32C-227 (7) �4 R
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" DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building '
Northwnpton, MA 01060
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massiachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her constNction sups::,• sor. The state defines "Homeowner" as, " Person(s)
who owns a parcel o$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 th&-City of Northampton wants any person(s) who seek to
use the home owner exemption, ta.act as their own construction supervisor, to be aware
that by doing so you become respotissible for compliance with state building codes
and regulations. The inspection prod s requires that the building department be called
to inspect work at various stages, which '%bildin2 lude foundation/footings (before backfll),
sonotube holes before our a rough inspection before work is
concealed insulation inspection if re ul ed and a final buildin inspection,The
building department requires these inspection before the work is concealed, failure to
secure these ins ections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform wor\ades cal, plumbing& gas)the
homeowner will be responsible to make sure that thhired secure their proper
permits in conjunction to the building permit issuedt they get their required
inspections. Failure of the individual trades to securmits and inspections as
required can DELAY the project until such time as er 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 r the building permit
issued to me.
Date
Address of work
location
O O
A - E �t aoaatrhntrtle' -
d DEPARTMENT OP DUILD0\1C INSPeC—I101.'S
212 Main Street Municipal Building
Northampton, Mass. 010GO
i
%NVORICCR'S COI/[PENSATION LNSUR CF AFTMAVI-l'
i
(Ii ccnL--rJpermi ttcc)
a principal placc of business/residence at:
�{' �✓,',y� (phone:.
( city/siatda p)
do hereby certify, under die.pz_ins 4nd penalties of pc9uiy; =.hai
r _
i
( ) I am an employer providing the followinc worker's comocnscoo, cove zge for uty
employees worldng on uiis job:
_ (Inset—� Conp ) (PeLic; ?:u_-�irr) (r;pirtior )/
O I am a sole proprietor, general contracior or homeowner (c cie one) 2nd have hired
the eonractors Gsted below wbo have the following workers coi pens2don policies:
I
01111lc Of Co-^=nor) (IrR rattcc C0111D1it}'/hOUCi T�ru(71LC:) (1_?:Jtrd ^? Datc)
(Name of Conmaor) Rrsi-aacc CompanylPolicy Nurncrr) (EkDir.on Date)
(Name of Connaci ) (Irt_surana Company/Polk)' Numbu) (E.-,:pir"6o!3 Date)
(Dame of Contractor) (irtsuran Comcauy/Policy Number) (Expiation Darr)-
(a2r-h a dit;'oca1 rbcc.irnco ry to aidudc iaforauE oa p_�
to.11 eoca-rs_oz) .
{ ) I am a sole proprietor and have no one working for me.
( ) I am,a home owner perforTning all the work myself.
NOTE:plc=4c be ewart th,'wi )c bomcuwvcra wbo aaploy pc=To,=to eU r---;,-rr,• -c' a c rt-air-ork oa d-,Ib.Z of
not ranee th r o: rn-i icb the bocnocm+ r=z do or oa the p-oun zpputtea_:j tires�,ox oL-=.d=i w be
ai=pioyc-uarc the w- o=Pc=_ oa Act(GLt 52 n I(S)) apptiapoo by n 6omcoavc for c!ic r-v_or permit n_y c+idcax LLc
1 cra!naau of en c=PIOyer under dt Work.cec Compoa at Act
I uod�d chat a oopy of tbia cat_aot oyy b,fora. xd d to tt o Dopa.tmr d of Indactrict ncc&.ry Office or 4ay-+oce for the
covefi vtrTjc=ioo r"d ttu L-iltac W t==*eo%c- under=c Goa 25A of MOL 152 rya la_d to the imxsaioa of==icA pea'1 icr
coa=Lmg of a riot orup to S I X00.00 and/or 633;a-iyo orup to ooc rzr end air pautua in rx form of a Slop Work Ord=nerd a
rim of S 100.00 1 d:y L p•iaa me
ror1,t u,c only
Plamrt Numtc _
�..��.�,z /r Lot K
SiL i cr>rtittci e -J F
i V
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: �,r,'�v✓ r' �� �7�5�+
s icense Number
A"
Address Expiration Date
"07 Telephone
,: k Not Applicable ❑
9 12enrsfei=ed HorrielrnaroxemeriGontractoG y, -
fir.• :E- � -��'r^ � .r ������Y
Cori panN Name Registration N�uun er
Address T— Expirati Date
/x7,j,"d roy,, Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G .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 b 'Iding permit.
Signed Affidavit Attached Yes....... No...... ❑
� n P
The current exemption for"homeowners"was extended to i�clude Owner-occupied Dwellings of one(1) or two(2)families
and to allow such ho eowner to engage an individual for hire%on es not possess a license,provided that the owner acts
as supervisor.CMR Sixth Edition Section 108.3.5.1.
Definition of Homeowne •Person(s)who own a parcel of lhieh he/she resides or intends to reside,on which there
is,or is intended to be,a one r two family dwelling,attached or deta ed structures accessory to such use and/or farm
structures.A person who cons ets more than one home in a two-ve r period shall not be considered a homeowner.
Such"homeowner"shall submit t e Building Official,on a form accep le to the Building Official,that he/she shall be
responsible for all such work erf med under the buildin
As acting Construction Supervisor yo presence on the job site will be requi\de o time,during and upon
completion of the work for which this pe it is issued.
Also be advised that with reference to Chap 152(Workers'Compensation) 3(Liability of Employers to
Employees for injuries not resulting in Death) the Massachusetts General Laou may be liable for person(s)
you hire to perform work for you under this pe ' .
The undersigned"homeowner"certifies and assum responsibility for compliate Building Code,City of
Northampton Ordinances,State and Local Zoning La and State of Massachuaws Annotated.
Homeowner Signature
SECTION 5 DESCRIPTION OF PROPOSED.WORK(check all applicable)
New House ❑ Addition [] Replacement Windows Alteration(s) ❑ Roofing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[oj Other[
Brief Des�cription of Propose l r
� 4�I/ ?/ �rs��Work: GX E <--r7 - z l;*4 xl
Alteration of existing bedroom Yes_�No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes -;� _No
Plans Attached Roll -Sheet
sa:lfilewfioase'_anCd'oI` dt#1Orl #c=:exls€ing.�iou�s[ing;compieehe a tciwrg:
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. T' Dimensions
e. Number of stories? ',
f. Method of heating? -' Firep aces or Woodstoves Number of each
g. Energy Conservation Compliance.,'
ompliance:' 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 CON,; ` "CTO,R-A PPLIES`FOR'BUiLDING PERMIT'
I14LI as Owner of the subject
grope >
hereby authorize r f� �t✓'� l"/�, �
to act on my beha ,,o -ar sxf:50ative to work authorized by this building permit application.
Signature of Owner Date , a
thorize
Age ereby declare that the statements and information on the foregoing application are true and accurate,to thOes f my owledge
and belief.
Signed under the pains and p nalties of perjury.
Print
Signature of Owner Agent Dat
v
Section 4. ZONING All Information 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
f
Side L: R: L: R:-
Rear -�
Building Height r---
Bldg. Square Footage o
Open Space Footage o E(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 Q DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW YES 0
IF YES: enter Book ; Page: and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intend 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.
City of Northampton
Building Department
y ,
212 Main Street
c ,
Room 100 r _
Northampton, MA 01060 �s
done 413-587-1240 Fax 413-587-1272
w �
APPLICAT16k t0`CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
Tfiis sect�orr to be completed by office
1.1 Property Address:
Gj'-7LJ 6fiir c N[ap Lot unit
&c
✓�;' //'/ Zone Overlay Dtstnct
J
Eun sr nstrtct ,., ca nlstr t ;
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Pri Current Mailing Addre
Lf� -� ,11
e, Telephone
Si nature l
2.2 Authoriz Agent:
Na rint) Current Mailing Address:
l-z&
4.,tur Telephone
SECTION 3-ESTIMATIk/U CONSTRUCTION COSTS,
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building -.7 (a)-Building Permit Fee
i —
2. Electrical (b)Estimated Total Cost of
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
Building Permit Number. Issued:
Signature:
Building Commissioner/inspector of Buildings Date
1
File#BP-2006-1181
APPLICANT/CONTACT PERSON COLIN HOFFMEISTER
ADDRESS/PHONE P O BOX 1301 Northampton (413)586-8791 O
PROPERTY LOCATION 76 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
Typeof Construction:_POUR BASEMENT SLAB&INSTALL WALKOUT FOR BASEMENT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 078842
3 sets of Plans/Plot Plan
THE FOI
J.,LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOYMATION PRESENTED:
pproved 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
v6
s
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.
76 HAWLEY ST BP-2006-1181
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-227 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-1181
Project# JS-2006-1739
Est. Cost: $3800.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin COLIN HOFFMEISTER 078842
Lot Sizei sq. ft.): 4486.68 Owner: FLYNN CHRISTOPHER T&AISJAH T
Zoning: U RC
AT. 76 HAWLEY ST
Applicant Address: Phone: Insurance:
P O BOX 1301 _ (413) 586-87910
NorthamptonMA01061 ISSUED ON:51412006 0:00:00
TO PERFORM THE FOLLOWING WORK.-POUR BASEMENT SLAB & INSTALL WALKOUT
FOR BASEMENT
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: p�
Footings.— 6 1'C' 3`��d• O G
Rough: Rough: House# Foundation: C)1< o 9!j I2/p6
Driveway Final: 1
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil:
Final: Smoke: Final: ol< o61ot166
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. ;
Certificate of Occu anc Signature:
FeeType: Date Paid: Amount:
Building 5/4/2006 0:00:00 $50.00444
212 Main Street,Phone(413)587-!240,Fax: (413)587-1272
Building Commissioner Anthony Patillo