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32C-314 � R �assachnsetfs DEPARTMENT OF BUILDEW INSPECTIONS '212 Main Street • Municipal Building INSPECTOR Nordiampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups:: •' :;or. The state defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be,a one or tivvfsmz __-- 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 buil mg departmenf for the City oTNorthampton wants-any persons)-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 L 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 k_ r i p�O f j pa E QrTfl,7 Cf {crrfliallt}itoil f -+Ii7 tR(I�IIGCIID- c� DEPARTMENT OP DUILDr,\,G INSPECTIDt.'S I _ 212 Main SLrcct Municipal Duild;ng NorthampLon, Mass- OJOGO I . ! _ _ 'ORICEIZ'S COMI')✓NSATTON MSUIZA-NCE A=AV ZT i %"Zth a prZncipaJ place of businessfresidence at: -- - l�3/ mil x2 - ' ) y (SU=Ucit ' tap) do hereby cerdi -, under tic palm a-od penalties of penury, h.I (� I ern an employer providing the following workcr s comocns�bon cove age nor Intl etuplovices woriong on this job: �V7, A4. . < Lu c. S 3"6` �7 21_p)_nom ,) (Polio:Nu-mo`r) (=:pirtior,DzL} I ( ) I am a sole proprietor, general contraaor or homeowner(c c:e one) aDd have hired t-he conuactors list-d below rgbo have the `olio,ving worker's cacoen_ta6on policies_ (I+^II2C of ConnC:acior) (In.FLranc-.. Coinpan)•/hoUc }"IUMh-:r (Y':-)lsd Q? D11C) (Name of Coucrzctor) arLnc� - I' � Ms ComDaa�•/Post; tiu.acrr i:��irtion Date _ (Name of Con>zaetd.) (Innuance Compzo)--Polio• Numb J) (Espin6on Datc) (Name of Contractor) (LcSuraIICti Compaay/Policy Num)rrr) t-Expiration Dasc) (atxs�a:.dai�oczl c5cei,ir acoeu_•y to aac'u iara�.�oo petnsa:.ns to all C. --=On) . O I am a sole proprietor and have no one wort ng for me. ( ) I am.-a home owner performing all the work myself. NOTE:plcx be a9r=rr LL .�`ic hcmmvrocra to employ perLoct to do=As= cV- Sao c rcpzi .orr on i d,.�1]_z or not tnoct th 't ro L-aiex iu t''sieh the bomoowne raids o<oo tb a Qoceae4 z?pytca 1h -0 e: xx —.ny a�cd.-ad w be CC*Icy=-s 1"'d the..ui e�cc=P==I en Aa(GL'152=l(5)),�P(cn 000 by a bomeoaac rC a Gam=or�aa=y a-id—d e leg-n of an c?ioy<r under d,o worsts-.C.oet�omii;oa AeL I undc*+od tha a°OFy of tbi.m1®cct may bo rota carded to tba(}opartmcrat o f Iv�+tricl A..A_ C LM_or Lswooe ror tb.. CO` vc'irctioa and UL-i L-il=c to smut:eo%crDse=dc soeiioa 25 A of M(DL 152 cna Ie_d to the i. p=i6oa oreimiazl pc=16= --3a oC a rwc or up to s I_�oo.00&"j4 cOC @,1}y�yp�y�Of P lA OOC yCr Lod ci%id p=.I,JO tD LAY f-cm or t Sson Work Ordc and a ri>✓ 0rs100.00 i day tpian t� For dq.naa�-.1 u.c an17 . 0 .. - Pcrmlt NtuDbcs $t�37-'1 C1tTC f)f I_ir_-n errlP�.-�,:re .. area t R: e SECTION 8-CONSTRUCTION SERVICES .t 8.1 Licensed Construction Supervisor: ) Not Applicable ❑ Name of License Holder r� License Number Address nn ® � Expiration Date Signature Telephone SwteiseEbe rn°raie ' Not Applicable ❑ 4%12, Company Name Registratio`n um er —-- -- Addre s /- Expiration Date �! ",9 h-- 7-6 1 AL Telephone � [z�7J SECTION 10-WORKERS'COMPENSATION tNSURk NCEAFFIDAVtT(M.G L.c,-152,;§-25C(G}} 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 108.3.51. 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 buiidine 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 r SECTION 5--DESCRIPTION OF PROPOSED WORK(check-all applicabi New House ❑ Addition ❑ Replacement W" dows Alterations) Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [0 Siding[p] Other[O] Brief Description of Proposed Work: -,G 05 >9 / f 011' W/IV Alteration of existing bedroom Yes No Adding new b4droom Yes No Attached Narrative Renovating unfinished basement _Yes No Plans Attached Roll -Sheet -..:.a ?. "i4` �,sa. ,3 a; �...-'""" fa,fNV �rorrs n �drES t xcst>knc iar�sertc�.,�oi�t�Fet��h�a[C��r�g; 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.AUTHORIZATION-T,O BE COMPLETED WHEN. OWNERS AGENT OR CONTRACTOR APPLIES-FOR BUILDIb[G�PERNfIT I, A ` //4- 4..,/V j u,A T S k— as Owner of the subject property hereby authorize z�­o) tJ �3" ,b to n my behalf, in all matters relative to work authorized by this ilding permit application. 7 C Signatu of Owner Date as GWftr/Authorized Agent hereby declare that the statements and information on a 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 ofZ540WAgent Date ' ~ � Section 4. ZONING All Informatibil 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 Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volumej&Location) ' K. Has Special Permit/Variance/Finding ever been bsuedfor/on the s�a? NO' 0 DON'T KNOW 0 YES 0 � IF YES, datobxued IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON7KNOW 0 YES IF YES: enter Book PuQo ' and/or Dooumant# ' B. Does the site contain a brook, body of water orwetlands? NO 0 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? ~ Needs tmbeobtained v���~\ Obtained �-�_�� 0ata ���ue��'' C. Do any signs exist on the propert �� ��y? 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 0 N 0 IF YES, describe size, type and location: E. Will the construction activity disturb grading or filling)over 1 acre nrisd part ofo common plan that will disturb over 1acre? YES r NO K } IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r -City of Nor0ampton t? N �,, Building Department fe -a P 3 l 212 Main Street S�erse tt its T Room 100 er eE � rb ;-Northampton; MA 01060 phone.413- 87-1240 Fax 413-587-1272 , APPLICA€TIdd_ C9N9 UCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTIOR 1.-SITE INFORMATION � Thrs section to 6e co�pletedGhyroffice" 1.1 Property Address: k 3S— 1 J E R- e S 'r Map Lcit ju rZon'e � l��rerla Drstnct le A Ar �T� �� 1'y!4- 2EIrrSE©istncf "`= ;CB DistFtct - . , ` SECTION 2,-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Name PPrinU Currer4tAailing Amress: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Maili Address:: Signature Telephone SECTION-3-ESTIMATED-CONSTRUCTION COSTS, Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building l j0 Building Permit Fee 2. Electrical (9 (b)Estimated Total Cost of Construction from 6 3. Plumbing _ Building,Permit Fee 4. Mechanical(HVAC) 5. Fire Protection l 6. Total=0 +2+3+4+5) /Q `:i Check Number This Section,For Official Use Only Date , Building Permit Number. Issued: Signature: r i Building Commissioner/Inspector of Buildings Date 35 HENRY ST BP-2006-0375 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32C-314 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0375 Project# JS-2006-0546 Est.Cost: $6210.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: B & R Siding 100465 Lot Size(sg.ft.): 43560.00 Owner: GLOWATSKY ISABELLE J Zoning..URC Applicant: B & R Siding AT. 35 HENRY ST Applicant Address: Phone: Insurance: 781 Bridge Rd (413) 586-4167 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:101612005 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS 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 10/6/2005 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo