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12C-068 (3) i - I � I M �•t1tAMP�. - � Crx#p of Xorf4ainptan _= Z a v =asaac n:aes i=' `b DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street 0 Municipal Building North,unpton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act aS ;.is/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 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/footing before bac!iE 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 occupanev 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 J I, understand the above. (Home owner/ eside 's ignature questing exemption) I will call to sch ule all quired buildi g inspections necessary for the building permit issued to Date Address of work location ­�1 /+ I s - . a .E U,if-�3 jai cry fI�a)It}itall _ r — � " E 3�asarcrifnsrtla. _ _ o DEPnRTME1J? OF ©UILDf,,,,C 1NSPeCTf01.'S — 212 1fain Strcct KU01ciPal BUIlding Northampt.on, Mass. 01060 %NVOrUCCIZ'S C06[PENSATT0N MSURANCr AF AVIT \vith a plblcipal place of business/residenc(-, at: (phone,?) (sa zw tici ty/cr a t r/2i P) do hereby cerufj, under the p?jris -nd penalties of perjury, hai ( ) I am an employer providing the following worker's comocnsabon cove^ge por Iny etupiovees working on this job: (Instu�c Conn c}) fPeLic: 1;tL r) -- (� :piration D:,x) O I am a sole proprietor, general contraaor or homeowner (c Cie one) and have hi=red the cone actors listed below who have the follo%ving worker's cocinensadon policies: �[+flrI2C Oi COnr;-1Ci0r) �ltl�l!t-..tltC:. COIT1Dulj'/2�GUC; ?��11II1LG:) -- �t"_i:71Fdt?Qi? 1�.11C� . (Namc of ContTzcior) Rasara.ne: Coman-viPo!icy Nitmcrr) Date) (Name 01Coturacto,-) (�?rdnc ComPzo)-1PoUq- N,I.niW) (Expirtioo Datc) 0h2-mc of Contractor) ansurancc- mdu� Compzay/PoLcy Numbr) (Expirtoa Daic) (aaach:d��ocil zb c jr ac,_ co j,3.r aoo pcn . W.1J { ) I am a sole proprietor and bave no one worttdng for me. ` j I am a home owner performing all the work myself. NOTE:plesc be ewzr<r+,.w+. .l0 6cmcrn+vcra u-h0 cc=p1Qy P(=T=w do = ���ro c rcpt. r wark d%,v J:-Z of aA(MccC thr�Lbr1 -U:M?a La l%-!Zc:7 the bomoowoc raider or od LS c p-au. 6 rgpl_rL.-u=th=en LT ooc C-n . lY ne=rd.-o:i to be caiployco rpdC the--k---c -_.,'cn Aa(GLI S 1�1(5)�_P Lie-6ao by a hommava far:Ga== cc pamirt r=y c-id_—trc I�IL---of as crployor coder d--W orir.ele C.omp.omeiio¢AeL [uadCa+ad[ha>ooyy oC tS.aatcmmx—y ba fo. dod to tbo p of ln�atric!nccd�OQ o0 0([=»Heron for the oovcrr-G'C vQiGcaioa and t1r_.z Elba to scnuc'cov.c- turd scci_ion 25 A of MO L 132 an Icd to Lbx i.=�Oa of a imicL Pca'16 a oc'= .i5g oft ED<ortp to S I-500.00 and/or 4mprj o 2 orup La ooc - Lod c�i]p=.&t-ja in tx form of a Slop Wort;Ordc and a Cun 0(5100.00 1 d_y apj.,j¢� �r Far dc�-'1 u,c only - -- f_\.\/1 �CYLlI[ 1�t LLtD l'CS Lot SigA,-t c turc of Li =,- t crmiucc J g' SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9 Reuisterer'.Flome lmprbveriienbEonfracfor Not Applicable ❑ ILE Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE.AFFIDAVLT"(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.nf_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 _ r s SECTION 5-DE§CRIPTION OF PROPOSED:WORK(check all':applicable) --T New House F7 Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ED Or Doors t-M _ Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[� Sid' g,[l�] Other[o] -17 A of 44ol Brief Description of Proposed + qq ^ '\\f E sYs,. V f Work: `' 1 vl3Y thS l� Gl�. (/�/I b i ctf Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet s If Never pause°arcF orcCtlFt�on.to,�x�st�nor�sccccompFettrW falfova: 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 7a-•OWNER AUTHORIZA7:ION-TO>BE COMPLETED WHEN- i OWNERSAGENTOR CONCRAGTORAPPLIES-FOR BUILDING PERMIT, as Owner of the subject property , hereby authorize to act on my behalf, in all Enatters relative to work authorized by this building permit application. Signature of Owner Date I, Sr r"Z� 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. fns Print Name Signature of Owner/Agent Date ' * ~ ~ , . - Section 4. ZONING All Information 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 Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) A. Has a Special Perm it/Varunoo/Fi been issued for/on the site? NO DON'T KNOW YES IF YES, date issuo& IF YES: Was the permit of Deeds? NO K > IF YES: enter Book Page; and/or Document#: �� �� B. Does the site contain a brook, body of water urwat}an�? NO ��� DON'T VV �~�KNOW YES �_� IF YES, has permit been or need to bo obtained from the Conservation Commission? Needs to be obtained �-\ Obtained ��� Date Issued: x~� \~� ' � 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 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre nrinit part ofo common plan that will disturb over 1 acre? YES � > NO �� IF YES,then a Northampton Storm Water Management Permit from the DPW is required. t w , DepattmeF�,ltft o611� w x r a S, City of Northampton StatpofPermtttix B (j inrn n,-nartmPnt irl 17nicaur ij 212 Main Street s& FSeptA� ial R om 100 U ater�elt EE u1466„pE+h..- qq Northampton, MA 01060 Toets o�StruraPt>�~ � 77 7 phone 411-587-1240 Fax 413-587-1272 i ite i?Ian M1 �` Qther�pec:� APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION`1.-SITE"INFORMATION This section do be completed by office 1.1 Property Address , Lot UnEt (or e{'!ce. MA IV/ Overlay 1]tstnct CBaDistrict SECTION 2-PROPERTY OWNERSHIPfAUTHORIZED AGENT 2.1 Owner of Record: JCL' MA NY, A 3r Nz��uL S . F1oreE�c , olvh� Name(Print) Current Mailing Address: 13 Telephone Signature 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 completed by ermit applicant 1. Building n (a)Building Permit Fee f'50,0 d 2. Electrical rJ- (b).Estimated Totai Cost of Construction from. 6 3. Plumbing �„ ,mil Building Permit Fee 4. Mechanical(HVAC) lJ�� 5. Fire Protection 6. Total=(1 +2+3+4+5) S 0*0 Check Number G This Section<For Official Use Only Date Building Permit Number., Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2007-0402 APPLICANT/CONTACT PERSON COX SARA ADDRESS/PHONE 31 HAROLD ST FLORENCE (413)585-1572 Q PROPERTY LOCATION 31 HAROLD ST MAP 12C PARCEL 068 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid of Buildinp,Permit Filled out Fee Paid Typeof Construction: INSTALL SLIDING DOORI&SIDING _ New Construction Non Structural interior renovations Addition to Existing Accessory Structure BuildinjZ Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INfOfiMATION PRESENTED: pproved 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 Co on Signature of Bui ding 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. 4 31 HAROLD ST BP-2007-0402 GIS#: , COMMONWEALTH OF MASSACHUSETTS Map:Block: 12C-068 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-2007-0402 Project# JS-2007-000590 Est. Cost: $2500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 12196.80 Owner: COX SARA Zoning: URA Applicant: COX SARA AT: 31 HAROLD ST Applicant Address: Phone: Insurance: 31 413 585--t5-72-0,-______ LORE NCEMA01062 ISSUED ON.1011112006 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL SLIDING DOOR, DOOR , REPLACEMENT WINDOWS & SIDINGS Q'6N0) j<iT('N6^J 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 10/11/2006 0:00:00 $50.003087 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo