23D-070 (4) City of Northampton
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Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 ss . �
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. 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 in ctions are made
understand the above.
I,
(Home owner/resid nt's signature requesting exemption)
will call to schedule all required building inspections necessary for the building permit issued to me.
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Address of work location y ) dCi /'Va ✓
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City of Northampton
Massachusetts
'- DEPARTMENT OF BUILDING INSPECTIONS R,
eet • Municipal Building
u .. Nor ampton, MA 01060
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DEC 2 8 2015 I
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SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET,CORN,STRAW OR SIMILAR STOVES,OR FIREPLACES
Check#
P lease fill in all appropriate information
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1. Name of Applicant : i
Address: l�� ii r"✓� � ��rr��i „�j -Telephoner
2. Owner of Property :
Address: 7 l-6✓JVV 1V rrk'l<l'�.-L,�t Telephone:
3. Status of Applicant : Owner Contractor
4. Type or Brand of Stove-:. L� v c� ✓e l�)����lz✓,- /��s �E i
5. Estimated Cost: b U
If applicant is not the homeowner::
Contractor name
Construction Supervisor's License Number Expiration Date
Home Improvement Contractor Registration Number Expiration Date
All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
6. Certification: I hearby certify that the information contained herein is true and accurate to the best of my
knowledge.
DATE: /:2 � APPLICANT'S SIGNATURE
DATE: IC HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
42 WARNER ST BP-2016-0848
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D-070 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate�)ory: woodstove BUILDING PERMIT
Permit# BP-2016-0848
Project# JS-2016-001437
Est. Cost: $1600.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sg. ft.): 20168.28 Owner: ERDT WILLSON
zoning: URB(100)/ Applicant: ERDT WILLSON
AT. 42 WARNER ST
Applicant Address: Phone: Insurance:
42 WARNER ST (413) 387-9537 O
FLORENCEMA01062 ISSUED ON.11512016 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL LIBERATOR ROCKET WOODSTOVE
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 1/5/2016 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner