17A-173 (7) 1 ,, fs
El
L 0
f P
1
/ lyeiy
,�+ CORBELASSOCIAAM
/ 148 PARK STREET ,
EaSMMPTOM MA 4'lW
�'CHAMP�.
goo " Grzfy of Xort aiirpton z i
$ � �lassaclTusctfa
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 his/her construction sups:.,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 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
`�'y�
o�.�ttl.Hl>TO X1.!.1.-\—
' �-
�i'zftT o ��tz fl1�t»t}�fnti �.
S1 6 jalC35RCIlIt6ctI%
DEPARTI,fENrT OI' BUILDING INSPECTIONS
212 Alain Street ' Municipal Building
Northampton, Mass. 01060
WORICZR'S COMTENSATION INSURANCE A; FMAVIT
r '
(l,ccr..°Jrcrrnittc^)
%vIl l a principal place of business./r, :sidenc t:
do 11Creby Cer-Ll-ty, idle' ;I- the• paiilS .'ii7 pCil 1tICS Oi C:rJllr}Y, ihit::
O I a.m an eriaployer providing the follov>vinc ••:orl_crS colncctlsation coves c for lily
EII2ployccs working un t?1is job:
(Las- C. Company) clic.N Lmtxr) ---- (Expimticn Date)
( ) I ant a sole proprietor, general c0u c cr c- h0meo'Wcer (cLrcle one) and leave hired
tel:; contractors listed belov,, the `O 1 P •i j F0 ce�S COi?t)en4 iOr1 'C!iC'CS:
Q,la IIe of ConLnctor) (IRS IlC CGI ^;:' i'�Gi1Cf NusntYI) % ?:: i. C' Datc)
(Name of Contractor) -- (71>sur nee Co?:)a:l`•(pc.hc,' Numrr_r) (1 >: iin Date)
(Name of Contractor) ;Ins nnce Cou ;an.;?ofic NuJntf_r) (=x;.:rtioa Date)
- (Name of Cortractor) —- (IDS- -1ict ColuT V Y!POcy NumbLr) Dare)-
(^tLl G31_`.(�'±It:Ma)rs�et:..._.—.. '.:�:.:...�..�,.,;rY:J:1 t:Ci:�-C..—.... � eli O:(:_:=::�C:f•.1
�. � I t1IT1 i: :,U1C l)1-UpIICtUi i?iI';1 ili?V, n0 ,:)IIL ..'Ur�'; i`' t-OS ill:;.
n1l i_l v",_;:_;_,
NO TT.:plcau lr nt c tits:s-L is 6 v-cv jzr: . .o c pl ,'i> n::: :�nc�ar:: �m cr lrp-. t« d.cLir.
not ux)cc 11L:a throo unill in u{ C'i;.hc or oc;
c-mployc3 urv�' thr wcr}: s ar x i^r.,t'(G1.152_31(5)),np;':=anc.,by a ho:trou xr`cr a Lc-x or
Icgal cta!un of an czaployer unc'.cr thn Wcviccli t o t;ar.tion!.ct
I underhand th.!i coy of this ctat_i =c:�y bo to tl» of l�L inl Mzllty O ioa of for tlx
covcrxgc vct-ifiaaioo and flat f._ urc to 25A cf MOL 152 can lui to tlx im{oTitiat f c i I pa31:a
cocltxting of a fur_of up to S 1-500.01) of::p to .M civil perul:iu in 14 fcnn of n S!�,%;;cri:
f r>i of S I010,W a diy irr.in:2 tn..
4.. rr,<dq;uuzxa[>.1 u-Utly !
Pcrrnit Numtr.:r
5 :,vacurc of;.iccn cJI'crm ittc, :: F
S�CT10N 8 CONST;RUGTION SERVICES
8.1 Licensed Construction Su er isor: , Not Applicable ❑/
Name of License Holder :
License Number
Address Expiration Date
S 2T r �
SiRWilre Telephone
e eye :ome =m t creme"n" Cor.racto Not Applicable ❑
Company Name Registratio N tuber
/ **,r -7 40)
Address Expiration Date 7
Telephone/,//X�Z7 9���
SECTION°10 WORKERS' COMPENSATION INSURANCE-AFFIDAVIT(M G:L. 152, § 25C(6))
R.
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 pen-nit 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, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTfON� D 5 RTPT ON F PROPbSED 1+VORK check 11 licaA' m
,u
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks S' A g ] ter
Brief Description of Proposed Work: f✓`��.(�f� /c'OilOT ��'ri�/l�zcl ��iiLfrf 1 7;�-��
Alteration of existing bedroom Yes No Adding new bedroom Yes
Attached Narrative D Renovating unfinished basement Yes _LZNo
Plans Attached Roll❑ • Sheet o
6aff fio sa�eand:,o add;iti.onto:exlstin ;-Fio-tas�ngcoe.-e tefolaowi:n
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�Ia 1NNERAU�HORI45TJON TO BE COMPLETED WHEN
01NPfEf�SAGEI7Q�tCONTRACTOR APPLIES FOR'BUILDI-�1G PERMIT
as Owner of the subject property
hereby authorize .J1 ��/�L� C �1 �� c'C��'1� �'t'� r�'c��` to ac;. on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, �Jr/ t�V� --( �+w✓ � 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.
Signe n er the pains and pgnalties of perjury.
Print Na r •/�
SiggKture of Owner/Agent Date
m�
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
GD r.
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
a
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 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 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
IF YES, describe size, type and location:
of Northampton
Nj !� �nilding Department
- _- - - ,,
X12 Main Street
• '.Room 100
AUG u Lr05 No;t�; pton, MA 01060
phone 41�-58 1240 Fax 413-587-1272
---APPLICATIONTO CO 1 UCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
Thsectro�to be completer by Mice
1.1 Prop rtv Address: �
Map s »La 1ina
Iles
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mylin �rgs�s ��
+ Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
A ���/�.'�'
Signature
Telephone
p
SECTION 3-ESTIMATED CONSTRUCTIOWCOSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building ,rf G � 1..(a):Buildirig'Oermit.Fee
2. Electrical 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"Onl
Building Permit Number: ' Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2006-0171
APPLICANT/CONTACT PERSON CORBEIL ASSOCIATES
ADDRESS/PHONE 148 PARK ST EASTHAMPTON (413)527-9286
PROPERTY LOCATION 40 HOWES ST
MAP 17A PARCEL 173 001 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: REBUILD EXISTING 7 X 13 PORCH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 059611
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9RMATION 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 Co 'ssion
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.
40 HOWES ST BP-2006-0171
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A- 173 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2006-0171
Project# IS-2006-0260
Est. Cost: $4200.00
Fee: $50.00 PERMISSION.IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: CORBEIL ASSOCIATES- 059611
Lot Size(sa. ft.): 14984.64 Owner: BASSETT THOMAS A&BEVERLY A S
Zoninz:URB Applicant: CORBEIL ASSOCIATES
A1': 40 HOWES 51
Applicant Address: Phone: Insurance:
148 PARK ST (413) 527-9286
EASTHAMPTON MAO 1027-2162 ISSUED ON:8117105 0:00:00
TO PERFORM THE FOLLOWING WORK.-REBUILD EXISTING 7 X 13 PORCH
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: r
Rough: Rough: House# Foundation: � o/C
Driveway Final: G� AA
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Fina!: O K
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. �J
Certificate of Occu anc i nature:
FeeType: Date Paid: Amount:
Building 8/17/05 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo