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36-058 (5) 4�t1AMpl. y Z ♦ � � �Ilassacl�asrtte - of Wart4aluptan is. DEPARTMENT OF BUILDI]�G INSPECTIONS / INSPECTOR 212 Main Street • Municipal Building 5 , Northampton,MA 01060 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 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, 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 I lk G,'IfI7 of II EPARTME t�T T 017 BUILDP�G INSPECTION'S 222 Man Street * Municipal Building 1"Tor th amp toil, Mass. 01060 WORICE,R'S COMTENSATIOIN INSURANCE AFFMANIT principal place of business/r,2:>'dcncc ar-13 an employer providing the v,,oi-k'Cr-'s COMPCIIS?11011 or 111), cmplovecs woitdrig on thl�job: (Ia-';"L=cZ2: Company) (Pc!icy Nuan' L—c-') Daic) I � I I am a sole proprietor, gentral contl-2C77-0r 'Di- I llorncowocr (CL'I-CIP- one) ?Dd. afftC the contractors listed beiov-,' -,vl'o "�10F!Kf--'-!s ('Na-roc of Contractor) Nus-nt-�:) (Name Of ContTa'C"or) \111LM,b'-F" ion Date) (Name of Cori"T2ctor) 7 c,5 D a Ic (Name of Contractor) jas-m-anc--- Com7,,L:)�PoLic-, NIiimI:,Lr) Aim a home nvlm"e` iii. "111I1�' 11l i17 iii S Cr not mcceth--o thruovnhj in C'r Cx]'-".'t --:m m< Act((31,152-nm!(5)), fort L—c—i4cc legal rIXtUZ Of an tha VINiC.C1L un&--nixnd thz aco?yo[L�:, 11­7:= "--o for tlx -VCT-IE;c vcf f=Iloc and Ula-I flAulm to!"aur-'Ov—r--r-uz--k—r 25A of MGL 152 e,n I'--d to tlx --min--j PCT:aL`= Comistingofa flncofu?toslSQ .Cvo fin--Of 5100.00 x day&;.-Lirnt M-- FCC T-, -riaturc Of 5'�CT30N 8 CQNSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone Re ere a ome m.r:"vemen = °on ractor �_ -` .. Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10 WORKERS' COM„PENSATIQN INSURANCE AFFIDAVIT(M:G.L.-c. 152, § 2 ;C(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 Dwellin6s 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 them 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 Signatures i I i ku SECT♦OJE5C RlPTIONsOF PROP05ED WORK check all a Icable i New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ Other [ ] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0- Sheet 0 6a f W W`�ouse"�a'�n'�'or c d�tron"£to ez-fisting housing com-piefe the fiol:low=ing 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 Nc 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 C SECr101WNERAI)THORIZATION TO BE COIVI.PLETED WHEN OWNERSJ�IIGENTOR�CONTRACT:OR APPLIES FOR BUILDING PERMIT x _..M I, as Owner of the subject property hereby authorize _ to act or my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Emm 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 Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW 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 there any proposed changes to or additions of signs intended for the property ?YES_ No IF YES, describe size, type and location: �- of Northampton r Building Departments 4 ti Main Street Room 100 r { OR Norampto�i, MA 01060 ¢- , .: +.' 5 67-4240 Fax 413-587-1272 APPLIC/AXI&N TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION x This section be com01e#eRl by office 1.1 Property Address: Map a#Lion+v Unrt �.� a v n r__ gl r z dtie" Overlay DtStf7G# w y n r � e u ry a c t. Ur � E{I1d���lS'tTICt •., `,CE3�16t1�G�, SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone 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 b 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total = (1 + 2+ 3 +4+ 5) Check Number, a� This Section For Official Use Onl Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2004-1152 APPLICANT/CONTACT PERSON ASTE ESTHER P ei �p 6 `- /3 g ADDRESS/PHONE 25 REDFORD DR FLORENCE -07 PROPERTY LOCATION 25 REDFORD DR MAP 36 PARCEL 058 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid 37ro T_ypeof Construction: REPAIR SUNPORCH FOUNDATION,GARAGE&STORM DOOR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildiniz 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: 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 ommission 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. r J 25 REDFORD DR BP-2004-1152 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-058 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-2004-1152 Project# JS-2004-1742 Est.Cost: $100.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq.ft.): 12501.72 Owner: ASTE ESTHER P zoning_URA Applicant. ASTE ESTHER P AT. 25 REDFORD DR Applicant Address: Phone: Insurance: 25 REDFORD DR O 586-0439 O FLORENCEMA01062 ISSUED ON.5121104 0.00.00 TO PERFORM THE FOLLOWING WORK.-REPAIR SUNPORCH FOUNDATION, GARAGE & STORM DOOR 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 Sienature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 5/21/04 0:00:00 3480 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo