06-038 (2) 319 HAYDENVILLE RD 4 BP-2007-0576
GIS #: COMMON18 EALTH OF MASSACHUSETTS
Map:Block:06-038 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-2007-0576
Project# JS-2007-000845
Est. Cost: $12000.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME OWNER EXEMPTION
Lot Size(sq. ft.): 11238.48 Owner: Haffinans. Greg
Zoning: SR Applicant: Haffmans, Greg
..I. v . , . .,1 ✓, .Y . :�.
Applicant Address: Phone: Insurance:
319 Haydenville Road (413) 575-8488 0
LEEDSMA01053 ISSUED ON:11/21/2006 0:00:00
TO PERFORM THE. FOLLOWING WORK:Siding, patch chimney, reno kitchen and bath
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:i-3 ! -6 7. House# Foundation:
, {l�i"�1( Driveway Final:
Final: Final: r R-1.1A l ( 647.9
lA,g 7* Rough Frame: At A50 n iC
/� _ A+-4. 01< ri zl O1' 67 1_6u1
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation: 01<. ( 11< ‘11-(c) c57-1° c.7 1-44i
Final: Smoke: Final: Ph G • a S.C9 7
THIS PERMIT MAY BE REVOKED BY THE C TY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
----- C,e0,..›P' ..", -,Z4/.
Certificate of Occupanc ,0617—gnature:
FeeTvpe: Date Paid: Amount:
Building 11/21/2006 0:00:00 $60.001005
212 Main Street,Phone(413)587-1240;Fax:(413)587-1272
Building Commissioner-Anthony Patillo
411.11.14.
File#BP-2007-0576
APPLICANT/CONTACT PERSON Haffmans,Greg
ADDRESS/PHONE 319 Haydenville Road LEEDS
PROPERTY LOCATION 319 HAYDENVILLE RD
MAP 06 PARCEL 038 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
wilding Permit Filled out
eePaid 460.00 , 1Ooc
Typeof Construction: Siding,patch chimney.reno kitchen and bath
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 F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I F ATION 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
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.
,....Oeparhment.use only
City of Northampton Status o€Penn2.; _
Building Department Cufbeuttvnvew4Leem+n - xt,
212 Main Street 3aiygrlsephg Pv�iiidlty `
Room 100 Wa{eriWerAvai4';blti£ _
Northampton, MA 01060 7wrp-66tsaf5 - ns . s ; ice,,-
phone413-587-1240 Fax413-587-1272 Pion55e{>Ians `j RV bre-- Tea x,
ONer$pec�7y-"IIrbet r=
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWrj{ 9InEY4W6 titlNG•
f -
•
SECTION 1 -SITE INFORMATION
1.1 Property Address: Thissection to.'be compfetedlayofFce '--
3/9' R N j/4LIvj//(a f ,Map
(° -4,97
fink Unit
4- r`G,% -4 , Zone Overlay District
Odra OmMct CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
(tee / to'n 5 3
/ /fJ /9' , ,, i v I •
Name(Print) / Current Mairinp Address:�!re, n e �„ C AlR'
�e Amur Telephone Lir ) 575 ���.3'�
/AO/J.4—
signature 7
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION;-ESTIMATED CONSTRUCTION COST$
Item Fstlmated Cost(Dollars)to be Official Use Only
cornoleted by permit applicant 11
1. Building $7cg 7.ga O� (a)Building Permit Fee // /
-V pS7 !///Ci , ..�� COO/ 0406
2. Electrical (b)Estimated Total Cost of
Construction from(6) /
3. Plumbing Building Permit Fee tp Q. (/
_}
4. Mechanical (HVAC)
5 Fire Protection
6" Total (1 +2+3+4 +5) Check Number 00 r cep,eel
This Section For Official Use Only
Building Permit Number,„ Date
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
'This column to be filled in be
6uiiding Department
/
Lot Size _ _____-. __ —
Frontage
-- — --
Setbacks From —_.-:
Side L:_--- R:_ L aY
\ _—
Rear /—
v.
Building Height
Bldg. Square Footage ---% —'— v
Open Space Footage — ,o
(Int area minusbldg&paved ! _
parking) .... Tin.
**).
#of Parking Spaces - - —_\\
Fill:
(volume&Location) •
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW ffi YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW Q YES 0
IF YES: • enter Book Page and/or Document if
B. Does the site contain a brook, body of water or wetlands? NO $ DON'T KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission? '
Needs to be obtained Q Obtained Q , Date Issued.
C. Do any signs exist on the property? YES Q NO I
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO ,4
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,rnexcavation,or filling)over i acre or Is it part of a common plan
that will disturb over t acre? YES Q NO 7b
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) I I Roofing n
Or Doorsi _
Accessory Bldg. ❑ Demolition ❑ New Signs [C) Decks [I] Siding Other
Non/ 5TRuc1 twit. 2ENO . toN
Brief Dewitt ion • Proposed / .
Work: 'S ' i . Pt / / / ii - i 0004/ APG /9//aq/ , inting,
Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes v No
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Roll -Sheet
6a:If New hdaie-andbradditionto eYistinq housing?Complef th&fol[OWinq:
a. Use of building: One Family V Two Family Other
Ib. Number of rooms in each family unit: Number of Bathrooms
/c. Is there a garage attached?' VF 5
I/ d Proposed Square footage of ne7w OQQstruction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
Yes No
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
R Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. 13,gonstruction within 100 yr. floodplain
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=OWNERAUTHORIZATION.TO.BECOMPIETED WHEN -
OWNERS AGENT OR CONTRACTORAPPLIES FOR BUILDING PERMIT
I, yet O I Ie 1 •/ e-- ,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 �y y� ..[/� Date
f 71r(O r/ fJ Y'y �v/ / �// i Ov1/471 luthorized
Agent hereby declare at the s tements and informatlbn on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and permit of r' ry.
�/��J.r,(/YpJ,9 of
//— c;2/2 — o s
Print Name U
Signature of Owner/Agent Date
•
SECTION 8*CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration tate
Signature Telephone
S Registered Roinelitnprevement eantraetaf. _.. - :^ - Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE.AFFIDAVIT'(M.GL.c.152,§25C(8))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit win result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes Cl No ❑
11225 Ilnme 01;Elor txempti'on
The cutrem exemption for'homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 1083.5.1.
Definition of Homeowner:Person(s}who ownaparcel.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 bore in a two-year period shall not he 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 buildine permit.
As actingConstruction 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 m Chapter 352(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,von 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
`ZZo`9ning Laws and to of Massachusetts General Laws Annotated,
Homeowner Signature 'Scc ✓ (Y / -
1
1/xr
as a , f til l of arillathl toll
1
M
cs 0EPM.TM!NFT OF 011l LD!WC [NSPER%01=5
212 Alain Strcct ' Municipal Building
Northempton, Maes. O10GO
cv'OIiJQ.i2'S CON12ENSh 110N iENSURANCE Ar'PLI/AVI
O;CIrxm ittj
v/ii; a principal place of busioesstresid slice at
3l% ,_47_(263#1011/e }}`' I fr_ rt�- no,e,) J/"....575-5`x/88
(stoic„.yInstr'np)
do hereby terrify, under ram pains aid penalties of perjury, dui
( ) I aro an employer providing the fcISonvine ',Yorker's compersanon cove'age For my-
erooioyees tvorl.ang on This job
(L^su,--^ce Cc_eta end (?otic:bInsatnift t tspir_uor.Da )
() I am a wile proprietor, general ccouzaor or homeowner(ohne one) and have hired
the coni aciorn listed below who hive the following worker's cam?erv4don policies:
_ (tiemc or t ...._czar. (Insurance Co:npan//probe,-'.dumb ; ITI•rpurauon Jxlc)
(N int or Conn-?_c-or) (Inswanc Compaav;?oticy i uncal (C:-'pinuon Dale)
('ldamr of Conrrcm:) C:nswtnc Comp nyPPin icy N:ustest (°sder:6bn Dat;.)
•
•
_.... (Nana of Cootracror) (Lsvcanm ComoeoyfPoncy Numbui pelypinaos DbL:).
(said ,.^-_moi a.Jar,-_ -, v xvw.k'ororv.._.w c=winitis`-x.0 mom- n)
( )�� I am a sole propriecor and have no one wort:log for me
��` .
x Y I am a home ewer performing all the work myself
"°1)E-?'''l'. etJobcca cr to�tcy m.mr-, _ .a- t„_o
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os mac LL -co u',ad the W:xw'oe traido be oa the Cv4rt gµu:ev_=nervi c.a+C=*T-.b.a,zti& i 10 b'
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oa.eae.eiCyro cS ththe Lilco th.innnn)s)-erAtA...Ana' lacteal 23A MMOL 152 ca lelathe- re ma
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DEPARTMENT OF WILDING INSPECTIONS '+
INSPECTOR 212 Main Sveet • Municipal Building /
Northampton,NIA 01060 �
et
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sup:: isar. The stare 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, . L i �1 ' Xi( understand the above.
(Home ow der/resid s signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me).
Date II thi -do
Address of work
location /1Li /r_V['ngak-_,..
.
X