38A-088 (2) BURTS PIT RD BP-2005-0932
GIS#: COMMONWEALTH OF MASSACHUSETTS
MamBlock:38A-088 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2005-0932
Project# 35-2005-1303
Est. Cost: $800.00
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): Owner. CITY OF NORTHAMPTON
zoning:URB Applicant. CITY OF NORTHAMPTON
AT. BURTS PIT RD
Applicant Address: Phone: Insurance:
212 MAIN STREET (413) 587-1000 0
NORTHAMPTONMA01060 ISSUED ON.4114105 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE EXISTING SHED W/12 X 12
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 4/14/05 0:00:00 $0.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2005-0932
APPLICANT/CONTACT PERSON CITY OF NORTHAMPTON
ADDRESS/PHONE 212 MAIN STREET NORTHAMPTON (413)587-1000 Q
PROPERTY LOCATION BURTS PIT RD
MAP 38A PARCEL 088 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid `
Buildina Permit Filled out
Fee Paid
T_ypeof Construction: REPLACE EXISTING SHED W/12 X 12
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9AMATION PRESENTED:
Approved 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 Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission
rs°4���^� fes- Zc,IJJ
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.
t, V - ' City of Nortf arnpton
11; ' Building Department
n� 2a 2 Main Street
room 100 e
�n
Northam�ton;SMA 01060
phpne,41; 587-1 40 Fax 413-587-1272 `
-APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE-INFORMATION
1.1 Property Address: (zpll t"t,1 {T`C Thts section to be completed by office
5 0 tzT5 FIT- kb Ma LQ M itt
Uvecfa Distract
'A EIpTDIStrIC1� " '•: ^n -'," »sCB.D13tFIGf.
SECTION 2 PROPERTYCOWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
C f 1-- a r fJ o r'Tf-f�j=,1-UJB
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
M i �'�c -c's u tkv" 20 r I�lr��� �'T r--ta re�r►.Jc.� 0 t 0(2
Name(Print) Current
ttiMailing Address:
iL
Signature Telephone
SECTION 3,-ESTIMATED-'CONSTRUCTIONCOSTS
Item - Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $'j G (a)Building,Permit Fee
2. Electrical _ (by 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) iloo Check Number
Thisr Section=For Oflieial`Use Only
Building Permit Number. Date.
ssued:
Signature:
i
Building:Commissioner/Inspector of Buildings Date
w �
Section 4. ZONING All Informatl6h 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
it j {
Lot Size
Frontage
Setbacks Front ' l
Side L:� R:� Ul R:i
Rear
Building Height -
Bldg.Square Footage3 i % R*4
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces ---=
Fill: I { 1
volume'&Location) i
A. Has a Special Perm it/Variance/Fi ndi no ever been issued for/on the site?
N0 0 DON'T KNOW YES 0
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book Page. and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW Q YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued: 4
C. Do any signs exist on the property? YES 1� NO Q
IF YES, describe size, type and location: I
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,exca tion,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 - NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION,5-DESCRIPTION OF PROPOSED WORK(checkall aopticjble)
New House ❑ Addition Replacement Windows Alterations) ❑ Roofing
Or Doors CI
Accessory Bldg. CJ Demolition ❑ New Signs [01 Decks [0 Siding[If Other[C31
Brief Description of Proposed �-1 SL{ / •���8 S i�2s 1� /
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa=t ev roast irt. Ma ci ia�t acrs ° si is c t irp� r :na:
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 Tank City Sewer Private well City water Supply
SECTION 7a-,OWNER.AUTHORlZATION-TO BE:COMPI ETED. N
OWNERS AGENT QR CONI RACTCIR.APP'LIES FOR BIIICCIINC�PER IT '
I, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, 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. r
Print Name
Signature of Owner/Agent Date
� w
SECTION 8-CONSTRUCTION-SEKV,CES I`
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9:" '�sfere ort °" n Not Applicable ❑
Company Name Registratiari—Num er i--
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATIOWINStlRANCE AFFIDAVIT(M;G.
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 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
f
i
i
4-�iw•r�T r..
` GIL�3 LIf 'NTLtl f(�i11117fDll _ —
A f jlcs+i<rllncrtta' _
w p DEPARTMEIJT OP BUILDr?,,,G INSPPCTIOI.'S -
212 blain Strcct Municipal Building
Northampton, Mass- 01060
woo UCER'S COIATENSA'MN MSURA-NClr AI I?U)r1.V1�"
i
i
I
�'; (li ccns�Jperml tttx)
�1.9Lb a principal place of business/residence at:
(phone.')
(s�.t/city/statchp)
do hereby certify, under the.panns and pen2lties of pc*ury, :hal
i -
i -
( ) I am an employer providing the following',-vorkcr's coinocns-:jon cove agc for my
emplovecs woriong on tills job:
i r .
ionsu --D=Comr m,) (Pclic:)~unair_r) (r:pirztior,Dal:.)
O I am a sole propretor, general contractor or homeowner (C'IT cie one) and have hired
the c000-actor-s lister+ below vybo have the fok ing worker's comoen_taaon policies:
(i+1ID: of Contncro-) (Innlrancc. ColnDan)•/POUC{ Numh-:r) (I_`:JIrJ i^? Date)
(Name of Contractor) (lnslra.ncc Comoan}•IPOUM, Numcr-r) (-Ei-Diraiiorl Dale)
I .
j
i
(Name ofconnaclo;) (Incur-anc; Compan)•/PoUq• NumbJ) (Expiraoa Date)
i
(Name of Contractor) (Insura cc Company/PoUcy Number) (Expiraz600 Datc).
(+tures..t�:�ocal�cG,if aceaa�•w;—judc iafor=z oa to.0
I
{ ) I am a sole proprietor and have no one woridog for me.
( ) I 2in,a home owner performing all the work thyself.
NOTE:plcsc be cwym tt..,v1 la be c rev �to Cplo-y pc'tona to da�x i• =-.:cuoo c tcpa;y..-ork ca a d.•clL^y of
ant mat tb---Lt.—t^Sf r is��cb the bomooa.ac r,=da or oa the p UXa6 zppurlca- ts=cw c-c ao(E^=.=Xy,occrd.-rni to be
eirploycs unCe the .uS sr�c�-k-"tioa Aa z-ppticaj600 by a bomeoava far a ties_or permit ray cvid=—the
1epJ ctaau of ea--Ploy. coder dzo Wor'cd.Cooapomalioa Aoc. '
1 uaderz+ad tit a oop"of thi.mt®crc=a y bo f«- urd.d to ebo popertm�of In�+xTiJ A—d..[Y OM—of Lx. I on far tb.
eove-aSe nzif eaioa aad ttu L-il=to saxuc loverase tmdrr=cLioa 23A or),(GL 152 na led to the impas:dioa of aimi-I pea&Wcs
co—LzLia of a fiat of UP to S 1.300.00 and/or 0(,,p to ooc y=end aL11 pmal'ua io be form of.Slop Wort;Order and+ -
fiaa 0(:S 100.00.d_y cpiaA me
For d�.nm�r u.c only -
crmrt Numbcr _--
i`42p." L'0
Si9niun of Lic.L= pcm iucc --DiCe—
--
¢�t1AMp�.
,_Crify of Warfha yton z =
s
�1844AC1�II4ttt4
DEPARTMENT OF BUILDDIJG INSPECTIONS
INSPECTOR '212 Main Street • Municipal Building
Nortluunpton,MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as }.is/her construction supe: ,� 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 famr� _
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
CaNr�v�ur�y G,g- � ,c� S/ �,r�
!rlcrPa fe Ck r`Ps�f- �vr�`r»�a7` �
.c rJcfs�'.r,f si'ace- Is 4-o-7
N
i Qo
•
l L y c/e
e/e.
J�ee,a r°x is�ihS ct�oorS 1
f
Gddi�i�
e&l Ve,S �k/��y Screams-iS�
,C
�o
` /A✓ 'c1l/,Pct •
t'h v 5l 014 ro o
N-iIN0051Nt91 W
}}O�- OS OL C
f
HEE
70Z M
•� ,�_ cJ S1��a .
! h
--
.•- -�1`�lsa tea. _
w _
✓e n t
2vo ;
y Salo s,c�e
a
"C
f
prc s S ire t ca-(�c� o S-l-s X L�. ✓�'
y ill A-c- lo1� woaaQ w4! j.�