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29-312
D escripkor/Are a N, A:1 Fr/B BBB sgfk I B:Wood Deck 52 sgfk C:Wood Deck Wand Deck 231 sgfk 17 X31 40 1B 4 24 1 Fr/B BBB 11 go oil I a C:) � N C\J CN CY) LO C3) N � � N d7 I - � 00 � iri O¢.tt�AM pTO y • �� M r �t�ssA�h��S�tts n DEPARTMENT OF BUILDITjG INSPECTIONS INSPECTOR 212 Main Street • Municipal Building ' Nortli,-unpton, 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 supc: :i sor. T he 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 nn /I I, understand the above. e owne�/rid�ent's�_sture requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location T(I ir, � a T1 6,ff, 't Ar ?° F E UI}�) C7f {Lll fl}aII1 1011 ,L' R .- E ll�s�arllrtcrtta• - — _= © DEPARTMENT OP BUILDfNG INSPECTIONS 212 Maio Strcet Municipal nnild;ng Northampton, Mass. OIOGO WORIC R'S COiAPENSATION I_NSTJRA-NCF Al, , AVl-S' � I (1J CtDSCZ'JpC'TT11J IICC) \,AIIth a principal place of business residence it: I _ (pnonc*!) (s1 t1c�ty/st='Z' p) do hereby certify, under the pains --od penalties of pcgury:; hoc i ( ) I am an employer providing the following worker's comoens-L)on cove age for Inv employees working on this job: (Instinn= Coca (Pclic: Nu.�r) --- F;-piroor tDat,c:) ( } I am a sole proprietor, gener2J contractor or homeowner (ci:cie one) and have hired the coon ors listed below wbo hive the following worker's coo2nensauon policies: i -- (Narnc of Contncw-) (II1R!rlt1c: Comparl)-i'l ou i ?�Ii.1J11_C:) �•'•JIiJG^i' I�:11C} � r (Name of Coomaor) (Insaranc;- Compan)vPolin Num6cr) (Expir,Lion Date) (Name of Coan-aaor) (I.nszu-anc: C.omp.an}-/pol;g- Numbu) (Expiraes Datc) i (Name of Cootmctar) (Lasuraac--- Comca ly/Poliey Numbcr) (Espil-,600 Date) . (aQar� arx3J e-clir aco=--y w etude iarorm�Eoa pcv�to.Jl { ) I am a sale proprietor and bave no ooe worh"iog for me. ( ) I am.a home owner performing all the work myself. NOTE:piesc be ewmrt tbzt�jj,hemco-o=ubo=V loy pezoat Lo d3 rgau-06,os of ont a�oct thenLt -mot,is%,-b cb the ride or ea the p-oun x7 urtcn tbcc e c ox C=am_!ly oL,=6---cd to Uc -=Vlaye-s uac a the---k&--i c= -:.,oa Act(GL152.-n 1(5)�=gp6=6ca by a bomco vc fcr c lica'a P=Mit r=y c.4d—tL- IcVI M--t=of as eegloyer under tLa Wockxec Compeonit Ad. I undcaa.nd th r x copy of thi.cn.L m m y be roc-�ded to the D.oportmc 1 or tadusricl 6Q--for th. covex-Cc%cirenioa-nd t}u Cc.LM to$x==tovctase tinder s.cdioo 25A ar?.tdL 151=led to the im;=itioa of crimiczd pcc..W,= ooasi:-.iag of•fiat orup to S 1}00.00-,N-i xgx-LO meet or up to ooe yc3r LDd 6-vu pcnojm so t5e form of.Stop W-I*Orda-d c fun of S I OD.00.d:y L piaS1 MC_ For d,,-,=,---Il u.c only . Permit N t1I bcr Lot Sign--icon or Lia=nscclPcrmiucc �e - J ¢ 3 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone J: 2eaisteTellarrimnioiremeht Contracfti Y= Not Applicable .❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCEAFFIDAVIT-(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...... ❑ rtx � : � T1F1G �lI� `Zl 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-vear 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 buildine 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 Signatu %� °L� SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ID Accessory Bldg. Demolition ❑ New Signs [O] Decks IM Siding[CI] Other[E J Brief Description of Propos _ r Work: C .S ` rX /® Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet �� ;� �� A 6a elf 9e0iooseaD�l ar;a c]ttlo ,t©Rexrsincr horrq:compe .,Vii; oIRour,q: 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 CONTRAC'FOR,APRt IES',FOR_BUILDING.P.ERMIT I, 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 as Owner/Authorized Agent hereby decl re 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. v Print Name i ture of ner/Ag t Date • Am,* r Section 4. ZONING All Information Must Pe Completed. Permit Can Be Denied Due To Incomplete Information Existing Propose Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front F Side L: R: L:' Rear Building Height Bldg. Square Footage 3 Open Space Footage a/o (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 0 YES 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 ` Page' and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT 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 0 NO IF YES, describe size, type and location: 1f' D. Are there any proposed changes to or additions of signs intended for the property? .YES 0 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. e City of Northamptons Building Department 212 Main Street Room 100 'Northampton, MA 01060 phone 413-5$7-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SIT.E.INFORMAT.ION 71iis section to be compiefeclby office 1.1 Property Address: Tl)0(�fn ce ' " ' © l d �.%Z Zone 41Xertay�is�ct CB }isfr3s t. �E�pa'" �Dt$trtc�a SECTION 2-'PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: L-) p I 05 fir!r Name(Print) Current Mailing Address: Telephone i I'll ure 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION'-3—E911MATEUCONSTRUCTION'COSTS- Item Estimated Cost(Dollars)to be Official Use Only - om leted b permit applicant 1. Building f (a)Bgilding Permit Fee 2. Electrical (b):EstimatedTotal CosYof` Construction from. 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For-Official Use Only Date W. Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2007-0174 APPLICANT/CONTACT PERSON BOUDREAU ROBERT A&ROSEMARY N ADDRESS/PHONE 342 ACREBROOK DR FLORENCE Q 586-9787 Q PROPERTY LOCATION 342 ACREBROOK DR MAP 29 PARCEL 312 001 ZONE URA/WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid T_ypeof Construction: REPLACE 8 X 10 SHED New Construction Non Structural interior renovations Addition to Existin¢ - Accessory Structure Building Plans Included• Owner/Statement or License 3 sets of Plans/Plot Plan THE F9CLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 on Z�(� Signature o uilding Officia 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. 342 ACREBROOK DR BP-2007-0174 GIS#: CONIAICYNAV ALT11 OF MASSACHUSETTS Map-Block:29-312 CITY OF NORTHAMPTON Lot: -001 Permit: BuRObq Category: BUILDING PERMIT Permit# BP-2007-0174 Project# JS-2007-000264 Est. Cost: $1800.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 11107.80 Owner: BOUDREAU ROBERT A&ROSEMARY N Zoning:URA/WSP Applicant. BOUDREAU ROBERT A & ROSEMARY N A_T_- 342 A0R_FRR0Q-K_DR Applicant Address: - Phone: Insurance: 342 ACREBROOK DR O 586-9787 Q FLORENCEMA01062 ISSUED ON:812212006 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE 8 X 10 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: Insulation: Final: Smoke: Final: OK 101 o E 1 d 6 t o,,1 S THIS PERMIT MAY BE REVOKED BY THE C Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULA IONS. Certificate of Occupancy Si nature: FeeType: Date Paid: Amount: Building 8/22/2006 0:00:00 $25.003634 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo