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02-023 (6)
4'THAI'1p�. of Xort4amptan Z $ � �lassachnsctts - s DEPARTMENT OF BUILDING INSPECTIONS /= 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 h%is/her construction sups :':sor. The stale 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 I, 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 Address of work location ' �. fib 'S• -.. Gl dhl of 6 ��ISS ftCl�it6[}i7 - DLPARTMEN1T OI' BiALDD? G INSPECTIONS 212 Alain Street ' Municipal Building Northampton, Mass. 01060 NVOI'~_TCETS COMPENSATION MSURANCE AFFFU)AVI.T Nvith a principal place of buslesdresidence a r do hereby cer ly, un er do pans ,!nd pen<itic; of pc:jllry, t ]at_ an employer providinS the iollo',v]nL' '.'.orlt_c!t colI pciisaUon covc,-a. e [or In ' employees wor�dng on MIS job: (InsiranG Corspam) clic;Nu ntxr ---- (rte ir.:ion Daie) l j I azz a sole propnF tor; renPrii c-on-i-ac`o; c- nocneo,,vDer ;c cle one) and 'tia,,-e 'tired the contractors listed Now who how the toll ;,'orkers compen-sa-taon -olic�ts: cName of Contractor) ftnsa-ncc Corrna-;,;Pc1.ic� Nt 7nlYr) �>. :atioa Date) (Dame of Contncto-) (lasur_nu Carp--i,ItivPo!ic; Ntn r) (1 •.aiin�Date) Warne of Consamor) (Incur Ilce C:,m-2nti'ii'ol;c; itinn�t._r) x,. r::zi o Date) - (Name of Contractor) —- Jns-umi e Coln-ry yll)olicy Numb,:-r) (I:,:ni-:iioz Date) I illll it ;;01(; ?rapnt;iJC itill l]'I -,r1,:.•,, 1 k c �., Il0 OI.., .i'�,..,!!!`� fOr TnE;. I am a home I11Iilg 11 i!i No'n'.:plcasc tic aw:uc ttlst. lc tf<rco 5 rn.+r:)c:., nT xnn MUM- -'�1 , .• •:n >:_.:::!c�inc�ar:__r•.:��m Cr cr:cp.u� ,.._,^: _L• not crxre th_a throo uniu a"on to"n""W ralz W a;'' �;;:s rte•r:n ri Lhcc o a c cr_{ccrrally c._-C::i::_:: :c t- cm Io uti!,cr the tvoci;�_ar r- p Y� _ .:m �r:(GL!S2�c!(Si;,a,:, ._a:�ca i,y a hotaro«->cr;or a Gcc_,c a 1cga1 AMS of nn omphya<unu' tLn Wcvi c s Com-r' ation Aci 1 undcritiad Ihi:a copy of t}v ctatc:sl c:ay bo fax nrciod to[ir>IYtxi t�xni of ir>ds #TiJ ArcvL�tf Ci-]o of:: Irc :o for t1>o -vcr &-c va-if catim and that •ilur-c to za;.::c covrragc 25A of?.1GL,152 can Ic-d to the impasition o;c'�i:_l pet:al;:cs ctixiiNIgofa fin ofuptoSl•S0'J.00h.: Joti-pr, r.�ti:_of::pt)Or.' � .i civil pCM1tiainticfcnnofaS!c,`;' i.CY z:-,d tx of,'100.00 1 day 1g.-.in:t ta.. / - { For-dcj:utn' I'd J r, only i w C'_. - F SECT�ONB CrjNSTRUGTION!SERVICES 8.1 Licensed Construction S ervisor: Not Applicable ❑ Name of License Holder ice Nurrl er Address ExpAdfion Date K7 Signature Telephone e ere .n:me ,m r: Y.ernen :Con rac.o Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTIONIO WORKERS' COMPENSAl. 11MRA NCE-AFFIDAVIT(M G.L.-c. Y52, § 25C(6)) _• _�. , o 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...... ❑ RM 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"homeo-vvner" shall submit to the Building Official,on a form acecptable to the Building Official,that he/she sha11 be responsible for all such work performed under the buildine permit As acting Construction Supervisor your presence on thejob 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 I ' I SfCTON `E`a . 1 ©NtDFROPOSEDaWORK2(cNecic aatapplacable) � - New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: -� Alteration of existing bedroom Yes N Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0• Sheet 0 aa. ou x�d�� = �r ron to�ezist"rng�h.ot��ing, corn"pae� �ie�'llowing: 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. 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 regulati.ons? Yes No . I. Septic Tank City Sewer Private well City water Supply ZL r SEC� � WNER >9TtIORIZATION TO BE COMPLETED WHEN OWNfRS EN ONTRACTOR�APPLIES FOR BUILDING PERMIT Z x � . . as Owner of the subject property hereby authorize to act ot my behalf, in all mattes elative to wor authorized by this Building permit application. y� Signature of Owner Date I. as Owner/.Authorized Agent hereby d are that the statements and information on the foregoing application are true and accurate, to the best of my knowledg and belief. Signed under the pains and penalties of perjury. Print' am - gna ur of Owner/Agent Date A 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 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 6� 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 ti^ 1 "C [,` 7, it P),�li pi partment _L' -11-2, treet I Roo 100 / CC1 i (�N¢ tampt MA 01060 phone 413.587-1240 Fax 413.587-1272 AkRUCAT J�D I :0 nti, a � r;r- �b-N--rr�'-1�L11G-T;,AL--TJER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: —FU Thissec#ao `ttsbe � mpJet' d=byffi h a 3x Zone ,EImtSt =DistricE' � '� CBisTr c �= SECTION,2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Na e( rint) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Nal rint) _ Current Mailing Address: Sign a e Telephone SECT N3 ESTIMATEID CONSTRUCTION "'COSTS Item Estimated Cost (Dollars) to be Official Use'Only' c,puipleted by ermit applicant 1. Building a OBuilding Permit Fee 2. Ele c-:rical (b) _:stimated Total Cost of Construction-from 5 3. Plumbing Building Permit Fee 4. Mechanical (NVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 + 4 + 5) Check (\umber This Section For Official Use Only Building Permit N. umber: Date Issued: t Building Commissioner/inspector of'Buildings Date T NolteS RDl BP-2004-0425 G1S#: COMMONWEALTH OF MASSACHUSETTS mock:02 023 CITY OF NORTHAMPTON Lot: -001 Permit: Building Cate og ry: BUILDING PERMIT Permit# BP-2004-0425 Project# JS-2004-0612 Est. Cost: $3000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group James Roberts 117154 Lot Size(sg. ft.): 81282.96 Owner: FRECCERO YVONNE Zoning RR Applicant: James Roberts AT. 602 NORTH FARMS RD Applicant Address: Phone: Insurance: 30 Edwards Rd (413) 527-6078 WESTHAMPTONMA01027 ISSUED ON:10114103 0:00:00 TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE 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• Receipt No: Date Paid: Check No: Amount: Building 10/14/03 0:00:00 2331 $25.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo