25C-133 (10) Whiteley Electric
52 Cottage St.
Easthampton, MA 01027
413-527-1440 Fax#. 413=5299788
Fax Cover Sheet
M N
t
Date 3&P /o
This cover sheet and the following o page (s) are being sent to the
attention of-
Name:—
Fax #:
From: �p, �
Comments: cz Cr'
Yf' ,t to ti T
A f . -
o 4 U4" E-Py AtiT D% /j to �G2NC
�OG- �e G uG• i L1
.der! h►' /"!�D h�t�,r�_P
•r��A2 s, }�,N4"4p
,T -�3 oexa,e z �"'��' I
yAhC
Ami
7 J �-
1
1
i
i
i
r
41,11.9
-rl'ov IT 4119 -J r4s Iron
0
O�gttAMP�O
G T
itV >afn #4antptnn z I
Y • '
�AS3RC{�liStttS -
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street 0 Municipal Building
Northampton, MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as !Js/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 one or hvo family
dtivelling, 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
1, 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
6itll of 'Norflimlipf[III Ella
FAM-
+
M
1)17 J`I'll RTMI ll?'TT 01"
212 Main SAM AW&KInd Bukdiq�
Northampton, Alaw 01060
W0j-,'_K:P,R'S COMPENSATION INSURANC)", AFFIDAVIT
ff
with principal place of buslesdreidence at
rl A
TV -Ala i 414 rl� JA ()10�u (p
do hewhy cc&Y under the pains and PCHUCS of powin
I ani au ' mploywl providing the Wog:' np OQUA Conn,wksyl:gin 01m :.e WF my
cIupluycc.S ""'01 oil t}ns job.
OLSUT-all",_ Date)
X1 LEI] a pole jo-OpAwn, gentimi Convacrey an humeo"vnC, (C"IC!C 011e) a11(; hired
the contract -s Red he wh) have the bKowny mACKS COMPOWWOn Ones:
TrAVC1,15 Lh5.-Co.
(N'mmc of (__'C'11. Date)
-5
c o
Of
Tame of Anna= e
I plopil'-,"oi have no on"- l'ol
?!OIL:p[c:lu I--
13 '�:,-p!'7y n-
Ti('t:n,ac tl�_n tllrrc Ill t01:c"l,I,_
nplolrs un' f thr rl'
legal"aws of an wiwhyx under tLo
oatf,-Y I-fon1-3 1.Q
covtd&c vc.-ificntioo r.:,.fj tlut fail=to falrc covc-t-ar-=4k-r 2 5 A ,,f MM,L 152 can Iced to tlx 1c'j
c5uhtog of fix of up to S 1SC).C)O al�-�'oc of up to c:-,-,)-'u t.'j civil lrrultiu jj' "cKlo of
a (A) a A-t I g:l i n.-A
SECTION 8'-:CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: ]. Not Applicable ❑
Name of License Holder : )Tet/C 1 ZU(Jl, �cr2' S]b
j� / / License Number
� " Naka soi\ �(�
0t<cl NJt t�t►n Q{`�.� / t F'1_ ,�00 -- --
Addr �f Expir
e tion ate,Pi,
Signature Telephone
Not Applicable
;9 f2eitered omelmprtivetn`enf Contractor:" "'''
PP El
100 0-Ir
q
Compa
any Name e (� (Q Registration Number
W� (J'EkSUo',
Address Expiratio Date
T �►+� Telephone 5aq-309
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...... ❑
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 huildin�,j permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, durin--and upon
completion of the work fe-which this permit is issued.
Also be advised that with reference to Chapter 152 (\Vorkers` 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 Zonin- Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5- DESCRIPTION"=0F"PROPOSED WORK(check,all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: �i i11 T �?d Cta C: �W►� 0 __ _ -
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinish d basement Yes No
Plans Attached Roll ❑ - Sheet ❑ aL Ue V�f vc
sa if"New h°ouse°and=or-atliiition`"t"o existin' tiou'si ;__com'plete he following;
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. 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 -_ 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
OWNErtS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1�1'reA,_E _r,� Le2 —7-- -- — ---- - _- -- as Owner of the subject property
hereby authorize �j fCue� �� L s�_���"i�►t�0 _ to ac� or
my behalf, in all matters relative lw®rk u thorized by th , t;uildinp permit application.
Signature of Owner _ Date —
--_.1-i_�,vtAA Z✓ec Lt,y�o 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
Si ure of Owner/ nt Date
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
Frontage
Setbacks Front
Side L: R: L: R:
Rear
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 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO _ DON'T KNOW YES
IF YES: enter Pook Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T 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 _ _ NO _
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
r .
City of.Northampton Status of�Per h
Building Department GbGut D a
212 Main Street Sewer%Septic a ab
Room 100 Wader/WeU>Aval'a r tty
AFB ^r', brth'ampton, MA 01060 Two Sets�ofStr aura ales
} O L.
phone 413-5871240 Fax 413-587-1272 Plot/Sete Plans ,
a
Other Spectfy� �� r ��- °�
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 .
4n1 A 1A OILu Zone Overlay District
}� Elm St. District — CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) G..rrent Mailing Address:
)LI!>_` -- ---- - --
v (� T eleph�ne
Signature
2.2 Authorized Agent:Narne(Print) C:rrent Mailing Address:JIA r
Si a ure T:I.�rphnn.^
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
------ ----
tem Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant —
I i Building (a) Building Permit Fee
1 h timated Total Cost of
-- — -- - 1,onstruction from 6) ----
3. Plumbing Building Permit Fee
I
14 Mechanic":
5. Fire Protection
6. total = ;1 2 + 3 - 4 --— Check Number _ ---
This Section For Official Use Only
Building Permit Number: Date Issued:_-- ---
Signature: -------- -- --
Building Commissioner/Inspector of Buildings
File#BP-2003-0951
APPLICANT/CONTACT PERSON Steven Zucchino
ADDRESS/PHONE 70 Gleason Road (413)584-3878
PROPERTY LOCATION 44 ELIZABETH ST
MAP 25C PARCEL 133 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid
Typeof Construction: DEMOLISH DETACHED GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 021356
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO)RMATION 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.
44 ELIZABETH ST BP-2003-0951
GIS#: COMMONWEALTH OF MASSACHUSETTS
MM:Block: 25C- 133 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: demolition BUILDING PERMIT
Permit# BP-2003-0951
Project# JS-2003-1518
Est. Cost:
Fee: $10.00 PERMISSION IS HEREB Y GRANTED TO:
Const. Class: Contractor: License:
Use Group: Steven Zucchino 021356
Lot Size(sq. ft.): 7056.72 Owner: LEE TERRENCE J
Zoning. URB Applicant: Steven Zucchino
AT. 44 ELIZABETH ST
Applicant Address: Phone: Insurance:
70 Gleason Road (413) 584-3878
NORTHAMPTON MAO 1060 ISSUED ON.5 15103 0:00:00
TO PERFORM THE FOLLOWING WORK.-DEMOLISH DETACHED GARAGE
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• Receipt No: Date Paid: Check No: Amount:
Building 5/5/03 0:00:00 394 $10.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo