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28-074 (2) -x i St i 11 L, Required ib-v I-IM COILmIll to 6��111' c"'bac Ls i--rom ii I'd in 17- Sp Ll c I r`2 1 L: S H'as --i S-D�cfa( Pc-t-mit/\%aria[ice/`.FF-in/d" g, zvk-mq- b en issued foi"lon the siL?: DON'T 1<310 YE7 dat- i-Sue'- 7-7 ".17ES, Alas the permit record Cl' at the Registry of Deeds? NO D N'T KNOVV enter BO" Page and/or Docur 3. Floes 'che site a) ain a brook, body of water or vvetlands', NO DON'i ;,J,101 S a permit been or need to be obtained from the Conservation rnmissioi Needs, b-c- obtainec. Date on the property? ES Elo an skins e,ist YES, describe size, type and location:___- -,,Are there any proposed changes to or additions of sins intended for the prc)pe:-h,,i YES __ tF V'-:Z, describe size, t`/De and location. �,�G �b� ��,�. 5d �aG �° �'�� S� �� � 2 � Sr �� ��� O�KIIAMP�O Grity of Xort4ainpton - i I � � Massachusetts '= Q., 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 his/her construction super sor. 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 carLDELAY the project until such time as the proper permits and inspections are made Wtio nders tand the above. (Home ow r/resident's signature requesting a I will call to scliedule all required building inspections necessary for the building permit issued to me. Date Address of work location of � 6 h?a3axrfJnsrtte ' d I.)EPZRTMENT OI' EUIL)DI G INSPECTIONS 212 Main Street ' Municipal Bui1(ling j Northampton, Mass. 01060 P�TCER'S COMPENSATION INSURANCE r' FFMAVIT 1, (liccr_s_: rrrmiit:^) v"Ith a principal place of busiresslre: Bence t: V a (str�eticir;;st'ua���p) do her6by certify, l:a:'cl ic, and pcn 1LiCS Oi 7C."Jury, i.11a" I am an cmployei- providin- the iollo'+viM—, '1'Ol-:Cr-s Coln DellsaLIO11 COYCra C iOf 1I1} employees worrdrig on Lhis job: �.RSZLI7..IlG: Corry) Folic;Ntz..,�.Fxr) --- (Expiraaon Date) l j I ant a sole pronnetor, enerz cone c i -I NDer Lcl' Oct) and ' uree-oI the contractors listed beiov, ,;ho 112.c the :olio,.;L, ; ,orkers co pers on .ol ass: 0 ('N'=c of Cont,-n t� o<) (n°��:.�c C cr:n-::;,:Potic; NusntYr) i� . . ca Datc) (Name of Contncto:) -- (_7llsvr,_nce Co I� r:ti,Po!icr Nurltr r; (F,::;iT:iion Date) (1\ame of CoatZ3ctor) (lI1S r�i1C^ CO i ;:?l:i%i70!iC. NI1II]lY_r� X,ii iI0 Dat',) - (Name of Conl'-ntor) -- (Ins raI)c Celnr_y!Policy Numb- r) (I;: i :iin Date) ( � I <LI21 it SO1C, prU1?ClcC�>i 2:tQ havC 110 OJ1'C 'r,'UL+^;.iiir{ t0i iil:,_ X '1111 <? home ovW?1C'r NOTE,:plcasc L+c awarc itut i not acre th n throe uni+j in,t t el iz,=rc_:,�:u x o; --mploycs u:der ttx�wti:r�a ec x-=:eti.c PC(G1,1'2 �a hortmu-oer:`cr e Lc-x a time Jcgal ctatua of an crq�loyx unur ttrn Wcr�ars Coi�;xr_..tion!.cL I undo--tt+ad ths!a cmy of this ctatcrs_•cuy bo fotwn dci l to tl'rn IY_{iarLZrn:of I.c+r.+.tsuriJ Mal ,t�'Citic+a of i:;:�.+r...�_a for lfm ooverx&c veiGc:iioa zLnd th:.t fi i u--to t-cr ac,:-.iM 25A cd MOL,152 can icul to the imlOsition petuit;C. cvcniating of a fur_of up to 51-500-00-n&,or ir,:itr r.^ r!of::p to on-}: r.-.1 civil xrultiu in d�fears of a S!r,`:'nY:Ch= r i firm of S I00.0() a day ts!.it A mc. For ciq=uvmt�t uic cnty ` Pcrinit Numtr,r ------- -- F Sisnaturc ' fi.iccn'ctJfcrnl,ttr: Si=CT30N 8. .CONSTRUGTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 1. [9111eff s ere orn ovementf;ontractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone ;SECTION—0, ORKERS'CQMPENSATION N' -UftANCE-AFFIDA1/IT(M:G:L.,c. 152, §25C(6)) x �. 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 acecptable 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, Sta nd cal Zon no 'aws nd ate of Massachusetts General Laws Annotated. Homeowner Signature SECTfON� �S. =RTP„TFOTI OF PR0P05ED WORK ch' kkATI:iZ liCa 6 r .,zm + ' New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ❑ . Or Doors ❑ Accessory Bldg. Demolition❑ New Signs [ ] Decks [ ] Siding[ } Other [ } Brief Description„Qf Pro oseedd Work: Alteration of existing bedrb6m Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0-Sheet❑ 6a: e, :,o d 6M.—Mcti. 6, is 7r 7housiJ- o;m=-5 fotla nGrai 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?- V d. Proposed Square footage of new construction. / y Dimensions G- e. Number of stories? f. Method of heating? /V Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck 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 confor to the Building and Zoning regulations? Yes No I. Septic Tank City Sewer Private well City water Supply SECTION° a�OINNER�ALITHORIZATION TO BE COMPLETED WHEN OWNfRS�AtaENT�OR�CONTRACTOR APPLIES'FOR Bt)'1LDiNG PERM'17 as Owner of the subject property hereby authorize to ac; on my behalf, in all matt s r laK,e o r k u orized 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. Print Name Signature of Owner/Agent Date r Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filed in by Building Department Lot Size l� l Frontage Setbacks Front 2 O 2 Side L: R: LA b R: �a Rear -�2) Building Height q t 1 2,0 / P Bldg. Square Footage % Open Space Footage n J % (Lot area minus bldg&paved `0000 � QG6� 8/,v parking) ` t/" cc������ #of Parking Spaces Fill: (volume&Location) A. Has a Spec' Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does t site contain a brook, body of water or wetlands? NO DONT KNOW YES IF YES, has a permit been or need to be obtained fro/eConservation Commission? Needs to be obtained Obtained , Date Issued: 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 No IF YES, describe size, type and location: r. l oq i i of Northampton R ( ,�:? i �� :`` ilding Department r 12 Main Street ; Room 100 __' .�ALar=tbampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 n. r APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property Address: �� ,- h tatbecompleted l office Lj Maim K , a {irut Cj Zpne •, Oerlay Dcstnct SECTION 2-PROPERTY'OWN'=RSHIP/AUTHORIZED:AGENT'' 2.1 Owner of Record. CUB c3 f lv - � Name(Print) Current Mailing Address: C= Uw� Telephone Signature 2.2 Authorized Accent: 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 2. Electrical (b) Estimated_Total Cost of Construction from 6 3. Plumbing Building;Permit Fee 60 CIA 4. Mechanical (HVAC) 5. Fire Protection 6. 'total =(1 +2 + 3 +4 + 5) Check Number This Section For Official Use Onl Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date t File#BP-2005-0471 APPLICANT/CONTACT PERSON MCCUTCHEON DAVID J ADDRESS/PHONE 263 SYLVESTER RD FLORENCE (413)587-4570 Q PROPERTY LOCATION 263 SYLVESTER RD MAP 28 PARCEL 074 001 ZONE RR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid Z5 Ot) Typeof Construction: CONSTRUCT 12 X 15 SHED&INSULATE&SHEETROCK BONUS RM OVER GARAGE 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 INF9ktMATION 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 Co ion /o/z/ c 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. �'�� r ..." :�. ;` a �,'� x��x� :�,�� aF.., r � � .,� i�� €,fi +�• �" s`sa�3K t �� #�a 4 � �*�� .- rid °'. - - � .:.,4s' � :.;{ `t s a'. a� �` � -� Fe"� ;lr"" ` �,:" 'fi �,e�, �zxz� ?,,,�s-�..��:<�` i,�� i� �_� �• r i �. a " �� $ �`�z�` �'�,,y �. v` .� s�1`F.�a?,� �'�• j fig.... � , t�r,�,. -'t' r s�'z"fit+ t s R '�'"�' :,, �.•"r n@..sy�s,s .as tG +�? ��' � N �, r �_ ,#.. r' r , l Fx+J hZ n r Sli 4 `uo J r L v h6 i Ex RD BP-2005-0471 Ir GIs#: COMMONWEALTH OF MASSACHUSETTS Map-.Block:28-074 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-2005-0471 Project# JS-2005-0621 ., . ' Est. Cost: $600.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sg.ft) Owner: MCCUTCHEON DAVID I Zoning:RR Applicant: MCCUTCHEON DAVID J AT: 263 Sl(�EAR RUP Applicant Address: phone. Insurance: 263 SYLVESTER RD (413) 587-4570Q FLORENCEMA01062 ISSUED ON:10122104 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 12 X 15 SHED & INSULATE & SHEETROCK BONUS RM OVER GARAGE 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:bi K G I q —/* Final: Smoke: Final: ©,K THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. J Certificate of Occu an si nature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 10/22/04 0:00:00 1966 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner Anthony Patillo