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32C-289 (5) �� tig ,,.C�ixf�r �f �ar�l�allr�xtarr z 2 $ � �1'ilttssacl�ttseffs _ DEPARTMENT OF BUILDI7�G INSPECTIONS INSPECTOR `212 Main Street • Municipal Building Northampton, MA 01060 S HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to act as hds/her construction supc.-,•isor. The state defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be, a one or tW6_ami y - dwdlling, 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 boil-ding ciepartment 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 in de understand the above. (Home owner/resident's sign a tu're-f-equesting 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 1 Flo ��oyE (rIf� L7f {tTrf 11U11113 foil - w DEPARTMENT OP BUILDING INSPECTIOt.'s 212 Alain Street ATunicipal Building Northampton, Mass. 010GO I • wOruan•S CO va ENSATION GNSURANCF AFMA..V-11' i - \I.nth a pMi cipal place of businessfresidence al: - - (st�.tici rJ/statLla p) do hereby certify, under die.pai and penalties of perjury., -jai I - ( ) I alt an employer providing die following'workcr 5 coinoensz:ion cove age for Im employees Ivor ng on dils jib: I - (Lsur-mac Conr ,) (Pelic-;NLL��r) — (r:piratior.Dzt_) i ( ) I am a sole proprietor, general contractor or homeow-cer (ci cie one) amd Dave hired the consactgrs listed below wbo have the folio•vin¢ -worker's coLoen_uaon policies: i (i+^1IIe Of con—'Mc—'Or) (Insurancz Cornoan}'i'l'ouc Date) I _ - (Name of ConGaaor) (Insurance COmDaIIti'1Po!ic; `tsnc=r) (i--pimaon Date) I I - - I _ - I (Name of Colinaetd-) (Lasuranec Com pan}(Folic} Numb r) (Emir-adoo Daic) (Name of Concractar) (Lnsuran= Compaa-ylPolicy Numbu) ( apil-dtioa Datc) . i ( -- aII1Gt a r-oc�J cC.ifnceca-y to incud iafora,�oa peLaynia�to at1 cc=—= 3) O I am-a sole pr-opnetor and have no one worid.ng for me. I am.a home owner perfon=c all Lbe work myself. NOTE:plex Ix ewate tfi•• .a--Jc hcm,vc a wtio empl%pe r om to Qi cst�ao a re�u work as L d—cm=;,of aoe meet th:.a t..-v_-�ru is�c�.aelz the bomoowvc rcmida oc oo the p-oua6 zppurtcn_=tbeeo t-c we C==-ty eecd�-cd to be ei;)Ioycs u^-'--the ec--,r-.r•pa Act(GUI 5)s 1(5)).�pLic i6co by a botnmaaa fc a bc.^v a pewit n_y nidmoc the Ic"-I C.-=.of en e2loyw coder do Wockoe.comp..,yi,.nest. I undczzand the a copy of ahia mlrmcvt o y b.fo--id to the Dryartmcoa of Indu ric!ncodrssa Office of[�su•ooa for tb. eove'ssc"eiCeaioa aad Ltt:.i L-iltac to scauc toverase un&--Iectioa 25 A of 1.t4L 1 S2 0o Ic=d to the=pos;ioa of eimiaa!pcnaltic ooal' :�2g of a fiat ort p to SI}00.00 and/or orup to ooc y.=r sad c.i1 pca.tia in dc focrn of.Slop Work Ord-aad a fl=of S 100.00 a(1_y LPjC:I CD,- - --'", For dc;s.rcz T..sl u. on)y per'mit Number - - — e p- Lot K I >r Sipa Licrsw---lPc=iatrjn -- SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone .�.Re"`is'�ere`"'d')!f`a�e='Crt rczverr>ec�:Cobtracfa � �• � Not Applicable ❑ Company Name Registration Num er ---- Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAV!F(M.a.L.c:1'52,.§25C(S)). 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 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,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. -- Homeowner Signature C r SECTION 5 DESCRIPTION OF-'PROPOSED WORK(check all applicabie) New House [] Addition ❑:, Replacement Windows Alteration(s) ® Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [ Siding [0] Other Brief Description of Proposed p"�' � {}- f Work: iJe w Gt r0 ��nnc.—ti S c �, a •� '� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet .> ro« _r :. m v.,,`3�6- -�' ,.-m i'.X^a? '.... .m;"t" `mss .,.,�.�.: '"• tra t New, odi64 ��„add �a aaexist� IC hot`ISlnct..:,Compfd' w �c>lt 'in- 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? 0 d. Proposed Square footage of new construction._ _Dimensions e. Number of stories? -2 f. Method of heating? rxw fA `Fireplaces or Woodstoves 0 Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction I. Is construction within 100 ft.of wetlands? Yes _A�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? X Yes No. I. Septic Tank City Sewer_X_ Private well City water Supply X SECTION Ta-OWNER AUTHORIZATION,-TO_BE COMPLETED WHEN OWNERS AGENT OR CONTRACTORAPPLIES FOR%BUILDING.PERMIT as Owner of the subject property IJ hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date 1 ,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. Print Name Signature of Owner/Agent 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 i Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved i �= arkin #of Parking Spaces Fill: r l (volume,&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW Q YES 0 IF YES, date issued:, IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES Q 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 Q Obtained Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: s D. Are there any proposed changes to or additions of signs intended for the property? YES NO IF YES, describe size, type and location: 1 j 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 r NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. z (� it partment wa 2, in Street en 100 rye ica�aiull �� - k-�� 28( ttha' MA 01060 es �Strrrc�ra 'ta d��ph�ne 41 T 12 Fax 413-587-1272 Bthe,�'pectfy �APPLICIYf►'F� C3 Cb ,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: Th�saection to be completecx byoff`ice c f Lot UntG Zone Overlay Distrct PElcirSL Distrctt CB DLstnct SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: f �c ,V,\C%' S'CL n t C d VN Name(Print) Current Mailing Address: C�/ III a jam/ A Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building - (a)Building Permit Fee �a . �ObD 2. Electrical (b)Estimated Total Cost of �� 0, Construction from 6v o 3. Plumbing ,�`/�-o V 0, 2 v Building Permit Fee 4. Mechanical(HVAC) O 5. Fire Protection S \ ; 6. Total=(1 +2+3+4+5) Check Number p1 This Section For Official Use Only Date Building Permit Number. Issued: Signature: Building,Comm issionedlnspector of Buildings Date File#BP-2006-0397 APPLICANT/CONTACT PERSON SALOOM ROGER ADDRESS/PHONE 44 NORTH FARMS RD FLORENCE (413)584-6324() PROPERTY LOCATION 134 WILLIAMS ST MAP 32C PARCEL 289 001 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: FINISH 2ND STORY 3 BEDRM,FULL BATH&REMODEL 1 ST FLR 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9,RMATION PRESENTED: _JZApproved 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 Or 'Ooll—T 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. y � 134 WILLIAMS ST BP-2006-0397 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32C-289 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:renovation BUILDING PERMIT Permit# BP-2006-0397 Protect# JS-2004-0464 Est. Cost: $60300.00 Fee: $220.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sg.ft.): 5880.60 Owner., SIMON JULIET Zoning.URC Applicant: SALOOM ROGER AT. 134 WILLIAMS ST Applicant Address: Phone: Insurance: 44 NORTH FARMS RD (413) 584-6324 0 FLORENCEMA01062 ISSUED ON.1011312005 0:00:00 TO PERFORM THE FOLLOWING WORK.-FINISH 2ND STORY 3 BEDRM, FULL BATH & REMODEL 1ST FLR 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: Date Paid: Amount: Building 10/13/2005 0:00:00 $220.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo x � t r. MV ?' Y 'pf E"---+ ...._ 7 m Q ter WNWR �'sy, r �r� r -.f �t a �•�„�f T ��� t 'r, „�i r�� �ti � `s �, .� P w'�`°,4..� �rx -. " � '`.�� � 5;, � � WNQ A7. MYTH* ` jam In:' e + r a>k a*"- 1MM 134 WILLIAMS STS p� y BP-2006-0397 GIS#- OF MASSACHUSETTS M�p:Block:32C-289 k ' 'OF NOS T.I PTON Lot:-001 Permit: Bulldina to •renovatio n BUILDING PERMIT, Permit# BM0ti•0397 Proieet# JS-2004=0464 FA.!r,qg:S§0 ftg x220.00 PERMISSION IS HERF.B.Y GRANTED TO: Const.Glass: Contractor: License: yse croon: Homeowner as Contractor Lot Size(,sn,ft.). 5880.60 Owner. ApIftaffmiii- �Zbc �-: S ALL C1 LA`. zonift:URC Apa___ticafit: SAL R F_R _ - A0n&aat Address: Phone: Insurance: 44 N RTH FARMS R2 413 584-6324 FLORENCEMA01 062 ISS UD N 0S 0.00 TU PERFORM THE FOLLOWING WORK.-FINISH 2ND STORY 3 BEDRM, FULL BATH & REMODEL 1ST FLR ST T IS CARD SO LT IS VISMLE FROM THE STREET Inspector tai Plumbing Inspector of Wiring D.P.W. Building inspector Underground: Service: Meter: Pam m 06W 014 111"1� . _,/ Footings: Rough. j = F ;f Rough: 5 4U House# Foundation:.if IVI; Q f Driveway Final; Final: � Flnal'� f /71 0 ; Rough Frame t F A r i a!t« Mh os tuui a Gas: Fire Dent ment Fireplace/Chimney: - insulation: t 2 65 C,oui�i - [ lation: jj l4 ? Final: -,fir _ smoke: S >1�.0� G1/,� Final: ©f<`�s( i`j6 06 THIS PERMIT MAY BE REVOKED BY THIS TY OF NORTHAMPTON UPON VIOLATI N OF ANY OF ITS RULES AND REGU TIONS . Ce ti icate f cc a atur e,. FeeTJ.I _..�. Date Paid: Amount: Buihiing 10/13/2005 0:00:00 $220,00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo