Loading...
17A-303 (3) �a � �.�„ ,. ,,, _ �. .. . s li i d -u -� 'P,..�v4 �� �� L� }'t �, �, 't„ �- s v.x.,.. ��.. .M,,,+ ��. .� .� «.�.s,,. ,-..a., ___ 3 1.,.. "�y � f � � ... \ F � � j i � � � '1 `� ' F ._ i ; a, „ , ; ' .� �; � �. ,.ti a�� � ' ( i ( - "° p,�?� '� � 7' F-.. � �.r. � '+� 2 f,� � — — . . ! f ""�:� s ( r �,,, �� .,,.....�.. w '. r -_,__ � j __.4 .. x . � __ °�. � X `� t a� ....�� - � s e � 4 .,.�, f�,,.�y� � . x � i Y �' ..... '6,. :rw rn� ,�, 6 '' r � � �, r�r'. � c ;. � �; �" .. .. r �.... _. e' � .- o ' ., 6,.�. ____-.v.m_.____�_---_ 4, i0 . ............. 4'CtUVNP�. 4 r � � �lassachusette t m 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 780CMR 108.3.4 to act as has/her construction sups::isor. 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. 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 understand the above. /resi re ( e ow r ent's signature reques g exemption) I wi call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location t C trO�–t—`Jf 4--7(o tnncl� A ���UN hTO ' � f✓� y $ 6 JRIK 77RC 11 tit;ctl a - m DEPfiRTT ENF-f OF £UILDNG INSPECTIONS 212 Train Street ' Municipal Building Northampton, Mass. 01060 NVORICERtS COMTE.NSA'nON INSURANCE AYFID VIT principal place, of busincssJr _;i�enc t'. CIO hcrcby cc!-u!y, a tits- d)1 ' p2illS 2iiCl pC i] 1t7eS Oi pC.I�llty, iIlllt. ( ) I am an employer providing t11e follo.:;n %V01,r_cr's cotnpcns Uon 1,01 lily tillployces \VOI dng oIl ahl1 )ob. J='L CG Compam-) Pc-c:Nu:nbcr) — "rte pir lion Date) I awl a sole proprietor, genPrai cen=ac`or f_--4_ec:ccwoerlcicle one) and tlave 'tiired tale contractors listed beiov ": o 1:� ,1Y1m`ol ,:;Q, rs coi!pen_�:'_lon (_N c of COritr:lctor) (Insa�.-n cc Cc:nn':)T,P(D1ic•1 NIurnlvr) I x-Z i rnucn Datc) (Name of Contr cto:) (iltsl ;ne Comna.nvPo!ic; Nt i�rr r) (1 `: .atin Dzte) (Name of Contractor) (Ins nee Co ;;;;zn.;i?olic Nuys ht r) s;.°r::do Date) - 'Na of Contnctcr) — (IDSZ rand COiP.? ,}' P G1iC 1ti1umYi r) 1 <L Il <'. Ole 1?l Ol?r1LtJi 211:1 it ?'',' 110 0I1L 2111 a home OW?l tiC. C`Ii11I1„ :(( i_. NO'I1i:plcasc t.nw•1rc t!s:-.tip i)c tr:�nco�t:r_r.u;-�r._.�!�;,r,.-��:.�::�:-�_-�,�.�c�cz:.:::n��m cr:-��ait�c•,;;:...._�«clii-�, noe mere tlL:n tluco l:ui�ir,t�i:ul t!�e lti,.-.�.•.lir�r`.:<:;�u a;'`�.-t;:�_:.:3 z �:r:ct:_.r1 Lhcetc a�tx:(ecrt�l!y ccr::::::::::�tv cV'ployc�u_•',cs tlr wcr?•x:'s cc -�:_icr.P.C:((3:.152.»!t5}!,--t:, ._;:ic;:%y a F.n:amu�lcr`cr a L­c-z'c ct I:::....._ 1oS11 statue of an e=pto)x under LLC wor�els C-CxL" _ 6t n:`.cL !w•�dc.-stand thL a copy of th:i ctat—:-s_•cuy bo fo,­Ivti�j to tIx fYS>ortz ,:of Ln riJ Ac66�_y Cf:l�of for llm my"E�c va ifiiCtioc aid Ih:t f ltuc to r c co�^`r ut. zccicr_?SA of MCI,151 can lc--d to the iriTI-',�sitio-3,�t c z--*--i.:1 pcc:al:_u comisting of a fur_of up to S 1•SLk OQ art.'x i^:;lr r.�1; of;:p to cr.--}u r.:.1 civil,cmlticz in do form cf a S!c;,' `nx Orx"and a f s�oC S 146.00 a day s g:61ra m-. Fcr dcT:ut: :al u,c lly 5€CTQN 8 CONSTR'UCTIQN SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone -" «" -"mow.""". r Not Applicable ❑ Reg"sere `ome lifraroiremenYContradtor- Company Name Registration Number Address Expiration Date Telephone SECTION 10 WORKERS' CQMPENSATION 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...... ❑ NO 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 Local Zoning Laws and State of Massachusetts General Laws Annotated. -&omeowner Signature ri WSP � SEC7IOfJ :a�D1=SCR�TJ0N10P PROPOSED NVORK check all a lica�le ,.. ,,.gym New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other ( ( i Brief DescriQtion of Proposed Work: / f"o Alteration of existing bedroom Yes -No Adding new bedroom Yes __IZNo • � Attached Narrative❑ Renovating unfinished basement Yes ENO Plans Attached Roll❑ - Sheet❑ 6a1.ff�te'w�hous"a ndor°addition/to eXisting"housing;comp`le e�thefoiLowing: a. Use of building : One Family t/ Two Family Other b. Number of rooms in each family unit:, _ Number of Bathrooms .i c. Is there a garage attached? d. Proposed Square footage of new construction. �Ce Dim nsions e. Number of stories? 07 6Lbayea� �d f. Method of heating? CPr'15 (0 6T; e Fireplaces r Weeelste ee / Number of each a 7►r7WI�C5 g. Energy Conservation Compliance. Sp Mascheck Energy Compliance form attached? h. Type of construction CC(,0101 ftt- i. Is construction within.100 ft. of wetlands? Yes �No. Is construction within 11000�y.,r floodplain (_ Yes],�No j. Depth of basement or cellar floor below finished grade t=t�� �CC-5&M 1�/✓1�-�u Iaou- / e3hf(l k. Will building conform to the Building and Zoning regulations? V Yes No . 1. Septic Tank City Sewer Private well City water Supply SECTION7a GINNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT�OR�CONTRACTOR.". PPLfES FORBUILDING PERMIT I, as Owner of the subject property hereby authorize to ac;. 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 forelJoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Nam / r ` Signat Owner t Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size dll kd d/1'?d_ j Frontage l71 �g Setbacks Front 7 � Side L: R: L: dV '/R:30 /�-- Rear Building Height Bldg.Square Foot % C;. Open Space Footage % (Lot area minus bldg&paved -parking)// #of Parking Spaces l0 Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO V DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES IF YES,has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: 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: J 071 P-61 �f Northampton i in Department ; r- Main Street !4' "004 oom 100 ��k L': JUN No pton, MA 01060 ►s r i phone 413 587- 240 Fax 413-587-1272 P . . , BU!lDl"cGtt�SFtCT0S LAPP& O CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-'SITE INFORMATION Th�ssect�on to be completed by oifr 1.1 Property Address: r s MaR ' tat Unit 1 1 1 tl �'l((� —��' F Zone L r Overlay YDistnct Zjp ---r . EImSt D�straict ;'CB D�stnct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print Current Mailing Addre . 11� 4LJ Telephone Signatur 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building -(a) Building Permit Fee 2. Electrical (� (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 l� ^ This Section For Official Use Only Building Permit Number Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2004-1279 APPLICANT/CONTACT PERSON DONNELLY TERRENCE P&GAIL K ADDRESS/PHONE 107 HILLCREST DR FLORENCE �� PROPERTY LOCATION 107 HILLCREST DR '1 MAP 17A PARCEL 303 001 ZONE URA 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: INSTALL ABOVE GROUND POOL W/DECK New Construction Non Structural interior renovations Addition to Existing Accesso1y Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN/FOMATION PRESENTED: Y 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 C ssion 11-71 Zoo Signature of Building fficial 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. 107 HILLCREST DR BP-2004-1279 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-303 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-2004-1279 Project# IS-2004-1929 Est. Cost: $5135.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sg.ft.): 21.823.56 Owner: DONNELLY TERRENCE P&GAIL K Zoning:URA Applicant: DONNELLY TERRENCE P & GAIL K AT: 107 HILLCREST DR Applicant Address: Phone: Insurance: 107 HILLCREST DR 0586-24600 FLORENCEMA01062 ISSUED ON:711104 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL ABOVE GROUND POOL W/DECK 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: /� 4-K 7 ,C Rough: Rough: House# Foundation:l7 OGs L�( Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final:6)A— `7- 2G.p t�/ _ THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA T OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy,_ /0��e_Sipnature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 7/1/04 0:00:00 2929 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo