25C-116 S TAV RO S
CENTER FOR INDEPENDENT LIVING,INC.
City of Northampton
Department of Building Inspections �
212 Main Street—Municipal Building
Northampton, MA 01060 '
September 30, 2004
Dear Building Inspector;
Enclosed is a delayed application for a building permit for a modular ramp that
was donated to Stavros, which we in turn donated to Robert Lawson of 59 Elizabeth St.
in Northampton. Through Stavros' Home Sweet Home program, we were able to
coordinate volunteer labor to install this modular ramp. With the timing of this
installation, and flurry of activity, I neglected to get this building permit submitted on
behalf of Mr. Lawson in the timely manner expected by your department.
With deep apologies, I submit this application late, and hope for your compassion
and understanding in the allowance of the ramp to remain in its location. The ramp was
installed with the volunteer efforts of the United Way of Hampshire County and the
Hampshire County House of Corrections support. There is additional lumber to extend
the ramp at a future date. But the current status allows Mr. Lawson to get safely out of his
home in his wheelchair.
The modular ramp system is based on a design from Minnesota. Details of the
ramp designs can be downloaded by going to: www wheelchairramp.org and scrolling
down to the manual section. Stavros' Home Sweet Home program is continuing to match
folks in need of wheelchair ramps with volunteer labor and donations of materials. We
are connecting with the vocational technical schools in each area, as well as Job Corps,
United Way, and other organizations to assist in fulfilling this desperate need for safe
wheelchair access that allows folks in need to remain in their own homes.
If you have any questions or concerns,please feel welcome to contact me at 413-
256-0473 ext. 240. I look forward to speaking with you and cooperating in future
proj ects.
Sincerely,
Lois Brown
Home Sweet Home Project Coordinator
691 South East Street
Fiscal Intermediary Office 55 Federal Street•Suite 210 262 Cottage Street
r
Amherst, MA 01002-3045 409 Main Street Greenfield,MA 01301-2543 Springfield,MA 01104-4002
V/TD 002
(800) 804-1899 VTDD Amherst,MA 01002-3045 (413)774-3001 V/TDD (413)781-5555 V TDD
(413)256-0473 V/TDD (800)442-1185V/TDD (413)772-2556 TDD Only Fax(413)733-5473 qtr
E;
Fax(413)256-0190 (413)256-6692 V/TDD Fax(413)772-2556
Fax(413)256-3849
�g1iAMp�,
� � �i'ilassxcl�useffs "
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR '212 Main Street • Municipal Building '
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CNIR 108.3.4 to
act as his/her construction super~,• sor. Tlie state defines "Homeowner" as, ".Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two fami -
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 r',egulations. 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 your), 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
t�
understand the above.
(Home owner/reside is 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 .�' � cr 4
I! ) CA �'41�,L_)( (A) (`Iii(16C,
4�iwrP�
Pf �\To tljalliploli
g E ,31 a3 akchntrlle-
_
o DEPARTMEI-T OP BUILDrNG INSPECTIGI S
212 Alain Street ' I-funieipal Building
Northampton, Mass. 01060
WOR1tI:1Z'S CONITENSATION L'-�SURA. CE AF MrIvVIT
-- (li ccus.^rJperm�tTcc)
��'itli a pnncipai place of businessfresidence at: —
(j—hone.)
— (sur-_.(/cirj/stalc�ap)
do hereby certify, under the.pa-ins and penalties of perJury, -.hal
( ) I
am an employer providing the following worker's comocns�do, cove age for Intl
eluplovices Nvorlong on dus job:
(Lruranc Conn ny) (Policy Numbcr) -- (r:pir d6rr Dpi-)
O I am a sole proorretor, general contracor or homeowner (ci:cie one) and have hired
the coup-actors listed below who have the `olio%vino workers co=--asation pobcies:
(Namc Of COR!^C or) Gns-urancc Coinp3 lyill obc�, ?-rUMrC:) �`:�1F000R I�1lC)
--
(Name of COUa-ZLIOC) (Las-a=cc ComoanyfPolim• `unc^r) iraon Date)
(Name of Connaaor) answ aac:COMj=)•/POGcY N=bcj) (Ezpirraos Daic)
(Name of Coaaactor) (Iasurancm- Comoauy/PoUcy Numtnx) (Expiration Date) .
(.aAch addi-�ocas c'•.cct,ifacca.-v to inc!n !xfoxma-'ioo Pctaiaia6 to a-11
( ) I am'a sole pr-opfietor and have no one wor dng for me.
( ) I am.a home owner performing all the work myself.
NOTE:plc=4 be-wr=rh.•-bijo I an tat to c=plcy PCSoa to WSJ r �c oo c rcna Boric oa.d..c1L^r of
Got moce the ` oa tmta is t�'S�Ux boa�oolwc r ada or oo the�ouaca zapurtsn_r1 tb.-- C,=d rode k
ciVloyes 1, the w=k=--orsp=.:tica Act(GUI 52S31(5)�appltaljon by a bomcaa-=fW a tip.oc pcsmit ra_y ride LL`
Ic-g.l ctsau of as c-ployx under dro WwiC t Coc*p =&iioa Act
1-4---d ch.2 a oopy of tbu mtemnn may bo for-v.nrded t4 tl o Depnrtmooi of 1..&.,,id A.&.&Orrroe of L.+r—foe tb.
ooverxc vcif alioa and th_s L-ilrac to tcaus`eovetnse under=C ioa 25A of hIGL 152 as I—d to the iuu:Pctttioa of a miasi pea+]sic
ooaystix&of a fux of up to S 1300-00.ndfoc im{a-iwomey of up to one y=and civil p.Oj-is dx roan or-Stop W or'Order Lad L
fine 0(5100.00 L day L&XiaA me
. roc dcy.rtaL�u+c only -
PCiID.il Nub= -
I.ol K
Sig= urc of Lia=scc/Pccmiucz e
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9 R+ensereHomemaraveno�iiCataat Not Applicable ❑
Company Name Registration um er --—
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M:G.L .c."I52i;§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...... ❑
aww",na
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 L cal Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
r
a
f
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all_,apnlicalb
New House [] Addition ❑. Replacement Windows Alteration(s) ❑ Roofing
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [C]) Decks [p Siding[oj Other[
Brief Description of Proposed
Work: M 0`Dv
Alteration of existing bedroom Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes _�L*No
Plans Attached Roll -Sheet
6a-fi fevto>IS riaex>s `n fieiIC 0ifa�rr��ci:
a. Use of building:One Family Two Family 29ther
b. Number of rooms in e h family unit: Number of Bathrooms
c. Is there a garage attached.
d. Proposed Square footage of newwnstruction. 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 '
L Is construction within 100 ft.of wetland ? Yes No. Is constriTs ikon within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor bel w 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 AUTHORIZATI6N-'T-Q BE COMPC:ETED WHEN
OWNERS AGENT OR CONTRACTOR.APPLIES'FOR'BDILDING�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
`"J ja 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. '
'Roo LAW.20N
PrI N,ame
(s 1.
Signature of Own&Agent Date
i
Section 4. ZONING All Informati6h 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
6
Side L:E R:1 L:F , R:7
Rear
Building Height
Bldg.Square Footage % 1-- --
Open Space Footage %
(Lot area minus bldg&paved
-kin
#of Parking Spaces ' I
Fill: �� 1
(volume,&Location) '
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW YES 0
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Date Issued:
k
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:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 r NO `<n
t
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of NorWampton
Building Department
212 Main Street
Room 100 a
Northampton; MA 01060 Se.
phone 413-587-1240 Fax 413-587-1272
the 8E i e y
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
$ECTION`.1, SITE INFORMATION
v
�s�secttP comd 6x off
1.1 Property Address: ' � . `-��' �# �` , pete ice�,
59 i
}�
�p L n'
N O�Tl M D!" ��9� Zones � Ove D�sfnct
j s �a
g St a3 G�E1�strict
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGEN
2.1 Owner of Record:
L�W5 _Abj Th �I �V�k77}►�i�l'i�,�v ,r��}
Name(Print) f Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
.SECTION -ESTIMATED,-CONSTRUCTION COSTS GUC e ` t rt"O.Qiajj oxnoi
Item 4,, Ut.+1 1-IM to Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 4:ve i ��.�yt [t.Uyl� (a)Building Permit Fee
2. Electrical I (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
Date
Building Permit Number Jssued
Signature:
c
Building Comm issioner/Inspector of Buildings Date
59 ELIZABETH ST BP-2005-0399
GIS#: COMMONWEALTH OF MASSACHUSETTS
a :Block:25C- 116 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-2005-0399
Project# IS-2- 05-0531
Est. Cost:
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sa.ft.): 6011.28 Owner: LAWSON ROBERT W
Zoning:URB Applicant: LAWSON ROBERT W
AT. 59 ELIZABETH ST
Applicant Address: Phone: Insurance:
59 ELIZABETH ST
NORTHAMPTON MAO 1060 ISSUED ON.1016104 0.00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT MODULAR RAMP
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• Receipt No: Date Paid: Check No: Amount:
Building 10/6/04 0:00:00 0 $0.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo