Loading...
25C-219 (2) t 20 S t i t i s f � t i i i P i s i 1 1 i "r ti, —L_e7 Life Vf 3Aassaci�uscffs DEPA—RTMENT OF BUILDIjG INSPECTIONS B— 1. INSPECTOR 212 Nfain Street • Municipal Building ' ,V Northampton,MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CNM 108.3.4 to act a:: l.is/her construction sup,.. i-or. 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 backT111). sonotube holes (before pour). a rough building inspection(before work is concealed),insulation inspection (if required)and afnal_buildirm 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 m de s I, C7 T 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 The Commonwealth of Massachusetts Department of In dustrial Accidents Office of Investigations a 600 Washington Street Boston,i1I4 02111 rty www.mass.gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lefribly Name(Business/(Drganization/Individual): Address- City/State/Zip: Phone.#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction ?.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp,insurance comp•insurance.$ required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.�K I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption'per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] --`°"y­appilcant Matchecks oox 41.must also ria out the section Eciowshowmg ear workers'compensation policy inforniLiton. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors trust subrnit a new affidavit indicting such. :Contractors that check this box must.attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.n: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Erne up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a --e of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investizations of A for insurance coverage verification. I o hereby Z and the pains an enalties of perjury that the information provided above is true and correct— 'o2latnre _ Date:one# 7k I LC* only. Do not write in this area,to be completed by city or town official n: Permit/License ii hority(circle one): Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone : r ti SECTION-8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone x. y Not Applicable ❑ 9=Re`uCsfer'ed ktorrre_Ffiip�vice�ientrCorrtraefoF- �,. �"_�.�„�_ „;�. �-x.-��,�-''9 Company Name Registration Number Address Expiration Date Telephone SECTION 1.0 WORKERS'COMPENSATION.INSURANCE RFFIDAV.T tM.L_c..'F52;¢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...... ❑ .. r ;R0 " 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 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 es responsibility for compliance with the State Building Code,City of Northampton Ord' ances,Sta and Local Zo ' ws and State of Massachusetts General Laws Annotated. - -- 26FO Homeowner Sig ature SECTION 5 DESCRIPTION OF PROPOSED WORK(check alt applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 171 Accessory Bldg. Demolition ❑ New Signs [O] Decks [Q Siding(0] Other[O] of Description of Proposed 0 C71 ork: Alteration of existing bed.a,m Y. No Adding new-bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet v ._., � sa (f( ev hor�seac ac acTdFttQ t excst�nfiousctc:cpiete t � oEtaii74: 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 withi 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-OWNER;AII'>iFdOR1ZATION T0"BE"COMPLETED-"WHEbt OWNERS'.AGEiVFOR CONTRACTOR APPLIES;FOR dlLEIING: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 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 o;-peg ury. Print me VA a- Signature of Own !Agent Dafe r � FSection . ZONIN G All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This colu=� N V Building Department led in by rtment B d Lot Size —�Od Frontage l✓� Setbacks Front Z Side L. R L: R----I- Rear Building Height Bldg.Square Footage �, % Open Space Footage % ("t area minus bldg&paved ©�fd arlcine) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW O YES 0 IF YES: enter Book Page and/or Document#: B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained ® Date Issued: C. Do any signs exist on the property? YES ® NO 0 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 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. • � � Qe �Cfl�Ieri�C[SkTbr3ljE„--. `��-� �.2 s City of Northampton StatusaPermrT.. ` Building Department Ctsc6�rtvet?ea 212 Main Street SeweFSepttc°Aua7a6rrrE l Room 100 �-. �- Cr North mpton, MA 01060 kvo Sets'o �t cfet al Ptan r h 41,1-!M 1240 Fax 413-587-1272 Plal Siff Plans �� APPLICATI,QhLTO„f,0 ,-RUCT, LTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION.t=BETE INFORMA-TION _ r 1.1 Property Address: This sectiortta t5e4campi�efedFb�r�thce _ �Iltap E=at EIntT /VO(Z r H A rA �'ro t” " ° �aae ^Overfay Orstncf s ® ter = c> 1�>= SECTION 2-PROPERTY'OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: � —1—t t fvto;'f `!ix �/A tilal JT -It- r'o kT �jAM(�—jO nJ Name(Print) Current Mailing Address: Telephone Signature '? u 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-EST IMATEF�CONSTRUCTION:COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ^� t-�-° :tai Building>Permit Fee 2. Electrical_t (by,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) �� -- ClaecR Number This Section-For Oi efiiiWse•Onl -- Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings. Date File#BP-2008-0282 APPLICANT/CONTACT PERSON SALDO TIMOTHY&DENISE J MINER ADDRESS/PHONE 46 WALNUT ST NORTHAMPTON (413)586-7814 Q PROPERTY LOCATION 46 WALNUT ST MAP 25C PARCEL 219 001 ZONE URC 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: CONSTRUCT 20 X 20 SHED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 3 sets of Plans/Plot Plan THE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 St ommission oej Signature of Building fficial Da e 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 BP-2008-0282 GIs #: COMMONWEALTH OF MASSACHUSETTS 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-2008-0282 Project# JS-2008-000409 Est. Cost: $22500.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 6403.32 Owner: SALDO TIMOTHY&DENISE J MINER Zoning:URC Applicant: SALDO TIMOTHY & DENISE J MINER AT: 46 WALNUT ST Applicant Address: Phone: Insurance: 46 WALNUT ST (413) 586-7814 (� NORTHAMPTON MAO 1060 ISSUED ON:912012007 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 20 X 20 SHED 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 9/20/2007 0:00:00 $40.002849 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo c� cn�� 46 WH"LNUT ST BF42008-02$2 GIs#: COMMONWEALTH OF MASSACHUSETTS Map-Block: 25C-219 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.IT Permit# BP-2008-0282 Protect# JS-2008-000409 Est. Cost: $22500.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: . License: Use Group: - Homeowner as Contractor Lot Size(sq.ft.): 6403.32 Owner: SALDO TIMOTHY&DENISE J MINER zoning:URC Applicant: SALDO TIMOTHY & DENISE J MINER AT: 46 WALNUT ST Applicant Address: Phone: Insurur.ce: 46 WALNUT ST (413)586-7814 (� NORTHAMPTON MAO 1060 ISSUED ON:912012007 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 20 X 20 SHED 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: "Awz : Olt 1--3 0- a THIS PERMIT MAY BE REVOKED BY HE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULA Certificate of Occu an Signature: FeeType: ate Paid: Amount: Building 9/20/2007 0:00:00 $40.002849 212 Main Street,Phone(413)587-1240,Fax:(413) 587-1272 Building Commissioner-Anthony Patillo