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32C-227 (3) ¢TtSAMp�, O O DEPARTMENT OF BUILDING INSPECTIONS J INSPECTOR '212 Main Street • Municipal Building 'o Northampton, MA 01060 r 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,::.zisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be a one or tWo fame y -- 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 buil mg department for the City of Northampton wants-arty 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 backfiIl), sonotube holes (before hour), 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 occupancv 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, 1 l stand the above. ( ome owner/resident's signatdrk requestin exemptio ) I will call to schedule all required builds g inspections necessary for the building permit issued-to me Date / 66 Address of work location 4 — lZa W It r /ai6�i� �i o4itw•r ado r.. - a `E �JT 131 �II1"fIIi3111�J�DlI _ g _ f ��c7 a>ccllnscll a' © DEPARTh4EI T OF ©UILDr\10 INSPPCTIOI.'S 212 plain Street Municipal Building I " Northampton, Mass. 01060 I «GR=_R'S COIVZPENSATTON L`iSUTZANCE A=,-�vI7'. I v.nth a principal place of business residence at: -- / (phone:') 5 L do hereby certify, under the.pz_int and penalties of pegury:, ha { ( ) I :man employer providing die following!,:orke>✓s comnc Asa io, coverage for my etnplovec:s worlong on uiis job: I � - ie sumo coo=\') (Polio:Nu-ter) -- (=r pIraaor. Du^) ( ) I am a sole proprietor, general contractor or homeowner (ci cie one) and have hired the cony-actors listed below who have the following —workers canoensaaon pe!icies: i (i+Hine of Con=w r) (IRSLranc; Cornpan)-Pt oUC'i NUSIICt:) (rtiJ1F1G^R I�StC} (N:mc of Conlzaor) aa5-w anec CompanvfPoticv Nuncrr) (L»imaon Dait) (Name of Co=o-1o,) (L a5ur'anG= Company/policy Numb,.I) F,_xpiraaos Dalc) I - (Name of Contractor) (lasurasic-, Comczay/Poticy Nu.mtrr) Date) (aCaL1�'1S::Odi ibeC,tf neGCU_'1-ln ate!u�tIIfOrID.a_1 o4 petatraias b ail oc�_C-0:�� - - .._..._.. - I am a sole-pFopr etor and have no one wor'dng for me. I am.-a home owner perforr=g all the work myself Ii OTT-. w plo be zwwl:dfi K•t�� .-•e bcmco ,=M W 1 amp%pc.-c=to cso ,�c_—.:ciao c rcpau,.•orx ac a d.•cil_E of aoc moot th a L= -_L-arJ is%tinch the bomo ,c) rondo or ca the gouncS appurter+•^+the eo r_-c ooc C==2y ccc.d..cd to be aitploycs 11 =the woi rs:=c=p-=ticQ A=(GUI 52-=1(5)},a+pti=6ca try a bommama fc a!ice_a pcmit er=r cVPdmcc the Ico cu=x ores esp[oyac under dax WoriCda Cocspam.tioa Act I„nay,.oa ma i° PY nr tbu-w=m.y bo roc7,.rd<d to t>h.I3ryartmma or i ;mil AcodeuU OIL—or In_a,00e Jr—Lb. oovc�veirc=iioe and a"L-il=z_to scauc'eoverabc tmed,xoaioc 23 A er I,iQt 132 m I'd to the iszposaion of a miosi peeiliic cO= ig of a fmc ortrp to S I_�00.00 aztdroc orup to toe y�• end civil pcmr'a is^x focm ora Sum Work Ocd=and a Finn of S 100-00 a day LpjU7 I tlx For ti t u,c only f cT i Ntunbcr LtM M,p�— Lot Stgnatyc of Li cl7rtitic ce 1 P: s SECTION 8-CONSTRUCTION SERVICES r 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �. License Number Address Expiration Date Signature Telephone , Jane" "tereiTlarsie'lii""roverieriartFacfa T. Not Applicable ❑ Company Name Registration Num er Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATIONt INSURANCE AFEIDAVCF'(M:G:L.c:452,,.§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-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 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, tat and//Locavoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature V' r SECTION-5--DESCRIPTION OF=PROPOSED'WORK(check`altrapplicable} New House Addition Replacement Windows Alteration(s) ❑ Roofing Or Doors 0 Accessory Bldg. ❑ Demolition New Signs [0] Decks [Q Siding[1--]] Other[CJ] Brief Description of Proposed r Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.l��F�W��ra�se-aFir� di�ICZr��fa�xr��. �letsln .�or�r �et :th��aEta�l� b:ldi^^ �.^.°F8^'l" Twn Family Other y .., b. Number of rooms in each family unit: Nu er of Bathrooms c. Is there a garage attached?___ --- d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fir places or Woodstoves Number of each g. Energy Conservation Compliance. Ma check 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:AUTFIORIZATION TO BE.COMPLETED WHEN OWNERS AGENT OR'CONTRACTO IAPPCIES'FQR BUILDING PERMIT 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 OAuthorized A 9 ent he declare that the state ents and information on the foregoing application are true and accurate,to the my knowledge and belief. Signed under the pains and penalties of perjury. ' Print e za� Sig a ure of wne Agent V 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 Size Frontage Setbacks Front 1 Side L!_ R:'. -' L R:' Rear Building Height r— Bldg.Square Footage % i-- I Open Space Footage _ % �_ \ (Lot area minus bldg&paved ! — parking) #of Parking Spaces Fill: (volume,&Location) A. Has a Special Perm it/Variance/F di g ever been issued for/on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued:; IF YES: Was the permit recorded at the) a 'stry of Deeds? NO 0 DONT KNOW YES IF YES: enter Book Page; and/or Document B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conse ation Commission? Needs to be obtained Obtained Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO IF YES, describe size, type and location: j E. Will the construction activity disturb(clearing,grading, vation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES,then a Northampton Storm Water Management Pe it from the DPW is required. i City of Nortf ampton Sta u Building Department ' 212 Main Street a e e�' zt► # �' Room 100 gel Atralrtti 4 ou Northampton; MA 01060 phone 413-587-1240 Fax 413-587-1272 fotSlt 'Fans'h I WO APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION Thh section to be completed by office 1.1 EMerty Address: Irf ll �� Ailap� Lot k tJn 1 Zone- OveGlav District ElnzSt District >CB D►strrct SECTION 2-PROPERTY`OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: !Xze Name rir�Cj Curren Mailing Address: i Telephone Signat e 2.2 Autho ed A ent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item - Estimated Cost(Dollars)to be Official Use Only complete0y permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number This Section for Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings- Date File#BP-2006-0980 APPLICANT/CONTACT PERSON FLYNN CHRISTOPHER T&AISJAH T ADDRESS/PHONE 24 PHILLIPS PL NORTHAMPTON Q 584-7474 Q PROPERTY LOCATION 74 HAWLEY ST MAP 32C PARCEL 227 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid L T_ypeof Construction: REMOVE 3RD FLR PLASTER,INSULATE&SHEETROCK 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 F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN 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 Elm Street Co 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. 74 HAWLEY ST BP-2006-0980 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-227 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0980 P_roject it JS-2006-1458 Est. Cost: $2000.00 Fee: 550.00 PERMISSION IS HEREBY GRANTED .TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 4486.68 Owner: FLYNN CHP.IS_TOPHF.R T&hISJAH T Zoning: URC Applicant: FLYNNI CHRISTOPHER T & A!SJAH T AT. 74.HAW LEY ST Applicant Ad ress: — _._ - 24 PHILLIPS PL _ O 584-7474 0 NORTHAMPTONMA0106U ISSUED ON:312812006 0:00.00 TO PERFORM THE FOLLOWING WORK:REMOVE 3RD FLR PLASTER, INSULATE & SHEETROCK 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: t;' House# Foundation: Driveway Final: Final: Final: Rough Frame: J r L v I'. G Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: ��,�- Final: Smoke: kinal: -/G-Q7 --141n THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS,,�, - Certificate of Occupanc y SIL nature: FeeTyle: Late Paid: Amount: Building 3/28/2006 0:00:00 '1'50.003238 212 plain Street.Phone(413)587-1240,Fax:(413)587-1272 Building Conunissionei�-Anthony Patillo