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35-061 (2) 4 r , c)vre-.vLcp y/4-t3 Rp PC-IA.) cAmAs 4.t�1AMp�, Crzfy of Xort4ain ptan Q J ! �ASf AChltStttS � 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 and 780CMR 108.3.4 to act as his/her construction super,• Sor. The state defines"Ho owner" as, " Person(s) who owns a parcel on which he/she resides or intends to b , a one or two family dwelling, attached or detached structures accessory to SA use and/or farm structures. A person who constructs more than one home in a two- ar period shall not be considered a home owner." The building department for the City of Nort mpton wants any person(s)who seek to use the home owner exemption, to act as th r own construction supervisor, to be aware that by doing so you become responsibl or compliance with state building codes and regulations. The inspection proce requires that the building department be called to inspect work at various stages, whi include foundation/footings (before backfill), sonotube holes before our a r h buildin inspection before work is concealed insulation insvectioS6if re uired and a final building inspection. The building department requires tXes a inspections before the work is concealed, failure to secure these inspections can ult in failure to obtain a certificate of occupancy until the work can be inspdted. If the homeowner hires of r trades to perform work(electrical, plumbing& gas) the homeowner will be respo sible to make sure that the trades hired secure their proper permits in conjunction the building permit issued, and that they get their required inspections. Failure o the individual trades to secure the permits and inspections as required can DELA the project until such time as the proper permits and inspections are made L understand the above. (Home own r/resident's signature requesting exemption) I will call to sc edule all required building inspections necessary for the building permit issued to me. Date Address of work location mJR4M" $ 6 �ixssxcflnsctts ^� DEPARTMENF-F OF BUILDD) G INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 010GO WORTCER'S CONDENSATION INSURANCE. A M)AVI.T with a principal place of busiressJre:, donc; t'. C{(� 11CrCJ�' CCR1I3', t'.Ilae!" t11C p iIl$ 3iil`t pC:il:?it1C`.i OI l7erill�}t, ifli!:: I am an ernp!0�ei prOVl(11n- the 1011OVY]' M OI'i;Cr S COtIIpCI1S�'U0II (;Overa`-,,e for In), employees Working on this job: (LTLS=c: Company) (?c!c;Number) ---- ("rte-pir.-t on Date) I a-m a sole proprictor, yen°rat c-:)ntc-er —, homco«,•oer (C cle one) and 'tl�,,e hireti the contractors listed beio,v . ho h'-,h'-,vc the oi1c l e� ,� r•.orit s coL:. �t� (Na-me of ConLmctor) (��s��acc Colon:n„Tclicf Nurn)vr) �:: .<a;c- Datc) (game of Conti ctor) i� a:�_rce Co-moa2y pohm Nttnbcr) (F,:D:ration Datc) (Name of Contractor) (lIl I S1G^ (,O y ;?l;i%PoI:C: 1 17JI?lr=r) 1'j,ir:i: l%1I') - tName of Cont?aacr) — — (IDSZIS3t1C� Coln _ly Po1icy Numb t) - (I%:pi-:tic.r Date) (.^.ILidt:dit�ne:al ifst:.'::!•Ctzs�r::7:^-C1.�_-::::'•rc:a[:e.:f-='•:.•:,•� r.i];�:C:.-rar•) (/ an] a 'sole pralm("tUi- a.""i In?vG 110 oI c '.'.'Cr�iii't� f01 III-. NO-IT:plcasc be at.•a;c tits:ttiL;ic txcrco tlr s o r pL_y;�..r ., n::> _:ten a.:_n r_m cr:rpa r ct;, .,cliir.:;s. not more 1i-n duct uni's in tct dt he 1 i�:tr.�: o cx a;u ^� rut cn sS LhCRD c L tr:{ ea!ploycs un.�l 4Y%Yrzk£T,S cC S- i^n tr (c;L!i2 s!(S;•r_,:r ._::ia:by hotncv«-xs for e Lax cc ]cgal rtatuc of nn¢aployoc unaer tLn Wcx{de oi,xr anon!.cL I undo sinad tha z copy of th s ctstct a t ruy to fo,o wdc 3 to tl»D-jt tZUnr of InaiLiric]Arc,, :'O:fi v of L ,r�.n for tix covcrasc vaitciioo and that fsihuc to uc co��r;ut 3: cciM 25.0.of?,(GL,151 cart tc_d to ti>c im{rositiort of cr i_l pc-t:aL:- co,=L.ai g of a rur_of up to S 1.S00.00 nt'.” CIr i^-,Iri n�.-,=!,Of tap to r } r-.J civil pertattia in u,fl,",cf a S!r,, fm of sI Do,o0 a dsy against m;. r: ----------- - - - - 1 For ltr4wtnrrta7 u.o only U y A r Jlwaivrt c I,icz t;cJPermitt_ T "t' ! f AIR- SECTION 8 CONSTRUCTION SERVICES _ 8.1 Licensed Construction Supervisor: (^ Not�Afpplicable ❑ Name of License Holder: 1�11n le'��a��(� 11 l pp�am, Licen a NuffibeF Address Expiration Date 7A Signature Telephone ees gr M mprouemen�$_ontracto `v, Not Applicable 0 Company Name Registration Num er i ) Address _ Expiration Date Telephone F�` J ` 55(3 0 SECTION 10 WO�RKEARS' COMPENSATION-INSURANCE AFFIDAVIT(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....... Ef No...... ❑ O 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 whigh•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 Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature r i SEt T O PST"OT1 i F OPOSED YVORK check JJ a I�zalile ` tX i New House ❑ Addition 0 Replacement Windows Alterations) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ) Brief Description of Proposed Work: VAIg Vt Alteration of existing bedroom Yes No Adding new bedroom Yes Fes Attached Narrative 0 Renovating unfinished basement No Plans Attached Roll 0. Sheet AF ott; . r �'ition to eX;istingh.ous°ing "coapeF a Tiefohlowing: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number athrooms c. Is there a garage attached? d. Proposed Square footage of new construction. bimensrons e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Com ance. Mascheck Energy Compliance form attached? h. Type of constructi i. Is construct' within.100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Dep>0 basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . 1. Septic Tank City Sewer Private well City water Supply SE YfiN R AUT ffik lZATIO TO"BE COMPLETED WHEN O�I.NE�S�..AG ,l�'�t�RCONTRACTOR�APPLIES'FOR B.IJILDING PEIrtM{T 1, ��`( as Owner of the subject property hereby authorize 1—YF Il yjPy to act on my behalf, in all matters°relative to work authorized by this building permit application. ,rah A � /1, �� Signature o0 0 I� Date I, � r c, 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. r Print Name Signature of Owner/Agent Date 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 filled in by Building Department Lot Size D oo O Z G Frontage (Do 'C) Setbacks Front -50 C0 Side L: S R:15_ L: ..r' R: 15 Rear L Q ( Q Building Height ^1 210 Bldg.Square Footage % 2C11� Open Space Footage % (Lot area minus bldg&paved parking) ""vv #of Parking Spaces Fill: _ (volume&Location) A. Has a Special 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 < ONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 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 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: I City of Northampton h Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 m APPLICATION TO CONSTRU ,ALTER, EPAIR,RENOVATE OR DEMOLISH kONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION � y 1.3 Property Address: �e mpie# b off[ce �#"'dR .33 tg- � ti a k_a �irp 3'���strac� SECTION 2 PROPERTY-OWNERSHIPJAUTHORIZED AG-'E NT 2.1 Owner of Record: TZYAO-1 -P-0 Name(Print) Current Mailing Address: Q ?,7 q r'?zzo i Telephone U Signature 2.2 Authorized Agent: Cty INUIT Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED C0 RUCTION`COSTS Item Estimated Cost(Dollars)to be OfficialUse,Only completed by ermit applicant 1. Building �+► :(a)Bwlding,'Perlrnit Fee 2. Electrical (bY Estimated Total Cost of 'ConstTUCEiora from G 3. Plumbing /"�O Building Permit fee C) �f 4. Mechanical(HVA 5. Fire Protection 6. Total = (1 + 2+ 3+4+ 5) znmo -theciC Number This Section For Official Use Onl Building Pennit Number: 0 Date issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2004-0610 APPLICANT/CONTACT PERSON Edwin Olander ADDRESS/PHONE P O BOX 60284 FLORENCE (413)584-6364 PROPERTY LOCATION 918 RYAN RD MAP 35 PARCEL 061 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 199,Y -,2& Typeof Construction: REMODEL KITCHEN&BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 049348 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 Commis . n .20 "Os 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. 918 RYAN RD BP-2004-0610 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35 -061 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0610 Project# IS-2004-0861 Est.Cost: $10000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Edwin Olander 049348 Lot Size(sq. ft.): 19994.04 Owner: BEEDE ROBERT Zoning_SR Applicant: Edwin Olander AT. 918 RYAN RD Applicant Address: Phone: Insurance: P O BOX 60284 (413) 584-6364 FLORENCEMA01062 ISSUED ON: TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN & BATH 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 Sienature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 11/26/03 0:00:00 1998 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 11 I 11 11,A��,�,�- "! �- ­ ,�'��, , �­`� 1':��' -�i�,:,::�_:� : -,"",:�:��'," ", � I i,",,, -­I I ,� ,),� ,�-­�.7 y �' s.+ _ .i� x ;# c a III pa- - ; sr• ash t, v ` �' k+a! F #, - 2 g� Ma as w'` ,4 e :t :` }r* 3+ ":r r g} m,7a art' F x. w a„�,k`�a a`x„°, B;x ',+ 3 €, -€ ; z .� n a��r`'?' o'x a` .s`z, a�=` s ,. 'g > a - v x .� r 11 t � r_ a 1 x —11" bg a# ex `s^ w' 3 x� a t Kr 3 't; a: a ,.Fss +�^ � :r + 11.5 Aye` r .#' ,x? "x';rw t++; k + �. 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BP-2©4 4-0610 rTs OMMONWEA.LTH OF MASSACHUSETTS. y.., 1' 'Cl►V NQR'THA 'TN ' u , BUIL NG- t ., V M krwect# 5-2Q 4-48451 Est.cost.JIM, U o PE"ISSIU.NIS HEREBY GRANTED TO: Contractor: License: Edwin dander 1)49348 At�rxr cank Edwin 9 i n J.L a18 UAN RD IMrnnce: 3 5$4-b3' ELOR 1062 M CL]LD- +fI N: PERFOW THE FOLL€WNG WORK.-REMODEL 4CHEN & BATH POSI-TEIIA ASQ1111S YLV=MOM STRE ius for of Plumbing Inspector of wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough:�, „/ House# Foundation: t 3 Driveway Final. 3o,' YV Rough Frame k -4jr Gas:' Eire Deoartt ent ' Fireplace/Chimney: Rouugh: oil. Insulation: Final: �, Final: e,,J� d}-of THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTH APT ON VI )LATI F ANY OF ITS RULES AND REGULATIONS WIYA Nes D to aid. C eck No• Am—Oupt' Building 11/261030:00-.00 1998 $54.00 212 Mein Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo