Loading...
17D-079 T O��HAMPTO Crify of Nori 4amptolt L �18SSAChIi ttt6 <s. DEPARTMENT OF BUILDITNG INSPECTIONS / INSPECTOR 212 Main Street • M11 niciral Building Northampton, M,A 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeownek the right under 780CMR 108.3.4 to act as has/her construction sups-„isor. The state defines "Homeowner” as, " Person(s) who owns a parcel on which he/she resides or int$nds to be, a one or two family dwelling, attached or detached structures accessotfy to such use and/or farm structures. A person who constructs more than one home in a tNvo-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 owhn construction supervisor, to be aware that by doing so you become responsible for cochpliance with state building codes and regulations. The inspection process requires;that the building department be called to inspect work at various stages, which include Oundation/footings (before backfill), sonotube holes (before your), a rough building]inspection (before work is concealed), insulation inspection (if required) ind 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 proDervermits and inspections are made I, �� �2v understand the above. (Home owne /resident's signature re uesti6g exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date �'(� g-o y Address of work location alo 4 A< C- O�1 t l-f PTO �, � C�1-zft�r z1f �ictz-flJ�•i1�t}�tnit � �iicssxcfJnsrlla' _- m llEf'/RTMENIf OP EUILD01 G INSPECTIONS 212 Alain Street ' Municipal Building Northampton, class. 01060 ' WOMCER'S COMI TE rSATION INSURANCE Arrm,�.«-T i, %Vlth a princip,-LI place of buSlracSS/rCSidcncLc _. !strc;ticit is;� :��gip) do hereby CMLLIti-, under the ,Pains ,end penaitics of p;:rylry, ii]al: I am an employer provi l]ng talc follO'ViIiQ '.';Oct:cf-s compensnoll COVCI<:L'•C 'Or lily errlployces working on this job: v j I am a sole proprietor, "tentra± cciltILIctor h011—'Cc 'rce: IcLc!e Oct) and. 't:a`,'e hired the contractors lister be.0w;vl'o the `Gil '�%'OritP"S GJi peIl��Ori `0!1C'.�5: (1I1l c of CO!ILactor) �Il_L�rIC CClr? �OIIL{ NllSIl i) T?'?` i2ti0i. Date) (Name of Contractor) Com:�ar`•/Pc.!ic Nlurlir_r) (l zp : do Date) (Name of Contractor) .,-._ x. n:i]C_ D ale) - (Name of Contractor) — - (last r iI1C ColnTrvIvlloGry Numl�-r) (H z-. ior', Date) (.^.tiiG1_-d-±i:imal s::-act i :x•r<-'�r-::;[r.-:1� _ - .� C,-M11- all t!. N0'f1: please be nIra:c L1:a! L-;Ic 1 x<7,co.t1 s«-:)c:_,pI�r 1 a nc: ci c7_:m ct r .1ir« :i_, not UK<c th_o throe u12l2 in c Gt a; '`..:���_:._s a �•�rtr.::r•1 LFtc::o e:e r>_-t Cc-rraly cir.::::_::�:o iti IcgaJ ctaiuc of an amployor under the wovkc.'z Core-;ra•.iion .t 1 undc.-ztand thi a copy of thi,ct_tc:r_•r_uy bo forty vcio-i to t2;o[Ytxirt x L of lrwhl-lrlal Ar66 &CHI— for the covcra&c waif calioa and that failure to Svc cote ur- SzIZ,iM 25.1 of MC—L 152 can Icy to tax inlposition'�;cr ir:1 pc sl_u existing of a firr_ofup to S I_ �).00 n:1'x i i r, t of;;p to cr..)-c:e-.j civil;xzutl a in do Ic,n of n S!cr"`,VnY.O�;.-:�nrd f ry oCSIOO.t?0 i a:y tg:.imt rn.. Pcrrnit Nuulb.r - - -- ----- - r of r.iccnr cJl'cr;tl t tr SECTION 8 CONSTRUCTI;bN SERVICES 8.1 Licensed Construction Supervisor: Not Applicable Name of License Holder License Number Address Expiration Date Signature Telephone Reg-s"'e ontractor - Not Applicable Company Name Registration Number Address Expiration Date Telephone SECTIONIO WORKERS' COMPENSATION VN yRANCE-AFFIDA�/IT(M G:L..c. 152, §,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...... ❑ © 1 e- S Ell" 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..1 Definition of Homeowner: Person(s)who own a parcel off'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 homg 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 jpb site will be required from time to time,during and upon completion of the work far 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 ate of use eneial Laws Annotated. Homeowner Signature ZU SECTIONS DESCR PST 0N1OF2PR60 OSED WORK(check all applica�ile) . 1A��?«r� .3b�WAbl�i'4 — ...:C✓5..*fia^+H,, r -T'[fiF.?.�'+x2,v .: -•f > �`�:hkR i,x�,mA.��0.1._..-? pM New House ❑ Addition ❑ Replacement Windows [Alteration(s) ❑ Roofing . Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ) Brief Description of Proposed Work: 2 oo /l Q STS: 0or rs SC Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll D • Sheet 0 60 f:. . ewe:o se nd o a'tlditionnto existing.housin K&T N eI he7 U1, rn 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. Mascheck 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 SECTI01�(7a �OWNERAUTHORIZATION -;TO BE-COMPL'E,�TED WHEN OWNfaS AGE1T 0 CONTRACTOR APPLIESFOR BUILDING P-ERMIT w h e property as Owner of e subject p ope y hereby authorize to act. on my behalf, in all malt lativ t horized by this building permit application. Signe re ner Date I, as Owner/.Authorized Agent hereby declare that the sta ements and information on the f regoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name a( .y Si wne ent Date Section 4. ALL INFORMATION MUST BE COMtLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing roposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: _R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been'.issued for/on the site? NO DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeps? NO Ll� DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlainds? NO V DONT 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 addition of signs intended for the property?YES No IF YES, describe size, type and location: R City of Northampton �r ..,Uilding Department { 212 Main Street ry Room 100ry mpton, MA 01060 a - phone)41 -5$ -1240 Fax 413-587-1272 AFB{ iAOIhN1 CT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION offi 1.1 Pronert�Address: This section to be cock pleted by ce nn � "'Z cJ c I`` iMap iLot ft kJnit El—o�e Nc e- �/� Q /V Zone Overlay District w k Y ' Elm St.`D�str�ct "' :CB t2�sinct SECTION'2-PROPERTY OWNERSHIP/AUTHORIZED-AGENT 2.1 Owner of Record: -03 /S/Z' 9 .0 rllaln. Name(Prin Current Mailing Address: 3 ` Telephone Signature 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 �U� (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) Check Number This Section For Official Use-Onl Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 503 BRIDGE RD BP-2004-1298 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17D-079 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2004-1298 Project# JS-2004-1954 Est. Cost: $700.00 Fee: $25.00 PERMISSION IS HEREBY-GRANTED TO: Const.Class: Contractor: License: Use Groin: Homeowner as Contractor Lot Size(sq.ft.): 10018.80 Owner: BROCKLESBY PHILIP H Zoning URB A-pplicant. BROCKLESBY PHILIP H AT. 503 BRIDGE RD Applicant Address: Phone: Insurance: 503 BRIDGE RD O 586-2873 0 FLORENCEMA01062 ISSUED ON:6121104 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE GARAGE ROOF 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• Receipt No: Date Paid: Check No: Amount: Building 6/21/04 0:00:00 169 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo