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PROJECT NO: 98-144
E Y DRAWING NO: 98144
FILE NO:
ALMER HUNTLEY, JR. & ASSOCIATES, INC. SHEET N0.
SURVEYORS ENGINEERS LANDSCAPE ARCHITECTS OF
30 INDUSTRIAL DRIVE EAST
NORTHAMPTON, MASSACHUSETTS
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DEPARTMENT OF BUILDIJNIG INSPECTIONS /
INSPECTOR '212 Main Street • Municipal Building
Nordi,unpton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to
act as has/her construction sup,;:-. so.r. The state defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two farm --
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 buil3ing 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
�TitlVl py,
Flo 3,�,��`ti IJZf�7 LT1 �,Tarf[IL Oil -
A E _51 cz a a%c4nsrt I a* _
DEPART MEN-7 OF BUILDr)\1G INSPECTION'S -
212 Main Strcet ' Municipal Building
?Northampton, Afass. 01060
«`oru=— Z'S CO3YTENSAg70N fflSUI AN CE A AVIT
(]i�nsxJperm�tfcc)
ith a prirlcipal place of business/residence at: - - -
(st`i-rr.\t/ci rr/statLfa p)
do hereby certify, under the pains aod pen2lties of perjury:, h:r
( ) I am an employer providing the following'worltc>✓s comocas"io, coverage for my
emplovices worlong on ties job:
ozsltr-an=Conr.-_M,) (Policy Nur—.�Dcr) -- (1--pir<tior, Date.)
( )ya.m a sole proprietor, general contractor or homeowMer(ci:cie one) and have hired
cone acws Es7ed below wbo have the follolvin2 workers c=oen_sation pckles:
(i+ rruc o;Cower cto-1 (Ins-uranc c Comoariyfiloiie,\ Date)
(Name of Contrctor) (lnsa=cz Companylpo6c Numo _t) (Lrpirwaon Dale)
(Name of Connaelo.-) (Insura.ne Comr=y[PoL-cy Number) (Expir=aon Dale)
(Name of Contractor) (Ilisurdncc Comcamf/Policy Numbu) (Eipt aaoa D'ac).
(-Mach to mead=,IIrOCID+3 oa pctdtaaas b ctrl -GO:'s� - ___ .._--
I am'a sole proprietor and bane no one woridng for me-
( ) I am,a home owner performing all the work myself:
NOTE:plcsc be aor,rc tfi+,bijo hear xn to caxploy pc..oci co d.D—• cr c oa c rcPaa work on a d••--Ii_Z:of
cvc—'hL---a_-tnitx is t�eb the banoowae raid..a oa the pouacS zpputtea=tbe-an cz Doc go--Uy acI=:d--od to be
czployc ttad=the--k=--cc=pc=:.��oa Av;(GUI 51 S 1(5)).-,ptio.600 by a bomm x fc_6=or perilit cry cridcorx the
Icgal cta3ac of as cr,loyx-c&Rd,o work et cow Act
I uad—z d tha x Dopy of thi. o y be foc—,ded to tho pep—,_.w of Inda+xricl Aondczs'Off oa of Is—for tb.
cov='Zc r-' clioa and cr._,Liltzc w swuc bovcra o^e tmdc soaion 25 A of hiQt 1 51 cta Icd to tho i=pauuca of eimiail pcazlt=
coati:izg art fiat orup to S 1}00.00 ar,d,or i=��orup b occ y-_r evd evil pmitio io ct.roan or.stop wort ordc and s
r=of S i 00.QO a d_y tpj=tnc
For dquta,��u.c only
pc=,l I`IUML--
I i-
J,/,ap, Lot R
Sit�tL ' ofLicc:, iva ae i
SECTION 8-CONSTRUCTION SERVICES J
8.1 Licensed Construction Supervisor* f y Not Applicable ❑
Name of License Holder: '/V / / : i S?S�� �
e,� License Number
Address 4 ExpiratVn Date
Si pure Telephone
Re4►sereckElome°Cmaoveineii >Cont arc Not Applicable ❑
Company'/ate me Registration Num er - Y
Address Expiration Date
Telephoner C `-r
s
SECTION 10-WORKERS'COMPENSATION INSUf2ANCEAFFIbAV1T,(M:6:L.c.'C52,.§.2SC(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 b ilding permit.
Signed Affidavit Attached Yes....... No...... ❑
The current exemption for"homeowners"was extended to include Owner-occuuied 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 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,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
t
SECTION 5 DESCRIPTION OF PROPOSED WORK(check all-apOicable)
New House ❑ Addition ❑. Replacemen endows Alteration(s) o Roofing El
Or Doors
Accessory Bldg. Demolition ❑ New Signs [0] Decks [[] Siding[0] Other[[:3]
Brief Description of Pr o ed , J
Work: / ~!d?f• i' L' Fi ' i �t fl �� C jt,"'
_..
j
Alteration of existing bedroom Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes KNo
Plans Attached Roll -'Shee#�
ayw.a„= z �•..- sn ss:i,-:- ,c7: .+sue.w_�"na.»-_ s w'r"�- :+•+s . y„v'i'a
6a > e =Crouse min brz to r d2bkISt1fi"W �ist�I4d Goth- df th��a11""'`tc1
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. Masscheck Energy Compliance form attached?
h. Type of construction
L 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 COMPLETEII WHEN
OWNERS AGENt OR CON'T:RA(C OR'A PP`LIES FOR BUILDING.,PERIIAIT
/ / e as Owner of the subject
property
hereby authofte _
to act on b If,in all matters relative to work authorized by this building permit application.
Si nature= a _> Date ; -7—
, ��-� 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 Date
Section 4. ZONING All Informatibtt 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
i r ► �- I
Lot Size
Frontage
Setbacks Front i d t
Side L:.t'`=!,R:-' L: ,
t--
Rear
Building Height O r o
Bldg.Square Footage t -5' %
Open Space Footage %
(Lot area minus bldg&paved
arkin - 7
#of Parking Spaces
' A--L
Fill:
(volume,&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
AIN
NO Q DON'T KNOW YES 0
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW YES 0
IF YES: enter Book ! Page; and/or Document#'
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Date Issued:
C. Do any signs exist on the property? YES 0 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, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton
Building Department C.w°
212'Main Streetee e
Room 100
("A � 1 Northampton; MA 01060
phone 413-581240 Fax 413-587-12721 Skt r
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: Thrs'sectron tabe cornvleted by office
^ NFaR totrt Un
Zone Overfay Drstrrct
lk Erm SL i[str��t cs DI.Mri�t.
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Name( rint) Current 'ng�e f
Telepho
Signature
2.2 Authorized Agent:
N me(016t)) Current Mailing Address:
Signat a 1i Telephone'-
elep oh ne—��-
SECTION 3-EST4kTED COIkST.RUCTION COSTS
Item - Estimated Cost(Dollars)to be Official Use Only
com feted by ermit applica nt
1. Building 17 (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) C Check Number
This-Section For Official Use Only
_ Date
Building Permit Number. Issued:
Signature:
i
Building Commissioner/Inspector of Buildings- Date
w
File#BP-2006-0467
APPLICANT/CONTACT PERSON COLIN HOFFMEISTER
ADDRESS/PHONE P O BOX 1301 Northampton (413)586-8791 Q
PROPERTY LOCATION 29 PLYMOUTH AVE
MAP 17C PARCEL 177 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Build in Permit Filled out
Fee Paid
T_ypeof Construction: REPLACE GARAGE OPENING W/NEW STANDARD DOOR
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included•
Owner/Statement or License 078842
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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.
29 PLYMOUTH AVE BP-2006-0467
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C- 177 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0467
Project# JS-2006-0687
Est.Cost: $2200.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: COLIN HOFFMEISTER 078842
Lot Size(sq.ft.): 4791.60 Owner: WALLACE WILLIAM J
Zoning.URB Applicant: COLIN HOFFMEISTER
AT. 29 PLYMOUTH AVE
Applicant Address: Phone: Insurance:
P O BOX 1301 (413) 586-8791 ()
Northampton MAO 1061 ISSUED ON.11 1112005 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE GARAGE OPENING W/NEW
STANDARD DOOR
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 11/1/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo