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28-022 a0 QAA4 ��,}Azzondtasetts _ O DEPARTMENT OF BUILDIRG INSPECTIONS INSPECTOR 212 Maio Strut • Municipal Building .' Ncuth mptm,MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CU R 108.3.4 to act as-his/her-construction sups:-•:isor. The state defines-Homeowner-.as, "-Person(s) who owns a parcel on which helshe resides or intends to be,a ones 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 g ep enf of�he-City of Northamptonma-m -any Pe�on(sj 'ho t° _ use the home owner ateimption,to act as their ovm construction supervisor,Wbe aware that by doing so you become responsible for compliance with state budding codes and fegalations. The inspection process-requires that the building department'be called, to mspdct work at various stages,.which include-foundation/footings Gore backfill), sonotube holes(before twur).a rouub building ersoection(before Work is concealed).insulation inspection (if reaaired)and a final building insaection:.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 occnnancv until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing 8t gas)the homeowner will be responsible to make sure that the trades hived secure their proper permits in conjunction to the building permit issuecL and that they get their required inspections.Failure of the individual trades to secure the permits and inspections as required can DEI;AY the project until such time as the proper permits and inspections are made L understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issuedto-me.: Dam Address of work location r t Ctj.if I of �Tazf l-aIIi: o1] 4 € �asawc!latrtte' - - DEPARTMENT OF BUILDI7-,JC INSPECTIONS 212 Main Street ' Muaicipat Building ATorthampton, Mass, 01060 _ ... ._..WO-Ma-R`S C4NOENSATTGN •DgSURAJNCE AFMAv1T: .(li ccnsoclperlaiticc) „,ith a prilcipal place OfLin esslreside at: / (Sa VCitp/staic/ap) do hereby cerdi -, under thc.pains and penalties of perjury, thai ( ) I am an employer providing the following k%•orkcr's comocasation cove BSc for my ; employees-working on this job: (Iasurmc Coaraey) (Policcr Number) (cxpirat on Dace) ' ( ) I am a sole propriecor, general connector or homeoproer(ci:ee one) and have lured the contractors listed below wbo have the following worker's cotnpenszaon.poGcies: (Na we or Coat-nror) Omran=Cotnpz,Y Pt o ic;Nua>tx.) (E Virauon Dnic) (Name of Contraor) (Iwuran=Compan)/POUCV Numb--r) ("Expiration Dam) (Name of Co C11*) (IaSww=Compaoy/Policy Number) (Expirauon Daic) (N2mc of Contractor) (aurae=Co /Poll_ Number) (Expiration lam), tatl voctl€xeS,iraaa sy,.�t,inGrudc iCrtM'7a.�:lap Pt U;Aiag to a OOCSC.D:7) ( I ata� a dale PFapn.etor and have no one worfang for me. ( ) I am:a home owner performing all the work myself. NOTE E:pre ?c be a ryz +dye-tik h==m.*= to=*I wr P—aw to ao—;-=act=====P=c retie-wk.=a d-%Lf.g or eat sort th:a ttsve c2ib is which It,bomoo.voc raid=«oa the PVUC&zppuruw=tbaaa=am t:=aaly ct=;d=cd to be boy—"916 the waekrr oZP=sti=Act(GLk i2as 1(:$).X aMfi eaa by a bona mmer fa,!=0=or Pima W--y--id—dse tegsl a_.,..ores aPtoy r,oder dw Wedge Co=p.,4;,o AaL t.tnd�ss.an m.r a aW arm;, b.ferward.e to th.DcP.,tmeot oflodats;al Aeeesaosl06..orLsaano,a far th. aoreaSc*=ir>et;oo,od Umt L-&m to swam=nov a y�da uc tma 23A armoL i S2 em tmd is the ia:�of eimaA Pahia aoai=i0a of floe,fup to S1•$W.00=CAW j=Wjw=0=orup to a=year sad cif pmad1.;=;dtba Corm ore slop Work Orde add a o tm�orstoo_oo a err ate,iat tt>< For b p.%ww=W uae dell �~ _•_.� SECTION A-CONSTRCCdiE ,'PMMCES r' I.1 Ucensed Construction S3ipervlsor. Not Applicable ❑. Name 91 LkMft Holdex License Number Address td Tetepbone --7`; C Not Applicable ❑ [� uD U&,Lj K PO -e,,c 1 � ' Address Data L E c.b AEI co/o_,�3 Tom► 3?7- Oa Workers Chan khsurarm affidavit must be Meted and submitted with!this appkmft.FAM m provide this MKII d will result in the denial of the issum"of the Signed Affxkr*Attached Yes.._.... No...... ❑ The current exemption for"homeowners"was extended to include Qw„ r-ec of one(1) or two(2)families and to allow suclk homeowner to eahgage an individual for hire who does not possess a license,provided tkiat the owner acts - . as supervisor.C M 780 Siztb FAM*z S 188.3.51. ` Definition of Hemeawaer:Person(s)who own a parcel of land an which he/she resides or intends to reside;on which there is,or is intended to be;a one or two family dwelling atachhed or detached structures accessary to such use and/or farm structures.A versos wire Mastrthe:ts more Vim one hose is a twe►-�ear veried:rT not the eoaaiieted a Mateowser. Such"homeowner"shall spa Mut to the Bulling Official,on a f a m acceptable to the Building responsible for all such weft perforated seder the As acting CoAdmefts your presence on the job site will be required firm 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(Wonitas'Coon) and Chapter 153(liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,Yes=w be liable for pawn(s) you hire to perform work for you under this pe rmiL The undamped"homeownee"cadfies and am=naponsibdity for compliance witb the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State ofMassechusco General Laws Annotated. $omeowner Signature t SECTION S--DESC WQE Ei?111lfQRK fcitecic alE'anc�licablel: New House Addition [] Repo Wirudovrs AtOeration(s) Q Roofing &Doors D Accessory Bldg. Demolition New Signs =q Decks M Sung RD] other[a Work: Description of Proposed W �� r•` ��L� �� Alteration of existing bedroom Yes L2W Adding new room Yes 1A. Attached Narrative Renovating unfirdshed basement Yes No Plans Attached Roll -Sheet Fir a. L' :.:::. :v::.y^:n�cM...■, Twn Famiy 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? t; Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masschedc Energy Compliance form attached? h. Type of construction I. is construction within 100 ft_of wetlands? Yes No. Is construction whin 100 yr. floodplain Yes No J_ Depth of basement or c e0w floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Sepfic Tank _City Sewer Private web City water Supply SECTION Tat QVIfHEIi« 1tk>Ilr �Yft1�lERS/lGEl1�F© if1YRRAA` - f� /E'/ GPI as Owner of the subject property Hereby autimorize m L�CE D�U_ o.� to act on 5v behalf,in as matters relafi ve to vlork by tm building permit app ion. Dabs ze I.- I I m o f y Loc& as OwnedAuthorized Agent hereby declare the staterrherhts 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. _ L - -� Print S�Inabae of owned pate Section 4. ZONING All Infbnmtkh Must Be Completed.Permit Can Be Denied Due To Meomptete MCarmatian ` Fadsi>ng proposed Required by Zoning This aohmn to be GW in by Building Deparmwo Lot Size Frontage } y f Setbacks Front j ,--� Side L:—!�--� Rf L RI Rew Building Height —�-- Bldg.Square Footage 014 Open i� Se Footage s (Lot am t bidg&paved #of Parking Spaces Fill: ' (vohMW* A. Has a Special Permit/Variance/Firding ever been iswed for/on the site? NO © DONT KNOW Q YES Q IF YES, date issued:! I i IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW 0 YES IF YES: enter Book -� Page, and/or Document#; B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained Q , Date Issued:C. Do any signs exist on the property? 0 NO 0 IF YES, describe size, type and location: 1 D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q IF YES, describe size, type and location: E. Will the construction activity disturb(dearvlg,grading,excavation,or Ming)over 1 acne or is It part of a oominon plan that will disturb over 1 acre? YES Q - NO Q ( IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r City of Nogehipton uilding Department c - 212 Main Street Room 100 '���.� )� P' ° } If Campton;-MA 01060 hone 413-587-1240 Fax 413-587-1272 F UCA'f"&ri 6MMUCT,ALTER.REPAIR.RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SEG[IONkt SRE7�IFORMA'�IOI�f - 1.1 Property Address• Y � z 76- - M 4 SECTlOI 2 Pft PERTYOI�fIN1fE`RSNIP'f!►F3ii Oi a— 2.1 Owner of Record: p ` �1 01 z©�/ lc �r' Flo Name(Print Current Mailing Address. r 1 , e Telephone 2.2 Authorized Asrerit: A T- L_y C E `� o X /4/- Name Cumaat MaIIng Address: Signature Telephone �EOL101�3_ ESTi�A�fvON'S�REJO:kYQN_t "5 {tem . Estimated Cost(Dollars)to be OWKid USO 0rdY CM~by permil ap~ 1. Building f, C� feM*Fee 2. Electrical iib� ted. ota1 Cost of 3. Plumbing BuikBttg PermitPes 4. Mechantcai(WAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) U� Number "T'fisSedion=FbiF ;E�e - Debtr'r -Bgtid'Utg'Pet[iNt 14ritpber' _. _ � : Signature: �- Building of+ Date f � ' L DR BP-2006-1059 GIs#: COMMONWEALTH OF MASSACHUSETTS 'MM-Block:28-022 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category BUILDING PERMIT Permit# BP-2006-1059 Project# JS-2006-1566 Est.Cost: $2700.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin TIMOTHY J LUCE 149288 Lot Size(sq. ft.): 17816.04 Owner: SMOLENSKI WALTER A JR&MARGAR Zoning: SR Applicant. TIMOTHY J LUCE AT. 21 O'DONNELL DR Applicant Address: Phone: Insurance: P O BOX 14 (413) 387-9800 LEEDSMA01053 ISSUED ON:41712006 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE GARAGE ROOF 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 4/7/2006 0:00:00 $25.00285 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo