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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 his/her construction super-,"Sor. 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
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
� 6 ?i�cssac}lu6rtls
of �,Narfljmllplml
z m L)EPfit2Tl.iENT OF BUILDING INSPECTIONS
212 T%frim Street ' Municipal Building
Northampton, Mass. 01060
,womcm,S COiN1'ENSATION INSURANCE AFItUMNIT
i, ---------��L/_•per_-�--��a���_.------------------ __ _ __ ----- --- __._-----
(] mitt;^)
o"th a principal place of busiress/r_:.Idcnc_2
S$��_. "��_lJs...�l l�l.-.L*_�.�1.f__,1/_•�I.__�.__,._-(.Fh.'ne-=%��._��i��b'�
CIO 11crcby Ccl–n y Ili!'.
( ) I a.� an employer providing the follo,vint;'��orr�cr`s compensation coverage `or my
employees working on t is job:
(Lz=.irancz ampam') (relic;NtImI>--7) '--- (F ir::nen Date)
( j 1 _4m a sole proprietor, (C,Cie one) and "t-:ave hired
th t contractors llstev belov•r-;,"lo ii „ lh� loll .P '�'�'oi C:Q�s CO p°IlS? Ort "ice iC'. S:
('NQCIIe of COnCaCiGr} (1�1_ll�I,1C CCl ^;:'Tir�011�J' Z11T11 Cr) T''�:"Faio' Date)
(Name of cont_r ctor) (7nsu ,mcc CoLca�.,�tPe!ie,' �Itrnt r) (Ixpiretio:?Dare)
(Name of Corinctor) (InEar-mc t :� ] '_u"il�Qi.C. t 1tSIll%7) ".� C' DaI'2)
- (Name of Contactor) --- (Iris rarlcti Cotnr r1ti;Polier ititumCr r) (E xp �:tior Dare)
(^thG.1_.d'�i�mi1 St:rc1:;•....-!--,-::n:c:a...;•:_•:Y:r:,[:Cr.;_._.... - -.i;c;¢:_..._.-)
i
( 1 a]1 a sole 1?I"Opr1E LJi clil;l }li1VC no OIle •.'OI'laii`. toi nl •.
1tOTE:please In tt:>t
arx 11Kce ih_a tiurc uniL5 ir:u{:idt;.he 1:;.::»,•.tZr-r=.-;_z c.c oe;•`�.;t;,�_..:s_�-•:.r;cr_.1 LhcGc a:e tx:t{,tms�l'�c._•;: i:r:c:c ti
eII*ployc�un!.cr t}r_tw;h _cc;�:- :a_irr.Ac:(C'i L!S2ss;(Sl!.a�:,•iic�.;ic::?,y n hn:aro t«w fore E. c.�p:r:::i::-
legal Haar;of an eMyloyer under n Novi; ;far-;xr.lion!.cL
I undo.-rtand Ihi:a copy of th,, ciatci's�coy bo fo,v it i to t)»IYpartz !of lx>duss ri_J Ot lro of I::.%u�: for tlx
coverage vaif amlioo and that f_iltuc to to uc coy r�ut c�.ir 2SA of MG1,152 can 1..,a to tIx imposition cf C—'--j pc,1,1,; s
0:.-istmg of a fur_Of UP to s 1_S00.00 m:�.I r i^::�ri�r.z;,-:!of::p to rr.-),`;�r.l civil peruttia in ic-nn C.f.,Sic-,,`IJni.0,,1, ar•3 a
firr-O(:M,0.00 a d,y ip�.ina rn-
For dT Uj,-e j u.c caly
/��,ys�
s
j
j
SECTl , a°R PO WORK l a(11 S 4 �Pk v a
. ,
-
.
New House ❑ Addition ❑ Replacement Windows Alteration(s) 0 Roofing
Or Doors ❑
Accessory Bldg. ❑ DemolitionX New Signs [ j Decks Siding[ Other [ ]
Brief Description of Proposed Work:R in oF:cY- Te esIQUgs V-°oF %F-LoL2 1C0)4sTaurT uEw flE&- tSTagz
Alteration of existing bedroom Yes � No Adding new bedroom Yes X No
Attached Narrative 0 Renovating unfinished basement Yes X No
Plans Attached Roll 0• Sheet 0
6 f Ne fi u ee n tor a"'ddition'4to° Fx-,isfiTj& ousfii'n "com°p'1b#-he l;l,ow��.nl�:
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. bimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck 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 N
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
"SECIi?JOOC� INNER A17 �lORIZATION TO BE COMPLETED WHEN
OWNERS EN O t�CONTRACTOR APPLIES T OR BtIILYD7NG PERK
r te. i'
I, f�A NSW iou as Owner of the subject property
hereby authorize WI to ac; o
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, a, 1 2, rn-,RA 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.
W1II1A�' ^II lUPt01�[HA
Print Name
Signature of&wm-r/A,6nt Date
r Pita CtT ON ,CO4N�S,,, !,RU.CTaIO'N SERVICES
8.1 Licensed ConstructiolnSu1pervisor: Not Applicable ❑
Name of License Holder : W/l�/d►� J. 1 u�o,nsMa Dt�o s�
License Number
58 E2our sr rr 0, FOX IT Lamps NA 01 NO 15 EEUUAgti a00Y
Address Expiration Date 7
Signature ` Telephone
Rets stereM'" e . rovemeffi Contractor Not Applicable 0
01 -7,2 Z
Company Name Registration Number
Address Expiration Date
0l0_53 Telephone 4//3 S L Zoo S
pk�T�Q, N OR, KERS' COMPENSATION INSURANCE AFFIDAVIT(MSG L c 1,52, § 25,C(
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 acccptable to the Building Official,that he/she shall be
responsible for all such work performed under the buildine 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 far 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
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 30 31 S FT 30
Frontage Z 2 2g Lj m,
Setbacks Front t o 0
Side L: O R: 10%' L: 0' R: 108
Rear Z3' z3
Building Height
30 Fz: 3o FT.
Bldg. Square Footage 6�qa % Z
Open Space Footage %
(Lot area minus bldg&paved 15511 SF. 'S0,2_1 156-11 S.F. So.21 'X0
parking)
#of Parking Spaces 2(c Sf'pass
Fill: N IA.
(volume'&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW YES X
IF YES, date issued: 23•Z-ulL Qm l
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book 10211 Page 01S7- and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO X DONT KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES X NO
IF YES, describe size, type and location: Act,wY51yu AU 11 a I4nQ-r"erz agar g17TP�tt��
D. Are there any proposed changes to or additions of signs intended for the property?YES_
No X
IF YES, describe size, type and location:
City of Northampton
Building Department ��
212 Main Street
Room 100
Northampton, MA 01060
hone 413-587-1240 Fax 413-587-1272 _
p � � y
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INIFORMATTON
T#ftbsecbon:� e completed'by
i.i Propeft Address: � � �� r F
Map
211 No RT'H ' Te.E E T .7
IE k
A^r 4 A�
,r �St Lt u4 CID,
SECTION 27 PROPERTY OWNERSHIP/AUTHORIZED'AGENT'
2.1 Owner of Record:
- \x/F_NDY AmQ lD. Au 1p NEWThw 211 Nopm sm?.E>-T ,)u T tt s
Name(Print) Current Mailing Address:
NORT1�ampT�*t kA aIo/
Telephone X113 • 5$S• O 12-
Signature
2.2 Authorized Agent:
14/i1//,a" S. Tu2ods 11,E P'0' box 141 LF_ErlS MA 010.53
Name(Print) Current Mailing Address:
q-a • s n' goon
Signature Telephone
SECTION 3--ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use on y
rnmbleted by ermit applicant
rp
1 O,oao
1. Building 16 0o a Via)Building i _-� 1
2. Electrical (b) Estimated*d `I Cost of
Cor►strucEio� morn 6
3. Plumbing Building Pe t4tApe
4. Mechanical (HVAC) ,
5. Fire Protection Ri�z
6. Total = (1+ 2+ 3 +4 + 5) Zt,00n.°O "Che ck-Number
This Section-for Official Use Oral'
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
,f
File#BP-2008-0030
APPLICANT/CONTACT PERSON William Turomsha
ADDRESS/PHONE P O Box 141 LEEDS (413)586-4005
PROPERTY LOCATION 211 NORTH ST
MAP 25C PARCEL 095 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
L, uilding Permit Filled out
e Paid
Typeof Construction: Replace Deck
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
INFORMATION 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 Commission
o �•�� 6 0 b
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.
211 BP-2008-0030
Gis#: COMMONWEALTH OF MASSACHUSETTS
Mp:Block � CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Categ v BUILDING PERMIT
Permit# BP-2008-0030
Project# JS-2008-000040
Est. Cost: $26000.00
Fee: $130.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: William Turomsha
Lot Size(sq. ft.): 8189.28 Owner: David&Wendy Newton
Zoning:URB Applicant: William Turomsha
AT. 211 NORTH ST
Applicant Address: Phone: Insurance:
P O Box 141 (413) 586-4005
LEEDSMA01053 ISSUED ON.711212007 0:00:00
TO PERFORM THE FOLLOWING WORK.-Replace 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 7/12/2007 0:00:00 $130.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo