32C-245 (2) y
°� f
�`� ��, -�
..._
.,.
...
,� �,.. __
ti.
�,��
--�-,w.�.,.,.z,.�,,�,.s
x���
04 TO
Critp of Xortljampton _ r
� � � �assacltusetts I�
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ! Municipal Building
INSPECTOR
Northampton, MA 010 60
rr
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 78OCNIR 108.3.4 to
act as Lis/her construction sup: : .-i:,-or. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or hvo family
dfvelling, 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
A'a
611,T) of ort 11allip I Lill
mg
46
TO
Wit? J 0!l
212 Alain Stied Alunhpal BuiMinj, Q,
Northalnpto !l, Alass. 0 10(ejo
C(ATPENSATION INSTJVANCY !kFFI-DAVjT
%vith principal place
do he by cy&y
I ani an employu proMPF the 5)hownlyl %"QWs
clnployccs "vol l,mlg un 1]'1is jcl)
prof' ivar,
thu contract a rs AM Mo ha haw to ic,J�
(Name of(Tonwano!
(Naw of QnvacwF;
(Namo of Onamnj
Nnue of Coactaq m za i i i l� D( N
am a :,ukC
n14!IXAC Ol-ni three units ill
legal".W;of an zpKyW.dM
lovt.lf,c vcnfic--tioa arAth--t in unk,owl Ka 25A can ictJt,)T!c
Ambling0fa to,OfuPtOSIOD100 t Ct
I 0,0,0fl n(ily
PMMQ NUMNS
"ks tar,.
•
SECTION 8 -.CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
`2 � �(� �i� r 01/l �'�✓h h I 6�� I� . /fir "5 2__#_ 731 - - --
Address Expiration Date
JL
Signatur Telephone
.,�°°? 2n`15, EF iA'e E " c i
G9Registered Home'Improuement=Contractors ; � ,, ,„ __.. . � Not Applicable ❑
Company Name Registration Number
Address Expiration Date
l0 Ev _1_311U � � ��� Telephone �
SECTION 10'- WORKERS' COMPENSATION INSURANCE 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. ... ❑
r
.va r
r £� ,ome � ,caner-EXeiff n
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 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 fc-which this permit is issued.
Also be advised that with reference to Chapter 1 5)2 (Workers' Compensation) and Chapter 153 ,!.iabilit\ of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you mav-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, C'it,,,
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5- DESCRIPTIONIOF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing 1,'W_
Or Doors ❑
Accessory Bldg. ❑ Demolition[] New Signs [ ] DeoKs [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative ❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet ❑
6a"if' u!g'NeWjho riii�or`addition'to`existing:housing complete,°the.folldWini7:
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?
In, 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 CONTRACTOR APPLIES FOR BUILDING PERMIT
_- -- _ as Owner of the subject property
hereby authorize _ 6 c= �!�, _ _ to 2c; on
my behalf, in all matt r a . e to wor autho _e ny th^, :uil iinr p�_ application
Signature of Owne Date —
as Owner/'A iiorized Agent"
hereby declare that the statements and information on the foregoing application are true and accurate, to the best o7my
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/ e �— 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 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book _ Page and/or Document #
13. Does the site contain a brcok, body of water or wetlands? NO 1jON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained _ Date
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:___ _
d-
R. 'xv.'4 .f ,.
Ira 1tiy � y of Northampton Sta�tusotP
uilcling Department Curb Cut/D ve
212 Main Street Se er/Sept►c ,
j MAR 19 2003 J f Room 100 WaterlWeFll
1 Northampton, MA 01060 Two Se t's?V af ;fir c a
p �A 41 -3-58�-1240 Fax 413 587-12 72 Plot/0 ite Plans
Other Specify
--
APPLICATION TO CONSTRUCT, ALTER, REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to.be.completed by office
1.1 Propel Address:
Map Lot- Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of co
rcnt �Jaii�cg Address: �t f
N 3me(Pr t
,atwe
2.2 Authorized Agent:
r
Ja,i ie i-�'1 int)
Maihn,, Address:
1 0 a`
-- -----------
- - - - I ---
,i�nai..re
----- 1 - - - - ------ -
SECTION 3 - ESTIMATED CONSTRUCTION COSTS -
tem Estimated Cost (Dollar,) to h: Official Use Only
i m
completed by p�rrnit a c�i�t
ilding I (a) Building Permit Fee
timated Total Cost of
� Construction from (6)
Building Permit Fee
(HVAC)
I ire Protection -
�_ 1 o t a 1 _ (1 1 2 + 3 + 4 Cn cn Number
--
_This Section For Official Use Only --
Building Permit Number- Date Issued:.—_ _ __---_-_-------
Signature: --. --- _ _ - -- ----- ---
Building Commissioner/Inspector of hildinrs Date
BP-2003-0764
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0764
Project# IS-2003-1257
Est.Cost: $432.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DE Sheppard Roofing 105885
Lot Size(sq.ft.): 11804.76 Owner: CARR ALAN L&ROSE-MARIE P
Zoning.URC Applicant: DE Sheppard Roofing
AT: 2 ISABELLA ST
Applicant Address: Phone: Insurance:
224 BERKSHIRE TRAIL (413) 587-0092 O
CUMMINGTONMA01026 ISSUED ON:3119103 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE SOUTH SIDE PORCH ROOF
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:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 3/19/03 0:00:00 734 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
now