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29-062 .Nft Crity of Nort4ampton z I y �185lRC1t ii8[tf4 DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton,MA 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as iris/her construction sups:. 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 proXct until such time as the proper permits and inspections are made 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 o (1-iftt of �K>_ rfljalttpfclit � 6 h�zasxcilnsrtle z DLPARTME?vii 01' BUILDING INSPECTIONS 212 Main Street ' Municipal Builcling Northampton, Mass. 01060 WOP CE,R'S COMPENSATION INSUIZANCE AFI)AVIT A vnth a principal place. of bus1FcSsJrC`;id1-11cc t: (StTc,-Ucir;i'; <�p) C{O L1CI"eU}' CCrt.LI}', ua:'c1" 1110 pc,M-s iiCl pCil it, of pof3ury, K I am au employer providing the fol{ov.,mL' '.':ol'r,Cr`5 COIIIPC;]Sat10I] COVCr<::.0 ror my employees wor-king on this job: v Zr�S , (Lam=ce Corn try) (e c;Ni nnbcr) ('ExTimiion Date) ( j I am a sole proprietor, v=.enera c:Onc Or honlcO (cL cle oat) and 'gave Hired the contractors listed beiow -,-0 o h� the `oll r e ^; -,,v mg v�or kP s co%!D nSa:tOrl (Name. of Contactor) (Ln_u�ucc Conn;:- Pc!icf Nunn r) ;�X, rn'ulon Date) (Name of Contractor) (Tns m.ncc Numb--r) m Date (Name of C.oatnctor I ___.--- (_om ti_Late) - (Name of Contactor) - - (T-aTIratic- CoTrT-:--}/Policy Nu.mh�lr) - (E;:pi-:tic Date) (r.ttidl_.d-!iticril i.:ct:-.._ -.- :n..._• .:-K:..,..... ,- -... �i;.+:<:.o.._,..-� ( 1 <llTl i. OIC 1)1 Opr]t t0i itit 1 h v:, 110 Ot:' for IP j Aim <? home ov"n— NOTE:ptcaae t+c nt+arc tl:s:•.,�•i)c not trx-cc Lh.a thmo uni+i ir:tc{;cl:he c '•71oYc3 u_z cz the n r ((3L152 a 1(Sl;,a,:;iin:ia.l,v hnt•icoa-ncr`cr a t ccu ct legal vwuc of an==ployor under tho We kC%'&C,,1-a=iiion _et [undc--zt. d thL a cvpy of UL-A ctaic::=.;:—y bn f,,,;-j j to tt'r_[y_txirtz�ccL of In�u:riJ An�r..m�Cupp or for Vl COvriy&c vaificlioc and that failure to:ter coti`tr_g^.,ut•.3c::c"icc 25A of?.iCt,152 can Icsd to the imposition c; COOStstmg of a fur_of up to S 1-500.00 n:t&,cr tr:;iri ti:_of::p to cr..}- e:.I civil xncltiu in do is nt of.,S!c,`Vern..Chia_r.:1 it firms of 5100.00 z day q!uwa m:. Foe dc{:uutnt�u.o uil y i?crinit NUITAX.r -- 1 �7c,IM LU IC" ..,tcca':C'J�l'°_fill ittr_c, -T; L ap SECTION 8 CONSTRUCTION SERVICES - 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: /`+( cs (—)t0gL0q O License Number K10 A)bito Address Expiration Date signatu Telephone Not Applicable ❑ ��eaES�re" Yinetfirrrpravemen` C"o�acta� �- � "�: ' ' �t�;` Company Name Registration Num er ' lb — d ress Expi atio Date a —Telephone Jr5/K SECTION 10-WORKERS'CONIPENSATION INSURANCE'AWDAvrr(r :GL c.12,'- 251C(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...... ❑ tea, 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 r i 9 SECTION 5-DESCRIPTION OF PROPOSED.WORK(check all:applicable) New House F-1 Addition ❑_; Replacement Windows Alteration(s) ❑ Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks (M Siding[C71 Other(a Brief Description of Proposed Work: 1 1? J 41 Alteration of existing bedroom Yes No Adding new bedroom Y No . Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a f€(Vew t`o se rt -orva "dl �a ci x�t�>ic ous i c�b p>�et+ t o NOW": ^ ^f bu;,Id;ng' One Family Two Family Other a. vac v ...y .. 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 L 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 Ta-OWNER AUTHORIZATION-Td$E COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES"FOR BUILDIUGR.PERMIT 7tAas Owner of the subject property hereby authorize to act my behalf,in all a ers relative to work au horized by thi building permit application. Signature of Owner Date as Owner/Authorized Agent reby 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 Parne 3b Signature er/A of gent Date .R Section 4. ZONING All Informatioh Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Dcl-m ent h Lot Size ' Frontage Setbacks Front >- Side L:° R:i f 'L:= R:I ! Rear -- Building Height Bldg.Square Footage (� % i Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces Fill: (volume,&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 Dow KNOW 0 YES 0 IF YES, date issued:, IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON-r KNOW 0 YES Q IF YES: enter Book ! Page and/or Document#' I B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , Date Issued: t C. Do any signs exist on the property? YES Q NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES NO Q IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 . NO r IF YES,then a Northampton Storm Water Management Permit from the DPW is required_ ep�use City of Northampton statics°ot Pe, , Y Building Department ec bictwD- 212 Main Street Sewer7S ptic . ifiiy Room 100 vtWAft0/Wet, l�rar at Northampton;MA 01060 Tv+to sets of StnicftiraG Ptaris ' � �� phone 413-587-1240 Fax 413-587-1272 PtoilStte Plans ether Specify _ <. z APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1. SITE:Ii!IFORNFA'FION ifirs sgctt�Qc �trTie coinpl "orlfiice 1.1 Prooerty Address: - EtcrrSt District - CB D�sirict S1�3 PROPERTIFOWNERSHIP{AUTHORIZED IGEl7` 2.1 Owner of Record: i Name(P' Current Mailing Address: Telephone Signature 2.2 Authorized Agent: 6n dat Cd (Print Current Mailing Addr Signature 4 Telephone AP W6 TIMATEEflCO SERUCTTON O TS -_ .._- Item - Estimated Cost(Dollars)to be Official Use Only completed by rmit applicant 1. Building i :(a}•guilding=Permit Fee 2. Electrical _(bk Estmated Total Cost of -- _Construction:firo7n 6 3. Plumbing 'Butiding.Permit_Few zs.cto 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) Check Number 9, 300 ZS•U� SectioEi Eor Elt€ieia[,Use:On _ Date;. Building Permit NO-mber. issued: Signature: Building.CommLssionerflnspector of Buildings- Date er .F0'#BP-2007-0026 APPLICANT/CONTACT PERSON Cyrus Newman ADDRESS/PHONE 697 Bridge Road NORTHAMPTON (413)586-1093 PROPERTY LOCATION 47 GILRAIN TERR MAP 29 PARCEL 062 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid uildin Permit Filled out ee Paid 0 0 Typeof Construction: Shingle over one layer of roofing 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 FOL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION 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 xg— 11L'eJ –07 t 0 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 BP-2007-0026 GIS #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building. Categor BUILDING PERMIT Permit# BP-2007-0026 Project# JS-2007-0041 Est. Cost: $500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Cyrus Newman Lot Size(ssq. ft.): 16204.32 Owner: WILLARD JAMES J&PATRICIA M Zoning: URA Applicant: Cyrus Newman AT. 47 GILRAIN TERR ,plicant Address: Phone: Insurance: 697 Bridge Road (41-1) 586-1093 NORTHAMPTONMA01060 ISSUED ON:711012006 0:00:00 TO PERFORM THE FOLLOWING WORK.-Shingle over one layer of roofing 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 7/10/2006 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner- Anthony Patillo