Loading...
17C-128 Gif—p of Xart4auiptan �8'JI ACttliSttf� - DEPARTMENT OF BUILDIAjG INSPECTIONS INSPECTOR 212 Main Street • Municipal Building '>o Northampton,MA 01060 s I 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 hour), 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 ��✓inM>>TO ��_ $ 6 fi�cssttcfinsctts -of �Narfljulllpf Lill m L)EPAt21?iEt�rr OF LUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 ` w0mCL;R'S COMTI NSATION INSURANCE: AA +F AVIT %vith a principal placc of busiress/r siaence -- — -(phone ----- - ----zi Cj0 11CrCU}' CCrt1I}', lli]Clci Till' l) i pC 7C:rJt11�7, mti n . I am an employer proviclin, the foliov.;im-- •,':oit:cl-'s coinpcns.'.Llon [or my Ca2ployces working on this job: (Insuana Coopam') (P Number) --- (F�piraon Date) j I am a sole prourietor, gerie-ral con�=-,-or homeow-ocr (CL'�cle one) and '"lave hirt;d the, contractors listed beiov ;v"n In-, flit doll :il: ,:;oFkers coL-pen.a -on p-!*- s: (I:t1ZllC Of CnnISlCtGr) �nS'=i3.'.cc C011,^.-!'Policy T umb--i) T? Ci: D2tC) (Name of Contnctor) -- (111 1mmcc Co M=L--v/Po!Ic— NI=br_r) (1 ?:�iratio Date} (Name of Contractor) CnmrIIIY/'ohc: NujnL'�r) =.x;.:r co Date) - (Name of Coatncior) --- (Ilzs ratict ue.- Dare) �..^.IL.IGl:.CL'�I:1 CY:�I S':.-G{:..._ _.. .. .�..�..:'Y:':1-:e['1-...._.... � eli'_:.._.--......•,� c ) I uli a :,ole propne )r til:i have nc) ollc ,.,,r n ' for mt. �l!)'� `'i,l l]o?I?C C�4'?1Cr 'tiCi-:C'I??lI'•" 11l i_.,, '�'.. ..; iiiYf.rlf. NOIT:please be tha:'wL;jc e:_:ploy 1>.^-: to:'.) m Cr not mccc thn[hroo UZI?I in N'i-idl he l:::.�.uzr rca: �u a;'` �.•_...3 z 'r<r r1 Lhcdc a c n.t ccrs--rally ox! :o ti -+'{7la}'=-3 UCk'It LlY ll'CC�:&:CC:'1:•�:�::fit]AC.((j .�:.::;-'.:7C:i by S l:pt:lCO tt'nf1 for L 1;CC1:C C<1?:I T!::::'. . ]cgal etxtuc of an a�loyer under ivy Wer�cic l:az.;a-✓align!.cL 1 undo,-nand that a cc py of Lh�uatci-^•a:ay bo fo wnr iod to cbn L}txi tZ of k dv -riJ cffl� of!: o for 11x oovcmge vaifiealioa and that failtuc a f A of M01,152 can lead to the impoSifian = pct al comisting of It Cur_of up to S 1.300.00 n:r--1'er of::p to or.:}- e:.i civil xnzltia in d�Irnn of n S!c ';Jc r.Ch;=an a fins of SlM.0t1 a diy tgaina m.. .- Fcrt'x�%uunatal u�c«ily { umtr.:r Sign tore of i.icc' cJl'crntt, T - � I ` l it x SECF�ON8 CONSTRUCTION SERVICES 8 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone Reg sfere ffl rn mn ovemen , ontra¢to Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECT10N70 1NMk'ERS' COMPENSATION INSU'RANCE;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...... ❑ F The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)firm ies 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,,vner"shall submit to the Building Official,on a form acecptable 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 fer which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 15') (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 J,� f `'�X/Z ♦ y =BCE T�0�- °EyS #t ,� 01�IORROPOSED�'WORK ch ck�ll�� I�ca'�b7e � ����' New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Dem li io ❑ New Signs [ ] Decks [ ) Siding[ ] Other . -_' �. Brief Description of Pr osed Work: ��btn I 1 Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes ✓No Attached Narrative 0 Renovating unfinished basement Yes ✓ No Plans Attached Roll 0 •Sheet 0 6a . w, o se� tad o-r di't`ion to ez:istin housin"" com e. .e fiol=F,owm: a. Use of building: One Family '2 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 S fT10 1fliNER A��HORIZATION TO BE COMPLETED WHEN QWNEF{S0 CONTTR`ACTORAPPLIES FflR BUILDING PER�VIIT 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, Z_l as Owner/.Authorized Agent hereby declare that the statements Tom and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and pe^naltiie,s. of perjury. L ``S�'�-- .�� ✓�r�4 L C1 Print Name 2 /l d Signature of Owner/Agent Date I 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 I Frontage Setbacks Front Side L: R: L: R: 1 Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) i #of Parking Spaces i Fill: (volume&Location) I 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 DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained_ , Date Issueed: C. Do any signs exist on the property? YES NO v IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property?YES_ No:Z - IF YES, describe size, type and location: City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 r APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION This sect�otryto be compietec�by office 1.1 Properly Address: " � �� ;g- L � � 4o- ya � `sµ It /19 Ma e. S 4 RWR tau33 r.�7'' SECTION 2=P.ROPERTY-0INNERSHIP/AUTHORIZED:AGENT 2.1 Owner of Record: y/ 1�� )�'yA 0/0I.S.Name(Print) Current Mailing Address. �,,,. Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION-3-fSTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be cial-Use Only completed by ermit applicant 1. Building (a)_B�ldJirig Permit Fee 2. Electrical (.b)Estimated Total Cost of Construction,from 6 3. Plumbing Building,Permit`Fee. 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (I + 2 + 3+4+ 5) -Check Number This Section°.For Officiaf.Use Only Building Permit Number: Date Issued: Signature: Date Building Commissioner/Inspector of Buildings A w 55 NORTH MAPLE ST BP-2004-0687 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C- 128 CITY OF NORTHAMPTON Lot: -001 Permit: Building Cate ory: BUILDING PERMIT Permit# BP-2004-0687 Project# JS-2004-0981 Est.Cost: $1000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 11238.48 Owner: MELNICK LISA Zoning:URB Applicant: MELNICK LISA AT. 55 NORTH MAPLE ST Applicant Address: Phone: Insurance: 55 NORTH MAPLE ST () 584-8652 (� FLORENCEMA01062 ISSUED ON:12111103 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL METAL CHIMNEY 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 12/11/03 0:00:00 659 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 55 NORTH MAPLE ST BP-2004-0687 GIS#: COMMONWEALTH OF MASSACHUSETTS Map-Block: 17C- 128 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0687 Project# JS-2004-0981 Est.Cost: $1000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size so.-t. 11238.4$ Owner: MELNICK LISA Zoning:URB Applicant: MELNICK LISA AT.• 55 NORTH MAPLE ST Applicant Address: Phone: Insurance: 55 NORTH MAPLE ST O 584-8652 (� FLORENCEMA01062 ISSUED ON.•12111/03 0.00.00 TO PERFORM THE FOLLOWING WORK:INSfALL METAL CHIMNEY 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: 01: insulation: Final: Smoke: Final: jff r S2-!© —4Lei THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA OF ANY OF ITS RULES AND REGULATIONS Certificate of Occu an Signature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 12/11/03 0:00:00 659 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo