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John Symanski One Cottage Street #32
License No. Vinyl Replacement Windows Easthampton, MA 01027
Constr. Sup. 032590 Vinyl Siding/Shutters Tel (413) 527-1149
H.I.C. No. 101291 Door Replacement/General Repairs Fax(413 527-1812
No Job 7bo Small
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SECTION 8-CONSTRUCTION SERVICES +
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder ::: C. h tJ •�'v t'1/itj i/1 11C 6 03 L)
o� License Number
Address Expiration Date
Mg. o,e 12 113 7- //-1 f
Signature Telephone
e �s a ornh.rn"4rverrr<enloi�tra o Not Applicable ❑
Company Name Registration Tlum er - -- —
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCEi41=FIDAVIT(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...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeuwuei to engage an individual for hire who does not possess s 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
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SECTION 5--DESCRIPTION OF-PROPOSED WORK(check'all°applicable)
New House ❑ Addition ❑; Replacement Windows Alterations) ❑ Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p- Siding(('IT Other[CI]
Brief Description of Proposed
Work: v,,4
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes '" No
Plans Attached Roll -Sheet
sa h ev f>IOitse and; %► MAN nc� RI Lio r � p e o fdwlrla:
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.
1. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER?AUTI HORIZATION.-TO,BE;COMPLETED:WHEN
OWNERS-AGENT;OR CONTRACTOR APPLI]E*. :OR BUILDING:PERMIT
as Owner of the subject
property
hereby authorize ^;1-1,%j�S ;✓►i[�t��t I<i
to act on my behalf,in all matters ref tive to work authorized by this building permit application.
it
Signature of Owner Datey
I, Ze-)b as Owner/Authorized
Agent hereby declar4 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. '
�K
Print Name
nature of erlAgent Date
(rsii-�) of �tlrfllal)I�tDI� _ =
4 ' E �la�skc}latrlta _
DEPARTMENT OP BUIL00\1C INSPECTIOI.'S -
212 Main Strcet Nfunicipal Building
Northampton, Mass. olOGO
WORICER'S COVIII'ENSATION MSURA.NCF All IIPA—VI7'
(li ccusxJpCrml ttcc)
v.I h a principal place of businessfresidence at: -------
t; Cz S 1 atj"t 3:a- kAf I a.mt?T6 A) CA (PhOneT') '//3
(=---Ucir;/SUI •p) 01-007
do hereby cerifj under thc.pzins and penalties of per3ury, --hat
( } I am an employer providing the following worker's cofnocnsado ; coverasc for Iny
emplovees lvorlong on Lilis jots:
i
(L=oran= Conrz-zv) (Polio:Nu_—,iho-^r) (r ,:-pircior, D21--)
( ) I am a sole proprietor, general contractor or homeovrmer (c cie one) aid Lave hired
the coatractors listed below vvbo have the fobo\vino worker's comp n_t2don policies:
Game Oi Cont^CiOr) (insuranc: Coinpany/PoUCi
i
(NamC of COEl Craclor) (insurance. Comoax"IPOUM, Numt-2.0 (—E»iroon Dale)
i .
(1 lame of Contractor) (I»anee Compan}-JPobq- Numb,-J) (Expiraoo Dalc)
I
{Name of Contractor) (Iosiran Comcany/Poticy Numbs) t�xpirzuon Date).
(atu<h sdliCOOJ dxct.ifncc,.�.ary to ircuct;iafortn,�oo pc�aiaiag to.11
am a sole proprietor and bave no one worhdng for me.
( } I am.a home owner perforr na all the work- myself.
;
jNOTE:Pie-zc be ewtm Eh'-tile hOax_o 1xcm utbo craplay pc=o to da c--.rjoo Cr rcpax r work 0-3 a d..ell:=E of
ant moez lhr o t'uo tares is ta�xie6 the bomoow nc resido or oa tb e p out 3 zpjurtea rl tb�rn r we G=r=Uy 00=:&rod to be
caxployca uacc the--1-5 C=Pc -,yea Au(GUI 52_=1(5)�&PpLicL6oz by a bomma-=far a lien=or Perms ray ea-rd='oc tl e
legal.ta.n''a of an==Ployw under dua Woc{'.ole Coospomaiioo Ace_
I atodcsiaad fiat a Dopy oCl6i.mscancm oaay be for'.nrded to Ibo I)opertmcod of L.&.zr icl Aced OfLoa of tr>axaocv Car tha
nrif e='oo°''d that r:iY=to A«a 'COW MCC undue sOe oa 25 A of),(GL 151 eaa led to the imposiGoa of ciminaj pca,l2io
comic of a fiat or up to s1 5oo.00 and/or inpr4oamc=of up to Doc yrw cad ci vU pcaahio is c5c form of a SS p Work Ordc sad a
rim of 5100.00 a d.y aPiaA CDI-
For dcqusu�=.�u.c only .
Permit Nu mtla-, _--
`� ____ �{np.
I pnatim, Uc=sce/Pcrmiucc Date
Og'C�IA'ypTO
Crity of cNnrthalliptan z r
� B j�ilssaxc}tnscffs
DEPARTMENT OF BUILDrNTG INSPECTIONS f:
INSPECTOR '212 Main Street • Municipal Building 'a
Northampton,MA 01060 y ,
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as l-,is/her construction sup, ."sor. The state defines"Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be, a one-6r two fa rn-Ty
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/footing's (before backfilI),
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
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. ° . .
Section 4. ZONING All Informat-i6ii Must Be Completed.Permit Can Be Denied Due To incomplete Information
Existing Proposed Required by Zoning
This colunin to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Building Height
-
Bldg.Square Footage
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume*Location)
A. Has a Special ever been issued for/on the site?
No 0 DONTKNOVV 0 YES
IF YES, date hsum
IF YES: Was the permit recorded at the Registry of Deeds?
NO �� D
�_» um/ umuxv 0 YES
IF YES: enter Book Page and/or Documenc#
'
B. Does the site contain a brook, body of water urwetlands? NO 0DNTKNOVV x~��� YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
-
Needs tmbeobumimed �~� Dbta�med »�� Date
�_v \_� ' '
C. Dn any signs exist onthe property? YES ���`� ��
NO v��
IF YES, describe size' type and location:
D. Are thane any proposed changes to or of intended for the property? YES �~� NO
- -__ ' ' - _ _ �~�
IF YES' describe size. type and location:
E. Will the construction activity disturb(clearing,grading,excavation,nr filling)over 1 acre uris8 part ofo common plan
that will disturb over 1acre? YES r. NO
�~� r
|F YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton
Building Department
212 Main Street
Room 100
. APR 2 1 2026 . orthampton;AMA 01060 .
phone;413-587-1240 Fax 413-587-1272 t ..
DEPT . .., .��� u . __ _. �.,.
APPLICATION To£ TRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 =`SITE INFORMATION
1.1 Property Address: This secfion to be completed bynffice
F
bta,aK �' it.�4� F� Lvt r a Unt
Overlay Dtsfnct
��'^`/ �/� 7 One-`'�•sr+ ,� ,
NL..t I ! P1 Ci%Gr L•G.' w z r
�`EImSf`'Distc►st �- CB„D�stntict_ _.
SECTION 2-'PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
r� Cl.�l.•ii•td Seel t �+ f� S•�/ /7��L IJF'_vC�� L JL�.-- �41Z t,t+�f dM
Name Pri tj Current Mailing Address:
Telephone
Signature
2.2 Authorized Accent:
l 1�i' �r , Y1 C± � Ki ��kY �� .c �- �l . troll #�
—�--I t � �
Name(Print) 1 Current Mailing Address:
ature Telephone
SECTION 3.-ESTIMATED CONSTRUCTION:COSTS`
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 20 Q d {a)Building Permit Fee
2. Electrical -(b3 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) Check Number
This Section For Official Use Only
Date
Building-Permit Number Issued:
Signature: -
i
Building Commissioner/Inspector of Buildings Date
File#BP-2006-1127
APPLICANT/CONTACT PERSON John Symanski
ADDRESS/PHONE 1 Cottage Street#32 EASTHAMPTON (413) 527-1149
PROPERTY LOCATION 341 ACREBROOK DR
MAP 29 PARCEL 324 001 ZONE URA/WSP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT _-
Fee Paid
Building Permit Filled out A4 4A 4
Fee Paid
Typeof Construction: CONSTRUCT 6 X.8 DECK W/STAIRS&PLATFORM&INSTALL VINYL SIDING
New Construction
Non Structural interior renovations
Addition to Existing Accessory Structure --
Building Plans Included: --
Owner/Statement or License 032590
3 sets of Plans/Plot Plan
THE FOLLOWING 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
Permit from Ehn Street C ssion
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.
kCREBROOK DR BP-2006-1127
4: COMMONWEALTH OF MASSACHUSETTS
:Block: 29-324 CITY OF NORTHAMPTON
nit: Building
-gory: "'WILDING PERMIT
n-lit# BP-2006-1127
i5ict# JS-2006-1675
Cost: $20000.00
$100.00 PERMISSION IS HEREBY GRANTED TO:
inst. Class: Contractor: License:
;e Group: John Symanski '032590
)t Size(sq.ft.): 25 3q.04 Owner: RITCHESON GARY A& LAURA E
ininiz: URA./wST' Applicant: John Symanski
34
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ipplicant Address: Phoi;e: Instirance:
Cottage Street# 32 (413) 527-1149
-ASTHAMPTONMA01027 ISSUED ON.-51212006 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 6 X 8 DECK W/STAIRS &
PLATFORM & INSTALL VINYL SIDING
_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:k'
Rough: Rough: House,# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
0' Insillation:
Final: Smoke:. Final: 0 K7- -3,0
THIS PERMIT MAY BE REVOKED BY TH/Y CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGUJATIONIS.
Certificate Of OCUIpanc signature:
Feel' e: Date Paid: Amount:
Building 5/2/2006 0:00:00 $100.009889
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo