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1 t R 7A ,.0 ( a �Rct r a(yc • ,,me Depot#2662 J DAGGET DRIVE, WEST SPRINGFIELD, MA 01089 (413) 731-9700 Wed Aug 27 14:38:09 2003 The materials for this project will cost$1467.25 i STEVE BARTOSZ 10 BY 12 DECK OFF HOUSE AGL 342344 — 3D View i I j;. �I I'll, Ili _ 'd j .. Y Y �I833AC}'ITSttt3 ' s 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 under 780CMR 108.3.4 to act as 1-11s/her construction sups:-.,;A 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 roueh 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 ttAR P 1! Uzf�; �1f la rtljalllpftilt - 6 h�cssrtchnsrtts = "r m DEPARTMENT-r OF BUILDING INSPECTIONS 212 Main Street ' Municipal I3uilcling Northampton, Mass. 01060 WOMICETS CONITENSATION INSURANCE A± AMA I-r T, principal place of busiresslre;sidenc - --- ------------------------------ -- ------- do hereby cel-uf'' dlc p s 'U"Cl penratie:; of p;:rjury tha:: ( ) am an employer providing the iollov inC '.vorku'S Comper]snoI] COVCI2' C For my employees wo6dng on this job: v (Ilu-.l=ct: Cotapain') (Pc c,NumExr) —_— (F�pir ion Date) j i acs a sole proplzt tor, general can c cr cr hon ecwoer (czrcle one) and lave' hired the contractors listed beiov. ;;-h �'� Fl ` ll� ir; . '-er e ok. .o t, tae .c ..',. y v orn s c�ot_.0 neon ;;��.�.,...s: t.t1LI1C Of CORLraCtGr) (�I1=1`,IC CGI ^?:i'r'iPG�1Ci N'�tinbcr) ;D- :; .+.'=o% Datc) (Name of COntr2C"Or) 0'11s mncc Come`'!Pc!ic; Nl rn r) 0--x T.): tio:l Date) (NlaII1(-t Of CGWLnCtGr} IIl * [1C t_;�u :n_i �G�,C: NvU1I?1r I) `.�.:,-:i:Ga Date} - (Name of Contractor) — (Ias�rar]c CGmr .Y!1'olicr lrtumcr�r) i { i l_ 1 I'LTl <l Ole (JIOpI1e W:' cii t'1 haVc tic C)I1; Qf lei rite_ '�ajn a 1:011?c oW11Cr iiCi.C;`I?]1P^ 11l iCi ii ..I NOTE:plc:se be at'Wc tltst,l]e he%a 1r s .�c ! ;r.,.- n t> �e r nc�cz::e n m er::yau«• :•^:_ el!i c: not ttxcc th_u throe tun`s in wL;•ch tx l ,y�;u r rc:c cr a; + t.-.� urtcr_r1 Lycc c c x t c rrsaUy er:ployc3 u_r u thr wer},y s ec x• ;ati:e rtr (G _'.SoV c!(�);.'.[ .1:_ ti y a hot•trou*tcr f.or z Gtc:;c ct Icgzl ctztuc of an a�ptoyar uaur the wcviccr'z tlol.�±orr.�.11ort:`.cam [tu-dc.-tt�d thi:a cmy of tlu ctntc::s_'c:.y bo fofwnrc;o-:7 to tl;o[YSnruncnt of It rutricl Acci&. &Cf lc of i::.:+--+r�A for U- covcragc vcriFir,..iion and that G.ilutt to:!1;.::c co�cr_;,,uz-,�:ccti.int!2 S.A of?.iGl.152 can Iced to tlx i:nposiiiat c;c.:.^.i^_1 pcz:aL':;s comii2i-tg of n fur_of up to 51-500.00 an''cr i :nri r z.=;:of up to Cn:} e-.j Civil xsultia in dc fc;nn c(+S!c+',Vr-rx C}u _r„f Lm oC S 100.QO a diy igr_in:.t m� . For 11• vtly Pcrmit Numlx:r -- ----------I Jirnaturct�fi.ic�n:;c�JI'crru;itr•�, r`t- SECT N l& INISTRUCTIONZERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone �Re te��ed°Iomfm o�uem'n"tContractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION.10'1NORKERS' COMPENSATION INSURANCE.AFFIDAVIT(M.;G:L. c 152, § 250_(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 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 0- � _ SE TtON =RS°R PT10TIOFPR POSEDYVQRK checktl>a livable v.'W 'A.asx..1-�> 'a"•.,.^A!T,k-'S:eu_,'#—Y.Yf^'»ux— mmr,.Fi %3;4'YT,x r..Sm ,sa-IL.n,N:.�"�sr.... New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ) Brief Description of Proposed Work: i -2 k 1 dam. Gil Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 •Sheet 0 d_o- a difl—Wto zrstft__ singMANO p1-eTe' t'ftbMJowin a. Use of building: One Family 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. Mascheck 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 SECTI01�7 ERAU7FlORIZATION TO BE COMPLETED WHEN OWNE S GENT 000NTRACTOR'APPLIES,t"OR BIJfLDING PERMIT as Owner of the subject property hereby authorize to act. on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date as Owner/.Authorized Agent i 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. Print Name Signature of Owner/Agent Date I I Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAYBE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning .This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T 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: 4 City rthampton DII epartment J 21 Ma n Street SEA oom 100 r pt MA 01060 e ��, 240 Fax 413-587-1272 d erp c APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING S ECTION 1 -SITE CNFORMATION This section to b com 'eted b offlceJ 1.1 Property Address: P Y a ' s� u .„r. ©verlay��lstrtct Elm St District CB D,s rich SECTION 2 -'PROPERTY OWNERSHIP/A UTH04I.2ED'AGENT 2.1 Owner of Record: Name(Print) C rrent lailma Add res : L� Telephone clinzy_�.ts/�_ 0 Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION3.-'ESTIMATED CONSTRUCTfON COSTS Item Estimated Cost (Dollars)to be Off icial Use completed by ermit applicant 1. Building a (a) Building Permit Fee 2. Elec.rical (b) Estimated Total Cost of Construction from:.6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number Ab S� This Section For Official Use Only Building Permit-Number: ��` `�"oZy3 Date Issued: Zak Signature: _ ( ! " Building Commissioner/inspector'of Buildings Date T • 11 WINCHESTER nRR BP-2004-0243 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:36 045' CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0243 Project# IS-2004-0358 Est.Cost: $2000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group Homeowner as Contractor Lot Size(sa.ft.): 10018.80 Owner: ANDREWS KENNETH R&BARBARA A Zonin,iz.URA Applicant: ANDREWS KENNETH R & BARBARA A AT. 11 WINCHESTER TERR Applicant Address: Phone: Insurance: P 0 BOX 60492 (413) 584-1886 () FLORENCEMA01062 ISSUED ON:914103 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 10 X 12 DECK 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 Occupang/ Sienature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 9/4/03 0:00:00 mo47385814 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo