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17C-283
• 651L- DEPARTMENT OF BULEDUIO 11WEMONS X12 Main SUM i MuMicqW BpHdMg , INSPECTOR Nadmulemk MA 0106 HOME OWNER EXEMPTION ACKNOWLEDGEMENT . The State of Massac setts allows the homeowner the tigk i 7800M 1083.4 to act as-hislher-construction super .-.:sor,The state defines-Homeowner"as,"-Persoi(s) who owns a mud on winch he/she resides or intends tob Awor dwdliag,attached ocdeuwkkid stnx tares a+ccessmy to such use and/or£arm sauciures.A person who consuticts more than one home m a two-yearperiod shall not be considered a home owner." e tFUMMg K, Of M CAYOf140fdUon4*XI. _ - - use the home owner erawdoo,to act as their o6 constructim MVMVisac,to-be aware that by doing so YOU become responsible for comp&nae with bu Nding codes and egalations.The inspections proeess-r that the buildng departimat be called. to inspdd w+ock at various stages,which inchide- &eW back " ( oe oursonotabe holes ro &b ' n e 9n Mfm yeidt is - concealed&iasarlation inspectooa(d rwacu ei� inanedion:.The building dam-requires these inspec6ow before the wotit is eoaoeaK Ito MOM these ins can result in UAa re to ebtik s cer of 2gayy m UNA the work can be inspected. = If the homeowner hires other trades to perform work(dect:rical,plumbing 8c gas)the howowner will.be ale to make sure that the Uadegs hinged secure their pry permits in eo*ncdm to the building permit ismekasd that they get tbeir required inspections Failure ofthe individual trades to secumthe permits and inspections as requu-ed ran DEf.AY the project until such tune as the proper permits and dons are made I, understand the above. .(Home owner h vsident's signature requesting camption) I will call to schedule all required building inspections necessary for the building.permit __.. _.. iasuedto.me: .. . _ . . .. .. . - -_. ._ .. .._. - Bate Address of work location r (riN i# Nart[Iamp!on a DEPAR2-364WT OP BUIL#)DEG INSPECTIONS ` 212 Main Street ' Municipal Building 141'orthampton. Macs. 01060 V4'OI2.Tt It'S C(Jk�OtNSA710-N "I�i i$TtA-NC� A", • �S,NI • �-° •(litx-.nsaclpermitfac) - X%rich a principal place of busioessfresidence au . (phone) 13- 39Z-7,960 . (stz�trtaty�slaulziip) - do hereby certify, under Lhc.pains and penalties of perjury., :hat ( ) I am an.employer providing the following 1work-er's compensation cove mac for ►n)• ; employees %ror!~ng on this job: (Insluzc Coelr,3ag) ±(Polio Number) (-xPilat oa Dam) ( ) -I am a sole proprietor,general contractor-or homeoWmer(ti=de one)and baw hired the contractors listed below rAn.have the following workees'compensaaon.popes: (Natnc o.CoacaCW,) (tasllran=Company/Pl obey Numb--) _ (Ekpimuon pate) (N---C of Cootxamor) (iasttr acc.Company/Policy Numb r) -.(Ezpvaaoa Dace) (Name of Coo act)- (lnsura M Compa,oy/POUCy NUZ bU) (Expiiaaoo Date) (N ) ,(Insur'an�Company/Yotiry Number) tTxpiratioa Daft)., ..._..... ._. (Name of Contsaetor (.each sildFeeal 6x%ira4oaanp to 6CIU a iafa' Oa Panaraios tam xom+ar_orn) (< I am-'a sell PmOetor and#gave no one wori og for me. ( ) I am a home owner perforrniimg all the work myself NOTE E:plow be:s Bate flue•.la7e bom000mm+•ia.mPI y Pemoos to an sot fleece tlta 'Lsomeair is r the bomnorroar:taidrs«m tLc pwoda f6�e+r.R mt�aasa_r monad is he 6a we.#c`z xr ciao Aa(6I]l32.-alM mmr=6=by.bomm mw ra s 6 =my Cridem=the: k J atlas Oren-*WW Wa.r trap we&.e s Comp.=4;m wee. !"Wansod Out a espy artbi.omaaaet as&y b.rortwrr W is the Dapaatm cd afU&m 64 wamdaw Offs orlaaur.ow far tba Ow—V Mairmaim cad th A E-Zmc to$4Wm lop WmV lade C=0600 23A a(MOI.112 tea ksd to tba 64Q&—xrtaStoioal P=-%Wea xoasssteg ors rtae arteP tx S1 OOAO*A&ar hnprioxaaCt*CUP to eme Y=W sad e$+4!Pmahio id.6e ram ore Stop Walt Oedc and a Fee&vim-moW 0-6 OWY rtffi x[5100.00 t dsY eP,tio,t me - SECTION I CONS�RtIi iIOI�S�IGE� ' f 8.9 Lie sod Constrcee fhctt SuoervkQrs Net APpk3We 0 Ham*of Ucwnse Hoidoc License Number Address E)OMIon Dabs SiB^eture Telephone ' igm" rl NotAppkaW 0 -�-- /y 9 2-E At- Mde C�oarn Nam � - - Res�shadom - Address EVka&pn L 5 A11 4 05-") r F Workers Compensation bwmmxs affl&*must be completed and submi l ed ugh Vas appica m Failure to provide this aitddavit will result in the denial of the of the b I&O peter AtTidaerit Attached Yes....... No...... D The currcnt won for"homeowners was cdcaded to include Owow DwOMs of one(1) or two(2)f mlies and to allow such homeowner to engage an individual for lire who does not possess a license,W that the earner seals - as aoervdaer.C1NIR 780 Sim Edition Seealoa lOS.3z.1i. DeBWdoe of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,an which there is,or is inunded to be,a one or two family dwelling altachad or_ddachedd slntcMM accessary to such use and/or faze str xUays.A person who eoastraets more time of Home its a two 21K varied stag not be osndde red a i�tnaeowter Such"homeowner"shall submit to the Bwldwg Official,an a form acceptable to the Build nil bell resaoasibef or aE sne3t wart nada' r bstlidhta!<neemit. As acting ComIraction Saoewvisor yow presence on the job site will be mrabW fiam time to time,during and Upon completion of the work for which this permit is issued. Also be advised that with refemce,to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for miudes not resulting to Death)of the bbssachuseft General Laws Annotated,"a may►be JW&for PerS*S) you hire to perform work for you under this permit. The undeiaigned`bameownet"ceps and assumes re epomsibility for con flimm with the State Building Cork,City of Northaoagtmn Ordinances,State and Local Zoning Laws and State ofManchmetts General Laws Annotated. Homeowner Signature ti S,ECTION 5-BwES�RIPTIONflF PROPOSED'11iLffRtt: New douse [] AddiMon ❑: Rep ac Tento Aiteration(s) C-1 Roofing �DoaNs Accessory Bldg. ❑ ownci ton ❑ New Signs Lt7j Dedm 10 SkSM 6:31 OdW[El Brief Description of Proposed Work _ _ --- _ ' ° v nV- Air t Alteration of existing bedroom Yes Adding new bedroom Yes No - Attached Narrative Renovating unfinished basement Yes No Plans Anached Ron -Sheet UL 6. n 6' Use a—r s..s1.S.... e e T4!�F$InA1I Miner - b. Number of moms in each family unit - Number of Bathrooms--__- c. is there a garage attached? d. Proposed Square footage of new constnxtian. DlmernsIOM e. Number of stories? f. Method of heating? FIreplaces or Woodstaves Number of each g. Energy Conservation Compliance. Masscheck Energy Complkum farm attached? h. Type of construtlion I. Is construction within 100 IL of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade It. Will building conkwm to the Bung and Zkoi ng regulations? Yes No. 1. Septic Tank City Sewer Private wag City water Supply SECTION Za I, C/ xy, mr, S �f7,1'D,5,k,,1''PY, as Owner of the subject property I ll hereby authorize .11 1- to act on my behalf,in all matters . to work authorized by this bung limit application. Signatwe Owner Dam as OwnedAuffx rized Agent hereby declare that tfte statements and Information on the foregoing application are true and ikxi—=a ,-to the best of my knowledge and belief. Signed under the pains and penalties of perjury. :7D mo-7-4 _! LUGS — PrGrt iJatne 7Z-A U Signature of Owner! 'Date .. - h Section 4. ZONING All M0ormatl6h tllM 8e compteoed.Pan*can Be Denied Due To k=ompk*&k9ormaCM Existirg proposed Required by Zoning . Ibis caimaci to be Mled in by Bm'ld'ea� Lot Size ! i i 1 � Frontage Setbacks fit ? Side L R� i_ R�� Rear Building Heigbt --- Bldg Square Footage % Open Space Footage ----� % (Lot ara mum bldg&paved L� }! L--j ---� #of Parking Spaces Fill: (volmue-Bc Laaaoa) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW d YES Q IF YES,date issued: 1 IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW © YES 0 IF YES: enter Book Pec�e and/or Document#'i S. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date issued: _ C. Do any signs exist on the property YES Q NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of suns intended for the property? YES 0 NO IF YES, describe size, type and Location: E. Will the construction activity disturb(dearbU grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q r NO Q t IF YES,then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton Building Department 212 Main Street Room 100 Northampton;11A 01060 a phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SEA 1 S!FEINFL�R>iN 'FION :... . . _ - .:� �.- 1.1 ProoertvAddress: r �" r � -m I `I - x --a.n+~---ate•- ....L m .(...(, ` Sv• fir. -'S^`."'i7f7f '.4.'T ' SECTION 2=PROPERTYOIiiMERS ' , a�1GEl =3 2.1 Owner of Record: IF� �. _.Cj_ aYW O .2 Rl � - (Pvin j1 PA IC Telephone 22 Authorized&vent: _ Nerve Current Mv&V Address. OU0 -Rkj mtwe Telapiwne Item Esterrated Cost(Dorms)to be Offal Use 0* 1. Building T( P Fbe 2. ElectricalbEsliErraded C?dst:af _ n iori frd*i 3. PiumUng Buld mgPenrnitFree 4. Mechanical(WAC) 5.Fire Protection 6. Total=(1+2+3+4+5) heck Number , -_ 'BU1ldug;Peanut-Number •Signature. Braiding Date �z BP-2008-0318 GIS#: COMMONWEALTH OF MASSACHUSETTS 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-2008-0318 Project# JS-2008-000457 Est. Cost: $4050.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin TIMOTHY J LUCE 149288 Lot Size(sq. ft.): 10890.00 Owner: CARPENTER FORREST E&CHARLOTT Zoning: URB Applicant: TIMOTHY J LUCE AT. 22 LILLY ST Applicant Address: Phone: Insurance: P O BOX 14 (413) 387-9800 LEEDSMA01053 ISSUED ON.912512007 0:00:00 TO PERFORM THE FOLLOWING WORK.SHINGLE GARAGE ROOF & PORCH MEMBRANE ROOF 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 9/25/2007 0:00:00 $25.00524 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo