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25C-058 (3) O O C-itV of Narf4a»tptan , �y DEPARTMENT OF BUILDIj\'G INSPECTIONS 212 Main Street • Municipal Building INSPECTOR Northamp(on, MA 01060 r r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as iris/leer construction sup,.-: .- ,or. Ti he state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family divelling, 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 routsh 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 occupancv 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. Nome 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 A 6-ifl) Qf �l>_ rt1jullip till � 6 JiiasaacVlasrtla' j^ IMPARTMENT OP BUILDING INSPECHONS 212 Drain Strcet - Municipal ,Builtlinl; Northampton, Mass. 01(76'0 — WORTQ�R'S COYIP�NSAZTON 1hiSURANC�: AFFIDAVIT A 1C:nS;CJ�'CIiI11t1°�) With a principal place of busulesslresidencc �?r. -- - -- •;i IL.UCl I\ ... �"I t>1 aill -11t es 0--p(.1 ...._ ( n an ctnpioycr providing the ii)ilovvitl(,'.�:tnr_cl _ coultuns<?u'.ln c.clvc:a.�c �o :i)y enlplovecS Nvolkk llu oil tili;i job: (Int�lianc Com. ""my) (Pciie:Nun bcr) ( ) I am a sole prol)lictt,r, general contractor or honleovvne: �circic ()ii,;) am }iaye iureu the contractors Ilste,� bt'iov h0 11 \' the fol1G•:vlB wOrke-S --_ (Name of Conti-;1C10 ) -- _—(111Slli'.nc:. �`011i^2 ir�i�011i;i N11i11C•:;l i,j.::;'::.. ..f. I)2lC) of(,)I:II2CiQC 1 U1SlL1?IIC:, COIL�a .\'i1 0 1Ci (1\lame of Contnicio:) (111su-ailcc Comp],-1}'lllolicy Ntljnl-�r) 'ti :i.:i:`:1 !_%atc.) (Name of Contuactcr) (InSL1 non Coln any/11'olicy Nuint-:s) !' 1 1 Da(c) (zttadt zbiitice:al rxct i'rc,•r-v:-::. :.r-..�.. .-:L<ru:i o(:� tai airy:.:eli��.<:-a�t:-1 ( 1 wil It sUIC ;ilC)l)I]C::)i 2:I;1 have no olle for nle. NOTE:p[czac be atvazc tl:a_ not zwxc th:n tltrco units in tairdt''�1::-a�i.ar rcr c�cr cxt t!�- :s z lurtm 1_`rcRo z:c[,X�crr:11';o.::::::c:i catplo}�s u•i rz tlr«t.}:ct's c :�—.❑licn rr:(G!_lS?s!(S)l.r i: 'ic:by a hocsmc. r for n Lca_� c Irr :•c t:r_ Iegal rtntut of art onzploya under V:o Ad 1 uod,—^tared lha:z copy of this c2 atr.:u:t auy bo fotwnraiocl to tlr IY.Sn.L,c<,t of Izwt(u'rid Actin: 11f Of"-of I::auu.:a for tfw 00%,Mge vcrificatioo and tlut fzilure to!-care covetxbo urn r c.iett 25A of MGM.152 can land to the i:nl*,Stftm of c;v _!lxtsl::u coalisting of a Carr_of up to S 1.500.60 a:k Cx- of up to Orr-r zr r.tij civil lxtuttia in�r i<'�n of a tit`-'�`' i ' A' LF--of 5100.00 ►&V lg:61)a m-- i);natttre t1I l ic�n:;c:JPct; (lac. qtr• _ t SECTiON`s =DESCRlPTlON OF PRQPOSED,WORK(checkxalfapplicable) New House ❑ Addition ❑ Replacement ndows 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 sa IffNew h uo sesand or adiiition;fo exastfnga;h°o'i i-ng complete th'f61RWinR: 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 SECTION 7a-,OWNER AUTHORIZATION -TO BE COMPLETED WHEN 6 1 NERS'AGENT OR`CONTRACTOR APPLIES FOR BUILDING PERMIT I, / / as Owner of the subject property hereby authorize to act o y behalf, in all matters relative to work authorize by this building permit application. Signature of}Owner Date as Owner Authorized Agent herd by declare that the statement and information on the foregoing application are true and accurate, to my knowledge and belief. Signed under the pains and penalties of perjury. Print Narw s� Date Signature of Owner Ag N f r 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 DON'T KNOW ✓ YES ,-Tf`YES, date issued: 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 41 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 IF-YES, describe size, type and location: y.� 1 r. Cl112�f Northampton Building Department . �'L12 Main Street Yn _ Room 100 a er W J' -Northampton, MA 01060 e s o phone 413-587-1240 Fax 413-587.1272 "Pilo /Site a r, ;T APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION Thissect�iloot a�b �cn1 0 e='om,p" ,bY0 ; ofice 1.1 Property Address: v ";01 Map 1141 a Zone Overlay>DistnC. Elm St. District C8 Dl's ir"' " SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: y� me(Print) r,. Current Mailing Address: Telephone Signature`-- 2.2 A thorized Agent: l iAm Nam 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 IV 2. Elecmcal (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) ,(�� Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date BP-2006-1142 G1S#: COMMONWEALTH OF MASSACHUSETTS pp CITY OF NORTHAMPTON �p Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-1142 Project# JS-2006-1690 Est.Cost: $1300.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin: Thomas C McCarthy 100364 Lot Size(sq. ft.): 20952.36 Owner: DUNPHY DEBORAH A Zoning:URB Applicant: Thomas C McCarthy AT. 25 LINCOLN AVE Applicant Address: Phone: Insurance: 3 BRODERICK ST (413) 527-5141 Workers Compensation EASTHAMPTONMA01027 ISSUED ON:412612006 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS 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 4/26/2006 0:00:00 $25.003985 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo