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17C-246 I Jy ,_... ..__ ___v__d �.,__� .� — _ ... __ -- -- � �. � 3 1 � � �i �� � 1� f I 55�. I� JI — — —_ � __—__ _._ {. ^F \ � I' _ _ I I� �� �' r � r E � � �' �--- ! I i E �� C �� � � � _; q�._ _�_ .__�___. � �G � f I } G � i � �; t p; i � i ` {, !�, r � -- _—�_ � I � —, ,. � � G ({ ' I t i �t 4 z �._.__._� _.. _—___�...___ ' E � i � s � � �: �, i ��.._. 1 __ j t i � 3 - i 3 { f i i }� j s � � q ..�_.._,._..._.._ _.d—.–.. _ _ '� � � t( � �3 � —�—____.________. _ — .— mil_,_ i �3 �l i. j � ! ! ,,"` I i � ..— i i : { � � � l 4 t � 3. � �. `' � i � � i _ ._. i � j — � � . _.a.;-. „ _ � E e 8 t t � c e { x i I 1 E I i i � I I l Ir o i i J s' I __ - �. - -_ -�- ---- -- ----- -- _ --------- `' f '-a C ¢KtlAMPT .,, 51 DEPARTMENT OF BUILDING INSPECTIONS /= INSPECTOR 212 Main Street • Municipal Building ' North,-unpton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act aS his/her construction sups., ,fisor. 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 + I, A, 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 m . �-�► Date L' C�� 2 v6 Address o ork location �i �' • ��twrar _ rrrtilaIIIp aIi s l n ch n r.rl la' w c� DEPARTMENT OP L)UILDr)\G INSPECTION'S - i 212 Alain Strcct Municipal Building Northampton, Mass. 01060 «'ORICER'S CO1UENSATTON GgSURACE Al=, ANTI-I- i rs (liccvsxJpermittcc) -- I'Vith a prui lcipal place of busiDesslresIdence at. ( t/ci ty/sta.tdzi P) do hereby certify, under die-pain and penalties of perJury; h:t t am an employer providing the followine tvorkcr 5 comocnsa:Jon coverage por lny elnpi0vecs Nvorlong on iiiis job: (l=US=n=Comslav) (Pclicr tvu-ter) ( ) I am a sole proprietor, general contractor or homeowcer (ciuc:e one) and have hired the couiractgrs listed+ below wbo hive the coDov g workees co0oeru2'on pckies: I ;,qmc Oi Co:undo') (In--umnl„ Coinoan vPGUci Nunlh-c, rX71,J 20n j' (Name of Coolraor) (Ms'urancc ComoazwPoUc Nuncer) �iair,pion Date) Ma me o Contraclo;) (Laurance ComT)an}•/Pot;g- Nuimb r) (Expimtioo Daic) i (name of Contractor) (Ituuran Comcacy/Policy Nu.mbcr) tT—.% Mdoo Date). (na.aa�_d li�ocaJ t�cct.if aoc�sz�•to ax!u�iaf«nu3 oa pa-taiains w.0 oo¢r-_c.o:s) . { ) I am a sole proprietor and have no one working for me. I atn.a home owner perforrni.ng all the work myself. i NOTE:ple_se be mire l�vt Je hemcrn�ven who ecap(aY P,L�w M c rcpza.••oric on d,- --Z of ant moot LL-z is u't�eh the bomoo-mcr rc=da or oa the pourer{-zp7urtca_r1 tsceo e c ax C--aeeUy a-=r&T i to be eitploycz uc'--the..9;�{:mP.--. oa A,=(GLI SZ-l(S))� .ppiiaboa by.boacoava fc:r:6c=---a pain r=y c-rdr L c Icgal n».,or ea arployer undertbo Worrcic Compeo3.tioo A<t I und<rO ad tha a Dopy of thin cta_ x avy bo r«+nrdod to t!w pcpa moo¢at lodtcrri�l Ad..&OT,—or Gauiooa for th. covcr2-b`c rcrirCtioa read qu(L-i)tat to Lca=`eo%erag•u»r',rl soeiioQ 25A of MGL 152 ew 1¢d to the i ioo of aimi-d paintrics 000-zmg of a fine orup to s i.O .00.rztcc orup b ooc yes nod coil pcnitia is tx form of.Stop Wort Ordc.ad a rim c(S 100.00 a d_y iPjc j me For dcp.rta:-W u.c only Perna Numbcs Lot Sk-D-Ituxc of Licaz_scc/Pcrrniucc I Ce T SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9 -Reiirstered`home rrn6 avertientCotitFactar� �• , --a Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION:INSURANCE AFFIDAVIT(M.G.L.c.152,§-25C(§)) 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 Budding 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 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 an Local j1Zoning Laws and Sta of Massachusetts General Laws Annotated. Homeowner Signature ��" `�Z� C �• �. �, r ' SECTION 5 DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacemen Wi ows Iteration(s) Roofing Roofing ED Or Doors '54 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[E:3] Other[p] Brief Description of Proposedz�J Work: 1 Alteration of existing bedroom Yes L---N—o Adding new bedroom Yes No [� Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa �f%New f Ouse and©r aficl1[off extsi6 6 ousMtO di 1, 'd"' ott"",fir>zci 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 AGENT6R-CONTF`AGTORAPPLIES FOR,,BUILDING PERMIT I. 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 as Owner uthorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the my knowledge and belief. Signed under the pains and penalties of perjury. Print Nam SignAfe of Owner/Agent Date = ` . ". / / � v Section 4. ZONING All Information 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 Open Space Footage % 7- (Lot area minus bldg&paved #of Parking Spaces (volume&Location) A. Has / Perm it/Vahonce/Fi riding ever been issued for/on the site? r..-V �� �� NO \.-V DON7 KNOW �~� YES �_� IF YES, date issued:,, IF YES: Was the permit recorded at the Registry ufDeeds? ' �� NO �� DON7 KNOKNOW YE3 IF YES: enter Book Page and/or Document#| | �� �� B. Does the site contain o brook, body of water orwetlands? NO x���� DON7KNOVV �~� YES �~� IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs tobaobtaioed �~� Qbtoinmd �~� Date v�� �_� ' ' C. Du any signs exist on the property? YES 0 NO Ka IF YES, describe size, type and location: - ^��/- D. Are there any proposed changes tuur additions uf signs intended for the prope� � �y y? YES l NO IF YES, describe size, type and |unado E. Will the construction activity disturb( hng.gradin g nn.nrfi|Hng)uvor1 acre orieit part cio common plan that will disturb over 1 onno? YES 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Ju City of Northampton Satiisot Pe Bilildina Department tiirb lgcrtvicesntrE M 212 Main Street Sewer e� Room 100 W&eeta� Northampton, MA 01060vSes phone 413-587-1240 Fax 413-587-1272 x APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This:sectiorrto be completed byraffice "I Ma{ fat Unit �) TJ - As 11 0 / � � � ES District SECTION 2 PROPERTY OWNERSHIPfAUTHORIZED AGENT 2.1 Owner of Record: r' GC © � / Name(Pri nt) / Current Mailing Address: . _M4 C/9 E e,6 y \ 2� Telephone Sign re 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 (a)Building Permit Fee 2. Electrical t C� C (b)`Estimated Total Cost of Construction from 8 I G� 3. Plumbing ) Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) G 0 i Check Number ( s • a This Section-.For Official Use Only Building Permit Number. Issued: Signature: Building Comm issioner llnspectorofBuildings Date c File#BP-2007-0034 APPLICANT/CONTACT PERSON HAIRSTON ANDREA&PAN WELLAND ADDRESS/PHONE&JAMES C EMERY FLORENCE PROPERTY LOCATION 81 NORTH MAIN ST MAP 17C PARCEL 246 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid LP(uilding Permit Filled out t�e Paid 121 Typeof Construction: Remodel Bathroom(no structural changes) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildin¢Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOj2MATION 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 Commission C4-1— dro:wil 07/it D Signature of Buil ing 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. :M SST BP-2007-0034 GIs#:r COMMONWEALTH OF HFOJIA� CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2007-0034 Project# JS-2007-0050 Est. Cost: $15000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME OWNER EXEMPTION Lot Size(sq. £t.): 20560.32 Owner: HAIRSTON ANDREA&PAN WELLAND Zoning:URB Applicant. HAIRSTON ANDREA & PAN WELLAND AT.• 81 NORTH MAIN ST Applicant Address: Phone: Insurance: &JAMES C EMERY FLORENCEMA01062 ISSUED ON.7/11/2006 0:00:00 TO PERFORM THE FOLLOWING WORK.Remodel Bathroom (no structural changes) 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 7/11/2006 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo