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25C-197 rN 71S) ------------- �TttAMp�, O O Crzilallautr#art z M &SSACIt IISt{t8 - " DEPARTMENT OF BUILDIT;G INSPECTIONS INSPECTOR 212 Main Street • 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 iris/her construction sup:.: .]sor. he state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or hvo family divelling, 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 rya G 7 of Na tilailiptoll B6 Ji�caaxchnsctta' — DEPARTMENT OF BUILDi,\TG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 'WORKER'S COMWENSATTON INSURANCE AFFMA IT EJ /J I - ✓ �1°� -- - —---- -- - - (licenscrJlcrinittce) -- -with a principal place of business/residenc/e at. honc - � oC --- do hereby certify, un(Ier the pains and penalties of perjury, that: ( ) I ?n1 an employer providing the following v.,orker's compensation coverage for my employees Working on this job: (lns=ic: Coc p-ny) (Polio Nu.,nlxr) — ---v (I 1�ir,:tioa Date) O I am a s le proprietor general contractor or homeowner (circle one) and gave hired r the con tract ors-7iST����eTo�-�who have the fo11o.VM' g workers compensation policies: (Name of Contactor) (Insurance Comoaay,'Poticf Number) (Ex,,imtioa Date) (Name of Contactor) (Znsuranee Comoa.-iy/Pohc), NuniLzi) Date) (Name of Contractor) (Insur-ane-- Companyil'olicy Number) (Ix;:ir�aio�Date) -- ------------------ (Name of Contractor) (Lluuranee Comr,a-ny/Policy Number) (I'':pi :tior; Date) (attadt�itimil r!;�-ct iF::crc:z.r:::�i,_}xic c::orctu_ix rstainin�t:rill cresac'.�::.) i I tun it sole l;roplictor an(i have no one v.wkdno for me. O I am a home ownc: performing all the Nvo::': nrysclf. N0,11:plczIsc be awuc that 4 ilc F <rto ti;rra a,-,Play pc k.s w di=.i::tcainc�, v r n m ct Irpair not axre tl>_.n thruo units in«i::dt lx Ik.krouzrs m: nor«t tl�e r s pFurter n t1 cRo e c cxt�c K-r2lly catploya-3 u_adtt the At:(GL152-s 1(5)),apptic ticn by a hoaicottricr for a I:CCnSC cc P-rn:i:r:av legal rtatun of an os:ployx and r tho Wodccle Cocnpocnatioct A-Ce- I unit^ ind chit a copy of tlui ctntcn:cat auy bo forwanrod to tbo DcVxi to it ofIzvhL ial A.ocilcntt OfIioo of for tln coverage vmficatioo and that failure to!-CL=covctago under soc ion 25A of NI(IL,152 can Icad to il>c inipaution of c n l pct:allics ooatisting of a fs>x of up to S 1.500.00 and'c)c i prtsoczarcttt of up to Orr year a.�d civil penalties in d.c form of a stop Wet onil-ar,d a firm of 5100. e dsy igainA rtr. - For cici=u tnrsrsl t1—�tly / Permit Nlrmtx r --- ---— I �ir�naturc c' P SECT#lON 8�C�kNSTRtWN;SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : r"' i,, p osf" 09' 177 4 0 License Number9 Addres' Expiration Date ov 3 gna Telephone 9 eQg$ ecf me mp�. .ement. ntracforft Not Applicable!❑/ Company Name Registration Num er nn V Address Expiration Date Telephone SECTION 10 WORKERSr' GO,MRENSATION INSURANCE AFFIDAVIT(M.G1. c. 152, § 250(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...... ❑ of i , 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 °3 � - -.�,.'' �3�^,� SECTION - D PROPOSED'sWORKx check all�a licable .fib .. .;5 9.,t�,, 11 New House Ij Addition ❑ Replacement Windows ��teration(s)� Roofing C1 Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ) Other [ ] Brief Description of Proposed Work:_0�'No UYm V(7 `L) Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ s"WERNMIN se►afi'""d oraiii:fiontoexistin h uo sincol:e a th .fola.owin a. Use of building One Family Two Family. Other b. Number of rooms in each family unit:6 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�Z.0 Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction axtfD t_ 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 (G' k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer X Private well City water Supply/ SECTION 7a 3 01NNERAU7t�ORIZATION -TO BE COMPLETED WHEN 01NNER�S A�GENTOCONTRACIOR'ARPLIESFOR BUILDING PERNJIT- �.. f e2tU;-rte � � as Owner of the subject property hereby authorize te. vS��,�! An fi' to act on my behalf, in all atters e tive t work authorized by this building permit application. ZI Signature o Owner , Date I, J©SC'o' Aul-te�%, 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. int y a r caner/Agent ate 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 Book 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: _ rt�-�ity of Northampton Sat sit q I ;: building Department Curb C ut/D 212 Main Street ;S rSep tc Room 100 a er,1We v Li 11(x# 1 7 2,003 Northampton, MA 01060 phone 413-587-1240 Fax 413.587-1272 Plot/sit'AP a -- - ' 0ther�$pec1 `' Ptt£ �tOfi TO CONSULICT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Proae Address: Map �� '`{ Lot mx '01 nit J, Zone 'Overlay District Elm St. D,istrict CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name rint) Current Mailing Address: Telephone �/�j� Signature 2.2 Au horize ent: Z�10s . 1'714 Na, Tint Current Mailing Address. re Telephone SECTION,3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Elecilncal "7©0 (b) -_�timated Total 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 .� This Section For Official Use Only Building Permit Number: 5 ���°� [Date Issued: Signature: ---------- – -- .-_- Building Commissioner/Inspector of Buildings Date File#BP-2003-1162 APPLICANT/CONTACT PERSON R JOSEPH MURPHY ADDRESS/PHONE 65 RESERVOIR RD (413)582-0032 Q PROPERTY LOCATION 65 NORTH ST MAP 25C PARCEL 197 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinlz Permit Filled out Fee Paid /S Typeof Construction: RENOVATE KITCHEN New Construction Non Structural interior renovations Addition to Existiny, Accessory Structure Building Plans Included• Owner/Statement or License 059333 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 Commission Signature of Buildi g 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. BP-2003-1162 pis#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-1162 Project# 35-2003-1823 Est. Cost: $7700.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin R JOSEPH MURPHY 059333 Lot Size(sq.ft.): 6403.32 Owner: CREELY ANN&BRIGITTE PAROT Zoning:URC Applicant: R JOSEPH MURPHY AT. 65 NORTH ST Applicant Address: Phone: Insurance: 65 RESERVOIR RD (413)582-0032 (� LEEDSMA01053 ISSUED ON.6123103 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE KITCHEN 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 6/23/03 0:00:00 813 $50.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo r k KOM& Cg� t Kit' x 'a. �. �1k 4 � 2( s a rte. -11 it F Gtt# ittly,�hit R-Ammow"AT ink J r �5 C k, As MAW lA now k, An my r .. t'+ `� onto, 1 3� a� F. A lot WAN v Ami too Av Mal [TAY r �F � spot - 3 R m e r W MC— oil SRI 65 NORTH ST BP-2003-1i62 GIS#: COMMONWEALTH OF MASSACHUSETTS Mock:25C- 197 CITY OF NORTHAMPTON a Lot: -001 Permit: ! BUMtIQ Category. BUILDING PERMIT Permit# BP-2003-1162 Project# JS-2003-1823 Est. Cost: $7700.00 Fee: $SO.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group R JOSEPH MURPHY 059333 Lot Size(sq. ft.): 6403.32 Owner: CREELY ANN&BRIGITTE PAROT Zoning:URC _Applicant: R JOSEPH MURPHY . �-. J5 N lrtF,i •-Y CT Applicant Address: Phone: Insurance: 65 RESERVOIR RD (413) 582-0032 LEEDSMA01053 ISSUED ON:6123103 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATE KITCHEN POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring 1).P.W. liuMing Inspector Underground: Service: Meter: /— Footings: Rough: Rough: House# Foundation: Q Final:,. 1'r l.1 e41-1 Final: /7 /' � Driveway Final: Rough Frame:(--" Gas: Fire Department Fireplace/Chimney: Rough: Oil: Irk,laticn: CC$ Final: Smoke: Fir:a;: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate Of OCCU anc , Sienature: Fee T Receipt No: Date Paid: Check No: Amount: Building 6/23;03 0:00:00 813 $50.00 `212 plain Street,Phone(41',)S87-12.10,Fax: (413)587-1272 Building Commissiouer-Anthony Patillo