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17A-224 (3) Bmj , v�A A /vLe�67L) J 0 _ Asap � �� _j �0 C11 itg of Wort4amptor AASaat3�usetIS DEPARTMENT OF BUILDING INSPECTIONS / INSPECTOR 212 Main Street • Municipal Building Northwnpton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as its/her construction sups;: , or. 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/re ent's signature requesting exemption) I will call to schedu e all required building inspections necessary for the building permit issued to me. Date \-z, Address of work `n location `'\ U 0�c �� O�-(tVJ-IP�.O R a Coif of �nrfl�ai)t}�toti - _- Ar E �Zasaachnrclla" _ =_ DEPARTMENT OP ©UILDD\10 I2,4SpECTIO1,'S 212 Main Strcet Municipal Budding Northampton, Mass. 010150 %VOMCEIZ'S CONfPENSATTON MSURANCE A17MDA\ 1T' (Been permittcc) vkrlth a prulcipal place of businesslresid ell Cr- at: (phonei,) do hereby certify, under t}�e.p-_ins god penaities of pe Jury; :hat ( ) I am an employer providing the follo.vine %vorkcrs comoensaLIon cov=;c for im etnplovecs wor�ang on tills job: OMS1Lr?m=Conran)') (Policy Ku--zocr) -- (r:•pinion Dat--) (✓�I am a sole proprietor, general contractor or homeow-cer (ci de one) and have hired the cotluactors listed below crbo have the foko,ring worker's cocjerl_tation policies: �ItV�I�Vi i�`i- `-�:AfeCq q'1 3 (Name Of Co.^=a0r) (In-sur-A : Coinoy1)'CiGUC; (-Explly on Dntc) -- Manic of Cootracior) (blS,u-anc-- C.ompanyrPolic N-um fr) (-Expi-m ion Date) (Name of Co==ndo,) (Insurance Company/PoUq- Numbu) (Expimaoo Date) (Name of Coacmctor) (Lnsu=cz- Comeany/PoLcy Number) (Expi-,6on Date). (nostj]=d&iiocal rbea,ifncora.-V to mdvCjc iaCazvMoc pctasains to all { ) I am a sole proprietor and have no one worL-iclg for me. ( ) I am.a home owner performing all the work thyself. NOTE:p(eu be norut th.. not mote th:.n r v_its in tFbc bomoowoa•s xbo �loy p,-,,.to do rn ar work oo.d%,xJl:--Z of _ch J =da zc oa the gm O dr �pu.rtcp:r1 thceo e.-c ax doe-.11y oeer&-xcd to Nc crploy unc'. the ocr,P=rica Act(GLI5Z=1(5)�: 11n6on bf a homeoavc fer_UC=L—.a pcsmit ray cvid—the Ic�1 cl=ue of a 3 ploy c under tlao Wor[ala CooZpem.tioa A.x - I uada'*taad t`,ia a copy oCthu mlcmcaa m,.y bo foro.a•dnd to tbo r}cpnrtmvl of IabasricJ naadcoi�Offioa oC Ir:z+r.oce for tb. Oo"crlSe'rmrc="oa a_'1d dL-1 U-Lm t.o sc=at nder ,c=oc 25A of),iOL 112 eia I=d to the iopositioa of=%MiaA pC-16a ooasismg of a rine oCUP to S 1500.00 arzIcc i�iya�eIl oCup w one ycr rid a%i1 pm p,.%o be Corm of a Stop wort;Order and a C i=of 5100.00 a day apin-1 Mr For d q.rrm=-��,e nary ( Pc-rmil Number h•Lap�, Lot Si zLuna f Liccn-,cc/permiucc SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone Rei�istereElo"riifmpaYeiiYerion>to '' g w �' Not Applicable .❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT (W 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...... ❑ gg ME- 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-vear 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 buildine 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,State and Lo Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature " ��� SECTION 5-DESCRIPTION OF PROPOSED.WORK(check al4 applicable) New House ❑1 Addition ❑ Replacement W' ows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks (p Siding[1--3] Other[ Brief Description of Proposed Work:�(> 1GC,�_ Cox. tiW2 l�/.✓�l {bc�r� ��,.���,�5�Lo'kk. 7 i a `� �SS' �✓� ca.._ Alteration of existing bedroom Yes No Adding new bedroom Yes ✓No E r k ,p Attached Narrative Renovating unfinished basement Yes No �dtz f •,` Plans Attached Roll -Sheet „ s Cf 7- ditd,,anr�Ab atld rarl.#o exrs>WE _taus 1. co r��e> a Sri 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 W g. Energy Conservation Compliance. Masscheck 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=1APL ETED,WHEN OWNERS-AGEISfTOR:CONTRAGTOk APPLIES F6kB111[DlN)G,PERIIIIIT 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 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. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Da �M.~— 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 Frontage Setbacks Front Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bIdg&paved #of Parking Spaces (volume&Location) A. Has Special Perm it/Vahance/Fndi ever been issued for/on the site? � �� NO ��~� DO07 KNOVV ��/ YES �_/ IF YES, date issued: IF YES: Was the permit recorded otthe Registry nfDeeds? ' �� NO �� DODON'T KNOKNOW YES IF YES: enter Book Page! and/or Document#| ' �� �� B. Does the site contain a brook' body of water or wetlands? NO v���� KNOW DONT KNO YES ��� IF YES, has u permit been or need uo be obtained from the Conservation Commission? Needs tobeobtainmd x�� Obta�nmd �~� Date Is : �~� �_� ' . . C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are d`one any proposed changes to or additions of signs intended for the property Y YES K ) NO IF YES, describe size, type and location: E. Will the construction activity disturb( ng.gradim g .or8|Hng)nvor1 acre nris it part oio common plan that will disturb over 1 acre? YES NO IF YES,then a Northampton Storm Water Management Permit from the DPW io required. City of Northampton sa€ s anti a Building Department 212 Main Street Room 100 ► Northampton, MA 01060 e E* phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION'1,-SITE INFORMATION: Th section to be comptefe&lb' office 1.1 Property Address: _ l�iXZ C Zone;., Overlay DtstCrcf ZZ k z z �Ity @,st�rct ,.. . ` _> cela�st�► . _ . _ ,_.. SECTION`2'r-PROPERTY-OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: _ Name(Print) ? Current Mailin Addres �i .-L • -..-� `--"7 Telephone Signature ,- 2.2 Authorized Agent: Name(Print) Current Mailing Address: L-4 t 3-- -�')S4 Signature Telephone SEC]ON,3'-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ct _ (a)`Build ng:Permit Fee 2. Electrical (� - (ti).Estimated Total.Cost of Construction frorrx 6 3. Plumbing Building Permit Fee- 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) 7T Check Number This Section.For Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2007-0631 APPLICANT/CONTACT PERSON MCKEEVER JAMES P ADDRESS/PHONE 198 NORTH MAPLE ST FLORENCE (413)584-2250 O PROPERTY LOCATION 198 NORTH MAPLE ST MAP-1 7A PARCEL 224 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 4 d.144 Fee Paid Typeof Construction: CONVERT PART OF PORCH TO MUDROOM&INSTALL REPLACEMENT WINDOWS 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFS3RMATION 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 O`= 141 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. 198 NORTH MAPLE ST BP-2007-0631 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-224 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-2007-0631 Project# JS-2007-000948 Est. Cost: $19000.00 Fee: $90.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 6316.20 Owner: MCKEEVER JAMES P Zoning: URB Applicant: MCKEEVER JAMES P AT. 198 NORTH MAPLE ST Applicant Address: Phone: Insurance: 198 NORTH MAPLE ST (413) 584-2250 (� FLORENCEMA01062 ISSUED ON.1211212006 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONVERT PART OF PORCH TO MUDROOM & 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 12/12/2006 0:00:00 $90.00245 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo