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17A-149 (6) F{ooyE � � t�f {II1"flji3111I I JfOlI - )t ^ f '91X31 A chnrc(la DEPARTMENrT OP BUILDENG INSPECTIONS 212 Main Strcct Municipal Building Northampton, Afass- 01060 I WOR RIS CONIPENSATIO.N MSURAI�CE AFT-Mr.N�7�' T-I I I (Ii can-sxl perma tics) v.Itb z principal place of business residence at: - i (saw tla rr/Stazcra p) I do hereby certify, under dic.paitis and penalties of perjury, hai j O I am an employer providing the folloWIng'workci-s comocnszdon coverv--e for my employees worlong on t31is job: (Laszu-an=ComrazN (PeGc:N'u_—.Lbccr) (r:-ptr<rior.Dom) ( ) I am a sole proprietor, general contracaor or homeowner(ccie one) and have hired the contractors listed below rqbo hzve the followinQ workers compen_sanon policies: i (` amc, Oi Co_'! cior) (Irisranoc CotnOanyi-PoUci NIuIIbc-) 0.1tc) f -- (Name of Cootraor) (tnswmacc Companyrpolic Numb-:T) (Exp mtion Daic) (Name of Collazmo,) (Iasura-nez Compan}-/Polk}• Numbu) (Expiraon Dale) (Name of Contractor) Onsuran= Comrauy/Pobcy Numbcr) (Etpirtioa Daic). (-a IJI addi-Zoc-1 r'x�.iracca._-}-to c�c.'.vc�iafoms,�joo pcta�a�.as W.11 .-- j ( ) I am'a sole pFOpne-tor and have no one wor4d.ng for me- I (L�/I am.a home owner performing aU the work myself. NOTE:pi=se be acme t.i­Lhjk hem=µvm wt o c=ploy pezc=to do caa7- c r o -ark cc r Jl_�of G-mots th_c L"--t-ru iu t.�sieh the bom.,o,-raid.=ox oa the W.ed4 z?" rtL�tbe-cn�m oa C-c*=Dy oc--.d.-ni w Ne li -*O - urG=dt o=p==:Li.Az:(GLl 52-=1(5)),agplinhoa by.homeo.-oc fc-!iC-a pcmit n_y e+-idcc=tl`e lc-g J ct . of ea=Ploy r under dma Wcctc e.Comps ,Liao/.et I i I uodczt+.ad the z Dopy of tSi.aatcmem m..y ba foe•+ivrdsd to tha Dctxrtv�aoa of 1o�cLricl 11c�dow'Offon of Imur.me far th. oov�abc w^i('etion a.fd ttLt C_iltac w swat EvvcraSe tmdc zociion 23�of I.toL t 32 m lc�to the ixpos4ioa of cimiasl pcw3lia 000siitg oC a fine of rep to S 1}00-00 utdror oC up to Doe yr_r sad c�i1 pmalua is tSc room of a Stop Work Ordc sad a f=of 5 OO.QO a dsy apia51 mG for dcp.rusr—_�I u�c on17 pCTTIIIt Nt1IDlX1 - Ill v/VnVI i.(np: Lot Signaturt of Lic=is=/PccnT6ttc_ Darfe -- '� C�ixtg >af Nart4amptan z �Y1 H34ACh1IS[tf9 _ DEPARTMENT OF BUILD0\TG INSPECTIONS INSPECTOR '212 Main Street • Municipal Building ' Northampton,MA 01060 ,~ 5 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sup(:,---e,`Sor. The sta�e defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be, a one or t wo famz ---_ 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 degartment"fa t1 e-City of Northampton wants-arty person(s)-Who o--seek--tc7 - - 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 regulation. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before baekfill), 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, �� � �G Mu, �- 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 one _ - Date S Address of work location SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9,Reglstered Home Improvement Contractor: Not Applicable ❑ 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. - Home Owner Exemption 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,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,Stat and�.ocal Zo ing Laws and State of Massachusetts General Laws Annotated. Homeowner Signature ,//�J Alm g SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition Replacement Wind Alteration(s) Roofing Or Doors %L- Accessory Bldg. Demolition New Signs [ j Decks [ ] Siding [ ] Other[ ] Brief Description of Proposed Work: Of Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheets' 6a. If New house and or addition to existing housing, complete the:foilowina: a. Use of building : One Family t/ Two Family Other b. Number of rooms in each family�un©it� 7 Number of Bathrooms c. Is there a garage attached? N �-`-- . r d. Proposed Square footage of new co nstruction. �(!� Dimensions e. Number of stories? f. Method of heating? COLAS Fireplaces o If Number of each g. Energy Conservation Compliance. t/ Masscheck Energy Compliance form attached? h. Type of construction (� �`1/►�1 ---- 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 v & -ecc_, k. Will building conform to the Building and Zoning regulations? t/ Yes No. I. Septic Tank City Sewer I� Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ,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 r I' AAA 110 as Owner/Authorized Agent hereby declare that the statements and information the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of erjury. vo Print Name ��j d S Signature of Owner/Agent � Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size S � � Frontage r � Setbacks Front .� Side L R: L: R: Rear ( , Building Height Bldg. Square Footage ���"b ��• % Open Space Footage % (Lot area minus bldg&paved parking) / C ` #of Parkin Spaces ST � Fill: (volume&Location) A. Has a Special Permit an 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 N y IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES NO I IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,p1gqg, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. DO,partme use only City of Northampton ttierit -- di 'Department trtaut rhevvayrrmit 1 an Street I o e m 100 �i , ; _gQ-m k AUG - 5 JWhamp h, MA 01060 Two"bet of tract rel P,I i phone 413-587'--tA1b Fax 413-587-1272 P 1 a l ns er z�pt ci€y kii i APP-LIGATION TOE°CONS-ffluCT.& ER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Fr y F -1 y-✓1/! ' I\("m-e Map Lot Unit 1P -Le44Crt/- 614 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Ll 29 -4 l)I'& 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 ermit applicant 1. Building rL� (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 =0 +2+3+4-+5) ov UD Check Number 6--- This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/inspector of Buildings Date 28 FOX FARMS RD BP-2006-0141 GIs#: COMMONWEALTH OF MASSACHUSETTS Map.-Block: 17A- 149 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0141 Project# JS-2006-0215 Est. Cost: $1400.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 14810.40 Owner: MAHONEY PATRICK J&CYNTHIA M Zoning:URA Applicant: MAHONEY PATRICK J & CYNTHIA M AT. 28 FOX FARMS RD Applicant Address: Phone: Insurance: 28 FOX FARMS RD (413) 584-8944 O FLORENCEMA01062 ISSUED ON.818105 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL REPLACEMENT WINDOWS 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: Date Paid: Amount: Building 8/8/05 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo