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29-182 ¢�KAMpJ, 0�`� _Gritp oaf Nart4amptan Z Z �I855ACf(IISCttS DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR '212 Main Street • Municipal Building 5 •`� Northampton,MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as hls/her construction super,isor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one'Ue hvo fan_y 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 lull i g department for the City of Northampton wants-any persons)vho-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 dour) 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 the work can be ins ected. 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 L 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 - Dates Address of work location + i 4Ylt/l}r P�. J, ' Df CTZ71 aI1133 0 1.1 glcoaar{1atclla' DEPARTME14T OP BUILDI)\'C INSPPCTIOI'S 212 Main Strcct Tsunicipal Building Northampton, Mars. 01060 WORSa. RIS COM PENSATIO.N MSURANCF %Vl b z principal place of businessfresidencc at: — - .���- 1�� v1�1 e•C.f= �.t ���-�`-�. ��i4 G%�c�.::y � ():h on e�') ..S c��:� 7i •�--- I (scrrt/ci tylsiatcrzi p) { do hereby cer6Jf,-, under the.pa*us azd penalties of petlury, i , j ( ) I a m an employer providing the follo%vinQ Iv,,orkcr's compcnsznor. covcrv�c For III) emplovecs worlong on 11iis job: { (Esau-mac Conrz.�) lPclic: ?tip-n.irr) t=:•pir`tior. DzL} 1 ( ) I am a sole propricror, general conuacior or homeowner(ci cie one) aDd have hired the coouaGiors listed below CYbO have (be ',oUotvi.nQ wor tier's C.0, Ltat�0 pOIJCIes- (t=-, Oi ConEnCiO") (In2ranc Companyi-Poiic; !"ruII1=cT) (Name of COD U:CZor) Ri urancc Comnanyi?o!iey \u»c_r) - (xpx m6on Due) (Name of COaII-dclo:) Gmsuranc: Campam/Policy 1v;tmb r) (>_:cpij-a non Daic) (Name of Conmac-lor) (Lr—,i=cc Company/Policy Numk) (—Exp r26on Dais). (a—ch:d3i�ocsl to¢�cl iafoc G oo pcta n as to.11 ooc-sv�) {C I_am a sole pr=oprietor and have no one wo6;3.ng for me. ( ) I am..a home o,vner performing all rbe work myself. N07�:plcs be curare tt,. c bemcx4 ocx��o czaplay pe oai to cl�t`i=t=•^ ca-r�ao c rc3ir orx an d cLL^.�of j aoe moCt 11 !ter-='rj is wbkh the bo,�raid.oc oat the p-o�ata, �tb,-, r noe C=�=Uy oe =d_-ni w be 1 perc pioyca= the U _c m- - Ac (GUI52,=1(5)�=ppiia7oa try a b xm --fc b�-or m r--:Y c,,d�ec the 1cpI c==or ea c=*loyeruod.,dr Work; -,CocaQom-•Si ArL I uOdc-c- d that a oopy ortbi.=.co-w ovy bo foe+an!eC t.o the Depa,,c ,orIod,s j A, &.a:(C15-of Irr.—foe th< j - cov='%sc vcr6c=tioo sad lkut U=c to scurc'covzmcc tn]dc zociioo 25A of MOL 152 can led to the 6co or c-'m;z.t PCO 4:3 eoasi;axh of a rwc orup to s 13oo.00 arwor 6,opr6oaa,of up to ooc yc_r Lod aril pco-_Y,io in�fowm Ora Slop Work Ordc azd a i fim 0(5100.D0 a day,pia mc. For d�.na'1t u.c only --•-'-� {' permtl Numt-_T 1v(ap-^_ Lot � Si�istzt of Li r SECTION 8-CONSTRUCTION SERVICES t I 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of license Holder: License Number Address Expiration Date Signature Telephone Reaistere i 'ornemD o emenoirtracfor 'T` - $# Not Applicable ❑ Company Name Registration Num er — — S c' d: K�� t�r"c � r t7�t el Address Expires Date e�fct `3 —Telephone S ,(, 2-1`L SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(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...... ❑ MAW , 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. Defnition 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-vear period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that be/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 hirc 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 r r. SECTION 5 DESCRIPTION OF PROPOSED WORK(check°all applicable) New House ❑ Addition ❑; Replacement Windows Alteration(s) Roofing Or Doors Cl Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[06 Other[b Brief Description of Proposed Work: t`✓r'i <<r'"!—�1 `-: Z+` �.' .'I y' �� s lc Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.1#New hous"= nc >"�ddi ioh to exis tinal oustncr-complete the fovu nq: 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. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNERAUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR`CONTRAGTOR APPLIES FOR BUILDING: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 as Owner/A thorized I e3t..hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my kno ledge and belief. Signed under the pains and penalties of perjury. Print Name � Signature Agent Date '–' Section 4. ZONING All Informatibli 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 Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volurne,&Location) ' A. Has | Permit/Variance/Finding ever been �suadfor/on the she? ' �~� �~� � K0 �� D�7 �OW �� YES �� IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DDN7KNOW YES IF YES: enter Book Page, and/or Document#: B. Does the site contain u brook, body of water orwetlands? NO «���� DO07&NOVV �~� YES IF YES, has permit been or need tobo obtained from the Conservation Commission? ~ Needs tobeobta[med v,~� �bta�na� �~� Date �ssued' v�� \~�' ' ' C. Do any signs exist onthe property? ��V YES �~� NO ^�� IF YES, describe size, type and location: D. Am-there any proposed changes to or additions of signs intended for the property? YES NO 0 ' IF YES, describe size, type and location: E. Will the construction activity disturb or filling)over 1 acre or is it part ofo common plan thawN|disturbnver1onm? YES � � NO � � `~� ! ~—" |F YES,then u Northampton Storm Water Management Permit from the DPW is required. t N xw 2ar g n i . - De 6W,'Ju City of Northampton Building Department K' h - \ 212 Main Street m - Room 100 e i� Northampton; MA 01060 0 phone 413-�87-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to�ecorrapleted Uy office c� f �iVlap Lot: .t"? Unit t §4 El �Distract CH D4stnct SECTION 2-`PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Recorder n Name(Print) Current Mailing Add, s: Telephone Signature 2.2 Authorized Agent: /c�Vi�t✓ C-��.l�f'>/ I V _r_4s /L1i1 Name(Print) Current Mailing Address: -�� 4.j-- �- -Y'- '�1,'��')/�/— Sig ure Telephone-F-SECTION 3-ESTIMATED CONSTRUCTION COSTS' Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)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) '> 5 Check Number This Section For Official Use Only Date Building Permit Number Issued: Signature: Building Commissioner/Inspector of Buildings Date . $0,14W 82 BRIERWOOD DR BP-2006-0209 GIs#: COMMONWEALTH OF MASSACHUSETTS MM:Block:29- 182 CITY OF NORTHAMPTON Lot 00 b- Permit: Building Category: BUILDING PERMIT Pen-nit# BP-2006-0209 Project# JS-2006-0305 Est. Cost: $2525.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: John Corbett 104000 Lot Size(sq. ft.): 10018.80 Owner: POMPILLI KENNETH S Zoning Applicant: John Corbett AT. 82 BRIERWOOD DR Applicant Address: Phone: Insurance: 56 Dimock St (413) 586-8712 LEEDSMA01053 ISSUED ON:812412005 0:00:00 TO PERFORM THE FOLLOWING WORK.-COVER SOFFITS & FACIA & GABLE ENDS 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: FeeType: Date Paid: Amount: Building 8/24/2005 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo