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17C-070 (8) `$ Critic of Xartllamptaii ,b Massacl Its CHI DEPARTMENT OF BUILDING INSPECTIONS � INSPECTOR 212 Main Street 0 Municipal Building Northampton, MA 01000 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as i,:Is/her construction Sul,; Thc, state defines "lionieowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or hvo 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 c I, understand the about. (Dome owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to m . Date l� Address of work 1 ff location j � - Mv)\ - s �ttinarPT �r�L My o C\'tu"�1�21111�J�t111 1 =���� Iii:i'Ait1'M i"r'i' O° iiillll)1? G INSPl:i_`1'iC>1:J � -1�T-i� �! 212 Alain Street Alunicil>nl I3uIl<llnr' North.a nlOw, Mass. 010(h) W 01--l"C CONI-PENSiV.1,10N 1NSi1R?1NCI% - FFID,�VI'I' with 2 prolcipal PVC of at Cho Why CC:wn I! : 'U . Aw pips '.iiu pnAlaws dflypily, Q: :.. 1 3rl an enlp1oy_, providoF il:. :t)IIC. 7: cnlllloyccs v olkill,, oil jla": Orunnc, Com z 1 r . .,Itr2r) 1 aln cl Sole IJrO AC_ol, IUD=A Cail'.r-Clo: i an-,covrric, (c,..c:C oI1C) iin(i hot RA the contractors Red bNow , S havo the 1014 " wilds cypocnSWInn TCOW: (rinrue of Cantnctor) -- -- (Name Of( J➢ <C : -.. , . � ., _.:__. . .) '� Tame of Conawctol) ON3IIlC', Of Cont11Ci0C) I!ILSI:I2I1C:. CO!ll.,. �};�hC11.GZ' ��IIIIl�•�;� �t...i .....il.. I�di�� (^fi zcll�.<�±�Ci�cul z�v�t.1 rr. -.n:':•.... .. _ _... �.,::.-,�. - .:.�.c, t. r.is .._, 1 mil <I SOIC nrA atctc tIL❑tltrca uritt i:;u{ic'_t Lew-1-.�:-:xo•.�z,cr r^:�;�c.u,..0�.v_..ii z uttc,_r1 Lxcc r.:c tr_-t t;cr:r:J!y c.....,_.....�... API ctznu of an Mploym under 0.LV<vWA WY-aiion Aa- c.-a I undtnnd that a copy of t}va c1a!r.::cr_.r.:aV tw fati.i 1,3 to 0'-IYSMrt--i of Indrurrinl A—ir,!"Oft!—o:�:�:�:r a.>o for U- 2 5A of MCI,152 can Iced to tlh impo5ifioo Of C,Dg1i1ting of a firx_of up t 1.5�.(uJ nar'(Y c::;:rivrcr;.-:1 of up to eai civil peuultia in ti,f<x:n of n Slog Ati'o+ fh::nr,d s f rx of S (�.p0 n c ain�1 cn-- i �r Fcr ck;;a Lrr�tal urn only I I� Pcrtni! 1lu:ntr I SECTION 8 -,CONSTRUCT,ION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder - License Number Address Expiration Date Signature Telephone g A s �� �, fa�� NotA Applicable El Re istere �°Home�;�lm'rovement=Contractor ,,. �,$„ �t , .. ,,,_ ,__.,� �. PP Company Name Registration Number Address Expiration Date Telephone SECTION 10-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...... ❑ %mss n •:s 11.x. . r .ome ®.wnerEgemp�ion' 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 f(; 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 chusetts General Laws Annotated, you may be liable for persen(s) you hire to perform work for you under this p pit. The undersigned "homeowner" c rtifies a ar ssumes respon ibility for compliance with the State Building Code,City of Northampton Ordinances=Statea a _oning Laws an State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5 DESCRIPTIONI�OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ DemolitionV New Signs [ ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: ' vV., 1 ���� ` �C� 1(fi►L V _a, 15� Alteration of existing bedroom Y No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ 6a. IFN6W�i ou hia' lldWh : 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 _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 OR-CONTRACTOR APPLIES FOR BUILDING PERMIT 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 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 th p ins 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 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 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 t�S�fPerrntt Building Department Q01rb Cut/D-ve- a e 212Main Street Se er�%S ptIc Room 100 Wae W—111�v-a b i't y t:. �� P - ' 1orthampton, MA 01060 Two,Sets oITStr. c ura! ans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plas Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Pro ert Address: This section.to be-completed by office, } C'I�sS Div SA Map 7© Unit 1 `~ Zone Overla District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: J, nC Name(Print Current Mailin dq 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 permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) .- timated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) S. Fire Protection _ 6. Total = (1 + 2 + 3 + 4 + 5) EChe:ck:Nlumber ff3 This Section For Official Use Only Building Permit Number:�I�DD3"�2� Date Issued: Signature: _ Building Commissioner/Inspector of Buildings Date t } File#BP-2003-0876 APPLICANT/CONTACT PERSON LANDY DAVID P ADDRESS/PHONE 26 FAIRFIELD AVE (413)268-3800 Q PROPERTY LOCATION 97 CHESTNUT ST MAP 17C PARCEL 070 001 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 M d Typeof Construction: DEMO GARAGE&PORCHES 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 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 Commission x, 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. t c �- -,CHZ3T IJT 5T BP-2003-0876 GIS#: COMMONWEALTH OF MASSACHUSETTS :I31ock: 17C-01b CITY OF NORTHAMPTON Lot: -001 Permit: BUiidinQ Category: demolition BUILDING PERMIT Permit# BP-2003-0876 Project# JS-2003-1417 Est. Cost: Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sg. ft.): 18905.04 Owner: LANDY DAVID P Zoning:URB Applicant: LANDY DAVID P AT: 97 CHESTNUT ST Applicant Address: Phone: Insurance: 26 FAIRFIELD AVE (413) 268-3800 O HAYDENVILLEMA01039 ISSUED ON:4125103 0:00:00 TO PERFORM THE FOLLOWING WORK.-DEMO GARAGE & PORCHES 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 Not Date Paid: Check No: Amount: Building 4/25/03 0:00:00 4830 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo