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36-018 ¢�t1Aa1P�. . o ��`$ Cr, of Nart4aillptalt z = a =- 6`g, DEPARTMENT OF BUILDI7,,TG INSPEG'IIONS /= 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 !-is/her construction sup,: ,- 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 rouzh 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 I 0 Q_ZltA1rP�,0 I a . E Q, t I jai t1�a11t�tDtl _ _- 9 J f il+aanttlrssrlla' - _ o DEPnRTMEI-T OF BUILDING (NSPPC7101.'s 212 Alain Street Municipal Building Northampton, Mass. 01060 `'Y C)R E IZ'S C 0\'CP E NS A`IIO N L^t S URAN CF A ITIP A VI-I' (li CCULx permj ttcc) - �1 h a pl�,tcipaJ plac; of business/residence at: ��� �nrP� GIQr� dX �U��yYQ 1"Ii"► (pone;') S� U (sit/ci tylsZatc�ri p) do hereby cert;, under die.pairts 2nd penalties of perjury:, thai ( ) I am an employer providing h follo% ine %vk 's cotncnso ado, cove age for Ins etnplovecs working on this jib: (Lsur'.nc-- Conn,-.-) CPoLic; l-u-nixr) -- ' (E:piraior,Dzir) ( ) I am a sole propneror, general coo=c-Lor or homeowner (ci die one) amd have hired the coouaciors listed+ below who have the f000% iae workers C-0CD s2aon pe!)cies: (Namc 0" C0„^C"0r) (l[1�1 r1I1G Comoil,vr'ci;c; ?`Ittr1_C:l (C_>;>ITJ� n Datc) - (Name of COUT clot) (Lis-wanc: ComoazwPok Nuor -:r) (—Ex-DU,:tion Date) (Name of Conuaetor) Qmsura.ne; Compan)•/Pouq- N;Lmb r) (Expimacs Date) (Name of Contractor) (Losuran(z Comrzay/Poticy Nuibcl) (Expim6oa Darr). (a1Iar� �oczl chtC,if ncoca..n•to mc!ud=�nform.�oa petunias to.-U ra p {�am a sole proprietor and bave no one wor-tdDg for me. ( } I am.a home owner performing all the wort` myself. NOTE.:plcx be--4rc- 't_k hcmcov..n utlp cc ptc-f Pc`,- a co do cc;—,:r-0 cr rc ��..'or5c oo d..ctl_Z of arx most th t.h'w—11 in u'3ieh the bomoo-.rcmd.«ca the�ou�:r-T rj,o Lb--�,nee oecr--d to to cixployca un"—the cc=?c -+ica Acs(GLI 57 l(5)),=-vG=noa by.homcoavc fcr a 6cz=cc permit o=y c«dcocc 0-,c lc�l etas-of na a7loyx under d-W06--It Compaosat.io AeL I—Z--v-aad Iha x copy of tbi.mt m�m...y ao f----rddd to the Cc9wim.zi of lndusr;c1,lc Zo t-f office of 6m -.con for thn covcz-A-c v -Gclio,3-M Uu Liltac to sczL=tcovcr Ozai tmdcr:.cciion 2S A of htoL 152 can led In the i=, oa of cimi pcaxllicn cocw.:tz. of a Gx or up to s 1-OO.00.ac -Qc yi of up to occ yr_r red c.il pmxhia in be focm of a Stop Wort;Or'dc and a rinn of 5100.00 a d_y L pia-A t>x - For dGs.ruz�l,t u,c on7y ���'.�/' Lot JS. zLUm ofLianscc�Pcrmittcc �1 e J SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: / Not Applicable ❑ -1 -i Name of License Holder: ,J a✓V\ S V FG l e-� ��L S � 1 1 License Number _lU FoiPS-�' 661, 'br - Flounce- H A- 4 laslr Address Expiration Date Signature Telephone 3t Regfstbreif Home=rinprovbmenf-CortfracforF t4 j Not Applicable ❑ �I hGi50r'1rya �' C0hSJ✓(A Clld n 1('11' (o �o-7 -7 Company N&ne U Registration Number l() �erPs51- ��e� Dr . 'I o✓etc N �` G- io lob Address Expiration Yate Telephone-15-9 Ll -(o 373� SECTION:10 WORKERS'COMPENSATION INSURANCE.AFFIDAVr r(M.G.L.c.T52,§: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...... ❑ k-5 Xfli 4-1 The current exemption for"homeowners"was extended to include Owner-occupied DwellinEs 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 buildine 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 alEapplicabl_e) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[2j Other[0] Brief DescfiptiioJ��f Proposed Work: P%✓� Alteration of existing bedroom Yes - No Adding new bedroom Yes —,P< No Attached Narrative Renovating unfinished basement Yes X� No Plans Attached Roll -Sheet 6a�ff Ne� us nr horise,attd zracid�t4on/to-exis na ioM4 d6rho Qte"f .fciEta E�icj: a. Use of building: One Family -..-Z Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? V O d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? ; 5 Fireplaces or Woodstoves A/ 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 "SECTION 7a:OWNER,ACtTHORIZ/ATION TO-BEsCQMP.LETED:IAEHEN OWNERS AGENT OR CONTRikGTOR APPL'IES"FOR BUILDINGPERMIT, OVA a,,-, L k i L, as Owner of the subject property / hereby authorize !/' to J)act on my behalf, in 511 nmatters relative to work thorized by this building permit application. Signature o w ner I Date tizl as Owner/Authorized Agent hereby Vare that the statem s 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. �a oAc5. i/ � Print Name ERE of Owner/Agent 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 Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces A. Has o Special Permit/Vuriunoa/Fndi ng ever been issued for/on the site? �� �� NO \���/ DON'T KNOW KNO YES �~� IF YES, date issued:' IF YES: Was the permit recorded at the Registry n[Deeds? NO C ) DON7 KNOW Y[5 �� IF YES: ' enter Book / ' Pagoi ' and/or Document#� � �� �� B. Does the site contain a brook, body ofvvatorurvvet|ands? NO ��� DON7KNOVV �_/ YES x�� IF YES, has u permit been or need to be obtained from the Conservation Commission? Needs tobmobtainad �-� Obta/nad /�� Date �~� \_� ' � �� C. Do any signs exist on the propo�y? YES \~� NO �Nm 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 IF YES, describe size, type and location: | ` E Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre orinh part ofa common plan that will disturb over 1acre? YEG ���) NO ��0 m� IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ` Y EJePa>tnien use€�ttl GIR City of Northampton status oPermrt " ;Ruildinn I�enartment fnrh c lf]n�r�ur� P nn 212 Main Street SeulrerSelatrAva►latxl%t� v ,Room 100 Wafer�WelCAva�Ia6�ki = „'(T^^)Northampton, MA 01060 T a ets=o�tructuratPtaps * b 1hone 413-587-1240 Fax 413-587-1272 �+ PI©t�6{te 1?iaus �(z � Ottte�Speer .� � a� APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1m SITE"INFORMATION 1.1 Property Address: :This section torbe completed`by office �3 ("'0 ttS`4` 5��r� �/�✓ Mai Lot.- Unrt Z Overlay Qistri. �U P' Etrn'Sf �ISt'Ic CB Distr�c SECTION 2:-'PROPERTY'OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: .v► 12a,, 'f V-1 Fo rP A-- 6-I Pr, -by F1 e✓e vy e Name(frint) Current Mailing Address: AlTelephone Signature 2.2 Authorized Agent: 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 Building > 5 E. > (a)Building Permit Fee 2. Electrical / (b):Estimated Total_Cost of Construction,from- 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number 1 Do-is This Section For OfficiaI7 Use Only Date Building-Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date +e a 23 FOREST GLEN DR BP-2007-0444 GIs#: COMMONWEALTH OF MASSACHUSETTS Map-Block: 36-018 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-2007-0444 Project# JS-2007-000658 Est. Cost: $17500.00 Fee: $2500.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JAMES FOLEY Lot Size(sq. ft.): 14505.48 Owner: RYAN MARY L TRUSTEE Zoning:URA Applicant: JAMES FOLEY AT. 23 FOREST GLEN DR Applicant Address: Phone: Insurance: 10 FOREST GLEN DR (413) 584-6370 FLORENCEMA01602 ISSUED ON.1011712006 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS & SIDING 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 10/17/2006 0:00:00 $2500.00518 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo