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17C-037 (2) •-� 10 en ZYM i 4�t1AMp�, O O of Paz#l�tti�iatt L r �l AS5ACh1I8ttf4 DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as has/her construction supc :i 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 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 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 1, t- - - (' Qnderstand 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 In / S j Address of work location 1 3 /� mr,12 F/c) r2l�10 0 -- O b y �{ � �1-zft�r .�}f �ittz-ff��•tltt}tfnit - �. g6 ��asaacflnscf(s• s m 1>EPAt2TMtN'T 01' LUILDD? G INSPECTIONS 212 Af ain Street Municipal Building Northampton, Mass. 01060 ' WORKS,R'S COMTENSATION INSURANCE A- FMAVI.T ith a principal place of bus, ess/re:7 denc (strc:u� do hereby CCrtll}'; lln:1' 1" tI1C' h !r1S ?.il 1)Ci]<i�l��;i 01 �Cr�ll�� flli!i- O I am an colnnensation coves e `or my cmployces worlccing on t?lis job: (]SIS'7S2 1G Cotnpam`) (?c V u- e uon Datc) j I a_ci a sole proprietor, gelnera± c-sntTac`or o- hOMC01 DC- (C' One) and iurec t.h:; contTactors listed bei0w:i'h0 ill° `Old ii? v;Orke-'s Comunscp (Name of(ConU3ctor) (1RSL 3n CC 1�GItt^ {-�G11C{ T1llST)Y;� i� ?'; . .:iGi: D<'aC)- (Name of Contmc,,or) -- c7}lsrrnce Con?n :I`/Pe!ie, Ntrnber) (I ? ^tiny o2.te) (frame of Contractor) c-,' - (Name of Contractor) —- (IDs,,=e:. Com-``iy/Policy Number) (I;:r;i :tiG- Date) �r.Ill GG1-l.d'{li)M1I f:.�C1:..._-_ :n..�_.�.._ ....'Y:'.t...n. ,- ._._ ..:...�..,..,•l ] mil a sole propn(nou i1Il'1 }nvu, 110 011,3 Ol��iil�� f0i ?I? I ill 110i11e U1�;?1C'" iiCiYC II?lI1^ - ll 7 NO-IE::plcnsc t=atira;c it:s:•.tit iIc lrc<;�o•»r_ts���o r.;,�l�y 1�^-,:::n:S�;�i_:!,�ntc,ci.�_r.:��m cr:r,:ait.� •....._ ..�c11i:::,�. not:ztcYe th n iltroo uni f ir.tc{ ct he l; i� .izrr r a:;'-,or a; rS «xr for z Gcc c ct c�?ployes u--ti'.cc t}r_tvcrlxt's ar:;:-�:elim Pr.(GL!50� l(51;,n,:,•':r:ic:::,y a hotaro Icgal ftatus of an o=plo)w uude tLn Wcvicclf Ccn a Ation/-ct- I undo.-rte d ths!a cry of th:.rtnt—i—t-: y bo foix•nrcio-;l to tbo Ivlinrtncc�t of Ir>dzss:riel M-�l,,�t�'L:'iao of i:::._.r,?:c for tfx covcragc vaificalioc and that f-ilurc to ul--k._c,:'.icn 25A of MG1.152 can lc--d to the unposition of cr i._1 pc alr:cs oomisting of a ftrr_of up to S 1-500.00 nrtl'or i^:;trier.zti: of::p to cn.)' r.:.j evil psmltin in d4 fc11-111 cf,n S!r: nY-��-_:-A Lr> o[Si01D.W a dsy µpr t oc&r-1t1`j use cnt}• ''I • Jtt;llaturt: c>f;.ic�a��rJPernr;arc .;'r , t _..... ! r SCTONwB CONSTRUCTIQN SERVICES 8.1 Licensed Construction Supervisor: Not Applicable Name of License Holder : License Number Address Expiration Date Signature Telephone Reg sic a om ma ouem'ent,Vg"ntra�tn Not Applicable ❑ _v ,-vlc Ij Crz 4 mss' ompany Name Registration Number Address Expiration Date Telephone iw SEC ION41 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...... ❑ NIMBI : �n 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 Loc Zoning Laws and State of Massachusetts General Laws Annotated. i Homeowner Signatures ` V� � I « i i SEL�TO Sr TTN�FPROP05ED-,WORK check a'1f a lica�ble, k , s...'.."M + New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other Brief Description of Proposed Work: 1�nS6 '4 cgk N604i- ".Ji ;j (-u is rb� Alteration of existing bedroom Yes—Z�No Adding new bedroom Yes No Attached Narrative D Renovating unfinished basement Yes No Plans Attached Roll O- Sheet 0 a o a itro "o� ze ansti—g fous-n°" g com��e a fie f"ollowrng a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: 9 — Number of Bathrooms �- c. Is there a garage attached? N 6 d. Proposed Square footage of new construction. Iy i� bimensions - e. Number of stories? '- f. Method of heating? CkL' Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck 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 Nc 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 'r S7=GT© f ERA W."TIORIZATION TO BE COMPLETED Effli OWSAEN tJ CONTRACTOR"APPLIES°FOR BUILDING PERMIT . ...,ate as Owner of the subject property hereby authorize to act. or 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. Si bed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date �. Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing ProP9sed Required by Zoning This column to be filled in by t I Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (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 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 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: City of Northampton 4 Building Department 212 Main Street Room 100 Northampton, MA 01060 3f phone, 413.587-1240 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 sect�,o -�o' b om°ete`"il�i5yoffacea�� � �� � , >ff EI%�StZ&Nstnct a CB Dis r Wt_.';;_ SECTION.2- PROPERTY"OWNERSHIP,/AUTHORIZED AGENT 2.1 Owner of Record: 1 ov,D—r Lkj�4r Name(Print) Current Mailin Address:, --� Telephone Signs ure 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION`S:-ESTIMATED CONSTRUCTION CO'ST'S Item Estimated Cost (Dollars) to be Official Use'Only completed by ermit applicant 1. Building C(✓khl i1- I(�h)'W t(� (a) Building Permit Fee 2. Elec rica! (b) Estimated Total-Cost of Construction,from 5 3, Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4 + 5) o6 0 ,. (5b, Check Number This Section For Official Use On Building Permit Number: APO Date Issued: Ili nature: Building Commissioner/Inspector of Buildings Date A File#BP-2004-0580 APPLICANT/CONTACT PERSON BROWN WILLIAM&HEATHER DRUCKER ADDRESS/PHONE 113 NORTH MAPLE ST (413)582-1334 Q PROPERTY LOCATION 113 NORTH MAPLE ST MAP 17C PARCEL 037 001 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: INSTALL KITCHEN CABINETS,COUNTERS&CENTER ISLAND 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 FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 Co ssion Ilda 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. A-W- RTH MAPLE ST' BP-2004-0580 GIS#: COMMONWEALTH OF MASSACHUSETTS _': CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:renovation BUILDING PERMIT Permit# BP-2004-0580 Project# IS-2004-0811 Est. Cost: $10000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 19471.32 Owner: BROWN WILLIAM&HEATHER DRUCKER Zoning.URB Applicant: BROWN WILLIAM & HEATHER DRUCKER AT. 113 NORTH MAPLE ST Applicant Address: Phone: Insurance: 113 NORTH MAPLE ST (413) 582-1334 () NORTHAMPTON MAO 1060 ISSUED ON:11 110103 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL KITCHEN CABIN ETS,COUNTERS &CENTER ISLAND 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 11/10/03 0:00:00 1008 $50.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo