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28-023 �- I/ yL 1 � i �—' � � To,.,aT�✓f� 4 / acg ' Zxt-- r 40 O¢'C1iAMplO . �utA35AC1�1SSttf3 DEPARTMENT OF BUILDING INSPECTIONS J_ 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 ilis/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 your), 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 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 7-uwLr" j:6 Zook Address of work location d 0'V440wk�7 C �4-. ,tea aee�uc,L�. ��$ of aGL 1.1. -V 2-45 j Existing NM FRONT ENTRAWCE PROPOSM NW Al'rAC4M FRONT e4fRA)CE 40 eDOKNELL M F10RENC�MA 01061 DMVEUJAY STREET 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-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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition v"" Replacement Windows Alteration(s) Roofing Or Doors Accessory Bldg. Demolition New Signs [ ] Decks [ ] Siding [ ] Other[ ] Brief Description of Proposed pTrAG4E'- Work: jS��c 0 �ivcc os�b /S✓LouT c_�T,C�q,uc K�Koo� �k r s/1r�G cu�5ts Alteration of existing bedroom Yes i/ No Adding new bedroom Yes k-" No Attached Narrative Renovating unfinished basement Yes No 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: �/�r4 Number of Bathrooms &11A c. Is there a garage attached? ,y U d. Proposed Square footage of new construction. 9 V- SQ., gt Dimensions 7 'X 19 e. Number of stories? / f. Method of heating? =cr6!Q_7',er c Fireplaces or Woodstoves ,uv Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction w o o,g i. Is construction within 100 ft. of wetlands? Yes _L,1 No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade N�d9 k. Will building conform to the Building and Zoning regulations? r/ 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 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 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 r 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 . 333 A c►e&C _ 3 33 �4 crCcr �G Zj Frontage 40 3- 3 3 7 Setbacks Front 40" "t 3 3 ,r + Side L: R: L: i r ' R: t S ?.f� Rear Building Height Bldg.Square Footage % 9 Ir 1f FT Open Space Footage 85 S% �1 4�3 Y,.t, n (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 X 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 X 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: Department use only City.of..Morthampton Status of Permit: �� W OuiI ", ;Department Curb Cut/Driveway Permit F5D) ain Street Sewer/Septic Availability Qm 100 Water/Well Availability, �j J U I 1 4 2 rth t n, MA 01060 Two Sets of Structural Plans phone 413-5 7-12 0 Fax 413-587-1272 Plot/Site Plans [ arc Other Specify `-APPt1CATtOlMT6 CONS TER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 40 o rVjb1.,koELL- (J,e Map � Lot d3 Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: -,-/j A'<- -V K- GoalCw �f6 o�0awwiC� Z�y2• fLouc►�C 2- Name(Print) Current Mailing Address: 9�S-58C - Sa�j Telephone Signatu e 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com leted by ermit applicant 1. Building 6O00.00 (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) Check Number 6 '- This Section For Official Use Only Building ermit Number:- �O? Date g Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2004-1278 APPLICANT/CONTACT PERSON COHEN BARRY R&PATRICIA L ADDRESS/PHONE 40 O'DONNELL DR FLORENCE PROPERTY LOCATION 40 O'DONNELL DR MAP 28 PARCEL 023 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinp,Permit Filled out _ Fee Paid Typeof Construction: CONSTRUCT 14 X 7 FRONT ENTRANCE&REROOF HOUSE New Construction Non Structural interior renovations Addition to Existing - Accesso1y Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 Commi sion 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. 40 O'DONNELL DR BP-2004-1278 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:28-023 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) CategoaL. BUILDING PERMIT Permit# BP-2004-1278 Project# JS-2004-1924 Est.Cost: $6000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sg. ft.): 14505.48 Owner: COHEN BARRY R&PATRICIA L Zoning: SR Applicant: COHEN BARRY R & PATRICIA L AT. 40 O'DONNELL DR Applicant Address: Phone: Insurance: 40 O'DONNELL DR (413) 586-5093 () FLORENCEMA01062 ISSUED ON.6122104 0.00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 14 X 7 FRONT ENTRANCE & REROOF HOUSE 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 6/22/04 0:00:00 1407 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo R1 .� �� n 1, 7 y �b� �,� � C� � � S V4 i BP-2004-1278 40 O'DONNELL DR GIs COMMONWEALTH OF MASSACHUSETTS Map:Block: 28-023 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-2004-1278 Proiect# IS-2004-1924 Est.Cost: $6000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sg.ft.): 14505.48 Owner: COHEN BARRY R&PATRICIA L Zoninq: SR. Ap 1p icant: COHEN BARRY R & PATRICIA L AT. 40 O'DONNELL DK Applicant Address: Phone: Insurance: 40 O'DONNELL DR (413) 586-5093 0 FLORENCEMA01062 ISSUED ON.6122104 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 14 X 7 FRONT ENTRANCE & REROOF HOUSE 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:/J04 ; Driveway Final: Final: Final: ' d0vwi � Rough Frame:0 k $ 30, 6V Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: QK o2-y-p 5 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATI OF ANY OF ITS RULES AND REGULATIONS Certificate of Occupancy S; nature: Feel e: Recei t No: Date Paid: Check No: Amo. 't: Building 6/22/04 0:00:00 1407 $50.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo