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17D-027 (4) J ` ��tSAMp�, �834ACiFIt8ttf3 DEPARTMENT OF BUILDI,\TG INSPECTIONS �^ INSPECTOR 212 Main Street • Municipal Building ' Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to act as his/her construction supc:-.�i or. The state defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be, a Wie—or-two fami�---- 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"fo 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 eegulations. 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 occupanev 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 issued-to me Date Address of work location r 4•ctt'v'rPr f { E (rT ff Jcf f To f11L1113Ifo1) - E Jai ca a itchnscIIs r DEPARTME1-rT OP DUILDr)\'G INSPPCTf01.°S j 212 Alain Street Municipal Building Northampton, Mass. OIOGO WGR1CLR'S CONTENSATION I,'lSU Z, NCE 1.FFMAA, (fi txnsxlperm�flee) %%IlLh a principal place of businessfresidence at: - - - yc 3.7 A,' (phone') _,Z6�­3 S�' ( ca ty/-Sq=,a P) {� do hereby ccr-4,-, under thc.pains and penalties of per3ury, hal ( I aln an employer providing the followine!v:•orkcr's comncasador. cove'ge for Im employcc;s wMocig on this job: O uUx-anc Conr ) (Potic-: N* 't-',7LY_r) _ (E;•pirztior,Dat~) i ( ) I am a sole proprietor, general coou-actor or homeowner (ci:cie one) and have hired t_he cooiracigrs used below rvbo Have the `olio iog worker's caMoep_t2:ion pc?icies: I Oi ConcMCaOr) Cotnosn)-i'ouc,• ""UM c:} (r`:Ju-juOn D.Itc) i i (Name of ConU-aaor) (Ins uznc Com>3antivPouc; Ntunccr) (L»irrion Date) i i (Name of COIIL cId i ) (Instlranc: Campany/PoUcy N;unbzj) (Expiraen Date) a i (2`tamc of Cootzactor) (Lnsuran Comp-� /PoUcy Numb:r) t���irticn Date). _ _ - (ntu zdjs-�ooJ r'x�C.ifaces.._-,• to iT ttGL mfaaL:ioa pet,.inias to Jl cocr-�oz) I O I am'a sole-pFopnetor and have no one wor4 ng for me. ( ) I a>ll,a home ovwer performing ail the work myself. i i NOTE:plea be ev.arc Lfi•• bcccxovx-3'to ploy Pe-.,oaa to do rc,p:a work as a d%. [h^;:of ant mot th_�4'roe�t�is%-izci Lb-bomoowwC raid..oc oa the p ounces xPp�ttca_ tbc'a�r ooc Cam.Xy oL-=.d-cd to be eixploy-s uaCc the..aim cn=p=--.:ea Act(GUI 52=1(5))�ar^PIiaDOo by a bomco-=fc a Gam.or pewit=y cNidcD=Lh-c 1-9-1—of ea--=P'oyx oad< d-W-+-e-Cooapam,,I.io.Act i I uodcaLad tbi a° Vy of tbi,—I—my ba f,—ded to Lb. OZ-or Ioe;+r+ooe for tb. covcl.-c vcif eiioo and d=i L-iltac to soauc bovcyZ�c tm)d==c:Goo 25A of MGL 1371 ua Icd to the=Pa oa of cimiazl Pee-s1Sin ";ate of a fine orup to S 1-MOO xndror ia>{r6o==orup to oec y-_r end cNil pca.tia io t5c focm of a Slop Work Ord-a d. fl=o(S 100.00 a day.Caia9 me 'f For dc,.r_­j t u.c only Aill 2' Si�1 pf test=lPcrm;uc tJ�IC I -- I 1L F ti. SECTION 8-CONSTRUCTION SERVICES 1 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 5:Recistereii'`Flome firiar"overiYent OalitEaca >: `: Not Applicable ❑ „� .. Company Name Registration Num er -_- 30� _ aoLd Address Expiration Date bJg Lit-A OS J-i 44e- -42zo!9 Telephone 9kr 3 S-( 14 SECTION 1'0-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(NF.G.L.c.1.42,,,&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...... ❑ 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-vear 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(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 SECTION 5 DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑: Replacement Windows Alteration(s) Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [0] Other[0] Brief Description of Proposed n \ J Work: ?•]4-,*C-L kJt4*c.�w &A' s Alteration of existing bedroom Yes_1,,No Adding new bedroom Yes ✓N_0 Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa[f'nNev t; o�t"n br tit ur#a zisti ions�nc>cor atete ttie o[fa F : 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 Wank Clty Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENTOR CONT.RACTORAPPLIES FOR BUILDING PERMIT I, t :&1 (A as Owner of the subject property T- hereby authorize to on my behalf,in all matters relative tow rk authorized by this buildinp pe it application. Sign JTu re o Owner Date -------------- I, �L rte-) (, (� i✓C as Owner/Authorized Agent hereby de fare 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 Na z_-z--© Sign Owner/Agent Date JF Section 4. ZONING All Informatibri 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 Bldg.Square Footage % r-----7, Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces A. Has | Perm�/Vurianoe/Findi ever been issued for/on the s�e? ' x�� x�\ � N0 �� D�7K�W �� YES �� IF YES, date issued: IF YES: VVasthe �recorded ot the Reg�t�/ofDoed� NO K~� DONTKNOVV 0 YES IF YES: enter Book Page and/or Ducument# B. Does the site contain u brook, body of water orwetlands? NO Pf— DON7K0OV 0 YES 0 IF YES, has permit been orneed tube obtained from the Conservation Commission? ' ' Needs tobeobtaiomd x~�` ��ta�med v°~� Date ��� v�� ' � �� �f 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 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading ion.nr filling)over i acre oriun part oyo common plan that will disturb over 1 acre? YEG K ) r NO &�^� IF YES,then a Northampton Storm Water Management Permit from the DPW is required. City of Nort ampton BulklingeDepartment = vewa 212 Main Street Room 100 e�eAv P Northampton, MA 01060 efts m cat�>�ans ph6he,41 -587-1240 Fax 413-587-1272 F'laea n � 4 � x �� rt�theriS�eCrty �as a s � Vim. rywzav .�".'� APPLICATION TO'CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION Thtssection to�be completed by office 1.1 Property Address: P x Map L:'ofi Unit 73 S41ZA9J j4t/iF_ Zone OveriayDisfincf t l-f7JLr�t � AA^- ;ter Etm St.Dlstrlct CB D� tnct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ✓: CMerweJ IAnly Q 73 5+r to f ar N m (Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Pn t Current Mailing Address: Sig Te one SECTION 3-ESTIMATED,CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 7v cU ,(a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building,Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) (/1 -70 ` Check Number Thist Sectiom For Official'Use Only Date Building Permit Number. Issued: Signature: Building C ommissioner/Inspector of Buildings- Date 73 STRAW AVE BP-2006-0607 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17D-027 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0607 Project# JS-2006-0886 Est. Cost: $4770.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Jeffrey Cranston 101176 Lot Size(sq.ft.): 16335.00 Owner: JUNNO DAVID&CARMEN C Zoning: Applicant: Jeffrey Cranston AT. 73 STRAW AVE Applicant Address: Phone: Insurance: P O Box 307 (413) 268-3504 WILLIAMSBURGMA01096 ISSUED ON.121212005 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS 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 12/2/2005 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo