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' / 1 � At jt \ 1�F� . ••-�� .J 6.985 �SEI:FT. < _ 0 - - J _ ----A-- /C �g — - -- _-- ` \ -� 1 B .0} th0± k-6 .1 igl . - - H S 0¢y • (City of Northampton • . it=; r b # 4 .. ri i� ytd assacl� !setts • : :& ■DEPARTMENT OF BUILDING INSPECTIONS _= /_ INSPECTOR 212 Main Street • Municipal Building o ,4 Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction sups : visor. 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, 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 �o oy (1 f:12 of porfl 4 ►► - 7 - ,aZcsanclinsctta• Ir' `fi i , .• �I - - 11, DEPARTMENT OP BUILDING (NSPeGT(ONS • 212 Main Street. Municipal Building Northampton, Mass. 01060 r' WORKER'S COMTENSATION INSUR CE AFFIDAVIT • - -- (li ccusxipermi ace) with a principal place of business/residence at: 1 /3 au,- /44- / 0/ none:') G6 7 ad 3G (set /ci ty /s p) do hereby certify, under the pains and penalties of perjury; that ( ) I am an employer providing the followinu worker's comocnsaaon coverage For my • • employees vorng on this job: -/ y' =?0 -(,) to 1.29 /.. /6 7 (Insu.r nc Comrs •) (Pclic: Number) (Expiraon Dal ) - ( ) I am a sole proprietor, general conuac -er or homeowner (ciscie one) and have hired the contractors listed below who have the following worker's coo?e nsztion policies: , � • l 1�s tie -'5216 6 774 . (Name of Con'^ctor) (In uranc: Comnoar vi"oUCi Numcc) (Exptrduon Dale) (Name of Coo Tamar) (Insirance Compaa`vPotjc- Numcer) (E ai Lion Date) • (Name of Cou aetor) (nuraracc Compao N:unbu) (Expiraon Date) i. . (Name of Contractor) (Lnsuranca Company/Policy Number) (Ex Date) . ( aaach ad iticc al cbcc if occvcar co mcud: iafor i oc perulaing to di owe -c.o -a) ( ) I am a sole proprietor and have no one working for me. ( ) I am.a home owner performing all the work myself NOTE: plcx be ",arc Ulu w4 lc bemeowocn wino employ pcwm tot - 6=L ace -=.1JO a rtpx# work on c dwcaul , of sot room tin ' - oc tetra in which the bomoo ocr raid= oc co ehc Dunes z7purtcoar1 tbe-ao a no( coe-.11y a=crd. -red to be eitploya: undc- the wa-ld: cc erica Act (GLI52,sa appliatioo by • bomnoa fcr _lice- cc permit 1D07 cvidmee the c p.! ctnSU o(aa cs loy c under ciao Wor tole Cocapeosu.kra Act I vadaztxod daa a copy of this cat ®o= m.. be for...rdnd to tb. popurmm¢ of of Go- or foe th. covcrx vciCccioo o_'td that C_iitat to sonustovcro. ce ucdt tcaioa 25A of MOL 152 as icd to the impxisstioo o(ciminsf pea tai a cocci:zng of a floc *Cup to 51 500.00 andloc impri.3.0ozocat of up to woe yr.:1r eed civil pm•lua in d c focal of a Stop Work Ord and a rim 0(S I 00.00 . day tp-iaA etc, For dq.+ta� =it u,c orJy permit Numbc — Map.• Lot . s. Sitpaaturc o(LiccnsceJPermiucc Date J a SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : //,4 �z .✓� ( ' 0 OF License Number 6/3 (L.477 i2e, / -- - o.✓ 3Z 5/o 7 Address Expiration Date tit 7- G,z30 Signature Telephone 9 stetiitf ihi Iinpiouer 6Fi tiiiitriEtoE fi f :; , '� " ` .. Not Applicable 0 .��J.t r ( "- '72.9c „Jc— /2 y Company Name Registration Number JO /4 Address Expiration Date Telephone, SECTION 10- WORKERS' COMPENSATION- INSURANCEAFFIDAVET (ma 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 ❑ - 112 r '911 - 1 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 buildine 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 • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House [] Addition ® Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [0] Other [o] Brief Description of Proposed Work: /j7 JC— / CH 7 OUT !'arm /3 Alteration of existing bedroom Yes LX No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes )" No Plans Attached Roll - Sheet ` r w scan aar iift iti to z sitr r a. Use of building : One Family Two Family _ Other b. Number of rooms in each family unit: Number of Bathrooms Z Z c. Is there a garage attached? YRS d. Proposed Square footage of new construction. I/ 5©- FT Dimensions 7x !.3' e. Number of stories? / f. Method of heating? �n Fireplaces or Woodstoves A/c' Number of each g. Energy Conservation Compliance. A %" " Masscheck Energy Compliance form attached? 6449. h. Type of construction GJdoo {-,/b=0,-0( 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 efl k. Will building conform to the Building and Zoning regulations? V Yes No . I. Septic Tank c,/ City Sewer Private well City water Supply SECTION Ta - OWNER AUTHOR IZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTORAPPLIES FOR BUILDING PERMIT 1J 5 S.) t ./A ✓ , as Owner of the subject property hereby authori /,.0-1 to act on my half to tt relative to work authorized by this building permit application. AIM Signatu of wner Date I, "4 y' , 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. �l�t ✓i J Print Name Signature of Owner /Agent Date fr it 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 19 • /7 .100 W E Frontage /5c' I , /S✓ Setbacks Front ' j S� L . 3 2 ' 5) a T T Side L R:` � L:�� R:' 3 ".� , ? S,. Rear _ Z ' go': Z S Building Height 1 4 D,i s 3 r Bldg. Square Footage 206 1 % la530 Open Space Footage , % 3 (Lot area minus bldg & paved j C ' ! Fi'� ; ��� parking) r=. # of Parking Spaces 2 2 l Fill: i ---- I (volume & Location) - -- A. Has a Special Permit / Variance / Finding ever been issued for /on the site? NO Q DONT KNOW 0 YES 0 IF YES, date issued:; j 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 0 DONT KNOW 0 YES # IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q Date Issued: N livr -i7,e 20 r-iiC //f3'Zk - ' CA./ .5'' 7770 %7LAs./ C. Do any signs exist on the property? YES Q NO ) IF YES, describe size, type and location: ii D. Are there any proposed changes to or additions of signs intended for the property ? YES © NO 0 l 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 Q NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • City of Northampton ibis a. � 1-: 1 Building Department ;"a . w �` 212 Main Street �w ° r a e f.- `"y •) i �'�U -- Room 100 69t -, . Northampton, MA 01060 � e:t f; i; " ? phone 4115587-1240 Fax 413- 587 -1272 ✓ �ee�iP^+ k�' r4�P �€,.` i5'ds 4 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION t- SITE INFORMATION 1.1 Property Address: T mpCeted•byoffce htssectton, toM be; co _ /� �. ✓A1 / M ooi , ' / L1 �,aie 2' C e.i/.%/ *L• ,_ O uerfay District ', ' 7 8- Distrrct.L m-. ry C Di SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZEIYAG 2.1 Owner of Record: e 4re i <x) , ) ai Name (Print) Current Mailing Address: ‘44 '-1 -- %//e1/7...... yr 3 y 7� i 9 /40447 Telephone Signature 2.2 Authorized Agent: --- // y� / / (A ti/ y '/3 a,..„,,77, /� v AZ-11/77.1e,--7-Zr/,1 Name (Print) r Current Mailing Address: /..-e--2...4- y/3 61,,7 0 3 0 Signature Telephone SECTION'3 - ESTIMATED CONSTRUCTION .COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ; -(a) Building Permit Fee c; © 2. Electrical - (b) Estimated Total Cost of o 2S ` DO UO Construction from. (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= 1 +2 +3 +4 +5 ( ) ,� O ciao- Cl d Check Number �f/� () _�- This Section -For Official Use Only '-:Date _ Building- Permit Number. Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2007 -0350 APPLICANT /CONTACT PERSON TIMOTHY SENEY ADDRESS/PHONE 43 COUNTY RD HUNTINGTON (413) 667 -0230 PROPERTY LOCATION 182 CARDINAL WAY MAP 36 PARCEL 330 001 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 AO Fee Paid Typeof Construction: ENLARGE EXISTING ENCLOSED PORCH 7 X 13 New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 061088 3 sets of Plans / Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 Pe om Elm Street •ssion .i/c,c1 Signature of Building Official Da to / 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. 182 CARDINAL WAY BP- 2007 -0360 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 330 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 -0350 Project # JS- 2007 - 000518 Est. Cost: $30000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Cony +t. Class: Contractor: License: Use Group TIMOTHY SENEY 061088 I_ot Size(sq. ft.): Owner: SULLIVAN DENNIS A & KAREN D Zonir;_Sit Applicant: TIMOTHY SENEY s : 18? CARDI ■AIP.Y Applicant Address: Phone: Insurance: 43 COUNTY RD (413) 667 -0230 HUNTINGTONMA01050 ISSUED ON :9/29/2006 0 :00 :00 TO PERFORM THE FOLLOWING WORK: ENLARGE EXISTING ENCLOSED PORCH 7 X 13 POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector I;nuerground: Service: Meter: Footings: WA 6,.11' I8 Loo tS Rough: Rough: /, q z 4 f> House # Foundation: .driPti Driveway Final: Final: Final: / -31- 0 7 P p-% i Rough Frame: 6 ! I N. Q G Gas: Fire Department Fireplace /Chimney: t Insulation -. Final: Smoke: Final: D1< Q d + 0 j s THIS PERMIT MAY BE REVOKED BY THE CITE _ OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULAT NS. / Certificate of Occupancy .,1 Signature: z-- FeeType: Date Paid: Amount: Building 9/29/2006 0:00:00 $50.002419 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587.1272 Building Commissioner - Anthony Patillo