25C-133 (5) f z
ti
All
fAf/�wkfC
IJ
f
,�`/!•�� .o /7 c Gc. fie�1 .l�sc-r!�n6I, rF
�/ w GAS men r1
i 6?�"R,�
� ='Y.'1
t
n _ a �I ✓CYO y'a7D� 1i I� 1
41
GllT�tY'fill e a�S l�yJ�� j
/�d`w J`�►�� br/� �F � -� c'aur,7'aY✓ _ i � _��� lv ar.✓
,,,af��fJ�+,+f+,rJla�Y Y�Y���� � /"�•t/�04s7� �GOn��S
�u}c�f.1k)
SS AlAwe�� � ,JeJVC 6
y
1 �
f
d6VZO 90 60 Sny
z-d
Crzfy of Wart4ampton r `
�t !� �IdHHAC1j1iSCtfH w
DEPARTMENT OF BUILDING INSPECTIONS
{NSPGCTOR 212 Main Street • Municipal Building
Nortli,unpton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as has/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. I
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
20 o0 --_—
a (rzf Of _ '
A r E _5143trtch nrclls'
DEP/\. 7-),-fEt4T OP BUILDING INSPECTIONS
212 Alain Street Municipal Building
Horthampton, A1acs. 01060
1
WORICER'S COIMTENSA77ON CgSURA-NCF A=1 AV1
(liccnse P,_=J.tfcc)
\,.11th a pRncipal place of business/residence at:
C �7 I� L� i " r✓7 /�lrf� (phone:') N l
I (sa>w.t/c�rj/star/rip)
do hereby certify, under tic pz-uls and penalties of penury; thm
_ j
( } I an an employer providing the following worker's comocnSED02 Coverage for Iny
employees wor> ng on this job:
i-
JnSU1-'—,1r C Compam') (Potic: Nttcr) ---' (&;-pirarion Dzt`) '
j (wf'am a ole proorieto , general contractor or homeowner (ccie one) and have hired
the contactorsU et d below wbo hzve the follo1. i P, worke>'s campen_non pokies:
i
(Namc O: Con=czor) (Insurance- Coinoan)il'ouc; Da1c)
I
(Name or Contraaor) OJISurr_nc:. ComoanytPotic- Number) (ixDrtlon Dale)
(Name or Coaa-2clor) (Insura.nc:-ComT3zoyfPoUq- N;rmbzr) (Expirsaoo Date)
(Name of Contractor) (Imsuranc-c Comcany/Poticy Numb`r) (Expirauon Daft)-
(eIIaeb�tioceJ v',oC.ilocceta:l•to ix,cud;iaf«m�^ioo pma�.ains w.17 ooa=-_e.o:-�)
{ I am a sole proprietor and bave no one worl;3og for me.
( ) I am,a home owner- performing 8 the work myself.
NOTE:plesc be ewxrc Lc wt- hearowocn—bo cxapIcy pcz.=to L •;•- cs c,ao c tc�air wori a�.d— _.Z of
ant mote tb—tb:r—rents is wt6cb tax bomoo-w<s rcid,=oc oa the p-ounc:r zppsrtca.rl thccr oot ga:.ity oae:d=-od to lx
-=[play--ux a the �-c=:.,on Aa(G t.1 52-=I(S)J appiiadoo by a bomooaw fm:6==or pcmit r=y n�d"-noc tM
- Ir=a!cW'-of—Ployet uoder cl o WO&LDla Cooapoa—Lion Act
I—4--ad tb-z oopy of tbia¢alrma2 may bo for�w tbo Deganmmi of 1nd.zY,ric1 A.&.Ay Off oe-f Gsx+raooa for tb.
covc&Ec vciGc=L;0a sad lh..t!-'.drat to sa=ws bovcrabt trade z.xvoo 75A of MOL 3 52 Can lad to tba isgocitioa of c-imiazl pcn+liio
coastricq of z fiat orup to S 3}00.00 arYUor 6=pr6oa==or up to ooc y=r zod 6.i3 Pcnattio iv t�c roan o(a stop Wort Ord=n:A a
Ctm of 5100.00 t dzy tp,i=t>K
For d�.rim=.�1 u,c only
P crr[1t Sumner
Lot n ..
/Sil;Itum of L•ic=zcc/Pcn ktc= e
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: �i�",` t.GDi C r o
l License Number
ASIHKFrJ� l/ld4L /le 40 _
Address Expiration Date
� 71-j t
Signature Telephone
11Reciistered poinetinp ovemert �o�itiatF ' Not Applicable .❑
..,� .
y� ��if.YO/�Lf L1J�f7/4C lh /'�iLGf rK Ille
Company Name Registration Number
Address Expiration Date
Telephone X13' V-4,' 7J�
SECTION 10-WORKERS'COMPENSATION INSURANCE'AFFIDAVIT(M,I G.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...... ❑
It
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-vear 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 buildine 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
n
SECTION 5 DESCRIPTION OF°PROPOSED WORK(check all applicable)
New House [] Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks (p Siding[ice] Other[C7l
Brief Description of Proposed
Work: ZZ4 h iY.A# /�i'�✓ � rig/ry a.r*l Kr.�✓�l /
Al r i of existing bedroom Yes � No Adding new bedroom Yes y No
ached Narrativ Renovating unfinished basement Yes No
Plans Attache oll -Sheet
sa itj"W.I iouse'�and Q:
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
L 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.
1. Septic Tank City Sewer Private well City water Supply
SECTION'7a--OWNERAUTHORIZAtiON-TO BE COMPLETED,WHEN
OWNERS AGENrOA CONTRACTOR-"AP-PLIES;FOR`BUIf:D1NG PERMIT
I, 1 `e C c e- J l_. P e as Owner of the subject
property
hereby authorize Q V .I ✓ C d 1_0
to act o n m y behalf,in all ma ers r lative to work authorized by this building permit application.
-�Q K fJ Us
Signature of Owner V Date
1 �/N ;L as Own Authorize
gen ereby declare that the statements and information on the foregoing application are true and accurate,to the best o my knowledge
'60-belief.
Signed under the pains and penalties of perjury.
_70)4 ✓� �j 16'0 is
Print Name
Signature of Owner/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
Fronjage
Setbacks Front
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bIdg&paved
#of Parking Spaces
(volume&Location)
A. Has ( Perm it/Vahunce/Findi ever been issued for/on the site?
NO \�� DON7KNOW �~��� YES «~��
�
IF YES, date issued:.
IF YES: Was the permit recorded at the Registry ofDeeds? '
NO DONT VV�NO YES
IF YES: enter Book Page' and/or Document#|
'
�� ��
B. Does the site contain a brook, body of water orwetlands? NO ��.�� DON7KNOVV �~� YES x��
IF YES' has permit been or need to be obtained from the Conservation Commission?
Needs tobwobtained Obtained Da.~Issued:
0 0
C. Dn any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? yES K ] 0O �~J
IF YES, describe size, type and location:
E Will the construction activity disturb m filling)over 1 acre or isdpart oio common plan
thaw0disturhuvor1acre? YES ���l NO 0~���
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
�<
_City-of Northampton
Department
r--
ain Street
1 om 100 "
AUG - 9 ZMPrftmr on, MA 01060
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO COIi$�l` tlGTrALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION
This section to bescompieted byaffice
1.1 Property Address:
r .,r
h
j� ) Zone: 1 ' ,Overtay 13►sft�ct
M x
`[ EIin"`=•S>i District ' �' _" - .CB,D�sfr�ct
SECTION:2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: l i'z u Srr P p f
Name(Print) ,�. Current Mailing Address: .
`113 __x,62 -
� Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
40-7
Signature Telephone
SECTION t3-ESTIMATED:CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building ld dd2 -(a)-Building Permit Fee
2. Electrical (b}•Estimated Total Cost of
dDd Construction from 6
3. Plumbing S„ Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Z�/� d5 e Check Number Q tS
This Section For Official Use Only
Building Permit Number. ssued:
Signature:
Building Comm issionerllnspector of Buildings Date
File#BP-2007-0153
APPLICANT/CONTACT PERSON DAVID CHICOINE
ADDRESS/PHONE 16 EDGE HILL PLACE AMHERST (413)246-7536
PROPERTY LOCATION 44 ELIZABETH ST
MAP 25C PARCEL 133 001 ZONE URB
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: RENOVATE KITCHN BATH&LAUNDRY ROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 061582
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9F64ATION 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 Co ion
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.
BP-2007-0153
G1S#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category_ BUILDING PERMIT
Permit# BP-2007-0153
Proiect# JS-2007-000229
Est. Cost: $24000.00
Fee:$80.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group DAVID CHICOINE 061582
Lot Size(sq. ft.): 7056.72 Owner: LEE TERRENCE J
Zoning:URB Applicant: DAVID CHICOINE
AT. 44 ELIZABETH ST
Applicant Address: Phone: Insurance:
16 EDGE HILL PLACE (413) 246-7536
AMHERSTMA01002 ISSUED ON.811112006 0:00:00
TO PERFORM THE FOLLOWING WORK.-RENOVATE KITCHEN, BATH & LAUNDRY
ROOM
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 8/11/2006 0:00:00 $80.001040
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
44 ELIZABETH ST BP-2007-0153
GIS#: _ COMMONWEALTH OF MASSACHUSETTS
Ma_p:Block: 25C- 133 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2007-0153
Project# JS-2007-000229
Est.Cost: $24000.00
Fee: $80.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DAVID CHICOINE 061582
Lot Size(sd. ft.): 7056.72 Owner: LEE TERRENCE J
Zonin4: URB Applicant: DAVID CHICOINE
Al- 4,� C1. .17XRP I H Q
Apt)Lfi:41 lit11 ress: Phone: Insurance:
16 EDGE HILL PLACE (413) 246-7536
AMHERSTMA01002 ISSUED ON.8/11/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:RENOVATE KITCHEN, BATH & LAUNDRY
ROOM
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspecto of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: 1—L - c o KRough: House# Foundation:
Drireway Final:
Final: 0—Final: j'7
;
L Rough Frame:
ALL
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation: dj
Final: Smoke Final:
THIS PERMIT MAY BE REVOKED BY THE CI f OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULA ONS.
i
/,!
Certificate of Occu anc Si nature:
FeeType• Date Paid: Amount:
Building 8/11/2006 0:00:00 $80.001040
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo