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28-054 (2) DEP,_=_`=NT OF DUID:'J_\�G i vSP CT-1OVS 1NSP_CTCP 21?Main Strut • Municipal BuiIdiry Northampton, MA 01060 'rTf-vN r r, f-1,XI7NTV D C YT 7l T'7�17V' 9 T'7,-7V nWT TD(;FA4ENT r1V11'li�. V T►1Li� i�til�liu i�v_ . la���... .� The State of Massachusetts allows the homeowner the right under 78OCNM 108.3.4 to act a ris'her construction sups. .: or. The stare defines "Homeowner' as, "Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dive ing, 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 per sons)who seek to use the hoine owner exemption, to act as their own construction- super c:sc; 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 bacldiIl). sonotube holes (before pour) a rough building inspection(before work is co4icealed) insulation inspection (if required) a_adafn.aLhuildina.insnection. 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 insbeCz&- 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 DEI AY the project until such time as the proper permits and inspections are made un ders<and the above. (Home owner/resident's signature requesting exemption) I will call to schedule aI1 equired building inspections necessary for the building permit issued to me. Date �% Address of work location The Eommonweaith of Massachusers _---r-- De parrmeni off r-dustrial-?ccidenls ©nice of Investigations 600 W ashin,;zon Street Boston,M-1 02111 ~ � www.mass gov/dia Workers' Compensation Insurance Afzidatiit: Builders/Contractors/Electricians/Plumbers ADDlicant Information Please Print LesibIv Name(3u=ess/Orz=ization/Individuai): Address: Ciry/Statz!Zip: Phone," SECTION 8-CONSTRUCTION SERVICES 1" 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9 Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.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...... ❑ I L - Home Owner Exemption 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 wort: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 Pnder this permit. The undersigned"homeowner"ce ' es d assu es res i ity for compliance with the State Building Code,City of Northampton Ordinances;.,St e and Loc in s and St to of Massachusetts General Laws Annotated. Homeowner Signa-CUre- __ 1 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 [0] Decks [Q Siding [p] Other[O] Brief Descripti f Pr pos all C/ Work: Alteration of existing bedroom Yes ✓No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing,'complete the following:J 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? � I 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--OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, C'- 2 , as Owner of the subject property hereby uthonze to act n my behalf, in al elative to work authorized by this building permAli ation. Signatur wn Date I, M , as Owner/Authorized Agent hereby d6clare 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. M w Agent Ate v Section 4. ; ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information }� Existing Proposed Required by Zoning i, \i This column to be filled in by t Building]department Lot Size Frontage Setbacks Front Side U, R: L: .- R: ... Rear Building Height Bldg. Square Footage - Open Space Footage (Lot area minus bldg&paved narking) #of Parking Spaces Fill: (volume&Location) _.. . .._ __.._,.._ ......._. .. .. A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES Q 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 Q Obtained 0 Date Issued: C. Do 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 0 NO 0 IF YES, describe size, type and location: E. Will the constrnintion nativity disturh(clearing, grading,excavation, or filling)over 1 acre or is it part of a common p-lan that will disturb over 1 acre? YES O NO Q IF YES, then a Northampton Storm Wafer Mamagerrienf Permit from the DPW is required. 3 Y Department use only City of Northampton Status of Permit: Building Department Curb.Cut/Driveway Permit n 212 Main Street Sewer/Septic Availability ROOM 100 Water/WellAvailability Northampton, MA 01060 Two Sets of Structural Plans phone 413-W-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit --t O f �0 6 Zone Overlay District l 1 ,' Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: (. s� sc . xrne�2 xName(P-nnt) Cu re t Mailing d M�Telephone — - (.t� 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Es imated Cost(Dollars)to be Official Use Only cffnpleted by ermit applicant ilding L GUS\ / (a)Building Permit'Fee M-to)8/11�V'1'i"'* ", ll 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing �+f ,1.1 Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total= (1 +2+3+4+5) Check Number This Section For Official Use Only Building ermit Number: Date g Issued: Signature: -- - -- Budding Commissioner/Inspecfo>r ofBw ings Date File#BP-2008-0644 APPLICANT/CONTACT PERSON KMETZ JEFFREY L&LISA D ADDRESS/PHONE FLORENCE (413)584-2686 Q PROPERTY LOCATION 616 RYAN RD MAP 28 PARCEL 054 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building,Permit Filled out Fee Paid QLlyl Typeof Construction: INSTALL NEW KITCHEN CABINETS&COUNTERS 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 FMATION LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO PRESENTED: ved 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: § binding 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 Commission Permit DPW Storm Water Management Demolition Delay 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. r BP-2008-0644 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-2008-0644 Project# JS-2008-000981 Est. Cost: $6250.00 Fec: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 12066.12 Owner: KMETZ JEFFREY L&LISA D Zoning: SR Applicant: KMETZ JEFFREY L & LISA D AT. 616 RYAN RD Applicant Address: Phone: Insurance: (413) 584-2686 0 FLORENCEMA01062 ISSUED ON.111712008 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL NEW KITCHEN CABINETS & COUNTERS 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 1/17/2008 0:00:00 $50.002191 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo