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CDT Construction SOLE PLATE IzoUGN OPENING
158 North Maple St.
Florence, MA 01062
. ` O��►1AMp�O
Cri#y of Nartlja»ipton L =
M ass a chits tits
DEPARTMENT OF BUILDING INSPECTIONS `
INSPECTOR 212 Main Street • Municipal Building '�-
Northampt<m, MA 01060
Y
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as iris/her construction sup.::-„isor. The state defines "Homeowner” as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two fanxily
dfvelling, 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, 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
a a Eif) of NartEiaIlt} lon
g ? 6
�3t:saxcflnsclfa — .
EPAR7�11F_NT OF Lt1II1�11�G 1?JSPN.C1IOlJ.S
212 Main Street Municipal 13uiltlinf;
Northampton, Mass. 01060
W01ZKI R'S COMPENSATION INSURANCE AFFIDAVIT
I
(lic^hkcr}-r to Itec!
v"I'LlI a principal place. of btlEiliess/residence- at
f
do 11C'.rC_'i�' GCltlil', l7!!�.' lll" 1_1S ;Ii7cl pcnl,Itle. o!
c
elnplo��ec; w��r iu on this I,ob:
i
Qnsura�IC- co .1 t�nv) (pc'. . N�._..Itr r) (i �.r fon D2tc)
i
I IlI 1 d Sol (?rOUilGtOi en°,-fal contractor UC ho O'��P.eC icli'c;e jII
it1C GOIIti aCi01� IlSte D !0�'� v,—ho 11�av- the f01lovv1CS: '. 'OC:a'I S
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( `,Qnm.c of
(�.�:l..a :_ .'•CY it t - � _ _ -
l�l ILll 11 ;;olC ' IY)pl1�;tUi ..'1Q [121VC n0 OI1C '.'.'�; �;iiis: x01 i'r.0
,lay
not:IiC[-c t}nc Ll.rcc�:nip r;tv1:c�l'�x f :.,»•.v�,rr rcz:d.I c �cxl
a:ployr;a ca;cr t}r v�:5,'1' _�• t. n:',c:(CiL152.'s:(511,--[ -� -, -
1tpa1 ct.nlc of an«:q lo}'x un cr L`.o lL'cv�n'�(:uv;x:sutio Act
I und--ntuid dl.t a a�Iry oI t}::,t rtitarz:2 rsy bo(otzvw�{od to t.»fY;xi1 L:r<t:of II>.ir::n:1 Atc�.;.-nta'OIGc�of!:r;uri.�:._o fbr Llo
covc.Igc vcrific-Itioc and ih"t fnlurc to�nZtrc cUtr-ra�O under uc:icn 25A d MCI,152 can Iced to tfa:inljl—ial u(r,'�i.1 pccsl::cs
couaisting of a far_of up to S I.SOU. 0 n:r,'< i::Ivi nnx: oft-',,)to on'}- .r.j cdvil�K—Itics in 11"t,-n of ^.1
fr ofSl(T7.00 a dsv K;:urr.t In-. -
Pcrmtt TIunttr�.i
SECTION 8'=CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑ii
Name of License Holder
License Number
Addre sT Expiration Date
Signature Telephone
R`egtstered Home Im�ovementContractor. ;� P, ,,��,,, , a, 1 ,.�:...,__. . ; �r� Not Applicable El
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...... ❑
11. o e O�wneir: +M Emptin
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 wort: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 f6-which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
h.mployees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you rnay 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
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
------- ------
- — --- -- — ---
Brief Description of Proposed Work q� Vj N� _�Q_Cl � �1t Ad AA:
Alteration of existing bedroom ___-Yes No Adding new bedroom __ Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll f-t - Sheet II
sa. lf'Ndw hou"se and"or'addition to existing housing, complete the followin'g_
a. Use of building : One Family Two Family_ ._Other
b. Number of rooms in each farnily 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
OWNEr(S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby authorize to zc; o
my behalf, in all matters relative to work authnrized by th,s building permit app'iratirm
Si ture of Owner Date
t n I --
as C}ve iem/Authorized Agent
hereby declare that the statements an infor{nation on the foregoing application are true and accurate, to the best of nay
knowledge and belief.
Signed under the pains and penalties of perjury.
Prin ;fw Sign oner/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 idled 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&piwed
parking)
#of Parking Spaces
Fill:
volume&Location) _
A. Has aSpcial 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 hook Page _ and/or Document #
B. Does the site (.Jntafn a brook, body of water or wetlands? NO V _ DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained _J 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, desk ribe size, type and location: ___
— ------- --- ---- Y < , � D 'a'ft' on
City of Northampton Status-oj�rerrnitl.,
Building Department Curb Q'UVQrvewa
212 Main Street Sewer/,Septiq. allab
Room 100 Water/Wel A a ty ' .rear
Northampton, MA 01060 Two Sets 61`4S trt�cturatI P ar�taS.
phone 413-587-1240 Fax 413-587-1272 Plot/Slte Plans
�xx
Other
APPLICATION TO CONSTRUCT, ALTER, REPA kv A9 aAfl 0 OR TWO FAMILY DWELLING
JUL
SECTION 1 - SITE INFORMATION _
1.1 Property Address: pEPTOf BUILQINGINSFE" tion t be completed by office
NORT! �''�ON,MA 01060
"1 ap Lot U(0 Unit
Zon Overlay District
Elm St. District CB District —
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
—
0,5\ Y-Nk>Name(I'rmt) C rre Maihn Address f\Gv
v �� - �,IelE1>hr_uic
2.2 Authorized A ent;
an (Print) Current Mai!ir�p,Address:
SECTION 3 ESTIMATED CONSTRUCTION_COSTS
Item E-timated Cost (Dollars) to be Official Use Only
---- --- ---- -
- - - c ,rrpleter by permit aonlicant
l. Building Ir�' (a) Building Permit Fee
2. EIS cal qh) Total Cost of
— -- - (_'cnstruction from (6)
3. Plumbing Building Permit Fee
5. Fire Protection
r --
6. l otal - (1 i ? 1 `,) Check ( umber
This Section For Official Use Only _
Building Permit Number: � �� Date Issued: ---.—-----------
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2004-0067
APPLICANT/CONTACT PERSON CDT CONSTRUCTION
ADDRESS/PHONE 158 NORTH MAPLE ST (413)585-8677
PROPERTY LOCATION 137 NORTH MAPLE ST
MAP 17A PARCEL 206 001 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: RAISE ROOFLINE
New Construction
Non Structural interior renovations
Addition to Existing --
Accessory Structure
Building Plans Included•
Owner/Statement or License 003666
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFgRMATION 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
't
Signature Zrf"Offfilicia 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.
;� Nl4RII:E BP-2004-0067
GIS#: COMMONWEALTH OF MASSACHUSETTS
a";Blau; t'A CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0067
Project# JS-2004-0102
Est.Cost: $11600.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: CDT CONSTRUCTION 003666
Lot Size(sa.ft.): 23348.16 Owner: JASINSKI CHARLES E&LISA L
zoniniz:URB Applicant: CDT CONSTRUCTION
AT: 137 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
158 NORTH MAPLE ST (413) 585-8677 Workers
Compensation
FLORENCEMA01062 ISSUED ON:7118103 0:00:00
TO PERFORM THE FOLLOWING WORK.-RAISE ROOFLINE
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 7/18/03 0:00:00 5335 $55.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo