Loading...
42-074 (3) ©u-3 Q, Z� GI-it r of Xort4ainpton $ � �Tdassachusrt2s DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton,MA 01060 y HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supc.:,,;sor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 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 /, ) ?))(r- xt� understand the above. ome ie rresi ent's t nature requesting exemption) I will call t schedule all re1w d building inspections necessary for the building permit issued to me. Date Address of work location ttt_AMh� ;� �, (i-ifs; cif ��Itz-f1?�-illl}Jf1111 6 �S�iS S RCll 115 C 115 _ m UEPfu'T1vfE2Tr OI' LUILDDI G INSPECTIONS 212 Main Street Municipal Building j, Northampton, Mass. 01060 tiVORTCER'S COIITI'ENSATTON INSURANCE Al FF-DA IT ,v Ih a principal place of busirless/rc:iCCnc - ----------—- - ------- ----- ------ (T h o n C� '+ d0 hereby CCI-L1I't', un;lct- r-11C U2iIIS 2117 pCil�ii1CS O rCrjlll}'> thr!' ( ) I am an employer providinS the 0110'.virnt •:or'.�:cr�s Comncnsation covera'_"c for my cillpIOVCC;S worririg tin this job: v (Instran= Company) c! Number) — - (F�- ar,:ien Date) j I = a sole prou.netor, L'C l°rat GJi1 CCi G- t=n6o`:vDer (CliC1C out) aIIG tiavc hirtc1 the Cont:actorS hsteC beio `Olin PAC o .. -' OfK coma Il�Li0i1 (T:nmc of Contactor) (?ns ace t orT1o:r:Po!icr Nurnt• r) (i .,..i Date) (Name of Contr ctor) 711s rlrce Comn_,rr/Pe!ie, Nt rrcr r; (3.?: r.:tioc Date) (Name of Coanclor) (Ir> rc� Co .;i oGc, N,u�t,�rj =.x r�:roc Dat, ) - (Name of Contnctcrj - (Ins Lance Comr v y!Polier Ntrmt��*) -- (H,:-. -:uc-. pare) (^,tl G'1:.Ci•-'lI t;CC al i_..t..."-__... ::)..:-..�..:....'Y:..i..�t. r' ._.... _li�:( .:..--..-\ ( 1 "u`ll a 'sole pr opIlC:Ji alm a homc ov";!1C` iCi?';"tillll l L. :, ...`r...I NOTT:pease be a:vsrc t!1sc•.s -ile Frrc:�« r:«ro r, p! .;> :_i ,•,,. aran cc rr:-;;a r 11 cliir.,C: not Irtocc th:❑thrcc uni+s in tci:ic'1'Fx 1 .���•.\i��rc_:,:;�u<a;.:�.- �_:.:::. ��t:�_..^I L�cr:o crc a.:t �-filly cc�; `rc�:o cu;p1oyc3 un.!,c tlr:vc;}:rs cc m rS (GLI52_::�1(Sj;, by a hnrlcol nr`•or a Lccx cc prrc:i::: tir c L.c Itsal status of an a=Qloyx und t:c Wcvicclt o v a_.tim AcL I undc;itsnd d i i a copy of th.1 aatc:cc c:.y bo fo,µ',v1'dJ to t-' fY.Sxi tzY^,of Indiuri cl Aci dr if C'f ioo of I: e for the coven gc wailieafioo aid th=t Lilure to _:co,.—ram ur,.-: c"iM?}.q cf I.tGl,152 can lc_d to tl e im{ sitiall";r.mi:_!pmts Cs Nasistmi g of a rtrr_of up to S 1•S00.00 nn&'C:r i�:-1r, r,:ti:-1 of 11p to cr.:}- evil pcnzi!in in�r"c-111 of a sic.`Vni:(}ua tr,:l fro oC 00 a dsy igain_.t m" 1. YCK'v-�.st tti>rT:sl l:>•c Gtly j Pc:rmt Nauru r --.___------------1 Sinaturc �fi.ic�n JI'crmi' c: r _ S�CT10N 8==CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone Ree s ere :fr :ome<,mnrorement Contractor- Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone ;SEC TIQN 10„WORKERS'COMPENSATION INSU'RANCE.-AFFIDAVIT(MG L. c. 152, §25C(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...... ❑ 1 UN O �{ � n 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 acecptable to the Building Official,that he/she shall be responsible for all such work performed under the buildine 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 fez 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 "homeowne' ertifies and a mes responsibility for compliance with the State Building Code,City of Northampton Ordinances, a and Local orin- aws and State of Massachusetts General Laws Annotated, Homeowner Signatur SECTIONS IDES R]PTTONIOFfPRDPOSED WORK(check a11oa'p Ip icaf le) 5 Y}.a'.w+.° i'M Oz New House ❑ ddition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed World Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative D Renovating unfinished basement Yes No Plans Attached Roll D • Sheet D 6a�1 lew ou a andT-or additi nA o...eziMih3 dT.§ing rd6M, 'le a fhemfollowing: 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. Nfe�hod of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck 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 OWht kS AGENT OR CONTRACTOR APPLIES,FOR BUILDING:PERMIT 1. as Owner of the subject property hereby authorize to ac:. on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 1. 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 Owner/ e t Date i Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION i Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front / 10 r'7 Side L: R: L: 17Z R:_ � Rear ' D /D Building Height Bldg.Square Footage !^ % ( tt (Y Open Space Footage % (Lot area minus bldg&paved parking) rl U� #of Parking Spaces rJ Mae Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever n 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 DON7 KNOW _ Z YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT 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 re any proposed changes to or additions of signs intended for the property ?YES No _ IF YES, describe size, type and location: w Or- -- -City of Northampton ilding Department ` 12 Main Street " Room 100 J J N - 8 2004 ampton, MA 01060 phone 13-5 7-1240 Fax 413-587-1272 it'_ '.J ,w' kF{ �Sl'ti ��:`�`�`"..« b:C:„m r%.•- 7^.;x2A^ ..�. "%ati°`*"Z. �-i-� APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION'1-SITE INFORMATION i.i Property Address: This sechanr�ta be�oc�npleted by ofrEc+e Map Iat ' ez tlnrt 1 ' CC LP, WA 7 n[r� zone Overlay District E{[17'$t.DIStrlCt "'' CB Dlstrrct SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT' 2.1 Owner of Recorck Prin Curren M 'ling Address ,d Telephone Signature v 2.2 Authorized Agent. Name(Print) Current Mailing Address: p� AO- 0/ 1;L Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee 100. OD 2. Electrical 1 A/07 A00 (b) Estimated-Total Cost of Construction from `6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fare Protection 6. Total = (1 + 2+ 3+4+ 5) Check Number 07 91! This Section For Official Use-Onl Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2004-1253 APPLICANT/CONTACT PERSON ODGERS MARY C&CRAIG W ADDRESS/PHONE 97 GLENDALE RD FLORENCE PROPERTY LOCATION 97 GLENDALE RD MAP 42 PARCEL 074 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction: ERECT 8 X 12 SHED 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO)ZMATION 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 Commiss' n Signature of Building Official Date Note:Issuance of a Zoning pernut 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. 97 GLENDALE RD BP-2004-1253 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:42-074 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Perrnit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2004-1253 Project# 35-2004-1894 Est.Cost: $2100.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sg. ft.): 4486.68 Owner: ODGERS MARY C&CRAIG W Zoning: SR Applicant: ODGERS MARY C & CRAIG W AT. 97 GLENDALE RD Applicant Address: Phone: Insurance: 97 GLENDALE RD FLORENCEMA01062 ISSUED ON.6111104 0:00:00 TO PERFORM THE FOLLOWING WORK.-ERECT 8 X 12 SHED 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: Receipt No: Date Paid: Check No: Amount: Building 6/11/04 0:00:00 276 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 97 GLENDALE RD BP-2004-1253 GIs#: COMMONWEALTH OF MASSACHUSETTS iuiap:Block:42-074 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeoa: BUILDING PERMIT Permit# BP-2004-1253 Project# JS-2004-1894 Est. Cost: $2100.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 4486.68 Owner: ODGERS MARY C&CRAIG W Zoning: SR Applicant: ODGERS MARY C & CRAIG W AT. 97 GLENDALE RD Applicant Address: Phone: Insurance: 97 GLENDALE RD FLORENCEMA01062 ISSUED ON:6111104 0:00:00 TO PERFORM THE FOLLOWING WORK.-ERECT 8 X 12 SHED 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: ®K THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND 7z;kSi2nLature: Certificate of Occupancy FeeType: Receipt No: Date Paid: Check No: Amount: Building 6/11/04 0:00:00 276 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo