Loading...
17A-059 (2) �Q„'StfAMP�O c tie Crztly of Wort4amvton z $ � �Giaasxcl�usctfe lsi 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 iris/her construction sup(.,.,-,,,: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 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 '� a �1-zip,; z�f �ctz-tlJ�tllt}�fctlt _ �. � - e �+I=sanrt,nscct� m DEPI-JRTMENFF Of' LUILDRI G INSPECTIONS 212 Main Street ' Municipal building Northampton, i fass. 01060 WORICZR'S CO' TI'ENSATION INSURANCE /_FFUMNI.T \:pith a principal place of busiress/resdenc do hercI)y CCI–L1Ij', llllacr dlc p ins anc pC it 1tiCS OI npt;,�llrv, 1_1M*,. (V�I am an employer providing the ollov;ML: •.orr_crs colrinensauon covert: e or my emplovees working on dim job: (InsrranG Co �') i c:ic:?r`urn[xr) ('r�;rir,:aea Date) l j I act a sole proprietor, general co-, =Of o- rlorn,cowoer (c:.rcle one) and 't-:ave 'dirt d t.h, coiluactOfs listed be.o\'v ill: `Oil vjoFkPrs CO%1D°n-a--orl —1iC:es: (Taitnc of Contactor) (InsU-ncc Conc--i-!Tolicy NusntYr) rat;ca Datc) (Name of ConLr c or) -- ti lsJr,rce Comn_r:`/Po!ic' Ntnt r) atio Date) (Name of Contractor) ([n s1c� Co ;_ !;iPolic, i�uli tr r) - -xi: r c,D Date) _. (Name of Contractor) -- (I11S1 E-al, Coa,7 y!Polir--y tvtumi;�*) - (Fi:ri-::ior Dace) (atL,Gt:.d-±lhcc:al S(:CGt:_..__._. :O ..._.,.0.....'K':].1..,,v ,.-._.... � •.L J:G:._......' C 1 <LIl <t OlC prOj? 1C li Sill it ?�' il0 Op', c� —Mil-, all t!. NOTE:picric be awa:c tits,-.c ilc not tnete than(lute units in%%i--di c>i cx; txt�cxsallY a := C=ployv-3 U.-6cr t}Y tvcr}: s a�x-_:eti s,r.((ri.!52�a!(SQ,r:;._a;ia:try a hnr, o« w for z Lccu ct legal etatus of an cmployx under tl:a Wo,ic,'t o .Iion!.cL I un6c_-T-.nd thi a copy of O},x ctatc-,----:cuy ho to tl�fY.tinrtxrszt of Indutric!Ater-ms s'(DiFao of i:::+-,r 7_a for tix oovaxgc vai[ctioo and that f_iiurr to rn :001--r_g-o urd::4,:Uo-a 25A of MOL 152 can Ic_d to tlx irntOsition of crm i:_1 pasl::.% comisting of a fim,of up to mz`a'Y i^nrisr,z�.,of;:p to cn:)-,Z:�:.j avil),-Mltia in Itmn C.f.,Sir)` 'nY,OnI=tnd 1 f ac of S 1 P).W a dty \ rcr dcv; 1 'atsl u.c uily Lot Ji vacate ( T i.iccn:cJl'r_rm;;t _ _ _-_r ;_ F 11 oil S�CTON 8=CONSTRUCTION SERVICES 8.1 Licensed Construction --Supervisor: Not Applicable ❑ Name of License Holder License Number A s Expiration Date u. Signature Telephone Reg s ere �'`orne and•o�emerit Cont actor ` Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SEGTION 10 WORKERS',COMPENSATION IN (M.G:L. c. 152,§ 25C(6)) - � ,..e_ 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...... ❑ 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,v_ ou 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 f- ^• SECTIONMS D SCR.PTIONOFPROPOSED WORK[check alt apnlicale) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ) Other [ ] Brief Description of Proposed Work: �M� � `Z���'�1'� ��"��� (`�, � •p , � �_ L 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 sa :fNernuse ndor a:ddi#ion to.existing housingcoetetiefIlow.rne• 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 -SECTIOT[7aOYVNER AU�t10RIZATJON "TO BE COMPLETED WHEN OWIVEkSAGEtTOR CONTRACTOR APPLIES FOR BURDING,PERMIT as Owner of the subject property hereby authorize to ac; on my behalf, in a I matters relative to work authorized by this Building permit application. � L Signature of Owner Date �- a -�► /.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 undg,the pains and penalties of perjury. Prin e 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 j Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Buildin g Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Spe ial Permit/Variance/Finding ever been issued for/on the site? NO DONT 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 Issued: C. Do any signs exist on the property? YES NO >� IF YES, describe size, type and location: D. L7Aere any proposed changes to or additions of signs intended for the property?YES_ No IF YES, describe size, type and location: r City of Northampton Building Department t 212 Main Street Room 100 ` Northampton, MA 01060 r hone 413-587-1240 Fax 413-587-1272 OE APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A O &A?FLj DTfEWNR.::� 'i L AUG — 4 200; i a SECTION 1-SITE INFORMATION; i Thrs sect,o ,to b 1.1 Property Address: y, 5 �ZQne�F q.5 x.t° b OVerIaY IQ`i5tnct Etm 'Di �. G6 b�sfrrct SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED-AGENT 2.1 Owner of Record: �p Name( int) Cu rr Mailin Address: v,rr 0 eti � ��. 1 � Telephone Signature 2.2 Authorized Agent: \ a (Print) Current Mai mg Address: �> =nc::� �� \2�4 nature I Telephone SECTION 3-ESTIMATED CONSTRUCTION'COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ;(a)"Building 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 = (1 +2+3 +4+ 5) Check Number This Section For Official Use,Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 204 NORTH MAPLE ST BP-2005-0153 GIS#: COMMONWEALTH OF MASSACHUSETTS Xv;DjQck: 17A-059 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A) Category: BUILDING PERMIT Permit# BP-2005-0153 Project# JS-2005-0168 Est. Cost: $5000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: CDT CONSTRUCTION 130152 Lot Size(sa. ft.): 7230.96 Owner: MCCARTHY CHARLES E III&KATHY Zoning.URB Applicant: CDT CONSTRUCTION AT. 204 NORTH MAPLE ST Applicant Address: Phone: Insurance: 158 NORTH MAPLE ST (4131585-8677 Workers Compensation FLORENCEMA01062 ISSUED ON:8111104 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 Occupang si nature: Feel e: Receipt No: Date Paid: Check No: Amount: Building 8/11/04 0:00:00 5994 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo 4 0 Cd A VA ts I:?—<—T'N 00 0 tx V-)(4, 5t=1 CE 4 C) > ki 7�N!L�NC- Az LDS ZLD' Tp� LL N','-A - F 10. Do any signs exist on the property? YES NO IF YES, describe size, type and location: Are there any proposed changes to or additions of signs intended for the property? YES-NO V, IF YES describe type and location: 11 YES, UGS".rl e size, �r�. 11. Will the construction activity disturb (clearing, grading, excavation, or fillip ) ver 1 acr or is it part of a common plan of development that will disturb over 1 acre? YES NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO'LACK OF INFORMATION This column reserved for use by the Building Department EXISTING PROPOSED REQUIRED By :ZONING Lot Size Frontage Setbacks Front Side L• R: L: R: L: R: Rear Building Height i Building Square Footage %Open Space: (lot area minus building & paved parking #of Parkin- Spaces I I' #of Loading Docks Fill: (volume & location) 13. Certification: I hereby certify that the information contained in is true and accurate to the best of my knowledge. Date: "( Applicant's Signature NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Historic and Architectural Boards,Department of Public Works and other applicable permit granting authorities. W:\Documents\FOF-i\4S\original\Building-Inspectoe2oning-Permit-Application-passive.doc 8/4/2004 File No. e FF--. ZONING .H'E'RMIT APPLICA TION 010.2) Please type or print all information and return this form to the Building Inspector's Office with the $15 filing fee (check or money order)payable to the City of Northampton 1. Name of Applicant: l, UI{4 2 L C t2- Address: a 1 4 �V ��1� b���L j Telephone: S L"la 5 f � Z 2. Owner of Property: C 4-- G✓t. (f Address: W V--t t,4 4 L_ (�5 ) Telephone: 3. Status of Applicant: Owner L� Contract Purchaser Lessee Other (explain) 4. Job Location: 2 c'(4 '�' Parcel d _Zortmg flap#' Parce}# - DtArtct(s) - - � }ra E}rra Street Dtsinct i - In Central Busrness Dtstrict - - . .� 5. Existing Use of Structure/Property: F`�U lki -z- 6. Description of Prpposed Use/Work/Project/ ccuppation: Use additional sheets if necessary): 7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans s{. Has a Special Permit/Variance/Finding ever been issued for/or. 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# 9.Does the site contain a brook, body of water or wetlands? NO 'N�< _ 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: (Form Continues On Other Side) W:\Documents\FORMS\original\Building-lnspectoeZoning-Permit-Application-passive.doc 8/4/2004 File#MP-2007-0040 APPLICANT/CONTACT PERSON MCCARTHY CHARLES E III ADDRESS/PHONE 204 NORTH MAPLE ST (413)586-5712 Q PROPERTY LOCATION 204 NORTH MAPLE ST MAP 17A PARCEL 059 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT ee Pai Building Permit Filled out Fee Paid T_ypeof Construction: ZPA-RELOCATE DRIVEWAY 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: pproved 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 Com� OF / /, 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 the Office of Planning&Development for more information.