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25A-101 (2) O¢StV,MP�O "$ ;,.Crztp of 'Nart4aillptan z $" tl �1'i18158Ch3iSttfB = w DEPARTMENT OF BUILDDNG INSPECTIONS /= INSPECTOR '212 Main Street • Municipal Building 5 •'' Northampton,MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/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 orie or two ami y -- 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�uil department for tfie City ofNorthampton 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 r'.egulations. 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 L 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-tome _ - Date Address of work location r � 1 - �► i7 0f j t � fljd111�3f011 _ _ R � � ` �1a3aRChasrtfa' o DEPAR7ME1,T OP BUILDrNC INSPPCTFOt.'S - j 212 Alain Strcct Ifunicipal Duildn� Norihamplon, ATass. 01060 _ WORJ:C-LR'S CONIOENSATZO.N MSURA CE (li�Jperm;tip) v-11th a principal place of businessfresidence at: - --- - p x,360 76, –/3A-142a-7 �2r�r��,�o�✓, �►� • (S�onc') yi 3° z�7- /3 � (s�.11ci t•J/sza.tcfa p) I do hereby terrify, under dic.pa--ins ;md penalties of per3ury, hat T (X) I am an employer providing die followin-i%vorkces comocnsador. cove��e for Intl, employees 'vorlong on t.liis job: I i 1 ;,gvLS 7";PaV,G,?S 7�Tv�3_7�57/337—i--C S-12 (Insur-�c CoQracv) (Folic: ?:t=ter) _ (T..:•pim- or,DzL.) i am a sole proplreror, general contracaor or homeowner (ci cie one) and have hired the contractors list below wl;o have the follo,ving worker's coi nep_saaon policies: i of Con 7: croa (InnLranc„ Comoi-t}vlciic,- D.-Itc) j (Name of Cona-amor) Msu>znc Comi}aa}�Po!ie; tiu�c_r) (1 xpiraon Date) I i (Name of Coaaaetor) (Insurance Ccmpany/Policl Number) (Eapir dos Dalc) I _ i (Name of Conrractar) CLa-TU c-- Comp zy/PaUcy Numb-r) FExpir-ddoo Datc). (oast',ad??-:oc'!tbcC.il to mcvdc iaf,=,:ioo pc�to al.l i O I am-a sole proprietor and have no one wort ng for me. ( ) I am.a home owner performing all the work myself. NOTE:pl. be ctrxr[[f,.o )e 6emeov Hera.,bo-=Play Pm=- z to rrair work on i d%%mlLz of not mete th a tom`v tmt,is�c'se�ttx Iwmoo•w.r=d-,a oo the Qoua6 zppvrt the Co,c ox�—r -uy oc d cd to t� eitPlayes uaG=the..mot rte--,.-- -,'oa Ptt(GUI 5Z=1(5)1=ppU=.6oa by a bomco-=fa a!ice__or pemit==y c idm«the )cal 0 mac of a.a==Ployer oader dw Work e,coo=pam,tioa Act ' - !uadcsz,.od tb.a a Dopy of thi,cnt®mt m,..y ix toc�.arded to cba(}�panmcrc of Iub,sriJ Aced�ss�Offioe of lr:�u+xe for th. � oovease°eircvoa and flat f_iltac to scout tov�yp..o tmdc•,.,-•;oa 23 A of hiQL 1 SZ ea Icd to the i�2ioa of eimias!peos@io `s3 oC a rise or up to S 1�OO.00 andfor orup to ooe y,L.-w,4 6vU pcurja is tx form Ora Stop Work Ord.and. r>=oC S I QO.00 y,V�= For dq�r•.z=-J u,c orJy Permit Numtr p" -- 1.at Sig—tu.-t of Lich Crmitbcc �Ce I SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:— � ��+'��/�/� ,man( C•5 - o col License Number 7��f�2o[�i T��, T,l Address Expiration Date 4L--r� -� 1•�-_ y/3- P 7- a y 3 7 Signature Telephone - 9�Reaistereclfiome farcrriieCnntract2e ; � Not Applicable ❑ ru FCo^�� �o.�f'�vc�-ia.�J LC e Company Name Registration Number -7/z b/z--.:)0�& Address Expiration Date L,/,, -74,ji 73 Ta4, MA - i a(o d Telephone SECTION 10-WORKERS'COMPENSATION INSURAN`CE.AFFIDAVIF`(M:GI-C 152,4 35, )).- 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....... 9 No...... ❑ � a111t1i" ��t � 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 / X r i , SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House [1 Addition ❑.: Replacement Windows Alteration(s) 19 [Roofing ❑ Or Doors 91 1 Accessory Bldg. ❑ Demolition ❑ New Signs [C]] Decks [p Siding[O] Other[p] Brief Descri ption of Proposed Work: A4-lua 2''X)� re Z * I � ��F71�Y'�3a+� Q4 4JCi L o,,e- w p �?Z Alteration of existing bedroom Yes X No Adding new bedroom Yes 'A' No Attached Narrative Renovating unfinished basement Yes x No Plans Attached Roll -Sheet &a � t�etrt��o�se�tctd�oi� ��art�ex�nc> >toast c�c�:e±arx>�aFe��`�t{ieaitfa�u�r�ta: 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. Masscheck Energy Compliance form attached? h. Type of construction I. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. flcodplain 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 AUTHORIZATION-,TO.BE COMPLETED WHEN, OWNERS,AGENT.OR'CONTRIACTORAPPLIES FOR"BUICDf1 GPERMIT- as Owner of the subject property hereby authorize C7)nnu. L E-^+'J 4, to act on my behalf,in all matters relative to work authorized by this building permit application. Signature U-0voger Date I. E "^`"s'-N -N>, 'k""'J as-donoWAuthorized 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. C hmv.rD Print Name Signature ofGrwar/Agent Date ' ~ ` Section 4. ZONING All Informatio'n 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 Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume I&Location) ' A. Has a Special Permit/Variance/Finding ever been issued for/on the site? � ' NO DONTKNOVV ,��� YES x° x��� ' IF YES, datoissued: IF YES: Was the permit recorded at the Registry of Deeds? NO K } DONT KNOW YES IF YES: enter Book Page and/or Document#! B. Does the site contain u brook, body of water orwetlands? NO x���� DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? ' Needs tobeobtained x~~> O�tained �-� Date v�� x�� ' C. Do any signs exist onthe property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 0O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradingexcavation,nr filling)over 1 acre oriud part ofu common plan that will disturb over 1acre? YES K l N0 ~~� � / U /F YES,then o Northampton Storm Water Management Permit from the DPW is required. n --L--City-of N rtf ampton Building partment uvaen L Z6C212 .tom Street . R©om 1:00 rem Northarp�ton JVA 01060 ;, elsb r rc ttraFEfarts�� �� : phone 41; 0 240 Fax 413-587-1272 P,Eat �tee � � , APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION Thts.sectron 1.1 Property Address: to be completed b�office a eo € >\I A 2"T7a m M o Zote OVerlaV btstnct E1mSt Distncf _ CB DWict a � SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 3cic/ DC-i Sy c7� T/�AMJ� M+�" Name(Print) Current Mailing Address: i Telephone �^� Signature �i3_ SSG - 07 2.2 Authorized Agent: -76 f c.2 6 arT 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 ) 3w (a)Building Permit Fee 2. Electrical 5J (b)Estimated Total Cost of 0 U_ Construction from 6 3. Plumbing Building Permit.Fee 4. Mechanical(HVAC) A 5. Fire Protection 6. Total=(1 +2+3+4+5) -10 Check Number This'SectiorrFor Official Use Only-- Building;Permit Number." Issued: Signature: r Building Commissionedinspector of Buildings- Date File#BP-2006-1138 APPLICANT/CONTACT PERSON LENNIHAN EDMUND D ADDRESS/PHONE 76 Bancroft Road NORTHAMPTON (413)587-0437 Q PROPERTY LOCATION 344 BRIDGE ST MAP 25A PARCEL 101 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: RENOVATE 2ND FLR BATHROOM REPLACE 1 WINDOW&REPAIR SIDING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• - Owner/Statement or License 042506 3 sets of Plans/Plot Plan THE F LLOWING 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 Commission Permit from CB Architecture Committee Permit from Elm Street C ssion 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. 344 lM ST BP-2006-1138 GIs#: COMMONWEALTH OF MASSACHUSETTS : . CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-1138 Project# JS-2006-1686 Est.Cost: $18400.00 Fee: $66.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ED LENNIHAN 042506 Lot Size(sq. ft.): 29185.20 Owner: CAPERS RAYMOND L JR&PHYLLIS Zoning URB Applicant: ED LENNIHAN AT: 344 BRIDGE ST Applicant Address: Phone: Insurance: 76 Bancroft Road 587-0437 WC NorthamptonMA01060 ISSUED ON:51212006 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE 2ND FLR BATHROOM, REPLACE 1 WINDOW & REPAIR 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 5/2/2006 0:00:00 $66.003692 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo � z Wo N Ml sa z ' si ' , . d`St NOR— ss r a..� z1x ' f't d" ^x'Now ':rx "a4' aZI v r # P - # --mom 5. 'a .Now,'%�-", 3 ✓,s $' y ;_d v 0-1--, ,s mown,-u } v i $ r SO- 1 x '+W E Ft dam' k �„ t n I V111 x 01 A ���, �, i -.� � �, ic'�''a" � ��k.�`� a n•�uro &h �rs* P 1?' <- ✓r 4 s z $ �tc p �`ASa S s.F�" ix','s. sc � � Ammon r 344 BRIDGE ST BP-2006-1138 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25A- 101 CITY OF NORTHAMPTON Lot:-001 Permit: Buildit 5 Category: BUILDING PRMIT Permit# BP-2006-1138 project# JS-2006-1686 Est.Cost: $18400.00 Fee: $66.00 PERMISSION IS HEREBY GRANTED TO: Const, Class: Contractor: License: Use Group: ED LENNIHAN 042506 Lot Size(sq. ft.): 29185.20 Owner: CAPERS RAYMOND L JR&PHYLLIS Zoning URB Applicant: ED LENNIHAN AT. 344 BRIDGE ST Applicant Address: Phone: Insurance: 76 Bancroft Road 587-0437 WC NorthamptonMA01060 ISSUED ON.51212006 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE 2ND FLR BATHROOM, REPLACE 1 WINDOW & REPAIR 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:G f elo 6 �q.� House# Foundation: Driveway Final: Final: 7-1-0619' , Final:�'r31��j��/ Rough Frame• )-(� -; Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Ok Final: Smoke: Final: 01" 0910116'6 coos S THIS PERMIT MAY BE REVOKED BY THE C Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anC Si nature: FeeTvpe: Date Paid: Amount: Building 5/2/2006 0:00:00 $66.003692 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Connnissioner-Anthony Patillo