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32C-282 (2)
� � �'ilassacl�nsrffs DEPARTMENT OF BUILDING INSPECTIONS � INSPECTOR 212 Main Street • Municipal Building North,unpton, MA 01060 �w 5 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CNIR 108.3.4 to act as-his/her construction suyiL. ,'i:>ur. The state defines"Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be a one"or fivoamz �� 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." 71ie u2 Ing department' the City of Northampton-Wants-ary-personfs)-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 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 surethat 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, ryr t ` i14 understand the above. Toide owner Iresident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit - issued to rne. __ Date Address of work location 1 CyT 3 zsf TLTL"ff�i31111JfDI,t i A J £ gZt7aatflntrtln' -- = p DEP/LRT).4ENT OF DUILDr)\,G INSPECTIOI,'S � 1 j 212 Alain Strcct ' Afunicipnl Building Nhrorthampton, Mass. 01060 NVORI�T--IZ•S COi TENSATIO.N GNSURANCE AI'I'�1�r1.1TII': tb a priricipal place of businessfresidence at: �(� - j lX) 10 01106pph0nc=') ST 7` 0 I (=-=Vci t}/n uda p) do hereby certify, under the pains and penalties of perjury, hat ( ) I am an employer providing the follo%ving Iwork-cr's coinocns-ntioi,. cove age for in), etnplovecs tvoriong on Lilis job: ' 0MMU-mac Coo=-Mv lPcIic:Nu_•nocr) - (r-pinion D -) I i ( ) I am a sole props:etor general con=c-Lor or homeowner (c c:e one) and have hired the contractors listed below rho have the foilo•vine workers como°n_"ation pakies: i i ('";=c Of Con-=Czor) (Insuranc; Cornoanypt ouc; D.Itc) (Namc of Cona-zclor) (lns-w-a.nc C0mIIaativP0Uc-• Numinr) (-ILaPir bon Date) (Name of Connaeto,) (Lasurancz- Compan}-1PoUcy Numb_t) (E.xpifrtien Datc) i (Name of Concramor E1 irz6on Date). I ) (Lnsurzn� ComrzQy/Poticy Numb':r) C � (sCat!f •'KMi�oc�!t3cC,tro •^}-w c�c.'u�-iafoc�u�-oa pcv.iaas w.17 ooct�:a) 2.M'a salo pF©prietor and have no one wor'rang for me. VIV I am:a me o gall tt�e work myself. u-v'b �,c�, NOTE:p.be cwzm L*c1.;-}cLhcmr ��c�n w.ba employ p,=—c=to 4i c�- cs c,�o or rgaa rorit as a d-11_r of not moct 1�II LSO L--t?--lc�z1 tb-�+vc:�w• w rd et.[b,g oumfj Zpp 4r=:--=th--� L=ox C=.-ny cr-d-ad Le be ci*loyt_-a unrc the d �-•--_,;c.A,, GU152=l 5 { { )).-ppt:nnoo by a bomenax Ic r 1��=IX pcmrt r•y the Icpj ns=u of as cloy-uodcr dao I.Vwk s'r Co=pa=at Act ' [•oz--=. =d�K a��,or tbi,c7j�nary be f---dad to tl o Or ln.dac ,J A.&.:&Ofn-or L=—for tb. —vcf a-a-Mc sioo'mod tltct L-iltaz to so3us eeveny^e trade vxzion 25 A of MOL 132 ca irk to the izPxi OM of-imiazl P=-W- co¢zt rza Of a fine or up to S 1X00-00 u,Wc,,uz{a jo®ezt oruP to Orn year ead ctit peaaltia in dx rtxm or Sop W ark Ord-and a fizz or S 100.00 ` for -'-- �^ IoC77IIJt Nt1IDI)C1 ; S' Lw-r of Lic�scclF'ctznittc e J SECTION:.8-CONS.,TROCTION SERVICES f;r 8.1 Licensed Construction Supervisor: Not Applicable Name of License Holder: License Number Address Expiration Date Signature Telephone to to;' oiM "pravenre , . Not Applicable Company Name Registratio'n plum er -- Address Expiration Date Telephone SECTION 1D-WORKERS'COMPENSATION"INSI IF2EUICA1=(ESAVfFNi �. 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 buildie 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 1083.5.1. 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"certifi es d assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Lo 1 Zoning s and State o/f�assachusetts General Laws Annotated. Homeowner Signature r t SECTION 5--DESCRIPTION.OF--PROPOSED WORK(check:afF.applicable) New House ❑ Addition Replacement Windows Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[ID] Other Brief Description of Propos Work: 1 wNJ Alteration of existing bedroom Yes_ No Adding new bedroom Yes _No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa �evwFroa':7eMi V, cEE r _xrstanorisyt>s ,` . . K. . t _ a. Use of building:One Family Two Family Other A b. Number of rooms in each fami un': Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new co i Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction L 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 SECT14N7a ?OWNER.AUTHORIZATION TQBECOMMETED WF[EN x OWNERS AGEI�k'L'QR"COttTRACSOR=APPLIES`FOF�BCJII�IHfC-�PERMIT' as Owner of the subject props C�v' VeA "� U ,I (/1 U' J C/�t�✓��-✓� hereby au;hze t ct on e If,i all matt ers elative to work auth b is building permit ap tion. Si ture oner rate sla, + CZ'vL as Owner/Authorized Agent eby 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 f perjury. Print N e Ki—grAzre of Owner/Agent Date U Section . ZONING All Information Must Be ompleted.Permit Can a Denied Due To Incomplete Information Existing 7sed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front i Side L:r—' 1 : L:^ R: Rear Building Height t Bldg.Square ootage % 1,10 Open Space Footage S.t (Lot area minus bldg&paved L parking) #of Parking Spaces t Fill: .II i (volume,&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on th site? NO 0 DON'T KNOW d& YES 0 IF YES, date issued:; I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW YES 0 IF YES: enter Book Paget i and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 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 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 0 NO AdW 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 r NO i IF YES,then a Northampton Storm Water Management Permit from the DPW is required. s t , of Northampton jc __ -,Bli dF ng Department , Main Street oom 100 e Northam ton; MA 01060 phone 4134874 40 Fax 413-587-1272 .. APPUtAt10N T6 CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE iNFaRMATION' t "' `�;� � ,�� Tlirs-sectron to be co��tefedhb�-�€iTC�� k d 1.1 Property Address: �im � xSd �.x. "� "'-0„� ,m. e. £"w'� •co-""W�y s,.��,..a-w. �"�,5.,�., �'. 1-7,Wens _0veda 0i nc# t ` .z �' "�„` '.a C 'Rte FJM 1 istru _ SECTION -PROPERTY OVNNERSHIPIAUTHORIZED?AGENT 2.1 Owner 2f Record: Nam �"� / Current Mailing Address: �Li 2^ .-Z 7' 016_Z' Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone :SECTION 3.=;ESTIMATED'CONSTRUCT ION-COST8S' Item Estimated Cost(Dollars)to be Official Use Only m leted by ermit applicant 1. Building �"-O (aBuilding Permit Fee 2. Electrical `J (b},Estimated Total Cost-of Gonstruction.from'6 3. Plumbing Building Permit.Fee 4. Mechanical(HVAC) 5.Fire Protection , 6. Total=(1 +2+3+4+5) :Uheck Number ThisSection For Offrcial"Use Onl Date:> Building PermifNumber sstied: Signature: ' Building Gommissionerilnspector of'.Buildings- Date • y 102 WILLIAMS ST BP-2006-0230 GIs#: COMMONWEALTH OF MASSACHUSETTS MM:Block: 32C-282 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0230 Project# JS-2006-0335 Est. Cost: $500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sg.ft.): 6882.48 Owner: SCHMALZER SIGRID&WINSTON CLOSE zoning URC Applicant: SCHMALZER SIGRID & WINSTON CLOSE AT. 102 WILLIAMS ST Applicant Address: Phone: Insurance: 102 WILLIAMS ST NORTHAM PTONMA01 060 ISSUED ON:813112005 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPAIR PORCH RAILS & BARS & REMVE SHINGLES 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 8/31/2005 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo