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25C-064 cvPLC1Qn �y .'Y'. m "aft 17 k,_ t �r - �r�,'.�'°;rys. , f y *s 4� r � s s � �3 %�� ; � .4, r,"�. '� "•, � o ?,�..�- � � -f „" .:Kai �-�- t 1� e e 4k ew fP AA - �, > t fi a yF " " <— 5�#� 6+_� .'` j � €` # t . S tj } F ti >; V ��� �ry� �� � �� � e-�° �N J?F. ^.».^«tee.—. «..............�-TM �4'• r• , wad..eew.x ''. ap �`� � ««�.-.«..--."n.....�ma«•mn ....., ..i.. ��} *°,m.m .� �ii�'Tf� + 111111_ f mom„ • Y mom..-n^^...''T+ {' b1 a 2� f � pop— I HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 7800MR 1083.4 to act as his/her construction supervisor. 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 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 hour) a rough building inspection (before work is concealed) insulation insaection (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 occuyancv 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 pe<rm.'ts and inspections as required can DELAY the project until such time as the proper permits and inspections are made 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 5'121 1/0 Address of work ��location map The Corninonweai of Jlassacn:.rserrs •` �—x De�artrre;rt ofd=zdtcst:-iai_�cciderrs ©jfiCe Oj l7 vestigaPOns 600 N ashingz on Sz,,eer Boson, MAI 02111 x-wn wnass.g of/dia Vv'orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/P!=.ambers Applicant information Please Print Leaibiv ai"11e (Bus nes;Orzanizatio,,i"IndividuaI): Address: City/State/Zip: Phone:H: _ r2E e you an employer'Check the appropriate box: Type of project(required) 4. I am a general contractor and I am a employer with ❑ (. ❑New construction errmplovees (full and/or part-time).* have hired the sub-contractors I am a sole proprietor or parmer- listed on the attached sheet. 7. ❑ R�.zhodelin° ship and have no employees These sub-contractors have 8_ ❑,/Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [� workers' comp. insurance comp. insurance. qed] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 1 I.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] ' c. 152, §1(4), and we have no 13 ❑ Other employees. [No workers' comp. insurance required.] *Any applicant&.at checks box=1 must also`II out the section below showing their workers'compensation policy infornation. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must subrr t a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showine the rarne of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'corrT.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site inform anion. Insurance Company Name- Policy 1 or Seif-ins.Lic.T: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration pale(showing the policy number and expiration date). Failure to secure coverage as required under Section 2fA of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to S 1.500.00 and/or one-year imprisonment, as well as civil penalties in the fora of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herIce ' nder the pains and penalties of perjury that the information provided abov is rrue and correct Si?natur Date: J UP Phone 1: 6 u;ricial zrse only. Do not write in this area,to be completed by city or town ojjzciaL Cin�or Town: Permit-'License r Issuing Authonry(circle one): L Beard of Health 2.Building Department 3. City/Town Clerk 2.Electrical Inspector 5.Plumbing Inspector I 6.Other 1 Contacr Person: Phone. ScC T ION 8-CONSTRUCTION SERVICES + 2.1 Licensed Construction Suoerr,sor. I Not Appiicable Ore Name of License Helder: License Number ;ccress Expiration Date Signature Telephone 1.Registered Home lmnrovemonf Go-n actom- Not Applicable ;omcanv Name Registration Number .ddress Expiration Date Telephone ECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.132,§25C(&)) !orkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result the denial of the issuance of the building permit. oned Affidavit Attached Yes....... ❑ No...... . OMe'Qwergl €il � The current exemption for"homeowners"was extended to include Owner-occupied Dwellinss 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.CI'IR 780. Sixth Edition Section 1083.5.1. Definition of Homeowner:Person(s)who own a parcel ofland 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-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 heshe shall be responsible for all such work performed under the buildinZ 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 ofEmployers 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 Nor-champton Ordinances, State 161 Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-CESOPIPTION O= PROPOSED WORK(check all apolicabie) New douse Addition Q Replacement Windows Alteration(s) C{ Roofing Or Doors Accessary Bldg. a Demolition New Signs 10] Decks Siding 1=1 Other[u] Brief Description of Proposes ` Wcrk: 1, Bu w , vim Aitera*.ion cf existing bedroom Yes '� No Adding new bedroom Yes v No / Attached Narrative Renovating unfinished basement Yes ✓ Nc Plans Attached Roll -Sheet . ousm ,co �5a. [ Now tac$�a �cOC adddiionf0 eXfSiI7C hafEtei thQ1OWi1C 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 Wcedstoves Number of each g. Energy Conser.,ation Compiiance. Massoheck Energy Compliance form attached? h. Type of constructon 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 reguiatiens? Yes No. 1. Septic Tank City Sewer Private well City water Supply ISECTION 7a-OWNER:AUTHORIZATION­TO BE GOMPLETEDF-WHEM'' OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDINGPE MIT i as Owner of the subject, proper.;y 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/Authcnzed Agent hereby declare that the statements and information on the forking application are true and accurate, to the best of my knowiedce and belief. Sicced under the pains and penalties of penury. i not Nam I j �ec-,ion ZONING All Information Must,Be Completed. Permit Can Be Denied Due To Incomplete Information Exisbma Proposed Required by Zoning This column to be filled in by Building Department LOT Size Frontage Setbacks Side L: R:______ L: R: Rear Building Height Bldg, Square Footage % ................. Open Space Footage % (Lot area minus bldg&paved Darkiniz,) #of Parkina Spaces Fill: (volurne&Location) A. Has a Special. Permit/Variance/Finding ever been issued for/on the site? NO 0 DON7 KNOW YES 0 IF YES, date issued:- IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON7 KNOW 0 YFii; 0 IF YES: enter Book Page: and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON7 KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 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 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,exc;ivation, or filling)over I acre or is it part of a commas plan that will disturb over 1 acre? YES 0 NO en -IF a 1F YES, ___Nc_rtha_m_P_T_0n SFoFF-Mber Man­agemdff Permit from the DPW is required. Department use only City of Northarnptor Status of Perm�f: Building Department CurlsCut/Drveway_Permit 212 Main Street SewertSeptic Avalability Room 100 Wat&/WellAvailability Northampton, MI 01060 Two Sets of Structural"Plans y phone 4 3-587 1240 Fax 413-587-1272 Plot(Site Plans Other Specify i^Grp APPLICAIT1ONTO CONSTRUCT,ALTER,REPAIR,RENOVATE OR EMOLISH E_ SECTION 1 - 1TE INFORMATION 1.1 Property Address: This section to be completed by office 217 Rk,yft� Map Lot Unit Zone Overlay District rVtA. 01016 a ElrriSt District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: , 2AgP-u�C ,�- .l� ,IVI ,o�ab� Name(P t Current Mailing Address: Telephone 17 •� , �6 Sig r J 2 Authorized Agent_ JA Name(Print) Current Mailing Address: C1u, '�3• , 1�•ti�9 z Signature Telephone SECTIO 3-ESTIMATED CONSTRUCTION COSTS Item I Estimated Cost(Dollars)to be Omciai use Only completed by permit aoolicant 1. Building Q (a)Sui7ding Permit Fee 2. Electrical (b)Estimated?otal 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 0 This Section For Officiat:Use Only Date. Building Permit Number Issued: Signature: ----- ----- --- ---—. Building Commissioner/Inspector o ui dings — Date File#BP-2008-1065 APPLICANT/CONTACT PERSON FERRITER JOHN J&EILEEN M ADDRESS/PHONE 274 BRIDGE ST NORTHAMPTON (413) 586-9680 Q PROPERTY LOCATION 274 BRIDGE ST MAP 25C PARCEL 064 001 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: DEMOLISH DET GARAGE 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 FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOY4ATION PRESENTED: pproved 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 Pernut 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 Commission Permit DPW Storm Water Management Demolition Delay 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. ^ r BP-2008-1065 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Cateor BUILDING PERMIT Permit# BP-2008-1065 Project# JS-2008-001575 Est. Cost: Fee: $20.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 5749.92 Owner: FERRITER JOI1N J S I;ILEEN M Zoning: URB Applicant: FERRITER JOHN J & EILEEN M AT: 274 BRIDGE ST Applicant Address: Phone: Insurance: 274 BRIDGE ST (413) 586-9680 (� NORTHAMPTONMA01060 ISSUED ON:512912008 0:00:00 TO PERFORM THE FOLL O WING WORK.D E M O L I S H D E T GARAGE POST THIS CARD SO IT IS VISIBLE FROM THE STRf.ET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Drivewa.v Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy si$!nat«re: FeeType: Date Paid: Amount: Building 5/29/2008 0:00:00 $20.001988 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Building Commissioner-Anthony Patillo