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29-048 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS ' THE MASSACHUSETTS STATE BUILDING CODE SECTION 4'-W0= SRS IN613 Af7C��t B7DIit 1'.UI G.L»c 182. 6Cf6 '; 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 budding permit. Signed Affidavit Attached Yes....... JW No...... ❑ SECTWX 8 OF PROPOSED WORT&fe>keck all appilcsfi o New Construction ❑ Existing Building ❑ Repair(s) ❑I Alteration(s) ❑ Addition ❑ Accessory Bldg. ❑1 Demolition ❑ Other ❑ Specify: Brief Description of Proposed Work: f 1 Qve &w, //pia SECTIOW 6-ESTMATED Comm "cos" Item Estimated Cost(Dollars)to be £)1Heia l f 9tth# completed by/permit applicant I. Building (� (a)Btd€dtngPerm1tFee multiplier 2. Electrical (kl EstimsYal Total Gist of Constraetioa tom(+�I 3. Plumbing 4. Mechanical(HVAC) Suiliag lE !Fea. W wlb3_ 5.Fire Protection 6. Total=(1+2+3+4+5) C lteek.lufumhcr 8IWn<)f 7a-OVA=AV.r i$fxAtick-To at of IMM A>t NT G C0XMACr01t AFF`L 8 FOR HnII;WG F'RORT (, r Q as Owner of the subject property hereby authorize to act on my at o rk authorized by this building permit application. gn Lure Date SECTION 7b-. ! D ADOPT)lECLdRIIITDN 1. /"Lf//U [�/ S 1 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 tinder the pains and penaltie of perjury. �#ti 12- 1 arse at o Owner/ ent Date 672 780 CMR-Sixth Edition 2/7/97 (Effective 2/28/97) t 4 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS r APPENDIX B 4t�, The Commonwealth of Massachusetts State Board of Building Regulations and Standards FOR MUNICIPALITY USE Massachusetts State Building Code 780 CMR APPLICATION TO CONSTRUCT.REPAIR.RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING This Section For Official Use Only B11(Idi!)g PerIItilt Number: Date Issued; �lattge: 9utkttrig'�OlmnerJltisletarof BUi{dfngs` Date o ff'1? $';$ INFORMATION 1.1 Property Address: 1.2 Assessors Map dt Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use ' Lot Area(so Frontage(it) 1.6 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required provided 1.6 Water Supply(M.G.L.c.40.$54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public ❑ Private ❑ Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system G 8>E OH'� i�8d 7 r DW#F.RSHIP'�AI1T$ORIZEI?AGENT 2.1 Owner of Record: N ( t) Address for Services S Telephone 2.2 Authorized e(Print) . -.��/L// Address for ServiceT— Telephone SECTION S�CON'8TIIIJCTION'68RYI.C$S :; S.1 Licensed Construction Su ervisor. Not Applicable ❑ LYcerlsed Construction Supervisor: License Nu r as /�f��J +�jUl Expvatt nDate Telephone 8.2 Registered Home Improvemen Pontrac r. Not Applicable ❑ , lors �5 .t� ! �i �19.77�' Company Name J/ 1 Regis t n Nu r _ ss t rj�y �'' Expiration Ua at Telephone L /Z_- 1- 9/19/97(Effective 2/28/97)-corrected 780 CMR-Sixth Edition 671 ¢�l1AMP • ` I 1 Ijl � (f fail a rb..a�fta -, DEPARTMENT OF BUILDDZG INSPECTIONS INSPECTOR 212 Main Street • Municipal Building T 5 North'tmpton, MA 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCNlR 108.3.4 to act as his/her construction sur,:-,-i 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 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 -�JLAJL[p 4—\ Ago o •� l'J I1� L7I �Ctl:tl�cillt�ltt7lt -�— A aoancharc[Is' _ i — DEPARTMENT OP DUILDENG INSPPCT1Ot,,S "I 212 Main Street Municipal Build;nG Northampton, Afass. 01060 { �4'ORltl IZ S COi\'LPENSA77ON 6NSURANCF- Al=1 AVID O1 cros<x/permj t>CC) ���t� a plizcipal place of businessJresidence at: Ilf� i ' /�� kcok � ���` � (i ��' (phone') ' ( ty/sl3.tC/Z]p) do hereby certify, cl , under ic pint and penalties of perJurj; h:t (�) I am an employer providing the follo-vint workcr's comocasarion covc^ge for Iny elUplovecs worUng on this job: (laniran=Comn=v) (PcUc-,Nu.. r) (r:pinion Dzl } i ( ) I am a sole proprietor, general contractor or hocneo:veer (ci:cie one) and have hired the consacws listed below wbo hive the foUol�i q worker's compenSaaon POL)Ctes: ' (c+S1I1C Oi CO".r^Ci0"� (InSUr3nG;.COSIlOZ,'V}'t�l GUCi �tL1SS1LC:) �:-�1F'dUOi?1�11C) i (Name of Concraclor) (bi.7 rance Comoanyt?oUc Nunc_r) Date) j (Name of Coluraelo,) (LnsZCranc: ampan)•/Pot;cy Namberl (EsDiraeo Date) (Name of Contractor) (Iosuranc-c Comp. Qy/PoLlcy Numbcy) (Eapl-,600 Date)- (a¢aGh_ddizioc 3i 6=c if accc --v to me u4c iafoc�oc pereslniag to.11 { ) I am a sole proprietor and bave no one worldDg for me. ( ) I am.a home owner perforrni.ng all the -vork myself. NOTE:pl=sc be awzrc tfi--LJe bco a vcn wto ccapla),pcwm Lo cU of ant cocce th z Ulzm=al is-hick lbc bomoo, n ccid=oc oa the g owL c Lppurteasi tbecn oa rally occrd-rni to tic --ploy--u a the..ui d o=pc tioa Acs(GL152.a l(5)�z4vG=6oc 6y a bomcoavc fa_Gex..a Pamir nay c mod—the lcl;1 ru=ore.a erPloyor uodcr dw Workze&Coo�oa Aa- r uoJa -zd tbm a copy of thi.=Lic=at may be roc-+.wdod to the pgxttm�of lo�W Mid d&afros or L.---fa Lb^ covar.sc ve-if shoe and 011 U-L-=to c«urc'colcr =6cr scctioa 25A of 1.toL 132 na Ied to the L po idoa ors'!Pc-11i- oomis *[I fine orup to S1}00.00 and/or i=prjzoo=,=%of up to ooe yer e,d coil p,=Lhi is Ce roan-f-Slop Work Ord=Lod L Ciaa o(5100.00 1 day api¢2 mc- ��� F- Pcr�l = Lot n . ` Si J M.-n Lc JPcrmiucc e SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not plicable ❑ Name of License Holder: License Number Address Expiration Dat Signature Telephone r , 3 Re'"isYe�ecllorrifm"'r`aeinepantractara° Not Applicable .❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'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....... ❑ 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 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) Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[0] Other[O] Brief De nptionof. AcicWor oE C l � CU I' E � Alteration of existing bedroom Yes No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa tf Mew house°a'nd or additt"ono-ezrstrrrc 3tioirsrn corrrp ete t i �sttoW "I a. Use of building: One Family 5`' 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 SECTIONZa-OWNER AUTHORIZATIOU>-TO BE COMPLETED=WHEN OWNERS AGENTOR CONTRACTOR APPLIES.FOF BWLDINC PE -MIT as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by tfiis building permit a plicati n. 0/ 7 Signature of Owner Date 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. BOW& 12 4z Pr' t Name � 71 �� natu of Owner/ gent 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 bldg&paved #of Parking Spaces (volume&Location) A. Has a Special Perm it/Vahance/Fi nding ever been issued for/on the site? NO 0 DONT0VOVV YES 0 IF YES, date issue& IF YES: Was the permit recorded at the Registry oyDeeds? ' NO �� vv DO NT NO YES «�� m KNOW IF YES: enter Book Puge| and/or Document#| i ----- -------' ' A7N B. Does the site contain u brook, body of water orwetlands? NO W DON'T KNOW 0 YES 0 |F YES, has o permit been or need tobe obtained from the Conservation Commission? Needs tnbeobtained «_�v�� Obtained v~x��� Date' C. Do any signs exist nn the property? YES 0 NO �{ ) IF YES, describe size, type and location: � D. Are there any proposed changes to or additions of signs intended for the property? YES v—� NO |F YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre orinitpart 4e common plan that will disturb over 1acre? YEG ���l NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. _ Depal idt' Q x a ' t� V E �of Northampton at s of � trt t it iho Department OurCx t lave�l?errntt � ' Main Street Sev�tereptccatfar rfl z oom 100 �4A 200751 I s J�L 6 Noftham ton, MA 01060 ets©tStrc, xaP3fr►� T " �} phone 41-387-1 40 Fax 413-587-1272 I?toSlte l?Ians , 4.11)N� z � r� � I 1 nr n,ran Otfler Specter a r:: ! A C APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: to be i:ompteted lay office This<sectron: fot °t1n� Zone. -;OverfaDrstcrct 4Elirwst District CB DistF ct SECTIONr 2-PROPERTY'OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Ne(Print) Current Mailing Address: ZV&— � � -� a 0�� ('y � Telephone Signature 2.2 Authorized Agent: _ 117 Ale b; b P �, N me(Print) ) T— rrent Mailing Addres / l r J `7� / ture epho 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 Fees 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number ZIP This'Section-For Official Use Only Date Building Permit Number., Issued: Signature: Building Commissioner/Inspector of Buildings Date .r File#BP-2007-0019 APPLICANT/CONTACT PERSON BRYAN ALOISI ADDRESS/PHONE 107 ROCKY HILL RD HADLEY (413)549-5141 PROPERTY LOCATION 336 RYAN RD MAP 29 PARCEL 048 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT F e Paid uildin Permit Filled out ee Paid A Oa Typeof Construction: Repair chimney 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 IN t 9 F MATION 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 p;4", 0-7/10 O 6 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. ,f t BP-2007-0019 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Categor BUILDING PERMIT Permit# BP-2007-0019 Project# JS-2007-0033 Est.Cost: $4357.65 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor. License: Use Group: BRYAN ALOISI Lot Size(sg. ft.): 47916.00 Owner., CAHILLANE STEPHEN J&CAROL A Zoning: URA Applicant. BRYAN ALOISI AT.• 336 RYAN RD Applicant Address: Phone: Insurance: 107 ROCKY HILL RD (413) 549-5141 HADLEYMA01035 ISSUED ON.711012006 0:00:00 TO PERFORM THE FOLLOWING WORK:Repair chimney 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 7/10/2006 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building commissioner-Anthony Patillo ow