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17C-050 (3) WINDOW WORLD C`0NqTRA(-, IVIADO I I iVOR LAI) 01., 1-1114A. MA SSA('111,"St ITS. ()I Ic SPECIFIt-ATIONS, Of7 of no , wvlv'. 11i- tk Pj It pa'. dw oao o! :.,c i!70, t. Y'l t'sr fu:o i+: 1 110 k IT 1. Vv t MOW 1,117 k; C,il,i t it, !'ii 0"Jk", �N`IN DOW ( 3A R ANTEE 1.'(1 4!"4;1 Iir ,ti:OVV TK4 tO 1iq 1111 .!ill ff,W) itilk:dho%l- d"t �X I f 1 J'a N frf)w flaic at v 0 i3T an y :;'J 1 i 1A;1(, i i, I I g 1:'t I.! t w v m,t.abu A* ixr .14""S )f 4,116.4t:,J twill ruigh h0l1lidify h`,0 WId V i:};jjl tilt.' Iii" ii t�,i IJ110vf,gt day Fri jumf I c I fIvnf,ri '� � j>t�assxcltusctfs , r DEPARTMENT OF BUILDINIG 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 i:is/her construction sup<:-., sor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a d e or two fai 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 r',egulations. 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 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 r I ATO t.. of �\Tc illailiplo 1 J E .s.Rr]lnrctIs' _ I cJ DEPARTMEI-IT OP BUILDr,G INSPECTION'S 212 Main Strcct Municipal Building iNorthampton, Mass. 010GO WORKER'S COi\TENSA'nON LNSURA-NCI✓ AI FM,,'�,Vj-j-j (li=s.=JpermJttc,-) vIrl h a principal place of businessfresidence at: S� �rYYCUC K s( 1— r `� M c_^!r!S`, (l hone') SSG 7 71 (sa�t/ci rY/sZatda p) do hereby ccrd. -, under dic.pi'-ins and penalties of pegury:, hat ( ) I am an employer providing the following Iworkcr'S colnDUIS-EJO, covcrvgc for 11)), etuplovccs Nvoriong on this job: (L2nu-.�n=Come) (Polio:Nu-ter) — (r:pimion Dam) i - ( ) I am a sole proprietor, geoeral contractor or hotneow-Der (ci cie one) and Lave hired the coacactors Listed below who have the following workers comDenssaDon pokles: _ 0113m: of conmlao0 ) (Instranc,: Cotnoanyti'ouc; (-ExpiiJu011111c) (Name of Councior) (lnssrzncz Comoanyt'PoUm, Numcrr) Dwc) I I (blame of Connmclo.) (IIISWac= Compan y/policy N,.unbu) (Expui z600 Datc) I - (Nz-Mc of Contractor) (Insurance Comcaay/Policy Numb r) (Expiration Date). (.11a[b ddtroeal bee,tfao�.�-to atdud iaformaaoc pest:�Lo B coat-lLam) I O rietor and have no one worl�ng for me- I am a sole prop j ( ) I am.a home owner performing all the work myself. NOTE:plese be zwwt t4.,.-.]o bo=,=,mCn N o c=picy pctom to cio -*•-,• mr .=joa r tgau work as.d%-J:-.;of ace mots th a tksu—,I in Wbch the homoow oc r=d._a or ca the p-alndt zppunear1 tber_o r.-r ooc Caa _lty oe=.d.-rcd to he eitploye uz)d. the w= rt:oc=P-_.,:m Aa(GUI 52-=1(5)),:.ppli=6m by.bommave fr c Ge. .�a pewit ra:y e.idmec the legil nano of ea¢71oyx under d.w.,ku er comvom..Liou Act I t uodcr:.aa tha a oopy of tt 6=a—t o y be f---ded to tb<Dop.�of,.A.r;d A.6d ndY o(Gioo of ttaul+.00n for tbo cove a&- veila3i00,ud th_i L-..iltae to s=im bow aCe uadc section 25A of MOL 152 eaa 1�to the i�sivoo of mminA pcai(tio cOOMLvi t of.fine orup to S 1300.00■ndtot ixr o xi orup to ooe y=e.od avi]pm.Itia io tSc form of.Slop Wort;Ord-.ad r>m of S 1 00.00.day.ptiatt me For.-ty,_ �.t u,c only i } Pcs wit Numb- Lot S i mawrr of Lic=zcc/Pc m-i u= e I SECTION,8-CONSTRUCTION SERVICES .+ 8.1 Licensed Construction Supervisor. Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone �Jtea steoimproyreenCortra o - Not Applicable D n Company Name Registration Num er - — - Address Expirfition Date Telephone- G�37/9— 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...... ❑ b E. if a mC 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. Homeowner Signature r i 401 SECTION 5-DESCRIPTION OF-PROPOSED WORK(check all applicable) New House ❑ Addition ❑:; ReplacemerftWindows [Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[o] Other[c:j Brief Description of Proposed Work: � LLB f �� l/i/�7i!- i�lJt+t-c�LL' j 1- � Alteration of existing bedroom Yes No Adding new bedroom Yes No . Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet a. ',fitm-a' "' ;.. h. ,. "�. "s.�* ".sr r�y,".:,a*' _ S,^ sa. ev� ose anidadcl `iantex>ISing Tiorasingwcompfete ttae-7Qtlourmg: 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 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'AUTHORIZi4TION,-,TO'BE COMPLETED;WHEN OWNERS AGENT OR CONTRACTOR APPLIES.FOR BUIL"DINGPERMIT 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 'T- as Owned) uthorizedj 0!&d hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my kno3(edge and belief. Signed under the pains and 'penalties of perjury. Print Name Signature of Owne gent '�' Date .r Section 4. ZONING All Informatioh 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 Frontage Setbacks Front , 1--- I Side L 1 R: i L= R:I Rear I a Building Height -- r- Bldg. Square Footage ( % Open Space Footage (Lot area minus bldg&paved i =7 �a i -kin 7-; #of Parking Spaces i Fill: volume'&Location) 'I A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page; and/or Document#s B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: f C. Do any signs exist on the property? YES 0 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 U i IF YES,then a Northampton Storm Water Management Permit from the DPW is required. t ----- City of Nortf ampton � Building Department 212 Main Street l � Room 100 Qno, c0(`'S Northlampton; MA 01060 phone 413-58 1240 Fax 413-587-1272 .w APt I ICATI.ONf6 CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION'f-SITE INFORMATION Thts section to be completed byoffice ` 1.1 Property Address: °Nlap 1.cst ��°� Unit< ZoneOverlay Disfrtct SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: J c h'ki r E.1 i f S-6 )!m eve /L ! L r' r S p!'94 Name(Print) Current Mailing Address: S' ' re Telephone ECTiON 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) /6 7, Check Number This"Section For Official`Use Only _ ';!Date , Building Permit Number Issued: Signature: i Building Commissioner/Inspector of Buildings Date BP-2005-1021 CIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category BUILDING PERMIT Permit# BP-2005-1021 Project# 3S-2005-1402 Est. Cost: $4167.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: John Corbett 104000 Lot Size(sa.ft.): 19645.56 Owner: HINKS STEVEN L&MARY LEBEAU Zoning URA Applicant: John Corbett AT: 35 STRAWBERRY HILL Applicant Address: Phone: Insurance: 56 Dimock St (413) 586-8712 LEEDSMA01053 ISSUED ON:4122105 0.00:00 TO PERFORM THE FOLLOWING WORK:INSTALL VINYL REPLACEMENT WINDOWS 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 Sienature: FeeType: Date Paid: Amount: Building 4/22/05 0:00:00 $25.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo