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35-264 (14) I j 4 4.9 1 �l Loy w 1.l4 75 �► I T.G. ! 1'4 t�4rsfRO �sTaK r�!•AVSAO F I FOGY l�Ql� 1'hlA1 i NAVE&WMW THE MMWA AHC1SAM ON 00"4 MONUM S`AT*K Nt GAUM PIM#t CROAC14"8 AND BUN.1*8 APE UNWED ON THE tiP1"b AS MOWN AND THAT THE lIIJILDPW APE WRLY WRWN rrt Wr t041M i F�itTI�EP► MEAT THE lrM10hE1RY OS Nt7i LOCATED IN A t ODD PPO*AMA AS 8Nt7MN ON!8!'W.94URANCI M*6 POMt G`G#+iNIUWry +Dt�ld.7. DATED:_ _ 9 `22-99 Est THIS MAT FOR MCWr*At�E LOAN PUAPOW ONLY AND DOS SURVEYOR: NOT OON1STMJ C A PROPOW SURVEY. MQE+ TQACt LC"MPECTtON PLAT NO R.`T'H AM PTO Wj MASS. owhiE3lt f RtaWAL-D *ViRCviM1A DAWWL'S u S CALA: I tt,!;o w AkfWd J.UkftFP,bv..Arp ra ProkoskxW t t nd' Wr ttt)lane oftet,N*ftrop",Wit+•*I mo Q S1iAMA O O g� G1 fir of Xort4amptou z s �ASSAC}�IIS[tt5 DEPARTMENT OF BUILDI7�G iNSPEGTIONS /= 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 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 your), 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 understand the above. Xleome owner lresidejWs signature requesting exemption) I Ill call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location �6 OS �11ftT o �icTl"�1jci171�Jf[1Ii - �. � 6 fiiassnc}?nsrtts ' m 4)EPAft1-MENT ON EUILDIJ G INSPECTIONS 212 Main Street ' Municipal Bui](ling NTorthaLnpton, Macs. 01060 WORKER'S COMPENSATION INSURANCE ASMAVI.T v"Ith a principal place of businesslre denc� f: tic i t•:; do Hereby ccr-d.}-, ana�r thc• T),-MS ,1?ld pen:itics of pc:rjllry, :hai: I am an CIIlployer provl{Iln� tI1C i011U'.Viiii, '•YOtr:Cr-, COtti?)CIISCL1o➢ GOVCtc` C for ?ny erllployces worlan5 on t}lis job: (Las'al-an= Company) � C Cr NiLi11�Ci) _ (Y�1!1 U^�Daic) l j I a-G-1 a sole proprietor, general centi-ac`or or home Nimer (circle one) and tlz`,-e hired t.lie contractors llste�tl belov.,,;,to i':-.., lklt `01 :ti^i;g OrkP�S comons�ani1 no!!C'.t5: (Ntimc of Contactor) (Las ?ncc CG a:;,�Polic; Nu niYr) (max; ra oa Datc) (Name of Contractor) _ (ljrts mmce Co r_rtv;Pe!ie Nun,t,--r) (Exp ...:ion Date) (Name of Contractor) — (Ins'"rm-lice Co .;iY�olic Nun�tr r)- -.x. r::na Date) - (Name of Contractor) — (Insurartc- Come IyiPoucy Numblr) Date)- (^II-lGl ad'!It:Cr.al SE:'Gt:....__.. :D t ra'�e..:'K':[L t'•.Viz'.�L._.... � -eli o:G:.^_de:^) ( 1 ZU11 a SUIc prO1)r1C,---oi iludi fl�tvc-. no OI:c ,.'Jr`/iii; lOr fllE. NO IT: pIc-sc Lx nn-as c 11:a:`s1 Jc E ct;ca«zm I�rt "Cl Cr:--�1 r c!!i not¢nee th--z thr=uniu in ca ploycs uti'cz thr tvct�;to cc -_>:im •r (t>;.?52�-'.(5);.-,, ..anon by a hot:uotvncr`cr a 1 a legal etatuc of an ealployer uou' tho Wcv4cla I undc_--stand thit a copy of thza ctst--: –1 euy bo fotu't IcJ to tl»(Yjt tn—d of It-dutriJ Oifl w of is for fire eovetAge vctil'i!~Lion rnd tlut f_ilure to:ce.:rc eoV:r_,,urn r caic 125A of mc-1.151 can lc--,d to th cvazisting of a fin,of up to 51,500.00 an–"Or of up to cn }, r.:.1 civil"'aultics in�c fc;nn of a S!r,`:}'cis On,, -:-^I a Lr�oC S 100.00 a day a�ain:1 m,. 1-oc tj.3;uuTYxCJ UP--oily y Pcrrnit mlll?L:f S:�,nacurc of i.iccn�;c:�i crnlatr::: . SE CTONB vCONST;RUCTION SERVICES' 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone Rey g�ser" e ome rrra ovement C Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10 WORKERS' CQMPENSATION 1NSURANCE AFFIDAVIT(M G.iL.-.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 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 fur 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 l �.- _ !.. SECTIONS D R FTtON OF f?ROPOSEQ 1lVOF3K check= a livable �. . . � New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. Demolition❑ New Signs [ ] Decks [ ) Siding[ ] Other [ ] Brief Description of Proposed Work: •a/J�t ,t, �1 �� �L �jµQ y Z)x� Alteration of existing bedroom Yes No Adding new bedroom Yes _ No Attached Narrative D Renovating unfinished basement Yes No Plans Attached Roll 0 . Sheet 0 a i a mouse and O Wit©nntoTexi'st�n�;housing com° p e e he ollWW in a. Use of building : One Family Two Family Other=91� it - f Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? / r d. Proposed Square footage of new construction._ p _ bimensions e. Number of stories? f. Method of heating? 4/ Fireplaces or Woodstoves _Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction__.& crO d i. Is construction within 100 ft. of wetlands? Yes _><`No. Is construction within 100 yr. floodplain Yes__&o j. Depth of basement or cellar floor below finished grade _ �/d k. Will building conform to the Building and Zoning regulations? _Yes No . I. Septic Tank City Sewer Private well City water Supply SECTIOt7 WNERAU�HOR(ZATION iTO.BE COMPLETED WHEN �OWNEFtS/�GENT�Oli2�CONTRACTOR gPPL'lES f0R BUILDING RERMIT- I' �` `'f �`� f as Owner of the subject property hereby authorize to ac'. on my behalf, in all matters relative to work authorized by this wilding permit application. ,:,� D t__ P,06 04 Signat 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. J Print Name . luleY Signature D ate 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 7,-r 4 6 f Frontage Setbacks Front Side L: R: L: R:�d / Rear /�,✓ l Building Height Bldg.Square Footage % /�/A S Open Space Footage % 7 (Lot area minus bldg&paved parking) #of Parkin Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO �X 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 the site contain a brook, body of water or wetlands? NO IK 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: f Northampton i g Department v Main Street om 100 6 2Aort amp on, MA 01060 11one 4137-12 0 Fax 413-587-1272 P RUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION Thcs sectcon tafbe completed 1{iy office 1.1 Property Address: ws k � � 'r s ,g 01-662— Zon+a Overlay Dcst�ct "near.,�.. .x�.aw.. .. .... ... — _• SECTION-2-PROPERTY'OWNERSHIP/AUTHORIZED,AGEN T" 2.1 Owner of Record: Name(Print) Current Z 0 Mailing Address: 19 ®l > J0 -LL�4L it Telephone i � � � nature to 2.2 Authorized Accent: Nam (Print) Current Mailing Address: je�o ee, rh 19 aid �a gnature Telephone 4113 a — (o SECTION 3-ESTIMATED CONSTRUCTIOMCOSTS Item Estimated Cost(Dollars)to be Official"U.se Only com I ted by ermit applicant 1. Building ,r- {a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of "Construction from 6 3. Plumbing Building"Permit Fee 4. Mechanical (HVAC) S. Fire Protection 6. Total = (2 +2+3 +4 + 5) C��'. Check Number This Section For:Official.Use"0m Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File I#BP-2005-0195 APPLICANT/CONTACT PERSON DURFER JAMES E&ANITA M AD'?RESS/PHONE 49 WEST PARSONS LN FLORENCE O 582-6963 O PROPERTY LOCATION 49 WEST PARSONS LANE MAl'35 PARCEL 264 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZO: ING FORM FILLED OUT Fee !'aid Bui l i ing Permit Filled out Fee .'aid Tyr�,of Construction: ERECT 10 X 14 SHED New Construction Non Structural interior renovations _ Addition to Existing Accessory Structure Bu;' n2 Plans Included: _ Owner/Statement or License 3 sets of Plans/Plot Plan THE' FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INI' 101ATION PRESENTED: `,proved Additional permits required(see below) "LANNING BOARD PERMIT REQUIRED UNDER:§ ntermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ONING BOARD PERMIT REQUIRED UNDER: § I'inding 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 ssion Sigr � of Building Official Date Note uance of a Zoning permit does not relieve a applicant's burden to comply with all zoning regi inents and obtain all required permits from Board of Health,Conservation Commission,Department of 1, c works and other applicable permit granting authorities. *V, ces are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Plat. Development for more information. 49 WEST PARSONS LANE BP-2005-0195 GIS#: COMMONWEALTH OF MASSACHUSETTS MW:Block:35 264 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-2005-0195 Project# JS-2005-0239 Est. Cost: $2500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Groin: Homeowner as Contractor Lot Size(sq. ft.): 72745.20 Owner: DURFER JAMES E&ANITA M Zoning-: SR Applicant: DURFER JAMES E & ANITA M AT. 49 WEST PARSONS LANE Applicant Address: Phone: Insurance: 49 WEST PARSONS LN O 582-6963 O FLORENCEMA01062 ISSUED ON.8124104 0:00:00 TO PERFORM THE FOLLOWING WORK.-ERECT 10 X 14 SHED 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• Receipt No: Date Paid: Check No: Amount: Building 8/24/04 0:00:00 1648 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo