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17C-172 (4) GI-ify of Wart4amptan � � j�rlassac}�nsetts - DEPARTMENT OF BUILDDdG INSPECTIONS INSPECTOR 212 Main Street 0 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 super .,•isor. The state defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be,a one or twoftmz -- 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 build ring department for the City of Northampton w_ants any persons)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 backfilI), 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 L understand the above. (Home owner/resident's signature requesting exemption) BUY ,t.Lh __ 7 ' I wiii call to schedule all required building inspections necessary for e tvu11ut J1L1g per11ut -- - issued-to me Date Address of work location r DEPARTMEWT• OP BUILDr�\Ic INSPECT101.'s 212 Alain Street 25Tuniclpal Building j Northampton, Mass. 01060 i \'VOR]:CER'S CO'NUENSATIO.N MSUT4-A C1✓ Al'IrD�AVIT 1. (Ii ccvs�Jpermi flee) \,.,I Lb a principal place of businessfresidence at: l j (srr�t/c;t}Iscat.cta p) { do hereby certify, under thc.pains and penalties of pc9ury, ha i — —�- O I am an employer providing die following!.vorkcrs cotnocnsadon cove��e for Illy etuplovecs Nvorlong on this job: I (Insu r--n=Conp ) (Polio: Nu=n-T) I i O I am a sole proprietor, general coo=c-Lor or homeowner (clicie one) and have hired the contractors bled below wbo have the following wort es co pen_tzoon pokiest i j (Nl amc oi,Conl nc-,or) (In umnc::Compan)-Pi ouc,• ?,,'umh,::) Datc) i j (Name of Conlraor) (lnsarancc CORIoan-w?O'jc,• \u.tnc_r) (ta-*z6on Date) I - - (Name of Co=aor) (Lasuran=. Com /POt; Nam-bz.r) (Espircion Date) Tom)- �• I - _ (Name of Contactor _ I ) (Insurance Compzay/Policy Numbs) (E�-ptfzoon DaLC). (.Q��-�;�ocil�ca.if meet_-s�_-ti•sa c,duc�•iafora,�oo pc"'*,:�e.0 oozessn:�) - j I �l �V) I am a sole-proprietor and bave no one worl,-i.ng for me. ( ) I am..a home owner performing all the work myself. , NOTE:ple3c be zw-am ti-M• ' -oCn wbo=S pIOy p,,,=Lo(So C fSi �==oc a rgxc work on r d-,-U j:of ont taoct lti-n -I oc tai'.+in Mich the bomoo.wc raid.cc oo the pm to z,?p=-Lr th=en c.-r nx L•�rtly oe s d�-ni w be citptoyz-r ttaGe the a=:;> •,on An(GU152 a 1(5)� =pptia6oc by.bomma-=fc a!ice-or pent-Y--id—the Iebzl r=-of as c ployx under dao Wori,o .Co=pm.tioa Act I 1 undcn..nd m.t z copy of Lb;.mz m.y b.tocavrd+d to tha or o>L—or l—["-'b. covcagc v--Mc=3ioc and th_t&IJ=e to Lc=m)cover=s=frock sr=.ion 25A of M01- 152 na Ied w the i=,-c:C6on of eim+ait pcaslr= c0=!riag of.rinc of up to S 1 1,03.00.ndfor ia>;rizo�orup to ooc yc=r xad avil pco.ttio;n Zsc form of.Slop Wort Ord--and. ' ru=o(S I0D.0o a d-. cFn inA.t ' i For dcp.tsa.�u.e only ---- Permit Number — Lot iturt oft i caniu� e SECTION 8-CONSTRUCTION SERVICES t I 8.1 Licensed Construction/Suplervison Not Applicable ❑-1 Name of License Holder: 1 I V� re S ,/6� S `x� q� q License Number Address / Expira on D to S-J ` -Sig re Telephone J. ea1s om`enprclvemerio �racfor. Not Applicable ❑ Com_panv Name Registration-N m er ---- Address Expiratioh Dat Telephone SECTION 10-WORKERS'COMPENSATION-INSURANCE.AFFIDAVIT(M.G:L.c.152,.§;25G(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...... ❑ � . .&A WWWAW;eli 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 he 1e1.1e f r person(s) Employees for injuries not resulting in Death)of the Massachusetts General Laws Aiulotnteu,vo::.;.a,'., r--..---.-. 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 r i r : SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Q ReplaceTneLt Windows Alteration(s) Roofing Or Doors 'p Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[p] Other !] Brief Descrip on of Pro Work: C T_ V " 6L\, OQ r I Alteration of existing bedroom Yes No Adding new bedroom Yes p . Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet .� mow` "?:+= '��"w"�".�fw""" ? � ---+s..g.x j._ ,•... .r�,y+�°' A °a^� sa-tf rd se ra r dc�tta�is a is %nct i slnct: a g e#lrxe olio i a: 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 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-TOB,E:COMPLETED,WHEN OWNERS AGENT,OR CONTRACTOR'APPLIES fOR BUILD.l G`PERM1T I, �trc°e yK Cc c-/ � as Owner of the subject property hereby authorize f'I + ''*�! �45 U,41 to p t on my behalf.in all matters relative to work authorized by this building permit applicatio . ©� Sign re of Owner Date IF I, as Owner/Authorized Ag her y 8e&lare that a tements and in rmation on the foregoing application are true and accurate,to the best of my knowledge and bell . Signed under the nains and penT4i9s of perjyry. Print Name Signat&e-of Own /Age Date Section 4. ZONING All Informatibit 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 f I Setbacks Front ;? 3 r� Side L: R: L:' R:l Rear Building Height --- 777=.--- -_ Bldg. Square Footage ( —� % Open Space Footage (Lot area minus bldg&paved parking) 7--7 #of Parking Spaces Fill: j 3 (volume I&Location) I A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YES 0 IF YES, date issued:! I IF YES: Was the permit recorded at the Registry of Deeds? NO � DONT KNOW 0 YES 0 IF YES: enter Book `. Page; and/or Document#' B. Does the site contain a brook, body of water or wetlands? N0-0 DON'T KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: E C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: j 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 0 1- NO� IF YES,then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton Building Department ur� ttt7Q � AIA 212 Main Street Room 100 h Jv Northampton; MA 01060 s v phone 413-587-1240 Fax 413-587-1272 , F_ L APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1'hrs section to be cornteted boff�ce 1.1 Property Address: `} ��e��� �kal ,ZQneF` �Yerld�k'DIS Cr s �Elgi-St'Distnct. � ;,w '� CB.D�stFrct SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record}}: Yom/ STFsJ Name(Print) i Current M n Ad ess- " -&y3 V_Jsl� , (o Telephone Signatur 2.2 Authorized Agent: Name(Print) „ Current Mailing Address: Signature Telephone SECTION 3-'ESTWATED=CONST.RUCTION COSTS Item - Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building:Permit Fee 2. Electrical jbj Estimated Total Cost of Construction from 6 3. Plumbing _� Building Permiti Fee 4. Mecnanicai(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) S 00n Q Q Check Number (} This Section For Official Use Only Date, Building Permit Number Issued: Signature: r i Building Commissionerlinspector of Buildings- Date File#BP-2006-0910 APPLICANT/CONTACT PERSON Kim Rescia ADDRESS/PHONE 311 Locust St FLORENCE (413)584-5816 PROPERTY LOCATION 27 FAIRFIELD AVE MAP 17C PARCEL 172 001 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 79V wou Typeof Construction: INSTALL 2ND PLR WINDOWS&REBUILD ROT ON PORCH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 022464 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9J64ATION 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 on ZCN� Signature of uilding Officiagr 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. 27 FAIRFIELD AVE BP-2006-0910 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C- 172 CITY OF NORTHAMPTON Lot: -001 Permit: Building Cate g v or : BUILDING PERMIT -- Permit# BP-2006-0910 Protect# JS-2006-1388 Est.Cost: $3000.00 Fee: $ost: $ PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group_ Kim Rescia 022464 Lot Size(sq. £t.): 5619.24 Owner: STEIN FREEMAN&WENDY S Zoning:URB Applicant: Kim Rescia AT. 27 FAIRFIELD AVE Applicant Address: Phone: Insurance: 311 Locust St (413) 584-5816 FLORENCEMA01062 ISSUED ON:311612006 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 2ND FLR WINDOWS & REBUILD ROT ON 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: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: / Final: Smoke: Final: 0 f{ d'`ld�-/�1 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. f,f ��G✓ ., •+ Certificate of Occupancy 1 , Signature: FeeType• Date Paid: Amount: Building 3/16/2006 0:00:00 $50.001881 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo