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36-223 (4) �(l�► co�E'vvt� old `ve �`'��I f, 4 j' r � s f 4 t 1 f $ I4 I � i t z!gm oo l� ¢.ttlAAfp�, i $ � �J'ilassachusctta - Gilitly of Northampton i � 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 }:is/her construction sups:,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 fanu 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, 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 r y = of 4 r E g�L3aicchncrtla' _ DEPARTME14T OP BUILDr),,10 INSPECTJONS 212 Alain Strcet ' Municipal Building Northampton, Mass. 010GO WORIQ:R'S COtNITEIiiSATZOIii MSURACE AFFD)t, .Nr r (li ans-x/perYn�ttcc) \V1th a pruuZcipal place of busioesslresidence at: —--- - 19004? _ � (phone`') (saw-t/c�tr/szalcla p) do hereby cerdi ., under tic.paint and penalties of perjury:, _hat ( ) I am an employer providing the followinil lworher's comocnsado;: cove Mge Ior 11)) elnp}oyccs worng on ti>is job: (Instiran Conr=}) (folic:Nu-mb-cr) --- (r:piradorr.Dal.:•.) O I am a sole proprietor, general contractor or homeowner(ciscie one) and have hired the coairactors listed below cyho have the iollowioQ workees comoen-salon policies: (INamc 0, COnt=,or) (Insurance. Cornpany/ilobci ?,,IuIIl_C:) (E�alr uc-n Nato) - (Nzmc of Coua-mor) (Insilfancc ampaav/?OUC Nunlcrr) (t ��ir lion D te) t (Name of Coa=c1 ;) (Insurane; Compa yfPcUq- Numlu) (E.xaimdeo Date) (Name of Conaacior) (Insurance Comp (Expir<doo Date).yPi (an lah ad6,_:0c5.1 tsca,if ncceaz�•to iaCluGL iafortn,Eoa pevunins to.0 coa=-r..oa) - jam a sore proprietor and bave no one working for me- ( ) I am,a home owner performing all the work myself. NOTE:pl=c be GWlrC rfi+•ML 3C hcc aX Lcn_bo aaplay pC•iam to d� n, C=s,,joa c ncpau wori;ov of CDC moot than LbTx -amts is u'yds the bomoowocr rt�ides cc oa the Qouo4 z�7 tbeen it oo(C=>=Ry oecrdzui to be ettplo),es 1, e the v ui rt c==pu-- ca Aa(GUI 32=1(3) =;)plioboa by L bomco -na far a loci=_or pcmit cry e�idm the toil na�c of La<rployx wader dto Wockoe,Co�on Act- 1 uade•rtaod lbw a copy of thu mtemr1 may be f--,ded to d.pcgnnmre¢of j.&.rri.l ncedeaLd Office or L-for It" eoveLsc%c'iGc=ioa and ULA L-il=,c to"atrt:kavcnL�taadc son oa 23A of htdL 151 can led to the i=posi6oa of aimiazt penalties o C`:-:.ing of a Line orUP to 51 500.00 Lnd/or kaprtaoomcl oCup to ooc yr:r Lad a%il pea�hia in the forest CC.Stan Work Order and L rim oC S 100.00 L d.y L&Xja't ttx. For dcp.rtrx�=-�ux only .permlt 1•lunlbc.r ��-__ �: Sipyz Of Li cr n U(:r- e j SECTION 8-CONSTRUCTION SERVICES t 8.1 Licensed Construction Supervisor: Not Applicable ❑ f! r\ Name of License Holder: . k- v� p/�'IY►'Z © l �-)'0 License Number See &3,141P Address Expiration Date 2,?o3 Signature Telephone �:Re"is'tereF#oieTm ra OOC`oFtract6 Not Applicable ❑ Z 3�q Company Name Registration Num er q - ----- Address Expiration 1 Date Telephone SECTION 10- NORKERS'COMPENSATION;INSURANCE"AFFIDAVIT`tkGrG L,c.152,,;§2SC(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,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature i s SECTION 5-DESCRIPTION OF PROPOSED WORK(check alt,applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [lam] Decks [!=] Siding[0] Other[0] Brief Description of Proposed Work: RCp✓+i (( j fd -1� ✓von^►/9a"oe�QV 1_�44_yG l{o,'F//9&4-, Alteration of existing bedroom Yes No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet per °"`• r =„ &a�C [ ern ;hacrseY n Qr ac d�t>ar�araexla ltn liousincr pf fe i four�g: a. Use of building:One Family Xi Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? yeJ 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. 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 Ta-OWNER-AUTHORIZATION TO±,BE COMPLETED WHEN` OWNERS AGENTOR GONTRACTOR:APPL.IES.FOIR BUl DfNG PERMIT- V i ` ,y wC/04-f Pe&V l ✓ as Owner of the subject property hereby authorize Yf'i�h y- 2 to act on my behalf,in all matters relati a to work authorized by this building permit application. J `' L Signature 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. S¢evth p,s5 i-+z�, Print Name Signature of Owner Agent Date s Section 4. ZONING All Informatibil 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 I /'C " Frontage Setbacks Front I I Side L:s R:' L.+ R: Rear ,.. � Building Height Bldg. Square Footage % Open Space Footage —� % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: i I (volume'&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? N0 0 DONT KNOW 0 YES 0 IF YES, date issued: I IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW (D YES l IF YES: enter Book Page, and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Date Issued: C. Do any signs exist on the property? YES NO I r IF YES, describe size, type and location: j D. Are there any proposed changes to or additions of signs intended for the property? YES 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 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. s e.., City of Nortoampton Building Department 212 Main Street Room 100 e ; Northampton; MA 01060 e,s o � �� � phone 413-587-1240 Fax 413-587-1272 : tour to _ t 4 � � APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1.-SITE INFORMATION s ('� Itrs sectron to be comletedbyotice 1.1 Property Address: (�,j , eq W t�� Ma Lot Urtrt 1 JUN 2 0 1 orte Overlay Dtsfatiff �Elm'SC Distract g A. _. s V 6 D�stnrit SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT;--, _ . 2.1 Owner of Record: Name(Print) Current Mailing Address: / �'1 n clA fyt r "// jf,1 v Telephone Signature �- 2.2 Authoriz A ent: Name(Print) Current Mailing Address: Signature Telephone SECTION 1-ESTIMATED CONSTRUCTION COSTS Item • Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building �S 0500 (a)Building Permit Fee 2. Electrical -7 ,(b)Estimated`Total Cost of i"°O Construction from 6 3. Plumbing Building,Permit Fee. 4. Mechanical(HVAC) 7o t7 5.Fire Protection 6. Total=(1 +2+3+4+5) 00C, Check Number This'Section For Official Use Only Date Building Permit Number.', Issued; Signature: • i Building Commissioner/inspector of Buildings Date File#BP-2007-1265 APPLICANT/CONTACT PERSON Steven Pistrich ADDRESS/PHONE 7 RIVER RD SOUTH DEERFIELD (413)665-2303 PROPERTY LOCATION 89 WINTERBERRY LN MAP 36 PARCEL 223 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinj4 Permit Filled out Fee Paid ' Typeof Construction: ENLARGE DECK,REDO MUDROOM/GARAGE BAY&CHANGE ROOF PEAK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 048770 3 sets of Plans/Plot Plan THE F44kLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 mmission Permit from CB Architecture Committee Pe from Elm Str ommmission 00 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-2007-1265 NOW G1S#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2007-1265 Project# JS-2007-002018 Est.Cost: $28000.00 Fee: $131.50 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin Steven Pistrich 048770 Lot Size(sq. ft.): 74052.00 Owner: MARKEY KEVIN&ANN HALLOCK zoning SR Applic-ant: Steven Pistrich AT. 89 WINTERBERRY LN Applicant Address: Phone: Insurance: 7 RIVER RD (413)665-2303 SOUTH DEERFI ELDMA01373ISSUIED ON.71512007 0:00:00 TO PERFORM THE FOLLOWING WORK.ENLARGE DECK, REDO MUDROOM/GARAGE BAY & CHANGE ROOF PEAK 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 7/5/2007 0:00:00 $131.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 89 WINTERBERRY LN BP-2007-1265 CIS#: COMMONWEALTH Off' MASSACHUSETTS Map_Block: 36-223 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2007-1265 Project# JS-2007-00201-? Est. Cost: $28000.00 Fee: $131.50 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Grp_up_ StevE:n Pistrich _ 048770 Lot Size(sq. ft.): 74052.00 Owner: MARKEY KEVIN&ANN HALLOCK Zoning,: SR Applicant: Steven Pistrich AT: 89 WINTERI-ERRY LN Applicant Address: Phone: Insurance: 7 RIVER RD (413) 665-2303 SOUTH DEERFIELDMA01373-ISSUED ON.715/20070:00:00 TO PERFORM THE FOLLOH'ING WORK.-ENLARGE DECK, REDO MUDROOM/GARAGE BAY & CHANGE ROOF PEAK 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: n �;•_ - Rough: Rough: House# Foundation: Driveway Final: 1 Final: Final: 7/ �'7 J Rough Frame: {� ! F-7-C7� Gas: Fire Department Fireplace/Chimney: !z:r. Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON U r cN VIOLATION OF ANY OF ITS PULES AND REGULATI S. Certificate of Occl,aa Signature: FeeType: Date Paid: Amount: Building 7/5/2007 0:00:00 $131.50 212 Main Street,Phone(413) 587-1240,Fax: (4i3) 587-1272 Building Commissioner-Anthony Patillo