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36-313 (3) #1. ) a QLzt r of Narf1 &ntpton • ) _ _ r �v y 1 " , (� ` "Massachusetts _ ` = DEPARTMENT OF BUILDING INSPECTIONS / e. INSPECTOR 212 Main. Street • Municipal Building _ y Northampton, MA 01060 S`' . e HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as Lis /her construction sups .'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, kf-- 0 4 ), 1 ----- understand the above. (Home o ner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date ` /� --3 k / Address of work location / (2 , /2 Y1 _ r ,v,1 t_ 6L)!--A/ 1 , O L -&A, C E )C 0 1422___ . V . 1 a * . . - , -WAR P 7. . .------.. ...., fit 4 Gill; of Nortilaillpfoil . 4 .,) N. .1,. Or • 't: . „, 417 7. W.... . 7- 11144.2:t- - , .5... D EP ART1v f ENT OF BUILDING INSPECTIONS . • .-7:- i ' 212 Main Street ' Municipal Building , Northampton, Mass. 01 060 WORKER'S CONfPENSA'riON INSURANCE AFFIDAVIT _ (li c-,-,n.s2initic) \vitla a prin cipal place of business/residence (plione___ -- (strecticiity,":71.f,../7ip) do hereby certify, titi(ler the palns and penaltie:; of _ jury, that: ...._ ( ) I aria an employer providing the folio \vim: v;orkcr's compensation coverage for my enipIoyee,'s working this job: - ansurancz Company) (PcLic-; Number) CEI)rp i IT: tic n Dare) ( ) 1 a_ai a sole proprietor, general contiac or b o :al eowo er (circle one) and have hired the contractors Listed below 'who have the fOlir,Z:Yir12, V.1(:)ikPS compensaldon policies: (Narne of Contractor) (Lnsurance Comcany.Toticy 'Nu/Tibor) 1E, xp:ratacn Date) (Name of CODITZCI07) (lasuranc:-, CompanyiPoNcv Nurfrfizr) (1:x1)i:ration Date) , . —_-- (Name of Contractor) (Insnir-ancz Cc nnpa.nyiPo I ic7 N am 'rr ) (Fxr.:rat2:oo Dale) (Name of Contractor) (las ComanyiPoticy Nurnbcs) (Expiration Date) (..,EL..,..i.i .6-litic,..1 ...-,-.t if 'cc,,sry :n ic.-21-_,', ';:lf-x:n.:ic,-. -,---.:::.:::::::;:..; ,i3 ::,: .1 , ( ) 1 t.ita a pole )ropriet.ui arid have 00 anc -, :k.i11: - 4 for inc. S il 1 am a 11011le ()Vine:" lie,17:C7I111flg all tL,:', ,.■.,;1:-. NMI:: ple.zsc bc asswc that whtic 1 1.3 ;) L3 ,) :7 ct:-.trcr-,:scttlro or :rpair on not Inc(o th_ throt titlita irt v. i ',I 1:ono.:r'a r2-7:o or cc thc E ct. • ...1 th.o. ace n.:..t ccoorally c...y,:: cploya- ur.t.c.HT the veorkr,-;:. c.:-.4:-_-_--...-..a.ticso i.-ct (00152m1(5Y), ar.T. by a hotncownor for a Lc cc p71:: legal rtatuc of am cairployec under tit', Wokee's Coozpaicro Act_ 1 uncicrztand that a copy of this rtatcr...--...1 may bo for.v,trdo,i to t.ten 1) o f lothatalri al Accid--,ItY ofrioo of 1.,.....,,,,,, for th e coverage vcrifi=tiCx1 :lad that failure vccatrc covr. IIIIC, c.cctio 2!" A et MCI, 152 can lcati to the imposition of cc pettallic cocci:6 o f a. r o f up to s 1.3 an..2)r in.:prc.:It of up to or.-.. }-z..t.: ar.1 civil pcnahics in thc form of a Stc, Wo.ri•. Or- .^: and a ft, : or s 'alai a dly LF,un....1 rry..._ . / Fcx- (1,4,..tin=rsi LI AC C,iy " 1 . 1/ 9C 7 L1.. S ![- . turn of 7, ..i.cc - nr , ecil ) c-r1 . 1 ,7 ' .., tri' -' ' - ' 10/29/2003 18:00 4135292237 E B I- LhiBERG ASSOC PACE 03 MORTGAGE LOAN INSPECTION i q 7 F . t _. \ L t i ' • • 1 14 2.84'2 : l + ! LOCUS ROW CE. • ,„•. /. a BOOK 6703 PAGE 299 PORTICO I or 611-1r Lara PLAN BOOK zia Nees a4 • 85 ...per + 1 .. pmeg , a R + OAK + P . , D2 + IT'+/- CARDINAL MAY To: Countrywide Home Loan OWNER: AND:. CnTIC Lepine - Wzorek Associates I hereby report tbeat prbaLee shows on Sib *alb LOCATION: Lot No. 9 Cardinal Way. . not loaded ands a flood Bawd Ana as dawn amtut Northampton, Massachusetts Erman Ibis bhp, . Odom* No, 250167 -0001A E. B. HOLMBERG &Associates SCbotbe Aoril 3, 197, LAND SURVEYORS I ahlo moot, b the bane day 14towlodp, i�adm a7 UNION S77t�T. EASTHAMPTON MA 01027 -x945 ad ballad(thatthia fospoodon pbal ohm die 77 D/1LiON loin ROAD, .o a6w otoe2 0176 Mi wov n at or improrwwob a loaded al thadadra deeodbod, dot flat iaproorsoan aA wM6.ly of 1b . Ind lot fin woad ancrodionatz voodoo . o f y . , 1 " • 40' pagoda *imbed by to Iwamoto. data �pipiq dsosoaoept a � & EMI ` mad that Gam WOmanledt the MREpQ DATE: ttootshows ha>rooa�araptasranot i o H rr3 v October 27, 2003 / ,/ ( .1 \ i 4 tsN � `' , ��oq' JOB NUMBER: . i o: 03-347 /+iii T 1* PLAN IS POLIDENTIl1CAT1oN PURPOSES ONLY AND DOES NOT COMMUTE A P O!'1117Y SURVEY. Alib14N0'P roaccairmwrioN PI.ANIONO Letyotrr. Nash Home & Leisure: Sheds Page 1 of 1 I Ox*WOOD GABLE ht html 1/11/20'` • SECTJOPtS CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone Re: ere® g. iime veiren ontaac r Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTIOH1.O WORKERS' COMPENSATION INSURANCEAFFIDAVIT (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 kfi 024 � eras g. 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" c-rtifies and assumes responsibi , for compliance with the State Building Code, City of Northampton Ordinances, St. e . d Local Zonini4_o :ws and S :t• • ssachuse is General Laws Annotated. Homeowner Signature e/C,L _ 1 ■ ?SECTI-ON5* DESCRIPTtfON OF PROPOSED WORK (check all °applicable) t dg New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg_ Vi Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: SNCA TAsAtkA .A Con io'PC 2 -o Alteration of existing bedroom Yes V No Adding new bedroom Yes V -No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 • Sheet 0 6a01Age TOMVI TOTIaddi ionito ezisting"fMing comp °te: e l e followin 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 S 7' �OWN ER 4 AUTHORIZATIO N TO B E C OMP L E TE D : WH EN OWNERSIAG TOR CONTRACTOR APPLIES FOR BUILDING °PERMIT I, ,`i -- , - II , ' �7 ' )v , as Owner of the subject property hereby . horize ,/t1 S,LJ //4/L to act on my •-h. , in all r aters rel. .o work authorized by this building permit application. 1 p Signatur: of Owner ate �. -, 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. Print Name Signature of Owner /Agent Date 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 1 5P-! 0 156 .1) Frontage Setbacks Front '43 Side L: R: L: R: I� /D Rear Building Height -dg. Square Footage N(P1 % �� Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces l Fill: (volume & Location) A. Has a Special Permit/Variance /Finding / ever been issued for /on the site? NO DON'T KNOW V YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW t / YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 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 pere any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: , 1 _ ate^ 4 i!City,,cif Northampton - . a , _ Buil ii1 Department �� � � -': �'� �� � 212 Main Street . �. � Mt q , 2 3 C;, 4 Room 100 iT; -. ' � � A Northampton, MA 01060 a F a _ � • P �, 1 ' ,' 8 ' n ' a qk ' '� .1 phone 413 - 587 -140 Fax 413 - 587 -1272 J 4 is, � , ,, 3t � 4s':� h .. � � v � z APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1- SITE INFORMATION 1.1 Property Address: - Thissectlon to be complet ed by office \V\ \ cre L %S r ., i Zone ` Ovelrlay"D1 V 2 . {A Cam: iv\ C, `0 10 C- ? Eim St DDistrict ': ` * CB District ; SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZ AGENT 2.1 Owner of Record: R i'�i4 ,, ^, d�N C `c cJ z_(A s d C y n� 1� %C... Y ob k_ - 1 (0 `1 CP C:.D i e4 A L. VJ f V A.5 � .-e ,i �1- M P e t G Z Na (Print Current } Ad rt — t V2 3 PX . Telephone J Signature 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3' - ESTIMATED CONSTRUCTION COSTS jJ 0 -r u GL N i Item Estimated Cost (Dollars) to be Offic Use Only completed by permit applicant 1. Building (a) Building Permit Fee S H k_fl Z1 D G 2. Electrical (b)'Estimated_Total Cost of 1 'J " Construction from (6) 3. Plumbing 1 fr Building Permit Fee 4. Mechanical (HVAC) Ai 'P 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) , >77(/U Check Number 99g p ` This Section :For Official Use Only Building Permit Number: e �(f Date Issued: Signature: Date Building Commissioner /Inspector of Buildings File # BP- 2004 -0904 APPLICANT /CONTACT PERSON PENZIAS DEBORAH & CYNTHIA ROBERTS ADDRESS/PHONE 169 FLORENCE RD FLORENCE (413) 587 -0883 Q PROPERTY LOCATION 169 CARDINAL WAY MAP 36 PARCEL 313 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 9 �lff �t7 p ,, ,. Fee Paid Typeof Construction: ERECT 10 X 20 SHED 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 INFORMATION PRESENTED: i, /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 C�o�upis� ion , 77,777 ' .. "®G'. tom' 3/7-c/ie - 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. -4 169 CARDINAL WAY BP- 2004 -0904 GIs #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 313 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: shed BUILDING PERMIT Permit # BP- 2004 -0904 Project # JS- 2004 -1349 Est. Cost: $2700.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): Owner: PENZIAS DEBORAH & CYNTHIA ROBERTS Zoning: SR Applicant: PENZIAS DEBORAH & CYNTHIA ROBERTS AT: 169 CARDINAL WAY Applicant Address: Phone: Insurance: 169 FLORENCE RD (413) 587 -0883 0 FLORENCEMA01062 ISSUED ON:3/26/04 0:00:00 TO PERFORM THE FOLLOWING WORK: ERECT 10 X 20 SHED 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: Receipt No: Date Paid: Check No: Amount: Building 3/26/04 0:00:00 948 $25.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo