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34-023 (3) 41-, 4- r � Li dl Va ��.. cd K ^.1 cr 2 x rt } w �7�n JQ Lxi L-S) w � � s C ._ n F �a ! c ,� r N �o SO O�KHAMp�O "$ Crxt r of Nort4aui rtan � � �lassac}�nsetfs - DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building S 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:-., or. 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---_5/o 7/0 3 Address of work 1 location l3 .� ��rkl.LY l)t 1oYen ee / 0y G, dill of �l�t7z'ill�t>>r}�fnit R •. 6 ft?ass!tr}I!ts(tts DEPARTMENT Of' BUILD? G INSPECTIONS 212 Alain Street ' Municipal Building j- Nlorthatnpton, Mass. 01060 ' WORKER'S COMTENSATION INSURANCE /07FEDAVIT .uith z principal Wit f-btr r� re:ieence .._. CIO hcrcby ccrLu1 11111 C' i tll�'' o ms -'u"a p it ltle: C), 7Crjut-y, iTm"' O I am an employer providing the Iollov..,MQ v.orr_cr's cotnncnsation covera c or 'Illy employees worldrlg on this job: (Insur=e-- Compam`) (-P clic,Nt mExr) (ra.�.ir aon Date) I am a sole proprietor, general car hon?eowoer ICLCle one) and lla,-e lured the contractors listed beior, „vl hi � e il. _.� `P� e I ys. ?0 !1�'.'° (li r0 .,.v�y 'r Ofr< S COL p IlSc':!Oi! u�.iC'. (,Name Of Contractor) (�nS�i�nC� 07Il^": ri�O�ICf T11iA�i) •�?:'�7taiC' Dmc)- (Name Of Contnmc)r) -- (7i1s-um-ncz CO---Dc:a-4?c.hm, i`.illIllrl_'r) (;.` ilnn Dale) (2"'lamc of Contractor) (II1S1`iS1C C;)u :il:i/t'0�;�: Tv'i1lIl�r_7) X,,',-. u6 Dal,.) - (Name of Conimcior) —- (Ins r�ticc Cemrr_.}`iPo1i Trtum� r) -- (I :ni-::in Date) ( 1 <Lnl it �olc; proprlCL'Ji iii11 lilvc I-0 on Oi�.lii`{ tOr il? 12iI1 i 110I?le 0�:'Il iiCir l??lIl„ p.11 il.,'- v ?:O TI::',?I=SZ be ctrl c ar:r_nr_im cr:-gait- ... ... not here t1Ln thrvt Ln?s in\e{;i Gt1..he 1:::-.��:�T,�r:;:�Ce cxi'`�.:v:•:;=,rr•�.I:cr^.r1 LFicC.c--c(y�{Ccrrill'i CC!=:;;_::�`�l` c--. ployc3 un'er Ilr_tvc;f; s r•—:_:n r (Gt•'•5��s!�5).-,=r •-=;ic:;t,y a,homco'Nncr`:ore Itsal ctatui of an employer uo'' tbn Workclz Co,-l;,wr_-itioa:Axj_ I utidc^ctaud that a copy of Ox-a[titers•c:ay be foax� dv j io tf»fictiart�rn:of lndauzrinl Ar6&�&Oilioo of i::a_=rus:a for>fx coverage vaifiC_:iioo and that f:iltuc to t-z t c co urk::cZ.iOn 2 5 of MCI,152 can lad to ti,c impasiiion of c s^_1 Pt:s w —isting of a fur-of up to S 1-S .CYJ n:t 'cr i^;tr, •z_;!of;;p In cr,-}; --.I civil p'-MItics in do fi,nn of a Sjo-:' Lm of!;100.00 a dsy r<pdm-1 m:. Pcrrnit�' /� i•ofciq%utixs�ta Iuml tx r u>.c catty 7.J l,2 7`V 1 — --- ---- ..___ .....--.r- !. w Sf_CTON 8 CbNSTRUCTION:SERVICES: 8.1 Licensed Construction Supervisor: Not Applicable Name of License Holder License Number Address Expiration Date Signature Telephone ISNRggs U-Wb ffldUfn- oue e -e 'en ntr`ac o" Not Applicable Company Name Registration Number Address Expiration Date Telephone SECfiT0N0 VIfORKERS' COMI?ENSATION IN;S11yRANCE AFFIDAVIT(MG: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 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" certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zonni g Laws a State of Massachus tts General Laws Annotated. Homeowner Signature "Y— l I , i 3 1� 1 O M s " a b I�cable , New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks Siding[ ) Other [ ) Brief Description of Proposed Work: a6 4 L� �,01A'15 e Alteration of existing bedroom Yes X No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0- Sheet 0 6a. T O ° .Mr d -r ci�ition toe isting :ot in'g; comp"�E ae e fol=awing a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: 12�1 Number of Bathrooms v C. Is there a garage attached? yes d. Proposed Square footage of new construction. '�00 bimensions I e. Number of stories? — f. Method of heating? F R V y Fireplaces or Woodstoves pS Number of each FP g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction Q re'tiy,i-e Ve a1'C A woo 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 S `/�L k. Will building conform to the Building and Zoning regulations? X Yes No . I. Septic Tank (\ City Sewer Private well City water Supply � - ETb �lU ORIZATION TO.BE COMPLETED WHEN y` I ©NTRACTOR APPLIES„FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize to ac; on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date -e ylk L/ 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. Reitavl� Print Namve L 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 . C C s ,1r/�0 C'ttc(M4 e Frontage 117 9.0o of aq-e Setbacks Front toai'r i � I Side L: R: �� t L: R: a Rear l(� 4' {�L 4 4(f f 5 J Building Height u pt c�-f S Bldg. Square Footage t-10 0 % do cl 1,t!�-e j Open Space Footage yJ� 000 % 6e c(Vtl .e L!y, (Lot area minus bldg&paved / ���� parking) © (�t° #of Parking Spaces ✓" p (Lo Z - Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW X YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T 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 there any proposed changes to or additions of signs intended for the property ?YES _ No 4 IFYES, describe size, type and location: ------""�"n"" of Northampton .'1 V ding Department l 2 Main Street ` Room 100 AIIG 2 7 2CG3 aa° N rth mpton, MA 01060 .58 -1240 Fax 413-587.1272 1 "APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1'- SITE INFORMATION 1.1 Property Address: . t M a 0/0& Zon Over,la; D s#rict o EIm S � F tDistrict �CSU;��tr�Ct ,. . SECTION 2- PROPERTY:- WNERSHIP.%AUTHORIZEWAGENT O 2.1 Owner of Record: Na (Print) - _ Current t;-Address: V"J`'" Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION:3 - ESTIMATED'CO f STRUCTION'COSTSrt ` Item Estimated Cost(Dollars) to be Official use'Only completed by ermit ap licant 1. Building ` �/0()� 3/ 00,0 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from S 3. Plumbing Building Permit fee F4 Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 + 4 + 5) �l C>CJ U Check Number This Section For Official Use Only- Building Permit-Nuber: oZ Date Issued: m Signature; Date Building CommissionerAnspector of Buildings r- File#BP-2004-0228 APPLICANT/CONTACT PERSON RENAULD DAVID L&HEIDI H ADDRESS/PHONE 133 TURKEY HILL RD (413)582-7989 Q PROPERTY LOCATION 133 TURKEY HILL RD MAP 34 PARCEL 023 001 ZONE RR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: CONSTRUCT 25 X 12 DECK 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 FOL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON lNFO.RMATION 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 Elm Street C ssion CJ Z". Signature of Building Official D e 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. BP-2004-0228 GIS#: CIOM I OF MASSACHUSETTS � ;ORTHAMPTON Lot: -001 Permit: Building Category: ING PERMIT Permit# BP-2004-0228 Project# JS-2004-0330 Est. Cost: $3000.00 Fee: $50.00 PERT'_' `� GRANTED TO: Const.Class: Contra nse: Use Group: Homec _ Lot Size(ss .ft.): 160649.28 Owner: Zoning: RR Applicct `' ' ^� =IDI H AT. 13 Applicant Address: Insurance: 133 TURKEY HILL RD _ 582-7989 FLORENCEMA01062 ISSUE., TO PERFORM THE FOLL0WI - X 12 DECK POST THIS CARD SO IT IS VISIBLI Inspector of Plumbing Inspector of Wiriu Building Inspector Underground: Service: Rough: Rough: Foundation: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: T n.ulation: Final: Smoke; THIS PERMIT MAY BE REVOKEL ` V1 VTON UPON VIOLATION OF ANY OF ITS RULES AND REGULA'. Certificate of Occupancy FeeType: Receipt No: cock No: Amount: Building $50.00 212 Main St, �,�7-1272 Bu.