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17C-088 (3) i'i 'i I! __ _ l� __ , r ', sN� � 0 4 �I 834gt}tllSttfB - DEPARTMENT OF BUILDING INSPECTIONS I? INSPECTOR '212 Main Street • Municipal Building Nortliwnpton,MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CNIR 108.3.4 to act as his/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 one or two fame 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 c " DELAY the project until such time as the proper permits and inspections are made I understand the above. (Homeowr si ent signature requesting exemption) I will call to sc Vedule all re ired building inspections necessary for the building permit issued to e. Date Address of work location ► (c ' r 0 0 "� e Crif pf 'NTarfliallip oll rla3 Inch ntrlla' _ DEPARTMEI-T OP BU1L D,,G fNSPPCTiot S 212 Alain Street Municipal Building Northampton, A1ass. 01060 l 'O R :IZ'S CO�Q'EN S TTO N 0`1S U Z. CI✓ A FFM ,. TI-1- I (l1 CcnsxJpermi ttcc) �tii a principal place of businessfresidence at: - ---- (�' (ph on ) do hereby cerdf-, under dic.pains and penalties of perJury, hzt i ( ) I am an employer providing the Iollowine'tvorl:cr's comocns--do, cove rase for lnti emplovices Wor.Lang on tills jolt: i (La-nu-an=Comrm) (PoCic:Nurnir_r) -- (r:pirroor,t72je) I am a sole proprietor general conrraczor or otneowmer tie one) and have hired the contractors listed below cgbo have the foilo�ving �e�s comoerl_adon pebcies: (i`+nlne of Copt^ccor) (InSUtanc Comoan}'ti'cuc, ) (� irJu01 Datc) '�tlmsc; Y_XJ (Name of Concraaor) (lnsarane CompanvvPe!im Numccr) (1 iDi1T-60n Date) I i (Name of Coaamaor) (Insurane Company/Poticy Numb l) (Expirsaou Date) (Dame of Contractor) (Insurance Company/Policy Numtrr) kTxpi-atioa Darr). (naar�addi�"oczl rx�,if ccoci,:y-w c�c°ud;inf--ioc p=u!=oS to.11 cc=--x=.o:z) O I am a sole proprietor and bave no one woridDg for me- ( ) I atn..a home owner performing all the work myself: NOTE:pl be awzn tfi,.MjxDe bc�,,�,K,00—PloY p�m tp do C'rr-er.,,,._. c=--zajaa cr mpa W-oric on a d..cll_y of aot mote th-m t'see r:ifa is wt, c b the bomoow =rcmidn cc oa the Qourw4 zpput�them a-r Doe Cx Xy cti---d to be eirployc s"'C the..0 �z cc=Pc .Loa Aa(GL132s 1(5)) =wLianoo by a bomco-oa far e tiers:=__or pama=X-id—the IcS21 rwa of ca=Ployx uadcr dw W'j,c c a C,ompo�Ad i„nd.ea.ad tha a Dopy ortbi,maemcm m.y ba rof-+..udod w u.D. p.�of*l.&.r-,i.1 Ac d..&OfG—or lrau+o-for tb. covcaSc cif csioo&ad t1u L•it=c to so=rt tom uad�soaioa 23 A of i.(OL 132 can lmd to tba imposition of aimin--J pca Wcl eoal'zL g of a fiat artzP to s 1}00.00 andlor of up to ooc y=r eod a%i1 peoatuo in dx rocs ora Stop Work Ordc nod a ram of S I a day a&iast me rFar dcp.rta�=-'�1 u.c orvy ------- ' Pczmil NU ML--r j,(aps-- Lot. Si 'UZL- f Li crmiucc e ) 1l J � SECTION 8-CONSTRUCTION SERVICES t 81 Licensed Construction Supervisor; Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone S Realsere" 'ol�eniii�o erttcCr 'raa Not Applicable ❑ Company Name Registration Num er -— -' Address Expiration Date Telephone SECTION 10 WORKERS'COMPENSATION INSUI NCE"AFFIDAVIT(M-GI—c.152,,'05GO). 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...... ❑ — 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 be/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" rtifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,S c 1 Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature' r t 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 [oj Decks (M Siding(01 Other[E:31 Brief Description of Proposed © Work: ECT Pe-5-F—A-P P-V C rt-Tr=70 S` 1+`v Alteration of existing bedroom Yes No Adding new bedroom Yes i/ No / Attached Narrative Renovating unfinished basement Yes t/ No Plans Attached Roll -Sheet 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? In. Type of construction L 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.Ta'-OWNERAUTiiOR1ZAT1O N-TQBE,COMPLtTED WHEN OWNERS AGENT OR CONTRACTOR.APPLIES='FOR:BUILDtNG.EERMIT l 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 I, L� ©�` ►� VV" �LC��'`�"f 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 of perjury. f� Lw `I P t Name Signatu of Owner Ag nt Date ' ' . Section 4. ZONING All Informat-i6h Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This colurrm to be filled in by Building Department Lot Size Frontage Setbacks Front or i Rear Building Height Bldg.Square Footage % i Open Space Footage % (Lot area minus bIdg&paved #of Parking Spaces A. Hu's a Special Perm it/Vurunca/Fndi ever been �suedfor/on thmshe? NO 0 DON'T K�W YES 0 � IF YES, date issued:' IF YES: Was the permit recorded at the Registry ofDeeds? NO �_�� � DON . w"O"" ,"" IF YES: enter Bunk Page,, and/or Douumant# �� �� B. Does the site contain u brook, body or water orm/e[|ands? NO ��� DON7KNOVV �_� YES v�� IF YES, has permit been or need tobe obtained from the Conservation Commission? ' Needs tmbsobtaioed v�� ��taioe6 �~� Date «_� �~� ' . C. Do any signs exist un the property? YES K ) NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YE3 0 NO ' IF YES' describe size, type and location: E. Will the construction activity disturb(clearing,gradingexcavation,n,filling)over 1 acre oris it part ofe common plan that will disturb over 1acre? YES K ) NO ~~^ IF YES,then a Northampton Storm Water Management Permit from the DPW is required. f NorWampton [E 0 ng Department =---i Main Street oom 100 J U'! 1. 3 2005 i fi R pton; MA 01060 � � Y 4 w phone 41j-5587.1240 Fax 413-587-1272 oS �� Qt° J` Ri III NN!. I_ T DNS E�the� gecif�� ;-t I --—�4PPLICATt ,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This sect►on to be CamPCe#O, office ir c ' Il V�' V U��- Zone Overla�r Disfnct t �.EtitKSt Disfnct - � CB.Districf; SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: hi�A NO e A e Pint) Current Mailing69d4res D r Telephone Sign tur 2.2 A&itflrized Alit: 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 d (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) Gheck Number This Section For Official Use:Onl Building Permit te r. Issued: Signature: r Building Commissioner/Inspector of Buildings Date File#BP-2006-0057 ' APPLICANT/CONTACT PERSON CONROY MARUREEN L ADDRESS/PHONE 106 CHESTNUT ST FLORENCE (413)584-3840 Q PROPERTY LOCATION 106 CHESTNUT ST MAP 17C PARCEL 088 001 ZONE URB 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: ERECT 10 X 14 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 FO 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 StreetrCssion i 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. 106 CHESTNUT ST BP-2006-0057 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-088 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0057 Project# IS-2006-0074 Est.Cost: $2500.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sg.ft.): 10759.32 Owner: CONROY MARUREEN L Zoning:URB Applicant. CONROY MARUREEN L AT. 106 CHESTNUT ST Applicant Address: Phone: Insurance: 106 CHESTNUT ST (413) 584-3840 O FLORENCEMA01062 ISSUED ON:7122105 0:00:00 TO PERFORM THE FOLLOWING WORK.-ERECT 10 X 14 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 7/22/05 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo