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23D-101 (2) SL ^w � c 7>x y�Gc�t l F 3b FC 3- xta" na�� 7 ... c:rCr-l+� ac�r� +a n ZOO ON MA440JALIY (ZAiatM�, i A. i 9 fi �4te9 ' C'ARO X 4 lod. FL kk V,!� p 2-2x E),TFwP0,T, OAOC EXI-Sr lrl F t 3'�2!t K 4'N rSi'ON�. lie � 1 N P feA M1 4 PI- A�dQ -T-14 fZb a C,H iq 7:>-,D->'r-rr G/U ,`to. 5C(ACCA- i . s iT>6 C 6- 13 (v H jn9 c. j<L C ST� C d to - I& Neil Hornstead 408 North Farms Rd Florence, MA 01002 413-584-0458, AK PH. S H 114 c-r>x z 4 3- 44 E-A P e eA t 7� CaNT. -vj'gK-- CO)"T, VEA,77 ,LcD>f WALL S*6A-rf4"Vi WR C04 LL 5 °` t.°`A D I T 101-1 lelf fr soa FL&Apst *14 4w F, aopw� T� tow 1,157.'5 it 0 �ISI VI &rowe 2 A'f RA M W 4 5C(A CCA E SI T-->E U C 6- j<LE o(Z I-W A 4 1 i-)T UJQ A 010(0 Neil Homstead 408 North Farms Rd Florence, MA 010*2 413-5"5& 7-1) 7-4-1/e i'kl UPS A A L L &&V{ A) 7 , P TO Gl, i tD L ti i s Ac2E5 M I " a " tT � n N LE`r Srr� I JONNA SCIAGCA► �ES��Ea1c� / 36 HinjcKL eFY ST, IUO2TF(AMP7ON, Mt� 4l0(0 2 O�T1iAA1P�0 Critp of Xart4anrptmt - Z L �11A65AC�1i8ltt>S - DEPARTMENT OF BUILDING INSPECTIONS /? INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 s , HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as iris/her construction sup.;:.,;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 I, 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 s 0 A 6 %IK 5Rril ttbt117 ^ m DEPART?,{EN7 OP BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WOMCER'S COMTENSATION INSURANCE A 4 tU)AVJT –It a principal place of busiressJr : dencc I J C Old�2 �? -�oRT_f _Lh1��►?S '�_> � �`1�1� — -(Ph"ne';} �9t3�Sk9_0�{S� C10 11CI-CUB' CCI—LIII', UaC'cl- T11C p(_ins ilk pen:?tics Oi p:;ryll-t, Chl?i: I am an employer providin- the ollo'.v;nt orr_cl�s colnnensaUOn covera e or lay employce.s working, on this job: (Ins,=ncz Corap=") c c- Nu:fiber) --- (rte. .fir uon Date) �C) I azi a sole proprietor general cOD=,-Or c- hoMICC', aer (c clC 00t) and 1:-ve tared the contractors lister beio� ;; ` " t e ll 7 :o t: 1 `o co'pen on es: (-Nla nC Of O l[T1CiGr) (nsu mnc LOII^?;iri2 Gl]C{ NLIITLMi) i�?'; rn!c,- Datc) SyI� L'4 (Name Of ContTI CIGi) (7151 dP.0 CO��c;i\'/POIIC), Nil= � `:✓':" i]n2 Date) (?Fame Of COrltTaclar) (lI1S 1 I1C^ Ct�� :!]'iii C lrc NttII]fY_r) '.1;;',"n c--, Dat',) - (Name of Cont? Cervr .};Policy Ntimb��r) (E :ri-:iio- Dare) (^tL1C31:d'�t�oe':aJ SL:rrt...._'r_. 1:] ..r......�...�K:..1-.CY: .�._-•-- .. eL::f...]...,,.•� 110 0I13 'i'J?"ti:iL; t0; II-C. (, I drn 2 l home 0AV!I-- NOTE':plc-sc tr nt,Wc tltst•.tl;)c I -;co 1ir-s.,;roc_.�!, :.J +B Ir lc.F!; C,,L11:n:c. not ux,re tiLu lhrUO uni+lI in tti e+t-hc h.;��rtZr rc: s cr a; `��: ^s •1 crud Lhcc c c c n{(cam ra11,'cry;::;_:; t� ea?ployc3 un'es thr tvn:i_^ nn- :ati^e it (Gr,!52� !(Sl; a,:r ._:.tic::l,v a ho irottar for Gca_,e a per-ti:: tirx lcsal ctaiut of an c:=ployer under thn Wo Yc(e c,2,7^,m iticm!.cL I ur) e-=ia d thst a ropy of this etet--s1 auy bo fcrtw.vcin;7 to tlr>IYtnrtzun of Ir dsu ri l At�L�:�Li i o of:: 'r�,o for li. coverage vcificlioo and that C iI uc to e-1 re eot 25A of?.1Gt,152 can Ie ti to t}x imposifion eI c i::1 pall.; cvmiating of a ftrx of up to S 1.5WO. o a:t:�'cr i^:art r.z._-:!of t:p to cr..)-w r.-.j civil pcn:ltica in nlc fc,nn of a Str., fry of S10a.00 a day igain:.i m- -- Fordc�>vvnsral u.c only hC7Tnit J+t-naturc Of S CT ONe CONSTRUCT ION;;SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : 1-4Ef L H0A4S7-E*-0 License Number -Io fS NoKTH 64' ems RA F-i-o 2g 7ucc NA O to G z 0 :3 1 '2 '1 9 Address Expiration Date Signature Telephone 3 O _ ZOOS 191R—eg7sffle7e'a.91"6e Not Applicable ❑ Company Name Registration Number Ve?L 44.5 / 3 z 2 G Z Address Expiration Date Voerff F40eK—S 1?1>, "Telephone(4(-33 sr-f-0,1rv- 12 - t Ss - zoo s %SECT10N i WORKERS'COMRENSA,TION 111.NRRANGWFI DAVIT(M:G:L:.c- 152, $-2 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 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 fo-which this pen-nit 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 I V �ECTON �D S PONOFPROPOSED WORK check alll a lacable �� r . ... . :� ,� . New House ❑ Addition X Replacement Windows Alteration(s) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks stn „ g[ ] 0 her [ ] Brief Description of Proposed Work: ADD t3 R00#0 FORCY ECk : C0A)opeT t3e-oR000l To g-rtIr +Cgca&5. Af 6V/01 Alteration of existing bedroom Yes No Atl i+ new bedroom X` Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet's ff .SC. 4266 29'1If,+fAJ A 3 3&-7-->IL00m✓1 6a. w a e 0 to ezasting h.ous-ing omp a e ol'lowin: a. Use of building: One Family Two Family Other b. Number of rooms in each family unit: 7 Number of Bathrooms Z c. Is there a garage attached? 0 U p�,aPnlo@et,� 0 P d. Proposed Square footage of new construction. 72- /( Sq Py-,Dimensions f Z X 10 e. Number of stories? 2- f. Method of heating? Not W — Fireplaces or Woodstoves 00 Number of each g. Energy Conservation Compliance. k) G Mascheck Energy Compliance form attached? h. Type of construction Q oc�� F.Q+w., !F- i. Is construction within 100 ft. of wetlands? Yes -)<-- No. Is construction within 100 yr. floodplain Yes-)C_Nc j. Depth of basement or cellar floor below finished grade S PT, k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer G Private well City water Supply _ SECT© �ff1NE >JTFIORIZATION TO'BE COMPLETED WHEN DYNE SAIaEN CONTRACTOFtAPPLIES FOR BUILDING PERMIT l — Oft � as Owner of the subject property hereby authorize � to act. or my behalf, in all matters relative to work a permit application. Signature 0 Ow er Date NEIL H0MSTE14`p 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 A 3 Signature of Owner/Agent Date s Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size l' '�cf<L� S ern C>00 Frontage Setbacks Front Side L: 12 R: 2 S L:540C R: S*s*C /S Rear 400 Building Height 2 2 SA- Al C 357 J Bldg. Square Footage ?Poo SF 4J °/a 2 2 07 4.q 7,9 Open Space Footage ,/ (Lot area minus bldg&paved 3d Ud Q�,7 4 Zt7 C1 3 Raj,' 1p S��Q parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO D< DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T 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 there any proposed changes to or additions of signs intended for the property ?YES No IF--YES, describe size, type and location: c City of Northampton 'wilding Department 212 Main Street }- ��Y Room 100 l, MA 01060 a! - $ Ljc3 th ampton, ,; II OCT phone 13. 87-1240 Fax 413-587-1272 �FytPf}FG�f+TI'b '' 'r 4t�S-�RUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1!- SITE INFORMATION a �Thissectio tote om'°Ietedtiyoffac 1.1 Property Address: x' k 13 /Atc Map of # (�C7l2Tf-f A to 0 EIm St'District s 2,V.Bmts nct SECTION-2- PROP:ERTY-OWNERSHIP' ' UTA0RI2tEDA0ENT 2.1 Owner of Record: J OA)A-)A 5—�,cIA CCA i° 3 �i�uckl�`Y SE. Na int) Current Mailinc Address: bR-1, -g'17v� Telephone Sign ur 2.2 Authorized Agent: A)F iLr�f'1Tt �� 1�d2 i?{ Name Print) Current Mailing Address: F LZ,>P–Z--X�X– IRA Signature Telephone SECTION 3'- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Orily completed by ermit applicant 1. Building vU� -°—° (a) Building Permit Fee 2. Electrical v�e� (b) -7:stimated Total Cost of 2, Construction,.from 6` 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 4 ( C2 C20 Check Number I a- This Section For Official Use Only Building Pe.rrnit-Number> )u� o� Date Issued: Signature:. ' _ Building Commissioner/Inspector of Buildings Date --z File#BP-2004-0402 ' APPLICANT/CONTACT PERSON NEIL HOMSTEAD ADDRESS/PHONE 408 NORTH FARMS RD (413) 584-0458 PROPERTY LOCATION 136 HINCKLEY ST MAP 23D PARCEL 101 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiny Permit Filled out Fee Paid o S6� T eof Construction: CONSTRUCT 12 X 18 2ND FLR BEDRM&2ND FLR BATH IN EXISTING&6 X 12 PORCH W/2ND FLR DECK New Construction Non Structural interior renovations Addition to Existing_ Accesso1y Structure Building Plans Included: Owner/Statement or License 031249 3 sets of Plans/Plot Plan i F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON TION PRESENTED: ed 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 I Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commi 'on /d 2 0 Signature of Building 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. Y� 7ViolL'pPV y10 �nvPC] - NIJ 9�v4� 1� k1 136 HINCKLEY ST BP-2004-0402 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D- 101 CITY OF NORTHAMPTON Lot: -001 Permit: BuiidinQ Category: BUILDING PERMIT Permit# BP-2004-0402 Project# JS-2004-0586 Est. Cost: $36000.00 Fee: $125.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NEIL HOMSTEAD 031249 Lot Size(sq. ft.): 44431.20 Owner: SCIACCA JONNA zonine:URB Applicant: NEIL HOMSTEAD AT. 136 HINCKLEY ST Applicant Address: Phone: Insurance: 408 NORTH FARMS RD (413) 584-0458 FLORENCEMA01062-4513 ISSUED ON:10123103 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 12 X 18 2ND FLR BEDRM & 2ND FLR BATH IN EXISTING & 6 X 12 PORCH W/2ND FLR DECK 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: �j House# Foundation: or, /Driveway Final: UCH; ) Final: Final: / �� 3�� Rough Frame/ y / y Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation:O k Final: Smoke: Final:D k I--q-d c{ THIS PERMIT MAY BE REVOKED BY THE Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. - Certificate of Occupancy _ Signature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 10/23/03 0:00:00 985 $125.60 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Comm ,sio,er-Anthony Patillo