Loading...
29-312 (2) i� �gH�MpT 0 0 G1 i of Xart4ainptan �A35AChitSttt6 � `= 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 has/her construction super,4 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 homeowner." 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 Address of work location ` r • �.tyt/.N/•TU ���- C-If1�3 Of P\M7fljctlll}iftill �1�t37 AC{11t5ttt3 ^r DLPARTMENT 01' LUILDDDG INSPLCT'IONS 212 Alain Street ' Municipal Building Northampton, Mass. 01060 WORTCER'S COMI TENSA`ITON INSURANCE: ASFUMN .T 1 (11 tlllitCc) N;=ith a principad place of business/re:,idcncc f___CLr,j tPv1 5'r_u:1Cr3z t; .,_..._!r'P) ' _(pone 14 32,-11q y. ---. - - (StrceUci --- — da hereby Ccri1I1'• uncicl- die p 1T1J aii7 l)C it i 1CS Oi 7CI�ll11', ?l1F!i. atll 1II CIIlp!O�'Ci prOVl4ilrg tl1C i011OWit?L '.';Or''r:C1 S collwCns,2LA011 OOVCrar;C to- my elUployc=s wor�drlg an t?ris}ob-. a=,>_=cz Compam) cic:Ntt Ibcr) (Rxpir don Datc) I aL-i a sole proprietor, One) and, t-ve ILirt✓-d i.h'- con Tractors llsiet, belo'a;- l:o iiC 'Lilt lG .j e; mme C? ':il:, � Oitt S GOt� Il �Oi1 Q,Tamc of Contactor) (?ns nc Comn-.:rr,1'clicl TlurnLYr) !� >'; -,.._c- Datr) (Flame of Conti ctor) - (11zslr?P.G C Du Dc i`'IPDI1Ci Ntsilrr r) ( f:=ion Daic) (Name of Contractor) (1nJ:r nc° t D uj;'u'i/i'OI;C: 1 11IIJlr r) -Y '- i:D Da1'c) - (Name of Contractor) _ (Ins anc-, Comr y!r'o1i--� N=>;-r) i i�q z inn a sole hroprier�r <:Ild have no one v., O; I?Ie. am < 1101I)c NOTE:please lx away,till:.+i:i1c f crco a.r.� .c cz l y;r.. c n c:> �_�:�nc�a._n m cr•c..1it i not utccc th n throe uniu in,taj da u a;' �.•_;�_ .rtcr:r1 i--e'O z:c n.t(C 1a11_i ccv: _:: :c t� c^'•ployc�u_z�u ttr-tvcrl:rf_c�::l'--'-::cram:'•-a(FiL.:52.�s!(,l!.-,:a ._ tic.,by�hcn:ico�.•�`.or n LM:sc cc p-r^.:i::: ..'�rrx c.._ legal etatus of r.n omplo)w under tLe Wcvkcrs l.:oa�;>ar_-.ration!.eL I un&-- tI nd ah,t a copy of Lh,�, ctalc:s•n:ay bo forwnrciard to tt»fY.tiortzxst:of Iz>dzutricl M i&-re'Of 5— for t4x oovaxge verificzlioa and t1L_t f_iltut to r- t coI,-r_M und= 2j A of MG1,152 ctn Iead to tlx impr Lao t of c ^r_1 P =� romutmg of a far)_of up to S 1,500.00 aft.,Or i^:pri r,z-. of up to cr.;)-:r r:-.j nvil cnzlt n in dc fonn of a stc•,, f m of S 100.00 a dzy«vr_wl m:. . For 6,Twut>�ra1 uac uil}' I nature r E S�C�ON�B °CONS"TRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ //// c Name of License Holder : L) o-h ti S )i ki-i A t-S/2( / Q 3 License Number % G &j7-1 e.1. 4 61- 0-1,11-3 L�L�1S�y�l4yri�r�r.•— mA 0/0-29 ghyZ65' Address Expi—raTion Gfate ^21 419' Sign e Telephone Re , ,;e:eV .z�rn ,ffr x uer en _Un rac Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 1D WORKERS' COMPENSATION iN,§URANCE: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...... ❑ 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 acecptable 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 far which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 15') (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 I . q A i SECl .OtaI�D S. 2IiTd.0NOFPROPOSEDIW0RK check;afl a I�calE New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ) Siding[ ] Other[ ] Brief Description of Proposed Work: AiiO 1.100in R PH;tlzi-FLvvi- U. 044425' -tuj3 1VIit i7- Alteration of existing bedroom Yeses No Adding new bedroom Yes v'No Attached Narrative U Renovating unfinished basement Yes 4-" No Plans Attached Roll o. Sheet❑ fa :t. 7:evs�a" "'e�si ©r �.ition�to, `eX'isfing��hous�ing�°'comp���e' t`hefiol��w.�.ng: 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? It. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodpiain 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 SECTO YY ER�UI" IORIZATION TO'BE COMPLETED WHEN QYYNE S �ECONTRACTOR APPLIES FOR BUILDING PERMIT "a i as Owner of the subject property a hereby authorize 1106 A, SYM.4/-5 R 1 to ac; on my behalf, in all matters relative to work authorized by this building permit application. os- S' ature of Own r Date t I, J Gti A- 5 V }9r�� � I 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. J 0�j •c. Y bYJ/�.� K i� Print Name 5 Signature wner/AgpdV 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 Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage % 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# I i B. Does the site contain a brook, body of water or wetlands? NO 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: j 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 IF YES, describe size, type and location: City of Northampton - --Wilding Department 212 Main Street - Room 100 Northampton, MA 01060 4.11-t§7-1240 Fax 413-587-1272 � p ApPLICATION.T©,CONSTR ,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION e4 1.1 Properly Address: 3 y 2 AC R)> btZ00 K 0 A A MaP /,f'/j /�'}� /p j,,. /yy�L a.. c. t 9:• .... r .�a 'f7�7uJ1.�:.' 0m Distrii a . .C 3islts Cl SECTION 2-PROPERTY-OWNERSHIPJAUTHORIZED_AGENT 2.1 Owner of Record: B06 it-P.T � i�osi�jv�N i�y k4Le 5l9pif= Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: 5"y' 1►'If ,v51�C > / co774161;srr��iar3 Name(Print) Current Mailing A ress: S' ature Telephone SECTION 3-ESTIMATED CONSTRUCTION-COSTS Item Estimated Cost(Dollars)to be Official-lJse.Only completed by ermit applicant 1. Building {a);Bwldiog'Permit Fee 5 !J00, �Q 2. Electrical (W E�tiniated Total Cost of 900., 0a .;.Construction ftbmr.-5 3. Plumbing Btfliding Permit-flee: 000 0 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2+ 3+_4+ 5) �rSQ -Check Number d This Sectiont:For Official Use Onl Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date r . File#BP-2005-0845 APPLICANT/CONTACT PERSON John Symanski ADDRESS/PHONE 1 Cottage Street#32 EASTHAMPTON (413) 527-1149 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 Building Permit Filled out _ Fee Paid Typeof Construction: BATHROOM REPAIRS(FLR WALLS TUB&TOILET) New Construction Non Structural interior renovations _- Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 032590 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO161ATION 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 ssion 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. 342 ACREBROOK DR BP-2005-0845 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-312 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2005-0845 Project# JS-2005-1172 Est. Cost: $8800.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: John Symanski 032590 Lot Size(sq. ft.): 11107.80 Owner: BOUDREAU ROBERT A&ROSEMARY N Zoning: URA/WSP Applicant: John Symanski AT. -��?? ACR F63 n,nn i. Applicant Address: Phone: Insurance: 1 Cottage Street# 32 (413) 527-1149 EASTHAMPTONMA01027 ISSUED ON:3117105 0:00:00 TO PERFORM THE FOLLOWING WORK.-BATHROOM REPAIRS (FLR, WALLS, TUB & TOILET) 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.- �( � ti Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: LP C THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: - FeeType• Date Paid: Amount: Building 3/17/05 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo