17C-221 a
+A
DEPARTMENT OF AuLLDDw nrspampms
INSPECTOR 212 Main Suea • MWic4*Bmfiiag
Nm =npM MA 01060 `
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Masses allows the homeowner the right ands-78001083.4 to
act as-his/her,construction supeniiisqr. The state defines`Hdmeownee as,"-P s)
who owns a panel on which he/she resides or ircads to b l
dig,attached ordetached suudwes accessmy to such use and/hr firm stnicwm&A
Person who constructs more than one home in a trperiod shall not be a
home owner."
FU NxIjkS.)WU0 sew am
_.___The g rCi�y ttesnwamts mn9
use the home owner coq,to act as their 04;n consubwan sugIrvisor,to-be aware
that by doing so you become respons�bk for complhmix w1t6 states bugdnag codes
and ftulations.The inspection procewregrnres that the build department be called.
to inspdct work at various stages,,which mdude f fliffft ft
sonotube bdes-fbefere ilour�a route bw'ldmg'iosnecrinn -
wncealed ,=-- bb-on mspee ion-td reaaia+ed)aw it fmal by mg iosueeiioa.:The
building department-requires these�befce�e wort is co®oeated;fal+Qre to
secure fhese inspections can result in Inume ft a6hibz a ieesrtificat�e eocnn9ucv
unit the work so be iosaeete& .
If the homeowner hires other trades to perform work(electrical,plumbing 8t gas)the
homeowner will.be tespovs1Ie to snake sure that the trade hued secure titer prdper
permits m co*ncb=to the building Permit issumA`and that they get their required
iospectia►ns.Failure of the individual trades to severe the permits and ions as
required can PRAY the project until such fine as the prvprar permits and inspections are
made
L understand the above.
(Home owner/residcanes signature requesting ememption)
I will call to scii"de all required building inspections wry for the building_permit
Date
Address of work
location
's
2D4Tl..�tSa�D t
E (rI J. of Wartlla.11ip!ap j
DEPARTMENT OP EUILDDkIG INSPeCrIoNs
l 212 Main Street ' Municipal- Building
'Northampton. Mass. 01060
_..WpRT4 I2'S CO LPENSATION -DISUI� A .
CE ' , AA/IT.
Iron �1• LO Cam. _'- =----- - --
.(UCCUsaclpermictcc)
.,.pith 2 principal place of businessfresidence at: -
hona) Yt3- 39'7 S60
(Sa c�,/catj;/s Wvzip)
"do hereby cer fy, under Lbe.pains and penalties of perjury., Uai
( ) I am an employer providing the followingkvork es compcnsaiion cove mge for my ;
empioyccs woriing on-tliis job:
(1=3.r Cori*) (POUCT N-u=br-r) (Fxpmr oa Dal~) '
}
-I am a sole proprietor,general contractor or homeocy=(ar cie one)and hm hired
the contracors listed below who.have the following worker's carp-.moon"policies_,
(Namc of Coo:ractar) (lasuran=Coinpany/Pdt cy.N ba) (Ekainuou natc)
(Name of Coam=or) Oa uma=CompanyMoliey Nuflecr) (–Ea-pirslion Date)
CN.the of Goaaacto:}. (tnsuma=CompaoyNolsey Numbu) {' xp-_doa Date)
(Name of Conaactor) aasumcc Co>n any/Policy Nun*.r) (E=cpiravon Date)
(asaeh ad3e�oC:1�eezitneomas.-r so o�ude;nr«m.�oo pa„�nie�m.1t aos�seess) ._....--
am:a sole pfeprietor and nave no one working for me.
( ) I axn a home oum& performing all the work myself.
W E pteac be cawc dw whga bawam neo+ho.M*Up pesom m do=.iCz VWCr,===.=aoo e,ep+ur-atom a 1-CVi=z Of
mt O=m A=txw=io m the be
e:aployo^a mfrs tbe..eesx+i�-�./1u(6t�1S2�1(S�=pp�e�oao�7►a bamoeata�res a ber-_x er¢•mie FTes-dmoe dx
Iegsl RwM-of U w a ww drs Wetkarla Campow.4mal Amt
140dwaand the a mmpy a[tbia mtataimma may ba fwv d.d to thm Daparto efl.&MaW Aaddm w OW—mr4-s+ooe rat tb.
oov tsa^C vaiGtatiN and tha E'Jk—to U--4v mdar soc:i;m 25A arMOL 132=a lmd to tbe.is*mitios of aimim'Pecabtia
•ooa:a-tt:tg o[a rwe of aep to S 1.,SOO.oQ a:tdlor mtPessoeom4s�of rrp to oac year nod d.,7 ed,ebe.roaa of a Swp warp Order aad� -
fi**ofSloO-oo a dal tPi a C=
SECTIONOr
L-1 Licensed Supervisor: Not Applicable ❑ .
Nerve of Ucenae ttoltier
license Nsnber
Address Date
Signature Tekoxne
Notes ❑ _.
61-1 C-- /yyZjr
z `2
Address Date
Telephone �'� >�
SECTIM 10,490 RS'
Workers Cron kmnanc a affidavit must be clompteted and submdIed WO this application.Faiune io provide this affidavit VA result
in the denial of the issuance of the Wlldmq
Signed Affidavit Attached Yes....... No...... ❑
WIN■ +�.u".r.ri.rr� r�r�r
The c meat exemption for`9tameowners"was extended to include Owow-oeconied Dwegi of one(1) or two(2)families
and to allow such howwwrAr to engage an individual for hire who does not possess a license,provided that the owner MM
snoervtsor.CbM 780 Stab .Mien Section 1118.3,5.1.
De a,Qf HonceenW Person(s)who own a parcel of land on,which hdshe resides or intends to reside,on winch there
is,or is uuteatded to be,a one or two family,dwellin&attadred or detached structures accemory to such use and/or farm
structints.A person who teu+sfrsds WE than one come in a twos-year paned alb vM be csidMed a hamedwsa
Such"homeowner"shall submit to the Building Official,an a fame aoeeptMk to the Tiding Offictaij§V shall
nmmnsible for all Am*work nerformcd aft tie IIIIIMU nerIdL
As acting QMgb35.thg&ggabK your presence an the job site will be required from time to time,curing and upon
completion of the work for which this permit is ironed.
Also be advised that with reference to Chapter 152(Workers'Coaation) and Maple•153(Liability of Employers to
Employees for injuries not resulting in Death)of the b6mcimsens General Laws Anted von mw be Fable for permu(s)
you hire to perform work for you under this permit.
The undersigned"homeowner'"certifies and assumes nspo=U%ty for compliance with the State Building Code,City of
Northampton Ordinates,State and Local Zoning Laws and State of&b=acbndft General Laws Annotated.
Homeowner Signature
r
SEC'i'tON S--DESCRlP771JNf�
New House ❑ Addition 0 Or Doors � $� o Roofing
Accessory Bldg. ❑ Demolition ❑ New Signs Decks [L] Siding QDI peter[CA
Brief Description of Proposed
Work - --• - ___. ._
Alteration of existing bedroom Yes No Adding new bedroom Yes INp
Atached Narrat" Reaavafatg tulitished basemettt Yes No
Plans Attached Roll -Sheet
� r �
a. 1Na:.f btwlding:Onne Far. ; Tvin_ Famiv Other .
b. Number of rooms in each family unit: Number of BaUtroonts ,_
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
U. Energy Conservation Compliance_ MasschecC Energy Compllance folm attached?
h. Type of construction
action
1. Is construction wither 100 ft of wetlands? Yes No, is won within 100 yr. floodplain Yes No
j_ Depth of basement or ce1w floor below finished grade
k. Will building oonform to the Building and Zoning regulations? Yes No.
1. Septic Tank City Sewer Private well City water Supply
SECTION 7a
OWNERS"AGE -
Zhr- as Owner of the subject
authorize fYmy behalf In all matters work authorized by this bull ft pemid application.
LV
Sigrmture of OMM tea
1, trt o _.`40 C� ' as Owner/Authorked
Agent hereby declare that tKe statements ments and kdbnna ion on the foregoing applikation are true and acauate.to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
SignayA of Owned
.3
,
Section 4. ZONING NI ktavnatkn Must Be Co npleud.Permit Can Be Denied Due To kx=W ft btaw ation
Existing Proposed Required by Zoning .
Tbis aim to be IBtect in by
:r
1
Lot Size R I I
F-
frontage I
Setbacks From
Side L=71 R.= LL= R-=
Building Height
Bldg.Square Footage %
Open(Lot 3=mmus Space �
#of LEM
N spaces �
Fill: ,
voluou�c Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DON'T KNOW 0 YES a '
IF YES, date issued:1 I
IF YES: Was the permit recorded at the Registry of Deeds?
NO 4 Dow KNOW 0 YES 0
IF YES: enter Book Page[ and/or Doannent#
B. Does the site contain a brook, body of water or wetlands? NO 0 DOW KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained (D , Date Issued:C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(dearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
x
,,=f Noi"Pton
isle Department
\` 212 Main Street
.6orn 1.00
? rh pton;MA 01060
htSne 413-587-1240 Fax 413-587-1272
.. x?°
APPUCArION TO COIHSTROCT,ALTER,REPAIR,RENOVATE OR DEMOUSH A ONE OR TWO FAMILY DWEWNG
1.1 PTOvedyMdr�65S.
fAq A
.�
SE&IiON'2�PR0PER'X1 CfwKERs"IPWYrf1ORIZE01 €
2.1 Record:
h 41 7
4 i11 . ?n
SAO k2 r= oAt Fr1 icy a
e tint Adafiess.
C14t 48$ SA 1
1
►Z-G t C Telephone
signatwe `
Z2 Authorized Aye /f
Cuffelt
!& 3- -3
Signatwe Telephone
sr
IY 3
Item ° EStmiated Cast(Dollars)to be Official Use Only
completed by pennit
1. Building / �� "` 5' Fee
2. Searicai AT�T-Waf Cost:of
_ kviit W-
3.3. Plumbing
4. Mechanical(HYAC)
5.Fire Protection
6. Total=(1+2+3+4+5) ,pied Nwnber
D�r~
Building Permit-Number, wed:
Signature: r
1 -
StddkV CmaWsammAnspedorof Buld iVs Date
;P
BP-2007-1163
G> #: COMMONWEALTH OF MASSACHUSETTS
� 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-2007-1163
Project# JS-2007-001857
Est.Cost: $6100.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TIMOTHY J LUCE
Lot Size(sg. ft.): 8755.56 Owner: SHEA TIMOTHY E TRUSTEE OF THE
Zoning: GB Applicant: TIMOTHY J LUCE
AT: 7 - 9 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
P O BOX 14 (413) 387-9800
LEEDSMA01053 ISSUED ON:512912007 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL RUBBER MEMBRANE ROOF
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 5/29/2007 0:00:00 $50.00477/479
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo