Loading...
36-155 (4) �gt1M1P�. GI—ify of Xart4auiptan Z = �lASSAChIT8ttf6 ' 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 has/her construction supc .,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 understand the above. ome owner/resident'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 6;:7 / ���`�'/� 4� U® ��ltJ Nd T (i-xftT IafLt> ' 'fS�kSl AC11n5C11! � ._ ^� L)PPARTMEAT OI' LiJILDII�G INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORI,R'S COMTENSATION INSURANCE A.T+'I+LT AN7 T _----------- - ti lffi a principal place. of business/r�-�sldel]cc SiTL' UCltylS: i„I- ) do hereby CCI-u-I:. uI1:Iti!- dic --p :TIS ;''.iid 1)enil"IcS Oi nC:r�lltl�, ha" - am an cnaployci- provldlrlg, the i0110',v)nt '. Ork_cr's comncnsaUOIl elnployces Working on t?Lis job: (IrsuasG Cain m') (-:Pc;;ci Numb--r) (�-�,;r�en Date) l ) i = a sole proprittor, gcncrLl c-oLj�rac:cr hon�eo,�rner ;cre!e one) and 't: ve ','List l the contm=rs hSted below ,t'I.o (NIame. of CoriLmcLor) (NamP of Covtr ctoi) — (71LSI P-C C0 �c;i�'/POIICi N t if i; (l `:c i10n late) (i"'ame of Cone-actor) (In;I ncti Co�; s;iPolic, Nun)t; r) =� �o Date) - (Name of Contmactor) - (Insl ran c:. Coinr yll)oGcy NtlmbiLr) - fE:::ri-aion Date) (^tLlC�1:.(�"�1:30C:1�SL:eGt t..-.... :O 1'ra.i:;r:..;rR°:C:Ct:i-:._._.. � eii.`-<C�=C'i:r•.� 1?1'O1?Ilctoi c.?1Q htiVC Il0 0I10[i ilt� f01 ills. aill a Lome ownc nci e I1�1n - ail tI Iii 'f NOTEI pleas,be awx;c tl:>t s�a]c lr:nco :r a: c: 1 y I*- :: ;_ie1: nc�ci.z :r:-pair.,^:i;c:n not unce th--o throe uni s L^:tcj„C;1 t.�Y 1ir,1:,7:1ZiS 7^..I:.'_:J cn-IXi'�l•• V�';:_3'�.T�1C:G C-r^.t L�1C':<D L2 IX:{L�C•1'SiIlY CCr=::::::".'.:;f� c-.:I1pl0y=1 th,r_tw:t:7 cc-z:- ....icc AV,((;1.152.=c!(5)).-,:, ._ ;ic:by n ho:nro3t-r_r for a I:cc_,c Cc tegil etztua of rn csxployer under il:n%V vkc.'a ec m ,tion?-cL I ut3dc-stand that a cmy of tlia ctata:s c:ay bo fcnww! J to 11»IYtinrtmx e of Indu—iJ Azci. 151(::uoo Of for tjx coverage vairicalioa need that feiltuc tot rc mtcr,ur r cc,:*.iM 25,A of MGL 152 can Icy to the imposition 0;r is l pctal;::s cealistctg of n fim,of up to 11.500.00 e:r�-'x !n cr.-)-ar e-.1 civi),-nujtia in ntc Lrkc oCS100-00 a day ig�_inst m-. For dcput nzfal u.c only ltInlY� • t!;naturc of t.ic�nr;c.JI' _ --r'':-;,- S CT�ONB CONSTRUCTION iSERVICE! 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 11 -fe': �'om m r v -,e ,Con rac o - Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone i2 it� ;EC, QM,11' .W0RKERS'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 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, qLqte and Local Zon' Laws and State of Massachusetts General Laws Annotated. Homeowner Signatur '''e i SECT A 5- 5 0NLoF PKR0PMEMMORK 6"1-42136li ca�Ie New House ❑ Addition ❑ Replacement Win ws Alteration(s) Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition2— New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: 4 t&pvi 1 Vl v1 ' Alteration of existing bedroom Yes_4�No Adding new bedroom Yes No �' Attached Narrative 0 Renovating unfinished basement Yes ` No Plans Attached Roll D• Sheet 0 6a� ew ou o a dit�on to eXrsfin housin ,xc :Ie-,e WMVIIow>I.n a. Use of building: One Family Two Family Other b. Number of rooms in each family unit: �! Number of Bathrooms oq c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? 1 Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. fIJ Mascheck Energy Compliance form attached? r� h. Type of construction n wi hin 0 f . of wetlands? Yes 'r No. Is construction within 100 r. flood lain Yes Nc i. Is construction t .1 O t t i y p 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 SECT ON t�fVIRIE,HORIZATION T6,18 E COMPLETED WHEN DSIVNS�4#G O ONTRACTOR APPLIES FOR BUILDING PERMIT I Vq vs 4o ( nO1 as Owner of the subject property hereby authorize to act. or my behalf, in all atters relativ Lowo rk authorized by this building permit application. Signatur of ner Date as Owner/.Authorized Agent hereby declare that the statements and i mation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed der the pains a nalties of perjury. Print Name Signature of Owner/Agent Date 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 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 s' 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 onservation Commission? Needs to be obtained Obtained Date Issued:iq•--/s—eZ'r�' C. Do any signs exist on the property? YES NO �^ IF YES, describe size, type and location: D. Are ther proposed changes to or additions of signs intended for the property ?YES No IF-YES, describe size, type and location: w _ City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413.587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT, ALTER, REAIRf- -DEMOL,'Hi ONE OR TWO FAMILY DWELLING OCT 2 7 20'03 �` a SECTION 1: SITE INFORMATION - GlNSPEC�IC 15 N on"toff ;fete"Eby fficer " 1.1 Property Address: 1W _ �; o A,..o _ flap Lot ° ylftR� s , �1�i`hZ l�1%� / Z one g ,e I MAI �.. Elm 5t "District CB Dtstrtct e: ., SECTION 2'- PROPERTY'OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: n Name(Print) Current Mailing Address: Telephone (`1 �/[a 3 33do Signature ! 2.2 Rut ' ed A ent: 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 1. Building (a) Building Permit'Fee 2. Electrical / G� .. (b) Estimated TotaI CoStL of Construction from 6 3. Plumbing 7a� Building Permit Fee 4. Mechanical (HVAC) O 5. Fire Protection 0 6. Total = (1 + 2 + 3 + 4 + 5) Check Number This Section For Official Use Only Build. Lg,Termit Number> Date:Issued: Signature: Building Commissioner/Inspector of Buildings, Date T File#BP-2004-0501 APPLICANT/CONTACT PERSON DIMOS JAMES ADDRESS/PHONE 75 POMEROY TERR (413)584-3320 Q PROPERTY LOCATION 305 WESTHAMPTON RD MAP 36 PARCEL 155 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 'R5.0 Typeof Construction: SHEETROCK KITCHEN&UPDATE WIRING 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFtMATION 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 C ssion Xor Z40 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. BP-2004-0501 GIs#: COMMONWEALTH OF MASSACHUSETTS Ma 36 .1 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0501 Project# JS-2004-0712 Est.Cost: $8500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 54885.60 Owner: DIMOS JAMES Zoning: SR Applicant: DIMOS JAMES AT. 305 WESTHAMPTON RD Applicant Address: Phone: Insurance: 75 POMEROY TERR (413) 584-3320 O NORTHAMPTON MAO 1060 ISSUED ON:10130103 0:00:00 TO PERFORM THE FOLLOWING WORK.SHEETROCK KITCHEN & UPDATE WIRING 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 10/30/03 0:00:00 1877 $50.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 305 WESTHAMPTON RD (i3U_i GIS#: COMMON t- _..,At,t'�__ OF MASSACHUSETTS Map:Block: 36- 155 orTY OF NORTHAMPTON Lot: -001 Permit: BUIIdInu Catego:-y: BUILDING PERMIT Permit# BP-2004-0501 Project# 35-2004-0712 Est. Cost: $8500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin: Homeowner as Contractor Lot Size(s4. P.): 54$$5.60 Owner: DIMOS JAMES Zoning' U ri JilCtiidt: ice_;MVS .Jru ILS AT: 305 WESTHAMPTON RD Applicant Address: Phone: Insurance: 75 POMEROY TERR (413) 584-3320 O NORTHAMPTON MAO 1060 ISSUED ON.10130103 0:00:00 TO PERFORM THE FOLLOWING WORK:SHEETROCK KITCHEN & UPDATE WIRING 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: Roughy Rough :' House# Foundation: Driveway Final: Final: .l Final: E '"� ✓ i t ._y(JaL. Rough Frame: G K C Gas: Fire Department Fireplace/Chimney: j?�.,,r,;-.• (�il. Ins:;latioii:© k /(/ 6�✓ Final: Smoke: Final:0<� O� THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIO Certificate of OccupancV Si nature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 10/30/03 0:00:00 1877 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo