17C-199 (5) O4'StiAMP70
� � ,�Iassac3�asetta
DEPARTMENT OF BUILDING INSPECTIONS /
INSPECTOR `212 Main Street • Municipal Building '>a
Northampton,MA 01060 .
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as has/her construction sup<;r,,isgr. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a die or lwoianu y
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 buil mg department for the City ofN rthampton wants-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 backfiIl).
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 occupancv
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
m e
��, �,a(, understand the above.
(Home o ner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building perruii
- - -- issued-to me -
Date Z
Address of work
location j1Q 0-rTV (,C ),e
F Lag
0¢-C7VJ-f
R2 Of Y� IIT 3 � ��CI17fIiz31111Jtoil
j W DEPART MEIJT OP BUILDf,�C INSPPC-1101"s
I ; -
212 Main Strcct ' Idunicipal Building
j Northampton, TSass. 01060
w RIC. IZ'S COi\ PENSA-170Iq MSUTR-A.-N CF ?.17FM:A.,V-11'
'' (li ccnsxJpc;m�ttcc)
'Vith z principal place of businessfresidencc at: - -
(phone=)
j (st1 t/ci tylaza-la p)
do hereby cerdi :, under the pains and penalties of per7wy, _hai
{ ( ) I am an employer providing the following!%vorkCTc s comDCns_Z:j'op coverage for Im
emplovees worlDng on tin's job:
�c Con=• )
�---� .) (Polsc: ?�.L�;xr,
( ) I am a sole proorictor, geoeral cooa-aczor or homeowner (c c.e one) and have hired
the consactor's U5--d below wbo have the foOo-,vinp worker's comnep— don policies_
(-Nmc Of CO:It::lC!Or) (Insura =- CoinpanyiPobcy Datc)
(Name of Coan ior) (Insuran= Comoaa)vpoum, tiumc_r) (ExD-Lm ion Date)
I (Name of Coturaeto;) (Insu.rdne Com-pzo)•/Pouq- Numb-r) (Expirz6on Dale)
(Name of Contrdclar) (L>asa=c-- Company/Policy Numtr_r) (Expimuon Daac).
(nrx3 tl i ocil zScc.ifn�o�—u_y w c,cuc�iarora.=ioo Pcv,�to.1J
O I.am_a sole proprietor and have no one worling for me.
j ( ) I am,a home owner performing all the work myself.
NOTE:Ptese>x awa c tt,. .Je hc�oµac a. bo c ploy per s oa3 w do �-�cr a ao a rrrxs +ork oa d..cl1_�of
not mote Lt'.-�toe trots is��ieh the bomrw,+vc raids a tx the p-oaac4 z�purtta�tbe-eo r_z ooC�-qty or=.^d.-ai�n t?e
eitploycs ua�-=the..ui-riz�-_-,:�p•�{6L�1 SZ�t(5)�...P�,tincon by a 6ommaae fc:Gc_^+e«�cma a:-y e.-ed�x tic
lep.l a_^.•oC ea e�ioyx under tlw Woricola Cott.om,tion As;�
i underiand the x Dopy of Chi.ev.®em m.y be for�.a,ded w tha Dcpnnmma or ln�,;�i n�d�ofsoe or t�r.om ror tb.
O°YC'�c"�'T�1O°ezd o t t�in srrx:c to.�ase ms is soaion 23 of 1 toL 151 can t--d to the i=poz:6-of eimi-d Pcmrii- ,
oC a f i a t oruP to s 1 Soo.00 s n'1 l o r j=:p:�orup to ooc yr:r snd c�a prn pY m is's form of a Stop Work Ord-and.
finr
0(S I00.00 i d_y L p=tae
- For dca.rta.��u.c on1Y -
1 Pcrmit Number
L 2 J� G� i.fap=-- Lot K
Siraatm�c f Li CM-Liu= I Dyte J
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
9:items"Ieredoinerrmpca�remenoii4 . n Not Applicable ❑
Company Name Registration um er -—"- -_
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.rA52 7'g-2k,(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...... ❑
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 fob 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
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SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition ❑ Replacement Windows Alteration(s) Roofing El
Or Doors C]
Accessory Bldg. ❑ Demolition ❑ New Signs [[3] Decks [p Siding[O] Other[C1)
rief Description of Proposed ,
Work: k brk
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a if Nevi 11O'r se nct or t d t�ta� c exls nt� ioastnar-complete#Meg dllomnq
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-TO BE'COMPLETED:WHEN
OWNERS AGENT.OR CONTRACTOR APPLIESFOR 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, 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
nature of Owner/Agent V"' Date l l
^
^ , ^
'--
Section 4. ZONING All Informatj6h 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 J I
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume,&Location)
A. Has a Special Perm ever been issued for/on the site?
'
NO 0 DON'T KNOW 0 YES 0 �
IF YES, date issued:!
IF YES: Was the permit recorded at the Registry of Deeds?
NO �~��
� DON-r mxuvx 0 .^"
IF YES: enter Book Page and/or Documont#
O. Does the site contain u brook, body of water urwetlands? NO �~��� DON7KNOVV �_f YES
IF YES, has permit been or need to be obtained from the Conservation Commission?
-
Needs tmbeobtmimed x�� ��to�ne� �~� Date
v�� \�� ' �
C. Do any signs exist unthe property? ��� YES ��, NO �~�
IF YES, describe size, type and location:
D. Are the,*any proposed changes to or additions ofsigns intended for the property? YES 0 NO 0
'
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,nr filling)over 1 acre orioit part ofo common plan
that will disturb over 1 acre? YES [ j r NO � 3
_ / _
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
,.,�u� „Departrneaf[use only' � r
City of Nortf ampton ofP u wag `
Building Department
212 Main Street
Room 100 e
Northampton; MA 01060 „
phone 413-587-1240 Fax 413-587-1272 i
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be col�p ated byoffce -
Zone' � Overla�D�strlct
Nt-
4'Elm�t yDsstrcct 6B�isfract
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
R LU I -TK
Name(Print) S'� ��(n-1 Current Mailing Address: '��(i flt.-7 7l: G)
'A' aO_-- Telephone
Signature l
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 �-}1 C4/ � (a)Building Permit Fee
2. Electrical (r)C.� (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building;Permit Fee
4. Mechanical(HVAG)
5.Fire Protection
6. Total=0 +2+3+4+5) Check Number
This Section F&Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2006-0651
APPLICANT/CONTACT PERSON VALLEY TR SINGH RANJIT TTEE
ADDRESS/PHONE 2 BRATTON COURT FLORENCE (413)585-8727 O
PROPERTY LOCATION 2 BRATTON CT
MAP 17C PARCEL 199 001 ZONE GB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid
Typeof Construction: REPAIR PORCH
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 FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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 Coission
Signatu 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.
2 BRATTON CT BP-2006-0651
GIS#: COMMONWEALTH OF MASSACHUSETTS
MU:Block: 17C- 199 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category. BUILDING PERMIT
Permit# BP-2006-0651
Project# JS-2006-0957
Est.Cost: $500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 4138.20 Owner: VALLEY TR SINGH RANJIT TTEE
Zoning: GB Applicant: VALLEY TR SINGH RANJIT TTEE
AT. 2 BRATTON CT
Applicant Address: Phone: Insurance:
2 BRATTON COURT (413) 585-8727 O
FLORENCEMA01062 ISSUED ON.1211412005 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIR 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:
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 12/14/2005 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo