25C-075 (3) NOV 2 6 ry r,7
-
Sa �,� /�c t'9l e c S c t�_74-
r
(-7'
/J C e 4.�
IIIU Un .T
DEC-) UVSPEC71ONS
DEP.I-RTMENT GF BUILL
CTO P 2 i 2 Main Street 0 Municipal-Building
I NS Norrh=ptoxi, MA 01060
EXEMUPTIO-NA ACITC—NOWLEDGEMENT
The State of Massachuserls allows the homeowner the ria.12-1 under 780CMR 108.3.4 to
-7-or. The st -- defines "Homeowner" as, "Person(s)
act as hisilher construction sup,:.,
who owns a parcel on which he/she resides or intends to be, a one or two family
dwefling, attached I or dettached structures accessory to such use*e 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 -epa A- m ent for the City of Northampton wants any person(s)who seek to
O- S,
Upel-
as the:-own constracti- 11=v to be aware
use flie home owner exemption, to act -.1
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 back-fill).
so-notube holes (before r)our). a rough building inspection (before work is
cancealed). insulation insRection (if reagired) a-nd-aTniaLbuildin--.insr)ection. 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 occupancv
until-the-work ean-be inspecteA-
If the homeowner hires other trades to per,"orm work(electrical, plumbing&has) 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 Cie 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
77te Commonwealth of 1L_�assachusetzs
—�— 13epartmeni of"Industrial accidents
Ojiiace ofInveszigations
500 Washing—ton Street
_ Boston, M4 02111
WWW.mass.g ov/dia
Workers'Compensation Insurance Affldavrt: Builders/Contractnrs/EIec-tricians/PIumbers
AAplicant Information Please Print Legibly
_NaMe(Busmess/Orzanization/Individual):
Address:
City/Statw/Zip: Phone.
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§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...... ❑
11. - Home Owner Exemption
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-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, State and Local n Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
j w
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House F7 Addition ❑ Replacement Windows Alteration(s) Roofing
r7l Or Doors I E5
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks Siding[❑] Other[❑]
Brief Description of Proposed Q
Work: /("�/J
s�ft/� ,��/"�" ^-/'✓SJ�� �!✓qO� �i�/"�r
Alteration of existing bedroom Yes No Adding new bedroom Yes No �/
Attached Narrative Renovating unfinished basement Yes NX114
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms J ,)4
c. Is there a garage attached? /v
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 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
property
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/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.
Print Name
Signature of Owner/Agent Date
Section 4. ZONING All Information 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: L: R:n
Rear 44
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 0 DONT KNOW Q YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES
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 0 NO 0
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 0
IF YES, describe size, type and location:
E. Will the construction activity 6,;turh(rIParing, grading,Pxravatinn, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
De artme use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/SepticAvailability
Room 100 Water/Well Availability'
Northampton, MA 01060 Two'Sets of Structural-Plans
phone 413-587-1240 Fax 413-587-1272 Plot(Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
/ Map Lot Unit
)- yc 115 (( ( 6C 5
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
� � S ci 1-77
Telephone
Signature
2.2 Authorized Agent:
Name(Pant) 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 (b)Estimated Total Cost of
Construction from 6
3, Plumbing Building Permit Fee
4. Mechanical(HVAC) �ZS
5. Fire Protection
6,_Total_= (1 +-.2-+3+4+5) Check Number
This Section For Official Use Only
�A • ZOOS Date
Building Permit Number: . Issued:
Signature:
- - -- ---- p g — Date
Budding Commissioner/ins ecto�ofBu m s
2 BP-2008-0518
IS COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: roofing BUILDING PERMIT
Permit# BP-2008-0518
Project# JS-2007-001382
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sn. ft.): 8319.96 Owner: BURI JOSE
Zoning: URB Applicant: BURI JOSE
AT. 290 BRIDGE ST
Applicant Address: Phone: Insurance:
290 BRIDGE ST (413) 586-9617 O
NORTHAMPTONMA01060 ISSUED ON.]]/19/20070:00:00
TO PERFORM THE FOLLOWING WORK.-strip and reshingle new plywood 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 11/19/2007 0:00:00 $25.00398
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo