25C-229 (3) WINDOW WORLD
t.. Js, MA 10 a3
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O¢'SHAa1P�O
of 'Warthampton
� d jl>dassxchasrifs -
DEPARTMENT OF BUILDITIG INSPECTIONS /=
INSPECTOR '212 Main Street • Municipal Building S,
Nortli,unpton,MA 01060
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supc:."sgr. The state defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be,a one or two fanu� -
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 r'.egulations. 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 buildin.2 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
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Rio ��`e Cfiil� of �arfl��l�l}�#oIi
DEPAR7ME14T OP DU1LDf)\G INSPECTION'S
212 Alain Street ATunicipal Building
Northampton, Mass. 010GQ
WORJ:CER'S COWITENSA'XZON MSURANCE Al
01Ccn PcTjttcc)
prti-lcipal place of businessfresidence at:
Ui fit cCA -.&:I Z-V ��s .oV,4 c7-le- (phone-') �-
(sIIr-r/ci ty/s atria p)
do hereby certify, under the paint and penalties of perjury:, that
( } I am an employer providing the followine'workcr's coinpcns-n�lon cove mge Lor illy
emplovccs wortong on this job:
(Innir_n=Conn ) (Pelie:Nu-nbcr) -- ( :piratior, Daze}
( } I am a sole proprietor, general coou-actor or homeow-Der(ci:c;e one) end Lave hired
the conua(nors lister+ below wbo hive the ;ollo%ving worker's compen-saaon pokles:
(l+urine of Con actor) (Insurancc Colnpan)-/Poiic; ?,,ruMh,--) -- (-Expir-aUQn Datc)
(Name of Contractor) (1nsuancz- CompanvPobm, \t sacrr) (L:x-p'L lion Date)
(Name of Co=lor) (Insurance Compa.oylpobcy Numbu) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Numb:.r) (Expiration Daie).
(atuG+t —.CC11 CSCC,ifnccctal to irl tvc�=informi-ioc pertnining to.11 ooa=-_co:-a)
( i am'a -sole proprietor and have no one working for me.
( ) I am.a home owner perfotTni-ng all the work myself.
NOTE:plesc be cwarc o-vt;..1e bemeo.�vcra wto eaplay p c-ccni to da -.r..aao c rgzu.•oric oa i d..�.11•:�of
not morn th-n ` --in Whi the bomwwn rand.or oc the Vro-L ; zpp�tbccs r_-c oa C=>=Ry m=.daoi to be
eitployes unr'•-e the..u1 dz off- ca Act(GU-1 52za 1(5)�:.ppliot6on by i bomeo-=f=c Fick_cc permit r>=y a ida>nc ELC
Iegsl of La—Ployac uodvr d.Wocltra Coozpomilion Aut_
I unde-rtaad the i oopy of thin=XL.M u o y be foe�to tbo Deputmmt of lndaaT.rie1 Acad.saa'0(Sioo of trsauzooe foe tba
coverisc vteif alioa mrA th_1 L-il=a-W sr_urc tcovernse rmdc soetioo 23 A of MOL 13-1 can led to the L=P S oa of cim�peaslIio
000arsmg of i fine of trip to S 1300.00■zrdloc of up to 0 t y=r_od civil pmaP.ia io 6c form orL Stop WorE Order Lod
rua of S 100.00 a d--y aptinst me
for dcp.rta>,���K on7y
PcvM)t NUMLcr
} 2 ��P,-- Lot
Si�naW- of LiansccJPcrrttittct: c /
SECTION:8-CONSTRUCTION SERVICES- r
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
Fea[stereafbincicissv� ems `x oia' Not Applicable ❑
LC1'r t� c C,c t ik v
Company Name
Registration n um er —
y�. � ,�,tir•i I� -st+v rjie%'G�
Address / Expir—mate
�. 5 l �l C,/Gs r� Telephonei�� 7i
SECTION 10-WORKERS'COMPENSATION INSURANCEAFF,IDAVIT(M.G-L.c.152;.§25C(S)).
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...... ❑
el
v � x
.v )
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
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SECTIONS DESCRIPTION OF PROPOSED WORK(check all.ayolicable)
New House [,] Addition ❑ Replacement VVindows Alteration(s) Q Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[o] Other
Brief Description of Proposed
Work: -t-it.5i !)ll, tfid.;YL t'c�/)�-r3cv�Atcwis ,c4:t�
Alteration of existing bedroom Yes No Adding new bedroom Yes .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
61KTev� io�rse n� io �t eat�s�t`n ca stna�_coma efe e5 on IaEwEr>sg:
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. 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED:WHEN
OWNERS AGENT k C ONTFAC OR APIPL:_itst6k';gtiLDi4G-PERMIT
I, 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 Owne thorized
Agentfiereby declare that the statements and information on the foregoing application are true and accurate,to the best of my now edge
belief.
Signed under the pains and penalties of perjury.
S ;T-
Print Name `>
Signature wn Age Date
ot
Section 4. ZONING All Informati6h 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
I
Side L: R:' L:' R: ! �
Rear
Building Height 7,1 ---
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved �� L�
parking)
#of Parking Spaces
Fill: j
(volume&Location)}
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:`
t
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book I Page; and/or Document#l
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained 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 0 NO Q
IF YES, describe size, type and location: J
3
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 ,. NO 0
i
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
'Clty!of Norti arnpton
-
OuJiOing Department
14R Main Street
Room 100 a
�rthar�ipton; MA 01060 e
- phion e 4 Q-587 j1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION'1 -SIT E INFORMATION
1 � � �' This sectron to be completed byrnffice
1 Property Address: r
�,IVlap L`ot 4�. _r ` wUnitw
Zone. � Overlay Q�stncf
7�-- C��,.-"� ..�l �Elrit 5t:`'bistrict •= GB'DLStrtct
SECTION 2-PROPERTY OWNERSHIPJAUTHORIZED AGENT
2.1 Owner of Record: _
Irrr , ,wit✓ �; e=liv, y �/
Name(Print) Current Mailing Address:
s 7GiL
Telephone
Signature
2.2 Authorized Agent: /
_757_ //� y _
W�z r?-- "'' me)t. /C mac',' e14 s
Name(Print) Current Mailing Address:
Si- ure 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)
5. Fire Protection
6. Total=(1 +2+3+4+5) S' �s Check Number
This Section For Official Use Only
Date'
Building PermitNumber 'Issued:
Signature: '
i
Building Commissioner/Inspector of Buildings- Date
72 CHERRY ST BP-2005-0453
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25C-229 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2005-0453
Project# JS-2005-0600
Est.Cost: $581.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: John Corbett 104000
Lot Size(sq. ft.): 3615.48 Owner: ZINN FREDERICK C&
Zoning uRC Applicant: John Corbett
An 72 CHERRY ST
Applicant Address: Phone: Insurance:
56 Dimock St (413) 586-8712
LEEDSMA01053 ISSUED ON:10118104 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
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 10/18/04 0:00:00 2026 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo