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29-312 (4) �c t l �'CH�►1NP). GitV of Wart4aluptan $ � �lassachusctts - r s 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 his/her construction sup,_:,•i 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 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 ,y r7 (iI I I I zi f \1 til- -t I I I LI I I . . �3tsextllitsrtls' - i>EPART1.f'N"T OF £UII..DING INSPECT'IONs 212 Main Street ' Municipal 13uilcling Northampton, Mass. 01060 WOMCER'S COMPENSATION INSURANCE A FFMAVIT (lictin�^Jr^ttniitcc) __ _ - �:�itil a principal place of btlsil;esslre:i;denc� :. O I am an emplo yer providing the foil ow;nc •:orr_ers colnnensation covera�+,e for my employees Worcing on this job: (Insira�� Compam') ( ec:Nu 7bcr) — (rte pir�c�Date) ( j I am a sole proprietor, �,tntraj con�c`er ur hcmc-owner (C' de one) and, h"•e hired the coI]i actoFs 11steC he10�'v i' `f iO�C ii; ti r ' 0 1i''J° c ] v JOr1LP S C,0 pf-, oF1 S- 'Name of Contactor) (InS �ncc Corns :;T,Polic1 *1unMr) T`, .+. c- Datc) (Name of Contactor) -- (7ns�r_nce Coy .vJPe!iei Ntrnr) (F r :io, Date) (1"tame of Coalmctor) (1r1S r3I1CC (_.� y.:'_n.i/i�O�;C: l lUnlr r) `.ti.:;.a70 Laic) - (Name of Contactor) —- (Iasu=c- Coal:— /Policy Numb-=r) (r.tt.�dt:-djtucr.�l z::rct:!t:!r.-�a^::n:..-...._ .. �t'•:.•:c;•.r-.._.-.. .-.li o:<:r_:�c:--) ( I "cLIl'i it :;Ule propnte'-ni- c'il have no 7I1C ',','v?"�K.i:i s 4k S. CT�ON°8 -000 RUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ _ r r Name of License Holder : J }��/�' .S y � '- 5�'; 034 90 License Number C�r7WOE' S T T 3 GH -/-)M IV 17 �7✓/V/V- Address Expiration Date ature Telephone 19-91 s ere orne.1 faro 97M—6—n Not Applicable ❑ D 2-2Z Company Name Registration Number Address , Expiration Date Telephone `// '�—//�� SECTION 10 WORKERS' COMPENSATION-;INSURANCE AFFIDAVIT(M GL. 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"homeowreer" 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 fu;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 forlperson(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 u "SECTION �I:SCi2 AT�ION OF PROPOSED WORK chec f to licabfe p � NOW i New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors 10 Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [x) Siding[ Other[ ) Brief Description of Proposed Work:SrAlanA e l nf-©ti i,���1yc =��r��,r�/Q �y ��* �� � ,�.«� �, `� �•s t/_ V1 c-K Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll D• Sheet D 6a�: ; ewe,ou o�a� �i;tion�toexisfin�<#�ousrng co�°m."p� faefollowin� 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 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 SAC,T O�a�1lyN EMU T i-RIZATION TO BE COMPLETED WF(EN O�IYN SAGE T{�RCONTRACTOR APPLIES°FOR BU11_D1NG PERMIT ' as Owner of the subject property hereby orize _ -1 kA; q yh,>, k1 to act on my b If, i matters relativ to wbrk authorized by this building permit application. ur Owner Date I' -"[b�'A' "��t Ck VA as Owner/.Authorized Agent hereby declare th t 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. q-r-"LN 0-� Swy'lact flea ki Print Name I Sig ure 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 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 and Page or Document# / 1 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: 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 properly?YES No IF YES, describe size, type and location: NN Northampton � SOS� Department ain Street m 100 2' �.. Nort amp on, MA 01060 s phone - 7-12 0 Fax 413-587-1272r � IoKS c aIALD�NCi 1NS.t�16� PPLI n t! CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-S1TE"INFORMATION 4 "" This"secfiian tt� e zo nplet by ofEce 1.1 Property Address: e1 �9 "S�' a 3`/-2 A c`./i 1> i :% Mai �.a �� unit Zon+ ME- �Oxer#air t �str�ct { SECTION 2-PROPERTY`OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: �Ac 17 Name(Print) Current Mailing Address: Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION`COSTS Item Estimated Cost(Dollars)to be Dffisialrl7se.Only completed by ermit applicant 1. Building n {a)`Bwlding Permit.Fee P Z. Electrical (t►);Estimated_Total Cost of Construction from 6 3. Plumbing Building-Perniit'Fee_ 4. Mechanical (HVAQ 5. Fire Protection 6. Total = (1 + 2+ 3 +4+ 5) :2 J C„ -"Check-Number 'rhis Seddon"for Official Use Onl Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2005-0143 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 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction: REPLACE 4 X 12 SECTION OF DECK STRIP&REROOF,WINDOWS,DOORS& SIDING ROOF OVERHANGS New Construction Non Structural interior renovations Addition to Existing Accesso1y 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 INFO ATION PRESENTED: rpproved 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 Commis 'on 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-2005-0143 GIs #: COMMONWEALTH OF MASSACHUSETTS Ma; 31ock: 29-312 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Pen, it: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cats,-or BUILDING PERMIT Per. it# BP-2005-0143 Pro: -t# JS-2005-0156 Est. ('ost: $24500.00 Fee: 125.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use I'roup: John Symanski 032590 Lot ize(sg. ft.): 11107.80 Owner: BOUDREAU ROBERT A&ROSEMARY N AT: 342 ACREBROOK DR AP 'cant Address: Phone: Insurance: 1 C tta.ge Street# 32 (413) 527-1149 EA` THAMPTONMA01027 ISSUED ON.8113104 0:00:00 )PERFORM THE FOLLOWING WORK.-REPLACE 4 X 12 SECTION OF DECK, STRIP & RE -)OF, WINDOWS, DOORS & SIDING, ROOF OVERHANGS Pr ­-THIS CARD SO IT IS VISIBLE FROM THE STREET In: or of Plumbing Inspector of Wiring D.P.W. Building Inspector Un -round: Service: Meter: Footings: Ri, Rough: House# Foundation: Driveway Final: Fi� Final: Rough Frame: Ga Fire Department Fireplace/Chimney: Rot 'i: Oil: Insulation: Fi: Smoke: Final: 0/< /0-/S/.6 y T! PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF Ai OF ITS RULES AND REGULATION l 07 -ate of Occupanc Sisnature: FL ._;)e: Receipt No: Date Paid: Check No: Amount: Bl 8/13/04 0:00:00 $125.00 212 Main Street,Phone(413)587-1240,l,'ax: (413)587-1272 Building Corrunissioner-Andiuny Patillo