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17C-258 (2) ` . <L � � �tassacl�usctts DEPARTMENT OF BUMDD�G INSPECTIONS INSPECTOR `212 Main Stmt • Municipal Building Ncu-thampton,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 supw -,,isor. The state defines"Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be,-a one or lrwo WM_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 building deparanient ford e City oTNcrthampton wants any person(sj-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 fegulations. 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 sour) a rough building'insnection(before work is concealed) insulation inspection fif re(tuired) 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 L understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit - is-sued-to-me. Date Address of work location - F Crib ref ;crrfljzIIII:Jfal.t - R " E �c a j2+t3awrl�aLrlja DEPi1RT MENT OP BUIIDI)\C INSPECTIONS 212 Main Street Municipal Building ' Northampton, Mass. 01060 WGRIa'R'S C0VII'ENSA7I0.N 'MSURANCE A • AVIT' _ LL/ -- (li ccasec/peraii tfec) )An Lb a principal place of businessfresidence at: _ V � d�-tl��.,. . �� S 01`��3(phone-io (scrcrt/ci ty/atatcIi;p) do hereby certify, under dic.pains and pen2lties of perjury., JLai O I am an employer providing the following 11VOrf:CeS cofnpcaSBUon cove=c for my emplovees ivorlang on tlris job: aMSiu-mac Corer:cy) (Polio. )"urnbcr) - ( xpir-a on Dam) ( ) I am a sole proprietor, general contractor or homeo' er(c cie.one) and have hired the contractors listed below wbo h2ve the following worker's coroensadon policies: 0-1ame of Co.^.=clor) (I1LRlran= Co mD1,�'/lyGI1Ci 'vttlr7l.'c:) (Y'71:1Ii0ri I)aLC) (Namt of Coomaor) (1nSw-zn=Comnaaw?olitc• Nunlicr) (ExDir.-Won Date) (Name of Coa>iaCE ) (Insuran=Compan}•!Pout}- Number) (ExniM60n Datc)- . (Name of Coaa-actor) (Losluan=Comc uy/Poticy Numb-..r) (Eapi don Date). ...... 7Iam'ai syed.i l'neonia.�y to a�etude inraxxi-3*o perb6ziag to aU oo=--r_o:a) ..sale-pF©prietor and have no one wori;dBg for me. ( ) I am:a home owner perfonuing all Lbe work myself. NOTE plcu be aware thx 4lvlo bomciMVCra wtip assploy prom to do c-•,�_�o~.:caao c rcpair wait oo a d,-Jl--g of VOL Metz th-=L'TM is-bich Lbc bomoawroe rtado a oa ibe y v=6 appur�tba,-,L=oet tie ol1Y a yes d-oi w be e aploy—turC.the"o-S e'z C=V=--lion A={G0 52,=1(5A=ppU=Soa by a basumwoa fir a Ge=e«pctmit o_7-idmoe the legs1 a,aau of as aPtoy.r under dro WoAcdt C.omgooe Caoa Ant_ I vada nand d-a oopy of thfa aatesr d may be for.rd.d to tb.D partaaooa of ladwrlid Aa�OM"of loaraooa for th. co-r"b-�=Zc tioo am th:t adum to&MMM to,,erase wodcr soecion 25 A of MOL 152 m tod to tba iarpII;d a of eimiaal Pcaaltic ora tine aruP b 53 300.00.:tQla or up to a=)'.rx and eitiil peo&ljc-tbE form o(a Stop Work Ord-and a rt*of S 100.00 a d_y tptias't me ' u+c only -._,� • A SECTION 8-CONSTRUCTION SERVICES t-'• 8.1 Licensed Construction Supervisor Not Applicable 0 Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Reaisteietfomemb Not Applicable O Compamr Narnef Registration umber RCK ��tJ>L �( i4) Address F�cpiration to K S �A U t 05 Telephone -3 a /i� SECTION 10=WORKERS'cOIIAPENSAT1011NSCJRAFtCE 1FIDEVT �s-. a •Z5C(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....... 0 No....... O M The current exemption for"homeowners"was extended to include Owner-occuuied 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 1083.51. 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 shvctures accessory to such use and/or farm structures.A-person who constructs more than one home in a tw"yar 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 builkling uermit. 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 and Local Zoning Laws and State of Massachusetts General Laws Annotated Homeowner Signature r 't t � SECTION 5-DESCRIPTION OF-PROPOSEOfiN.ORKacheck�8lf°aaalicablel New House Addition []:,. Replacement Windows Atteration(s} Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C3 Siding[0] Other[EJ Brief Description of Proposed t? I" UUS £'� Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roil -Sheet ., . a. Use of vu iii::^y:0---Famil u T.Fami1V Other . ..j 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 L 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 Ta OWNER RUTH' FF ON-- �3 U tI=N x. _ _.._ QWNERS AGENT OR't',CyNTRAE1fOEAPIiES)I:ORiJi1N?fa PEt2M . I, R0 P,C k_I ` -U)A r&/ ,as Owner of the subject property _ // hereby authorize i Y�C.� r�l J L to a nmy behalf in all matters relative t rk authorized by this building permit a plication. f fb v U 4 Signature of Owner Date 1, Li^__ as Owner/Authorized Agent hereby declare ftt 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. ' c. J c—, Print Name­- Signatu&of OwnerlAge ate 4 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 Depanment Lot Size Frontage Setbacks Front j i ± € Side. L:7--7' R:l Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved t #of Parking Spaces—' Fill: f (volume,&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON-r KNOW 0 YES Q IF YES: enter Book ! Page; } and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: I C. Do any signs exist on the property? YES 0 NO Q IF YES, describe size, type and location: j D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q ,- NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. A ' Y4 City of Northampton Ri artment pn 2 Street ,7 Q V ;100 N Northampt MA 01060 , phone 413;, 7-1 )Fax4l3-587-1272 ' APPLICATIQN TO CON'STRUQT'SALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION t 51TE JNFORNFATIOI�f his seQn to�6e conf�eted"6Yofftce x t 1.1 ProoertvAddress: =� ,ZOLIe +.. ©1Ket'1;31�"di3�Ctr: NE6t�€$1 Distcf =ry CB DisictT. SECTION-2-12I1OPERTI(OWNERSHIPJAPTHORIZED 2.1 Owner of Record: Name Current Mating dress: �I / 7"Z wCc- itl/3 o/0 (� Telephone it 9 Signat 2.2 Authorized Agent: Name(P t) Current Mafng Address:2��' 4 - Signatare Telephone SECTION 3-ESTIM�lTEC1'CONSTRUC 1"IfJN_COSTS; Item • Estimated Cost(Dollars)to be Official Use Only com feted by rmit applicant 1. Building c), _(a).Building Permit Fee 2. Electrical /{ j bjEstirnatedTotal Costof _...Constnitliori froit, 6 3. Plumbing Building.Permit fee: 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) (}✓ heck Number Thr.;'Sectiort For f)EBeial[Use:On Building Permit Number_ )� ; Signature: r Building Commissioner/Inspector of B Mings Date S4 T ISM ST BP-2006-1035 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-1035 Proiect# JS-2006-1537 Est. Cost: $1900.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TIMOTHY J LUCE 149288 Lot Size(sg. ft.): 23870.88 Owner: STEWART ROBERT B& Zoning:URB Applicant: TIMOTHY J LUCE AT. 58 NORTH MAIN ST Applicant Address: Phone: Insurance: P O BOX 14 (413) 387-9800 LEEDSMA01053 ISSUED ON:41412006 0:00:00 TO PERFORM THE FOLLOWING WORK.-SHINGLE ROOF OVER 1 LAYER ON ONE SIDE 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 si nature: FeeType• Date Paid: Amount: Building 4/4/2006 0:00:00 $25.00282 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo