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32C-318 (4) { Zo � t 40 S' 77&-5. i I i i 1 i i 9 I �, i COKAW TJ c0�c-�(L TICS _ 2,X8, gStlAMP�. � yNasaacl�uaetis �-, DEPARTMENT OF BUILDING INSPECTIONS / INSPECTOR 212 Main Street • Municipal Building North,unpton, MA 01060 , HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to act as has/her construction supra: ,, :;or. The stale 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 backfiil), sonotube holes (before pour), a rouEh 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 JI, 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 e QLTN of Po flialliploll - _- .j,,.,,-_. 3;a3 t a c4 ntc((a' DEPARTMENT OP BUILDr)\C INSPECT10t.'S 212 Alain Strcet Municipal Building Northampton, Mass- 01060 \NV OIUCC IZ'S C O MP EN S A'IZO N M S URA CE A 17M A%rI-1- (Ii txns,^c/pernv tfcc) a pi-trlcipal plat,- of busloess/residCOCC at: (phone::') � (sa-�ticirJ/ atr�rip) !_ do hereby ce ', under the an and penalties of pe,t 7 ; :hat ,i ( } I un an employer providing the followine worker's comoeas-n:Jon cove 2ge Lor Im emplovecs wortang on tins jclb: l (IaiZtr'��Corer ) (PoLic:Numbcr) -- (r:pirzdcr, Dom) ! O I am a sole proprietor, general contractor or homeowner (ci cie one) and have hirea the contractors Este-4 below wbo have the following workef's comoensnion pokies: i ,( ([+^IDC Oi CG'C 1Ci0") (IRRfZnl COIII01,1)'/l�GUCi ��IUMb::) :>4J On l)1lC} I ' t (Name of Cootrezor) (ins-,tlanc: Como m-wPosc; Ntlncrr) (Expiration Date) j (Name of Connacto,) (basurmcc Compao}/Po�c}' iv,unLtir) (Expiradoa Datc) (Name of Contractor) (Insurance Coal any/PoLicy Numb r) (Eipirttion Darr). (aas�addiCocal exal ifncca-t•to a,du&iarort oa am a sole proprietor and have no one worL-ing for me. ^I am.a home owner perfon=c all the work myself. l NOTE:plese be ewirc t*�wi jc hcmeauven—bo cc play p,--,.oai to da=x; kc,, a uo c rc,av work oa,d— '-Z of ant mat 11.- t',;:oc,mti in ta'sc+a the bomw wcr euida or oa tlu Qounra zpput�tl�eeo i s ,c C=,-Uy m,=.daod to be ==Ployes uc?--the.—k=A%o:=,=-- ica Ac:(GL1 swGcboa try a hommaac fa_lies a permit zy etiidcooe the Icgal eta of ea erlloyor uodar tt,o Workoe,CIIIP .tioa Aa- I uada a aad d3A a oopy of thia mtcaxut oaay b.forw.vdnd to th.0�y. m o:of 1 6.y.ial n<cd..:f OfGoo of 4auiooe ford. covcr&E;c vcirtmlioa and thct L-iltac to tcm `oov�ry�uodcr xociioa 25 A d),(OL 152 tan Icy to the i=:p l oa of Qimiasl pcaaltics eoa+satg of a firec orup to s1}oo.00 ,djor 6= oCup W ooc y�=end civil pmahio is tSc Corm of s Stop Work Ordcr acid a rim of S 100.00 a d_y tP.ia-q me ° For dcp�u,c only Permit Number JA3P^ Lot ° s Sit�,Ztun of Lic�ccJpermiucc —I�� -- � SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone Not Applicable-❑ 9 ft'easf'eied�l=fom�1inpro�emen�:�ont�e�orx*° „ - Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSCIRAN"CEAFFIDAV4T°(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...... ❑ -W - WE 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 c Zoning Laws and State of Massachusetts General Laws Annotated. t Homeowner Signature SECTION 5-DESCRIPTION:OF PROPOSED WORT((check alf ac4licable) New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding[I:3] Other[p] X ef Description of Proposed ork: Lr J�e [t om ' IGC4— Alteration of existing bedroom Yes No Adding new bedroom Yes 7 No Attached Narrative Renovating unfinished basement Yes `Z!— No Plans Attached Roll -Sheet ¢0i Cf #04N( gird ©actd io �o ezist�n Fia sx „ter» .><' : :f a i rs: 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 Tai-OWNER.AIJ•TFIORIZATION,-TO BECOMPLETED WHEN OWNERS AGENTOR;C°ON_KA' .OIZ APPLIES FORyBIIILDIft0vv PERIV[IT I, as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date I, 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. Z Name Signature of Owner/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 Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bIdg&paved #of Parking Spaces (volume&Location) A. Has a Special Perm ever been issued for/on the site? �� �� NO �~��/ DON7KNOVV �~� Y[3 �_� IF YES, data issua& | IF YES: Was the permit recorded at the Registry nf Deeds? ' NO 0 DON7KNOW 0 YES IF YES: enter Book Pag and/or Document# B. Does the site contain u brook, body of water orwetlands? NO 0 DON7KNOV , YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs tobmobtaimed »�� Db�a�nad x~� Date v�� x_� ' . 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 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre oris it part ofo common plan that will disturb over 1acre? YEGK��> NO K��} IF YES,then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 e phone 413-587-1240 Fax 413-587-1272 a APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION t-SITE INFORMATION, Thrs sect�or�to hecompCefefboffIce 1 Property Address: �7 �1 "Umtt' „a s-r �t u Zone: Overlabrst�rci ' �Elinx"�`t� ,.' CBif118tcIGt a SECTION.2--PROPERTY"OWNERSHIP/AUTHORIZEED AGENT" 2.1 Owner of Record: 7��w� ST ame(Print) Current Mailing Address: -7�Lo )rr`i Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-.ESTIMATED;CONSTRUCTION.COSTS Ite Estimated Cost(Dollars)to be Official Use Only -- completed by ermit applicant 1. Building (a),Buil"dingPermit Fee; 2. Electrical (bp 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) t Check Number This;Section:For Official Use Only -Date Building PermitNumber. Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2007-0480 APPLICANT/CONTACT PERSON HOLDEN THOMAS C&MARGARET RICE ADDRESS/PHONE 47 HENRY ST NORTHAMPTON Q 585-9989 O PROPERTY LOCATION 47 HENRY ST MAP 32C PARCEL 318 001 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: REPLACE REAR ROOF STRUCTURE 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 INIT ATION PRESENTED: Approved 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 Commission 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. 47 HENRY ST BP-2007-0480 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-318 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2007-0480 Project# JS-2007-00070-1 Est.Cost: $10000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq.ft.): 36982.44 Owner: HOLDEN THOMAS C Zoning:URC Applicant: HOLDEN THOMAS C AT. 47 HENRY ST Applicant Address: Phone: Insurance: 47 HENRY ST O 585-9989 O NORTHAMPTONMA01060 ISSUED ON:1012612006 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE REAR ROOF STRUCTURE 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 Occupant Signature: FeeType: Date Paid: Amount: Building 10/26/2006 0:00:00 $50.00141 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo