Loading...
29-136 (2) i a a y`na�a�c f::ac:fs i� S N g, DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as 1-,is/her construction sups: • ,.nor. The state defines "Homeowner" as, " Person(s) who owns a parcel on 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 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 i h . e `E Gltj) at �Tclrtllai)1ptail g � e �Zrs•asrl,nsrua - — ,; _- 4 r� OEPARTMENT OP QUILDI7,�C INSPECT1Ot.'S - 212 Main Strcet Municipal Building Northarnplon, Mass. O1OGO V-Y O RfCE R'S C O iYEP ENS A TT O N •G, S UIZ.TI CE Al, %vlLh a prmi cipal place of busI-i�ness/resiiddencc/at: (sutic�ty/ �aP) do hereby ceaii -, under the.pz.Ir1S and penalties of perjury, --h:l (l�I am an employer providing file following %vorkcr's comocnsa:;or. cove age for illy etuplovccs �vorldng on Otis job: olzl " (In.nu�c Conn-) (PeLic: Nt>_ r) Du.) ( ) I a-m a sole proprietor, general concraaor or homeowrser (c cie one) Lod hFVe hired the conuactgrs listed below who h2ve the `OI1O%ving worker's policies: cNaroc O- CO`.,.=ci0"1 COInDa;IjPI GUC-i T��U.ff1LC:) .. �,.`')1Fi1000 D11c) -- (dome of Conmaor) (tnsaranc; ComoazyRoUc-v Nusncrs) (�sir :ion Date) (Name of cOM-zcI ) (flu-enncc. Company- PaUq- N.>.sb,-r} (Expiraen Datc) ( Namc of Contractor) J-asura c-- Company/Poky Number) (E,cpi-,ioo Datc) (sII3r�:d�i�ocil if n--c--•w mein inform-cioo pcu.inaa6 to.11 Y { ) I am a sole proprietor and have no one woridng for me. ( ) I a-m.a home owner performing all the work myself. NC1TE:plc.-c be ea-ue Lbl:ktJe to espiay p,=r to do r, r. cc�c.a c rti zu�orz oo a C..c11��of unc tao c t!r n ttsm—u is wt ch the -da or ca the goun6 r the Gn�z ox to tc -aVlo)—unCc the ,uS a:c-u---*'cn Act(GLI52�1(5)).=ppU=L6co b-f•hom< %-ocr f=:lick oc pcmit rs_y c�idcncc Lc lc� t3au of ea c�loya uad�r dw Worl�lc Com�om.tioa A<L I uadczt.ad tba x Dopy of thi,=u m—d m.,y ba Coe S d to cba D�gn,zmccn of lad u ri 1 n bd O�oa or l for th., covcrx--vcrLGc=Iioa and UL--t C:.j=to sccm'c tcovnma coder zoc600.25A of MOL 152 eia led to the= omi6m of==ina!pLaa eom�of a Soc orup to S 1,500.00 gnNoc in� oCup to ooc yr^ end cNi1 peniliia in do roan of•Stop Work Ordc end a ri=o(5100.00 i dey tpina Mc. �:.�/�• Fct dc-ii'rca'r�u.c oozy C I�CT-iII][ IILLIDLKS S i g-a tun of Lic=sc:lpc jT Ce 1 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: ids! sj License Number Address Expiration Date Sign V Telephone 9'.Re4ister4&l4o"fne Impr`ovemenf CQntractorr . - ui k._. r ; Not Applicable ❑ Company Name Registration Number Address Expiration Date .�----y f' � �r ZJL, — �1 r"�—z Telephone � �+ 7��� oe SECTION 10 WORKERS'COMPENSATION`INSURANCE.AFFIDAVIIT(M:G.L.c.152 §25C(6)) Workers Compensation Insurance affidavi gust be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the build' g permit. Signed Affidavit Attached Yes....... No...... ❑ um , 304 ixeI111pk>�0� The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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-owna.parce,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,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK-(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roo - g Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[ ] Other[0] Brief Description of Proposed �— / J Work: L�>/ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet eLk;New hoasetand oradctitian to exrst�na.ho�isit g�, comp etie h failoyr iric: 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. 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 AC7THORIZA,TION<-TO?BE EOMP.LETED.,WHEN= -OWNERS AGENT ORCONT.RACTOR'APPLIES FOR,BUILDING-PERMIT I, 51, Q 'J lox 16a as Owner of the subject property hereby authorize L �r°l�°� r-5 to action my beha , in all matters relative to work authorized by this building permit application. Signature of Owner Date � '✓Ly1 'A�J� as O+rer/Authorized Agent hereby declare that the statements and information,ofi 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 On Signature orCM"6r/Agent Date � ^ , ` , � 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 Rea Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bIdg&paved #of Parking Spaces (volume&Location) ' A. Has a Special Permit/Variance/Finding ever been issued for/on the site? �� �� NO \~��� DON'T VV x��KNOW YES ^�� IF YES, date issued:' � IF YES: Was the permit recorded ut the Registry ofDeeds? NO { ) DON7 KNOW YE5 `~^ IF YES: enter Book i / Pa and/or Document# �� �� B. Does the shecontain abrook, body of water uraetands �� VV �_�NO \�� DONTKNO YES �~� IF YES, has permit been or need uobe obtained from the Conservation Commission? Needs to be obtained �~� Obtained �-` Date Issued: v~� �~� ' � C. Do any signs exist on the propert ��y? YES \�� NO v_�� / 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 0 IF YES, describe size, type and location: | E Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre orisit part ofa common plan that will disturb over 1acre? YEO ���) NO [��) IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Y Depatlrrrettntlse.a�tlFy -- -__- --- ,,Northampton statu�a�Perr,tt' a ail in� DenartmP.nt ME --212 � ain Street Seu er ept[ A atiahtl R Room 100 at �4ett Avatb � 1 . OC i 2Ortheiaapton, MA 01060et 'o �trr�ctal phone 413-587-1240 Fax 413-587-1272 PIotGSlte Mans S j. APPLICATION..T.O CON$TRtiCT;ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1.-SITE INFORMATION This sect�ori t�bey com pleted b}f oIfF 1.1 Property Address. p Cl AiiaP Lot Untt _ _ �Overta Drsfcrct. ' 3 11�Ij I / ©im St ❑istrrcf :i G District SECTION 2-PROPERTY OWNERSHIPiAUTHORIZED AGENT 2.1 Owner of ecord: Name(Print) Currea yailing Address: if Z-AS11's ec Telephone G / Signature �� / 2.2 Authorized Agent: , , 1 3 ky Name(Print) Current Mailing Address: Signature Telephone SECTION 3.-ESTIMATEDrCONSTRUCTI N COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)-Building Permit Fee i 2. Electrical (by,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) t5 Check Number This Section-For Officiai Use Only Date Building;Permit Number.. Issued: Signature: Building Commissioner/Inspector of Buildings Date .0 r. a 337 RYAN RD BP-2007-0427 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29- 136 - CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) CategoryL BUILDING PERMIT Permit# BP-2007-0427 Project# JS-2007-000635 Est. Cost: $8900.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: B & R Siding 100465 Lot Size(sq. ft.): 22172.04 Owner: WALKER SHARON L Zoning:URA Applicant: B & R Siding AT. 337 RYAN RD Applicant Address: Phone: Insurance: 781 Bridge Rd (413) 586-4167 Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON:1011312006 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL VINYL SIDING 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 10/13/2006 0:00:00 $25.0020598 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo