: Insurance.
33 TARA CIRCLE (413) 586-41810
FLORENCEMA01062 ISSUED ON.815103 0:00:00
TO PERFORM THE FOLLOWING WORK.-ERECT 8 X 12 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: Insu�atio.::
Final: Smoke: Final: 4K —o'te'Z
THIS PERMIT MAY BE REVOKED BY TH ITY OF N RTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGU IO
f
Certificate of QccupanpL Si nature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 8/5/03 0:00:00 1108 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo