17B-018 (2) o�'Stil+MAlO
Crzttr cif Xarthaillptan
$ � j�assscl}usrYYs (� `,
\ DEPARTMENT OF BUILDING INSPECTIONS /
INSPECTOR '212 Main Street • Municipal Building
Northampton,MA 01060 s`
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as 1 is/her construction supe�r,, Sor. Tlie state defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be,a dne or"two fame y
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 buil ing 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 backfiIl).
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 occupancv
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
7
I, v, ,�;1 ) ,'�t� i,:E K- understand the above.
(Home owner/resident's signature equesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued-tome. _
Date
T
Address of work
location - r ill . ' x
)LO Iz
r
, / i
` r
e (riff of �c�-flt�lll}�tol�
Q � € ��z�axrtinsrlle' _
a DEPARTMENT OP DUILDr,,'G INSPPCTioll's
212 Tfain Strcct ' TTunicipal Build;n9
Horthampton, ATass. 01060
NVORICER'S CONEPENSA77O.N ?FFTJ ? A> ,-J7'
(Ii ccnsxlperml tics)
a principal place of business residence at: -
-1 / I N(v _�1_ h1e,I'—I MK/ Q 0110 (.p`hoer') -1 13
(s=t/ci ty lstatcfa p)
do hereby cezifj under dic.pains and penalties of perjury, _hat --
I —
{ O I aI7] an employer providing the following!w orker's cornocnsado, cove age for II))'
emplovecs Nvorlong on tills job:
i (I-sur- .) lPeLe. .
i
( ) I am a sole proprictor, general contraet:or or homeow-Der (ccie one) and have hired
the coauaCors lined below Wbo hzve the follotvinQ worker's comoen–soon pokiest
1
0";amc O" COnt^cior) (Instr3nc.; COIilpanl ./Pobci (r':)Injuon Datc)
(Name of Concaaor) (Instvanc:. Compam-17000 \Umb-zr) (-D:D m6on Due)
I (Name of coanMCIOr) (LnSIU-aQ CoMT=)-/PoU-cy N-.Imbs) (Exaimdon Date)
(Name of Contractor) (Insurance ComDaay/Poli_cy Numb-r) (Expilmlon Darr).
(aIISGjl�,�.1:'Odd s�cC.ir a<OC=st^t-Lo i�cju&inform loc P=%Xlnin;b..It WC:t-Cd'1)
I ( ) I.am_a sale pFopnetor and have no one working for me.
I amt.-a home owner perforr=,, all the work myself.
NOTE:plcsc be aorzrc Eb=bijc hcm=,-,,=wto cazPlcy pcsom to d:).-, cs:.cjoc c rc ac work on i d-11_F of
not ttwce tt a i4o t�rx in inch the o,oo the avtn6 zpptttea:_n theca Lz ox to be
1 eiiploycs oa :the..v.-k; - Aa(GU152=1(5)�:,PU=Soo by a homrnaae fc-_lir`=cc P=mn=y n idler the
ICg rts,.:uc of=¢ployer under dso Worke(a Comp.CMA ioa Aat- '
! [t:ade-st>tad tha>Dopy of tbi.mteoysa orsay be for—,ded to the Dcq.rtmaoc of lnduxsic!Acodeco'Ofs-or L_+r for ti.
oov=a -Mc=ioo and the LjLrr to&=M-r)eovam,6�tmdc soe oc 25A of I.SoL 151=lc-d to the imposi6o=of criminal Pcc-lW=
masiSi2g
*I&f=ortrp to S 1300.00■ridfor 6=;rj3o�orup to ooc y,e.od c%il Pm.I-ua is t5,fo at of.Slop work Ord- and
fun of s 100.0o:e--y a It ttx `
iFar 6c�rtm=.�1 u,c only
- 7 J Pcrmit Numtxs
2 1- D6 -- Lot
;rSi�aauur o ia�sa-JPcrtniu� __ .�
SECTION 8-CONSTRUCTION SERVICES +
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9:lteserecornein a ev menfganfcEo- .Y = Not Applicable ❑
Company Name Registration R—fir um a --`- --—
Address Expiration Date
Telephone
SECTION 10 WORKERS'COMPENSATION INSURANCE'AFF1DAViT(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...... ❑
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 buildine 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 ivlassac;uses 0=1-1--al La ws A notated,you rrmav he liable for persons)
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
i
4
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all ayolicable)
New House ❑ Addition ❑.,;: Replacement Windows Alteration(s) Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[a] Other[C7]
Wk'oerfDescription of Proposed G i!a fi L. f l i e W
Alteration of existing bedroom Yes_ No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes -y No
Plans Attached Roll -Sheet
�;�- -: —mom-
sab{€ ev �aorrse ., -oina, W661 ex s inc 6RI—na-.pcorrrpte��the I6W71iid
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 AUTHORIZATION-TO:BE.COMPLETED WHEN
OWNERS AGENT ORCONTRACTOR APPLIES FOR BUILDINGtPERMIT
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
I, J c r}N �' ��t��4 _ 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
Z4, d_
ature of Owner/Age Date
'
�
Section 4. ZONING Al I 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
Rear
Building Height
Bldg. Square Footage
Open Space Footage %
(Lot area minus bidg&paved
� .
#of Parking Spaces
(volume�&Location)
�
`
`
!
A. Has a| Perm it/Vuriunca/Fndi ever been �suedfor/on the she?
' �~� x�� �
x� �� D�TK�W �� YES ��
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Y ES
IF YES: enter Book Page, and/or Document#
B. Does the site contain a brook, body of water orwet|onds x��� NO �~� DON7KNOVV YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
~
Needs to be obtained v�~\ Qbtmined [ssmed'
�~� Oatm
t~� \�� ' '
C. Do any signs exist on the property ��� YES ��� NO
|F 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:
E Will the construction activity disturb grading,excavation,or filling)over 1acre or is it part ofo common plan
that will disturb over 1acre? YES K 3 NO
`~�
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Depa tment'use only
City of Northampton
Building Department
212 Main Street
✓fir, Room 100 u
h n > Northampton;'MA 01060 e Maras
phone 41,3-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,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
Unt#
�Vlarrt '1 jz�p � C I Zone overtayDistrct
. a t
fz`EImS�`D�stnct #' _. x" ,CBT�stnct - .
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT,
2.1 Owner of Record:
S c v 11"" l�t b , - � ,� FI n/wfi s�-jjz,-e.E-j
Name(Print) Current Mailing Address:
'%!g^` SOLI - l3 `l
Telephone
ignature
2.2 Authorized Accent:
q �
�4/ :1�' I'�'f'J�'�
Name(Print) Current Mailing Address:
X13 S71l- 3 �
ignature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS-`
Item Estimated Cost(Dollars)to be Official Use Only
com feted by ermit applicant
1. Building , 00& (a)Building Permit Fee s d,,,/g�00�
2. Electrical (b)-Estimated Total Cost of r SOD'
Construction from 6 r )
3. Plumbing Building Permit Fee _
'7 �- s
4. mechanical(i-i'vA%) J 5-w
5.Fire Protection /
6. Total=(1 +2+3+4+5) °t)L) Check Number
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
i
Building Commissionedlnspectorof Buildings Date
File#BP-2006-0749
APPLICANT/CONTACT PERSON BIDDLE JOHN SCOTT JR
ADDRESS/PHONE 19 FINN ST NORTHAMPTON (413)584-1379 Q
PROPERTY LOCATION 435 BRIDGE RD
MAP 17B PARCEL 018 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REMODEL KITCHEN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure -
Building Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF99MATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Pemlit 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 Stre ommission
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.
435 BRIDGE RD BP-2006-0749
GIS#: COMMONWEALTH OF MASSACHUSETTS
Man:Block: 17B-018 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0749
Project# JS-2006-1148
Est. Cost: $14500.00
Fee: $72.50 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group_ Homeowner as Contractor
Lot Size(sa.ft.): 9191.16 Owner: BIDDLE JOHN SCOTT JR
Zoning:URB Applicant: BIDDLE JOHN SCOTT JR
Applicant Address: Phone: Insurance:
19 FINN ST (413) 584-137O
NORTHAMPTONMA01060 612006
0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL 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: 6A-
THIS PERMIT MAY BE REVOKED BY THE C TY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULA ONS.
�y l
Certificate of Occu anc Si nature:
FeeType: Date Paid: Amount:
Building 1/26/2006 0:00:00 $72.50
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Conunissioner- Anthony Patillo