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07-008 (6)
RDI BP-2007-0211 GIS(1: COMMONWEALTH OF MASSACHUSETTS >Loz-ooC CITY OF NORTHAMPTON Lot: -001 Permit: Building Category BUILDING PERMIT Permit# BP-2007-0211 Protect ft JS-2007-000321 Est. Cost: $1000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: use Group: Homeowner as Contractor Lot Size(sq.ft): 43560.00 Owner: VOLLINGER JOHN J&GRACE F Zoning: RR Applicant: VOLLINGER JOHN J & GRACE F AT: 460 NORTH FARMS RD Applicant Address: Phone: Insurance: 460 NORTH FARMS RD FLORENCEMA01062 ISSUED ON:8/23/2006 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE SHED 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: FeeTvpe: Date Paid: Amount: Building 8/23/2006 0:00:00 $25.001471 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo D .-st of Northampton ,, ��sea^t. .1 �� wilding Department n& 212'Main Street "mo- ,a,. V 1. G 5 Room 100 Ngr5p6mpton, MA 01060 ere 1 > r , phone 413-587-1240 Fax 413-587-1272 5 .„e - APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: Ti�issechor leeomplefedbyaffice - 960 Nom Farms Rends .. . 3n1. . . kilt F/orence flbel o/04,a 'ay sone- Oved' ~D�,ngt ` ��f`m�cTllatdcf.==F `caoiaklcr - SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ✓ohn o/linyer Nto .or/A Farms Re F/crena M,4 clot? Na (Print) Current Mailing Address n/ d/3 se/ .2467 X Telephone Siafore 2.2 Authorized Agent: Name(Pont) Current Mailing Address: Signature Telephone SECTIONS—ESTIMATED-CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building .S/odd -- (a)-BuildingPernit Fee 2. Electrical -(b)Estimated Total Cost of Constnxzion:from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection ft 45�p 6. Total=(1 +2+3+4+5) *1000 Check Number /�l - This Section For Official Use Only- Building Permit Number Date r. Issued: 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 by Building Department Lot Size • . . Frontage •_ Setbacks Front Side L:—' R:— L''' R'— Rear Building Height Bldg. Square Footage Open Space Footage % —. (Int area minus bldg&paved u — p ng) , #of Parking Spaces - ' — Fill: (volume&Location) . A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW O YES IF YES, date issued:l, IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW © YES 0 IF YES: enter Book Page' • and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained © , Date Issued: I C. Do any signs exist on the property? YES O 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 I IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO 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) ❑ Roofing CKI Or Doors C Accessory Bldg. 0 Demolition E New Signs [O] Decks [O Siding[0] Other[o] Brief Description of Proposed G�_ / R-_(' renIaa Work: �l E'Li LOr— I Alteration of existing bedroom Yes )l No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet 6a aW-IO F•rl T I IOih X S IR51E{10051 •'".0 S. T ' -z-". 0lrain'q: 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 CoTiservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 h.of wetlands? Yes No. Is construction within 100 yr. Floodplain Yes_____Na 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 BECOMPLETEDWNEN -OWNERS AGENTOR CONTRACTORAPPLIEEFOR$UILDING PERMIT , 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 Xyv)/ 7J�, w is / as Owner/Authorizedmyknowledge A9 hereby decla that the statemBate a d information on the foregoing application are true and accurate,to the best of knowledge an belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 licensed Construction Supervisor: Not Applicable 0 Name of license Holder, _ ,,. License Number Address ___ Expl2tion Date Signature Telephone __ ri % �; x�,a,- Not ApWrpWe ❑ company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this appacation.Failure to provide this affidavit will result in the denial of the issuance of the building permit Signed Affidavit Attached Yes 0 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 1083.5.1. Definition of Homeowner:Person(s)who own a pared 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 hehbe 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,von may be Habit for persons) you hire to perform work for you under this permit. The undersigned"homeowner"to tifies 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. T. Homeowner Signature ( V,rr-f1m.e / 2/,,-^1.�fln.,.y-r'I _ • R,<lwf Sia _ r -el Fa- • p'^•PI49zE �S)� Of �TRl"t�)%3111�Ji011 1• . `�N £ .<gnc.u.- a • • DEPARTMENT OP M1!LONG- INSPECTIONS •� 212 Main Street ' Municipal Du !dinE Northampton, Mass. 01060 ` r1" WORIcER'S co MTENSATroN INSTIRANCE AFFIDAVIT • • piccnsa'/lar mince) • lana a prit-tcipal place of busioess/residenec• at-. • (phone#) • �.. .— (suwL/dtytnudnp) do hereby certify, under the paisis and penalties of perjury; that () 1 am an employer providing the folowine worker's cotPpcestnon cove2Se for .ay= employees worbog on this job. (lssw—nc Cock=cy) (Policy N>_-ob=t) Expintios Dain) .. ) I am a sole proouctor, general conuacxor or homeowner(cide one) and have hired • the coon-actors listed below who have the following workers campensenon policies: - " (Name of Com ne.o fin_uran=Comeb-bn-Ps bic Number) t='ptrau r Dote) • (Name of Coomaor) On Carat= Company/Policy Nu otcr) (Espinion Dale) • (Name of Coarrano.} (Innis—ape:a CompampPobei Nurhr } tx'pundon Datc) (Name of Contractor) (Luuan¢ Comp.nyiPolicy Nuwb^_r) Eapiauon Pale). (.ma a,::va 110[0=l..7 to w.ya a p a.0 cocnC ) ) 1 am a sole proprietor and have no one woridog for me. (d 1 am a.home owner performing all the work myself. • NOTE.plea bd.a-,r. v a bcocc _r>v.be cap oy pa*'mt to m r.:- --- e r"' 'or .I a,.w-cot ra marc thnthr a.v..w c th tb:Somaxaa r¢ido a m We ground,ansutcasst teeny o)Lw.ilkv ehc .ssgloyer w^ wklyzo-.-„---1ccA=(G1,152nI(5)].:_pptin000 bi.home>.I fa:ac.up.- a:Y"'"�'a LL-c 1c91 ea”...a. v c,a.y.e ued.r au W m£af.r r eta_ I..oaovan4 tons copy of W:.cc.tamatwY b fyRs44a W afioduv.J rnaaat OSag a(umv-+T t'S coa4y tflctim'ad Yu Cal=to an tkssKYaaL ,M,->aaiw 23A of MOL 151 aa kcal u We im:*aa+m ofcw+ul Pm+ide moire*of.floc a(up w SIy0000 and/or¢or-haccoy o(Vp toot r.ataro'c>J pda Jo w Oc lm of.Sm Wat Crle an d. f o(.100.00 t dy.€ilia rix, 9 j Ivw. .v only Permit ttml.c.r y// u L 1`T](>'• 1.01 "..Si atr<af l.i crmiucc / g= e . .) oa't��o a2 tig Life of t arfhainptan • 1!- -* 9-+'}.' /":18 $ieaeuhmatta l= 9 7 DEPARTMENT OF BUILDING INSPECTIONS Ei [; INSPECTOR 212 Main Street • Municipal Building —,, Northampton, MA 01060 I HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/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 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 Y i, v�, understand the above. ome own /resident's sig tore requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location �6o dorfA FatrOtc Li • Farenee. ,vn oiod a