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36-086 (4)
q�'CNwMP�, "'Grit-P of Paz#l�ttnt�tnn z Z $ � flTtassacltuseffs s ., DEPARTMENT OF BUILDITIG INSPECTIONS _ INSPECTOR '212 Main Street • Municipal Building '- s Northampton, MA 01060 , HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as i.is/her construction super, isor. 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, 00 understand the above. ome owner/res ent's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Address of work location l G All cer �" I - i 2Q Oy ,� E Crif� f �a�-fllailt}�toli � A E �Zcsawrhnsrtra' - — Q DEPARTMENT OP BOIL DF,\10 INSPPCT10111S 212 Alain Strcct Municipal Building Northampton, Mass. 01060 W RM:RlS COMTENSATIO.N ENSUR -N CE A FM AA11-1" i (];ccnsxlperm�flee) Vvir_h a principal place of business(residencc a1: --- ---- - (SO-=(lci ty/nalrlzi P) do hereby certify, under die pains and penalties of perJury, -h2,1 ( ) I am an employer providing di folowim" -vorkc 's colcnsabn on Cove.,-11,;c nor Ind elnplovices worUng on t111s job: (Iasul'_ac Corer ) (PcLic:Nu-rabccr) --- (T:-plyz or Daic) I O I am a sole proprietor, general contractor or homeowner(c c:z one) and have hired the coco-actors listed below who have the following worker's comoep_sa6on pabcies: i I (';-amC Oi Con,=c,0.-) (In urzr1GC. Cornoafly/flobc �tL1II1�<r) (YtiJt,1�^1 DBIC) (Name of Conlraor) (lnsarane:. Comoanvlpolk NuiME-2r) (-ExDU don Dale) (N.me o(C,) c1c;') (Insuranc; Compu)•/Pouq- Numb,-j) (Expirsrioo Datc) (Namc of Contractor) CL0Su=cc Company/Policy Numb r) (-xpi-a loo Dais). (aQZ.:h addr:;ocal>3[d.if nct�a�t•to mclu��nforms�oa pcZn_inins w all mG�-.C..o:7) . { ) I am a sore proprietor and bave no one wort-Dg for me. I am.a home owner perfor.m'mg aU the «cork myself NOTE:plea ix ea-z=tf•• tJe hemco+ivm.�,0o czvploy Pc sons In So c. - cs c�oa or rcpac-ank m,d,-Al -Z of tint taoct than 'LS- w�i'�in :+yic�the bom-awncr 1Xmd--ox ea 1h, oeerd-jai to tL� cirployc�ttnG�the .�S er:a xpcatioa Act(GL'1 S2=t(S)�appUcn6on by s bommava far c Gem_a po-m;i=y evidmac Lbc 1c9-1 ct of nder dao Wcrke ,e Coaapom anon Aec t uada ax+ad tha a oopy of thi.eat—m ),be foa -rd.ed to tbo papertmm¢of In�axricl Aa a cxy OE_or 4a+rwm for the cOvcxx6'e`=if talioa=d lh_t r:.am to sco we tcovcrasc UM&,s,ci oa 23 A of MOL 131 c3 led to the romp omi ioa of a-imiaA Pc=1= eoaulu tg of a tine arup to S I-woo arwcc impriyoam of up to ooc y=end a%il pcaJiio in be room of a Stop Wort Order and. rim 0(:S i oO.00 day t pla-A tree i \\ For d�u.a orvy - i / Pcrmit Numb-- n Lot of Li rmiUcc —�� Map-,-- j SECTION,8-CONSTRUCTION SER�/lGES t 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone w q k s : eere €�o`in"elm rarre rreiarao= Not Applicable ❑ i^k'".: Comoanv Name Registration Num er — Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE.-AFMDMV r(M.G L.c 1 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....., ❑ zAIMI 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 108.3.5.11 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.Akerson who constructs more than one home in a two-vear 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 tate and Local Zonin Laws and State of Massachusetts General Laws Annotated, Homeowner Signature W� r SECTION 5-DESCRIPTION=OF PROPQSED WORK fcheckcat[fapolilcable) New House Addition ❑:.: Replacement Windows Alteration(s) Roofing Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs [C]] Decks [p Siding[p] Other[C]] Brief cripti n of Proposed Work: r r Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roil -Sheet Ga 1VJ4eW WGUSWMNOV c r#1aL a. Use of building:One Family Two Family OtherL-y_X"y \-a be One- tw 'tl b. Number of rooms in each family unit: 1 Number of Bathrooms c. Is there a garage attached? - V (.Oq _ RO A- ^�i t i d. Proposed Square footage of new construction. �tf( r' Dimensions � - X u e. Number of stories? f. Method of heating? t-c z Tt� (� Fireplaces or Woodstoves `Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 1 DD ft.of wetlands? Yes No. is construction within 100 yr. floodplain Yes A—No j. Depth of basement or cellar floor below finished gradd l L;, } k. Will building conform to the Building and Zoning regulations? _Yes No. 1. Septic Tank City Sewer Private well City water Supply_ SECTION 7a,-OWNERA-U TO BE COMPLETED WHE- T"ORiCOI TATORAPPLIES FOR BUkN dlPERMIOWNERS.AGENT . Ad-ENT- as Owner of the subject property hereby authorize nt,, to ct on my behalf 'nil er relative to work auth-odze by this building permit application. Ir Si ur caner Date I. ;>an as Owner/Authorized Agent herebl declare that he stat 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, V�w r Print a ej U Signature of Owner/Agent Date 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 Department Lot Size �� Frontage . Setbacks Front Side L:= R: Rear '2a 3 Building Height Bldg.Square Footage % 9 Open Space Footage j ( % 6r ✓ (Lot area minus bldg&paved 1 �' 1 W j azkin I #of Parking Spaces Fill: volume-&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? N0 DON'T KNOW 0 YES 0 IF YES, date Issued:; IF YES: Was the permit ed at the Registry of Deeds? NO 0 KNOW 0 YES 0 IF YES: enter Book ! Page; and/or Document#f B. Does the site contain a brook, body of water or wetlands? NO ll DONT KNOW 0 YES f IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: j C. Do any signs exist on the property? YES Q NO (tom IF YES, describe size, type and location: ➢`'� D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 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 r NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. mpton Clfy ofi Nortf�a Building Department 212 Main Streetr t ' nrr Room 100 Kt6 thampton;l I A 01060 phone 413-587-1240 ` ax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 .SITE INFORMATION This sectron to be cotntetedlbfl"rce 1.1 PrOPertyAddreSS: x b , \ Mapes I�ot � Uai ,. +wZon' � Overlay�DES�ct�� e r' � ie a k s o ElimS6�stictCBisrct u SECTION"2-PROPERTY OWNERSHIP./AUTHORIZED.AGENT 2.1 Owner of Recor`d`:°� p L 1 ©9 E.0 f Chesleck-WMk e(Print) Current Mailing Address: Te eel h 61gristure 2.2 Authorized Agent: abir-la p Na Print + Current Mailing Address: % -L3 'y ig u e ivi v Telephone SECTION 3-<E$TI MATE D CONSTRUCTION COSTS Item . - Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee -7UO 000 2. Electrical .(b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee. 4. Mechanical(HVAC) WOO 5. Fire Protection 6. Total=(1 +2.+&4& Check Number This- ecfion'F&OfriciaF.Use Onl ;Date,. Building errnit Number? ` Issued: Signature: i Building Commi9sioner/Inspector of Buildings Date File#BP-2005-1195 APPLICANT/CONTACT PERSON HOYE SEAN M ADDRESS/PHONE 10 DUDA DR EASTHAMPTON (413)563-9903 Q PROPERTY LOCATION 195 WESTHAMPTON RD MAP 36 PARCEL 086 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 00 4x 4 04 42 dot 144 4 Fee Paid Zzmblz SO r46-yip Typeof Construction: CONSTRUCT GARAGE W/ACCESSORY APARTMENT ABOVE& 10 X 14 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• nn-- Owner/Statement or License i'L/17.i0 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Approval Board of Health Well Water Potability Board of Health ,/eptic ermit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission 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. } 195 WESTHAMPTON RD BP-2005-1195 GIs#: I COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-086 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category. PERMIT Permit# BP-2005-1195 Project# IS-2005-1616 Est.Cost: $56500.00 Fee: $426.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: 5B Contractor: License: Use Group: R4 Homeowner as Contractor Lot Size(sq.ft.): 41599.80 Owner: CRAFTS ROBERT W Zoning: SR Applicant: HOYE SEAN M AT. 195 WESTHAMPTON RD Applicant Address: Phone: Insurance: 10 DUDA DR (413) 563-9903 O EASTHAMPTONMA01027 ISSUED ON.6122105 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT GARAGE W/ACCESSORY APARTMENT ABOVE & 10 X 14 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 Occupancy Signature: FeeType: Date Paid: Amount: Building 6/22/05 0:00:00 $426.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo