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22D-070 (13) � O�'Ct1AMP�O C�ztp of 'Nart11alltptall � � �t1�AS5ACI1728ttt9 DEPARTMENT OF BUILDING INSPECTIONS " /a I=l INSPECTOR 212 Main St,eet Municipal Building Northannpton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to act as iris/leer construction sul The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or trvo fancily dfvelling, 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 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 -71110 Address of work location 6 F(ofebj w , ,s of I Of � 3 Strcct iu`untci >nl 1y.tilt!iu,; ` Northe:mpton. Mass. 01()GO NYOPINEAZIS <:�� it�h:���� z�roN �nsv ;��t ct,: Al"I"IDAvrr vc f)Cil!'.lil... l)I Jill v, ...-- N,._.It.�r; i!1C fb!1(_ a; �_.t..: CI ( O�i._..(_((.,"i 1�7�.I:?jIcc (.__Oi il,.' --(Nal,nc O1 l Ji L',?CiG1"") i[l:Z;i?I]C COIP.; ' 1 OL;Ci' ?ttlill?'?f' !'..`.. . Da c) (ru,� _.,:caul z•.r_. .. ... ..- -K;,., , - .a �1; l l tll i C 1 0 1, I'_' t :11 :1 1V-1-', 1)0 t-)Ilc :"" t01 ii?c. N Ili.plc- ._l�n«-�:c t!.at�.t1: t •:;'o•.�:r_;a��:z�c;ptcry Ir:r�:o;'.>::�.:.':aiz_c,�":t.:,cc.Y:c. _;;::; ., ...':..j i-::: c: ncx mcti-c t'nn tt:rrc I%ni l i:: c,s:.; -a i..:.(C�L1�2,.-S I{S)), f, ic: by n hov:-o�ti-rr ..r C:- -r. -� . _. _. .._rx Icgal ctalna of all_4,10yx under tLn AVcx4_c'��;o ;raration ArL I dial a copy oI thi,claLc:-ri__�,ay kw fwwwilod to tl»iY_LNVtax«:of or dm -o z-I&c vc~iCiczlioo n_-JJ t lit faih:c to sn::c of xo_vt.Scr c .icn 25A of MCI,152 can Icad to tiw im;»zitial cun:isimg of a f:rr_of up to S 1.5�J.l�J n:�bw:rr,iri:::nn�-.�oCup to cam,-}-Zr ntij civil h uldc.i❑ Lt:c of Sl 0_QQ a 31y a;r.im.i to Pcrtntt 1`,unttx�r I Sif,naturc SECTION 8 -''CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder _ _—_.._._- --- -- License Number --------- — ----------------- -- ------------- Address Expiration Date Signature Telephone 9 'Regtsterea°Home Irri�rovement Contractor ,_.,,}_ „�,� ,,,�,,e��,, �„ ,, _� Not Applicable ❑ Comp-any Narne Registration Number Address Expiration Date Telephone SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, § 25C(6)) 'Norkers 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...... ❑ MT HoriiieA..� W"M,, emp ion The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or two(2) fanniiies 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 LLiability 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 hd State of Massachusetts General Laws Annotated. Homeowner Signature _ .�--- � a� �� ' ,� - __�- ,� ____-_ r , _�- �___.�. _... �� �_ � �� �� �� Y i �----- � .� __ -- � ----- ! I +, .� --- _`_--- , , SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition[] New Signs [ ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work_/40AelIe//0'�`Qi1 -- Alteration of existing bedroom -Yes _-v_. No Adding new bedroom _— _ Yes /No Attached Narrative SAC ✓�s� Renovating unfinished basement __._____ Yes ��No Plans Attached Roll [i - Sheet [i 6a. If New-h"odse`and'or addition to existing' houSinf7, Complete the following: 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 f. Method of heating? _ _ Fireplaces or Woodstoves _--_ Number of each E, Energy Conservation Compliance. Mascheck Energy Compliance form attached? n. Type of construction Is construction within 100 ft. of wetlands? Yes _ No, is construction within 100 yr floodplain _ _,_Yes 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 APPLIES FOR BUILDING PERMIT 1 as Cwner of t��ie subject property hereby authorize to zc; o! my behalf, in all matters relative to work authori7ed by th,s ildin, permit a�olication. Signature of Owner 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. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage N Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage �UOlJ % Open Space Footage (Lot area minus bldg&paved t� .-�G/+✓'- parking) #of Parking Spaces Fill: volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page __ and/or Document # B. Does the site contain a brook, body of water or wetlands? NO _ u0N'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained —Obtained Date Issued:.___ C. Do any signs exist on the property? YES _ 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:_ ___ patirytent:useo. ly � City of Northampton Status of Perriilt '� 'ta �� . Building Department Curb Cut/Drtvevray ermit -� 4 � f <. t[Aain Street Seer/Septi6A vr VHbblitty ��� ������ "� ' � 2 ` p0tI 1 00 Water/Wel( Avallablilty � � ' � - `n .VC I I t• ( T�toli, ��t1, 0 1 c6o T`"'O Sets of SttUCtUfai�P�a115 � � # f 1 e r e (-)il ,, l l�1 �lJ F a J 1 / PiOt/Site PIanS - — AL v 7 Other Specify �3 APr'LICATI CfrJ}tSUCT, LTER REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING k_ s — — — -- — — — — -- SECTION 1 SITE INFORMATION This section to be completed by office f .1 Property Adcfress G1 a 771� p Lot_ Unit----- ---------_--._��_______,----- --- Zone u/0--loverlay District _ Elm St. District CB District SECTION 2_PROPERTY OWNERSHIP/AUTHORIZED AGENT - 2.1 Owner of Record: CD carne .( rinf) _ �! . : i ;ir ,• .._ "��`�' � 5'O'6 2_._2_ Authorized-Agent: IG I� CSECTION-3 ES TIMATED CONSTRUCTION. COSTS .tee ost (Dollar ' i o: OifiCl l Use Only I •n�pleted by perrniit ermit Fee �DoD. Dd - h n a Tnf l Cost Of frotj) ) Building Permit Fee �--�- I 5. Fire Protection v_ Ufa' eepw'06 --- Check Number _ This Section For Official Use Only Building Permit Number:__--,__— Q _ Date Signature: Building, Cornmissionet/Ins;.ector of Buildings pie File#BP-2004-0028 APPLICANT/CONTACT PERSON LAMPIASI MATTHEW T&LISA A ADDRESS/PHONE 86 FLORENCE RD (413)586-4421 () PROPERTY LOCATION 86 FLORENCE RD MAP 22D PARCEL 070 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid /d Typeof Construction:_STRIP,PLY&SHINGLE PORCH ROOF&CHANGE ROOFLINE TO HIP ROOF 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: pproved 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 C ssion 2 oC� 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. KE +�R1;A7CiJ BP-2004-0028 GIs#: COMMONWEALTH OF MASSACHUSETTS I -,22D t?7Q ' CITY OF NORTHAMPTON Lot: -001 Permit: BUIi ft Category: BUILDING PERMIT Permit# BP-2004-0028 Project# ]S-2004-0045 Est.Cost: $1000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group Homeowner as Contractor Lot Size(sq. ft.): 15246.00 Owner: LAMPIASI MATTHEW T&LISA A Zoning:URA Applicant. LAMPIASI MATTHEW T & LISA A AT. 86 FLORENCE RD Applicant Address: Phone: Insurance: 86 FLORENCE RD (413) 586-4421 O FLORENCEMA01062 ISSUED ON.719103 0.00:00 TO PERFORM THE FOLLOWING WORK.-STRIP, PLY &SHINGLE PORCH ROOF & CHANGE ROOFLINE TO HIP 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: FeeTvpe: Receipt No: Date Paid: Check No: Amount: Building 7/9/03 0:00:00 1003 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo