Loading...
25C-077 (2) 1�2TSSAC�1TStttB - DEPARTMENT OF BUILDING INSPECTIONS / INSPECTOR 212 Main Street • Municipal Building 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 ias/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 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 0 v�F 0.11f�7 of � o fljalliptoil Ay f ��coanc(lnu(ta' o DEPARTMENT OP DUILDr,C INSPECTIONS 212 Alain Street Municipal Banding Northampton, Hass. 01060 «`O RICL R'S CO,YfP EN SATZO N M S URAN CF A I'I'II�ri VIT (li ccnsxJpermi titx) j vIILb G principal place of business/residencc at: (phone') (s>�t/ci ty�szatt�a p) do hereby certify, under the pains and penalties of perjury; h=c ( ) I am an employer providing the following % orker's comocnsaio, covemse For 111y employees Wor�Jng on this job: (Innu.r-ancz Comp lay) (Polio; Nu_�r) --- (r:pirtlon D2(-.) O I am a sole proprietor, geoeral cooa-actor or homeowner (ei c:e one) and hzve hired the conuaciors listed below wbo hp-ve the following worker's caL?ensnon poLicies: l - (I+::IIIc of Con ncior) (ln-sur'ancc Compwi)'IPo6c I (Name of ContTaaor) (Ins --oc; CompazwPo!ier \(Incrr) (%i 6on Date) i (Name of Conrrac ) (Iasuraocc Compao)-/PoL-q- Nambu) (Expir[ien Date) ` , (Name of Coatmaor) a=raIIc-- Comc rry/PoLcy Numbs) (Expiraz ioo Datc). (anxch oc31 �it accc s��•ca in %14:50 inrorcv=j oo pct�to.11 I am a sole proprietor and bave no one wor4dng for me. ( ) I am.a home owner perfon=' 0 all the work myself. NOTE:plr=sc be Gcrirc tt,.v{ ]c bemco—ocra.a-bo captcy pcsom to dz - �;c,�c rent -art;as.d..cll_�of aot mode tbcn tt7v=t=r'a is%web the bomoownrr r.&=a oa the pbuo6 ooe C=-,1y oec daoi to be ®ployc�unGc the..ui cti oc=p==sim Aa(GLI5L=1(5)),=wUcm.poa by.bomcoaaa far c bc=_a pawn r=y md==rbc Icp-1 ctaaac or Gn arploy.r uoder dru Wor44eg Coa>p.m.liea.Act. I uadcscand rho>copy of(hi.mtc=m may b.for+arded to tbo pryutmm¢orlod...,ij A=d=&otnoo or(tQ++� fa�^ covm�c vccLctuoa a_nd tlu L-=c to sc=m Nco�e Ln c undcr section 25A cf MOL 152=lad to the i'n,ositioa of eim w pcnsllie co=!=img art floc orup to 51300.00 anwd im{a twomcy orup to ooc yczr nod ciZl pm+t'ja in tx roan or.Stop Wort;Ord=.nd firms or S 100.00.d_y apiuu me For dcp.rta�`'3(u.c only . permit Number Lot : �.ua au-r of tcauccll'c rrni ucc to SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable ❑ Name of License Holder: -404 04=14 License Number �2 3 t-4& tk c BIZ�7j/--�� Address / y� Q j� �/_ Ex ati n bate-/ C`/�'Lt dLf/�v�O/✓� !rte DDI�2`Z_ Signature Telephone S`T3'e`"stered Hoin ,oement; ontat r " z't � " Not Applicable .❑ Company Name Registration Number Address C>16 2 Expiratidn-D&P elephon —66 7'2. SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G L.c.152,.§25C(S)) 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...... ❑ a lid 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 Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature r SECTION 5-DESCRIPTION OF PROPOSED'WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors I] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other[0] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a I 1`ernr iOUSe'alac 13d IT,Dr ©ex�s Ing.tioosll _ff� mete e�..t e�o O- 0: 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 OWNERSAGE` OR?CONTRACTORAPPLIES F.OR`BO(LD[NG'PERMI L as Owner of the subject property hereby authorize tS ff7P to act on my behalf,in all matters relative to work authorized by this building permit application. S' nat of Owner Date as Owner/Authorized gen ereby declare at statements and information on the foregoing application are true and accurate,to the best of my knowledge a elief. Signed under the pains and penalties of perjury. ,, Print N me Signature Ow /Agent Date Section 4. ZONING All Information 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 bIdg&paved #of Parking Spaces (volume&Location) A. Has a Special Perm it/Variance/F i nd i ever been issued for/on the site? �� �� NO \��� VV �~�� DON70NO YES *�� IF YES, date issua& IF YES: Was the permit of Deeds? ' NO K ) DON7KNOxx YES^� IF YES:� enter Book ' Page, and/or Document#� �� �� B. Does the site contain a brook, body of water orwetlands? NO �~��� DON7KNOVV �_/ YES «�� IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs uzbeobtmloed *�� 0btoined �~� Omte |ssued' v~� x_� ' ' C. Du any signs exist on the propert �� ��y? YES �^� NO v�� IF YES, describe size, type and location: — - D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb .grading,excavation,nr filling)over 1 acre nris it part nfo common plan that will disturb over 1acre? YESK��) NO K } IF YES,then a Northampton Storm Water Management Permit from the DPW is required. w City of Northampton _ a. - - u�lding Department i 212 Main Street R _. Room 100 " Nb ampton, MA 01060 " a',;L �, e 4187-1240 Fax 413-587-1272 a„ APPLICATION TP,C, hSTRU6T,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE1NFORMATION` 1.1 Property Address: =, Tfi�sectco rftobecompTefedtiyofFice u.n.i .x k v Zone OveEfay Ocstn'ct SECTION 2-PROPERTYOWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(P' Current Mailing Address: Telephone Signature 2.2 Authorized Accent: O)U-,S It 22 y rz1','�Sllnei ?XlyrC Name(Print) Current Mailing Address- 7c-LA- 4'6 01' l- Si ature Telephone C�-7 SECTION 13-ESTIMATED CONSTRUCTION-COSTS-- Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building q� (a)Building;'P_ermit,Fee 2. Electrical // t'(b)Estimated Total Cost,of` Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +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-2007-0070 UIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 Permit: Building Cate_ory:roofing BUILDING PERMIT Permit# BP-2007-0070 Project# JS-2007-0114 Est. Cost: $1195.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Groin: DE Sheppard Roofing 105885 Lot Size(sq. ft.): 5401.44 Owner: SQUIRES JOSEPH D&MICHELLE L Zoning:URB ppUcant: DE Sheppard Roofing AT. 300 BRIDGE ST Applicant Address: Phone: Insurance: 224 BERKSHIRE TRAIL (413) 587-0092 O CUMMINGTONMA01026 ISSUED ON.712112006 0:00:00 TO PERFORM THE FOLLOWING WORK.-SHINGLE FRONT PORCH ROOFS 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 7/21/2006 0:00:00 $25.00929 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo