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17A-050 (2) o�'CKAMP�o y Crif ! of Northanytou 7 Z = $ � �Uassacltnsetfs - 5T DEPARTMENT OF BUILDITNG INSPECTIONS � INSPECTOR 212 Main Street * Municipal Building Northampton, MA OIOFO r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as iris/leer construction sup : ,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 divelling, 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 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 6*il) of arillmlipt Lill OF '212 'Main Street Municipal 13-Ming Northampton, Mass. 01060 CO-M NSATION NStRANCE AFFIDAVIT v"Ith prilicipal plact, or business/residcuce t_ '3-7 c te e i-e 01(2 �69 Cho h(�I-chy an C 11 2pluv C cls "Y u I I I I i-,. 1l I Yolc th, Contractol-'s ksteQ' (Ntamc of a tc) (if of -:in 1IL.jIc'SC I not:1Kcc t cxI t`.0 tlr tVt'i fl'-' (6I,l 1 Ics-I't.tiiz of nn—;Aoyor uo,'c L!:o 1,cvu ccs c—,iltirig of a filvi,-of up to sl �:-.l civil�, Tultin in 1� �;n of r, and 1 ciinit SECTIONS -'CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder , IVJ P–,/"i✓ E V 3 9 © U A License Number Address Expiration Date 5-2--- Signature Telephone 9 :Registered HomeImprovementiContractor g r+? ;,. Not Applicable ❑ 15 6 vv�o 46 Company Name / Registration Nur ber 0 (go / Address e Expiration Date Telephone 2JV � L? 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...... ❑ 11. = O e ®wnerEemptton 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 f6—which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 f,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, Cite of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION"3 DESCRIPTION OF PROPOSED;WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks Siding[ ] Other [ ] Brief Description of Proposed Work: /v :r= C -- Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet 0 6a!lf&NdWMduse and or addition to existin`,hd0SihJZ,'completethe.followin _ 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. Mascheck 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 CONTRACTO APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize t– "'✓ IV to ac; or my behalf, in all matters rela e to work authorized by this 'Duilding permit application. Si ure of Owner Date _ Lj Z� b C (_ (rt -- — -- – as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are trae and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name Date Signature of Owner/Agent 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 7 4 1 n I7 3 Id,03'V Frontage � � ` �K Setbacks Front 30 t Side L: 15 R: ! D L: R: Rear 3v Building Height Bldg. Square Footage 1 ,100 360 Open Space Footage % (Lot area minus bldg&paved parking) �� #of Parking Spaces 760 Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book __ Page _ and/or Document # 13. Does the site (-)ntain a brook, body of water or wetlands? NO DON'T 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 L 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: a City of Northampton Statuso*4W er ft ' Building Department Cu b,Cut'/.D- e a. 212 Main Street Sewer/Septic Room 100 Wauer/Wel�Ava g H , Northampton, MA 01060 TWOSetsoftr phone 413-587-1240 Fax 413-587-1272 Plot/Stte�P ans � Other Spac 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 C &j) Map Lot v Unit T`� , (j ZonerQ"` —" Overlay District Elm St. District CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: IJAS Name Pri t) C.rrent Va�h-),-Address: iephon, nature 2.2 Authorized Agent: Name(Print) CL;rrent Mailing Address: - ----_1 �-_- ---- - ----.�- - ---��-� ---?-sit---2 - Signature ?elephon SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be _ Official Use Only completed by permit applicant 1 Building -� � � � (a) ft �i�ding Permit Fee �! 1 !h, , "-sated Total Cost of :cnstruction from (6) 3. Plumbing Building Permit Fee 4 Mlechawc-i (I lV"VC) � . Fire Protection 6. Total = '1 + 2 + 3 -+21, ChecK Number This 5e tion For Official Use Only i Building Permit Number: d Date Issued: — Signature: ------- ------------------------------ -- — -- Building Commissioner/Inspector of Buildings i)ate OAT Crit�l of Xo tilumpten �. A � �assacftnsrtts — - "� DI'PAR'?M,iF..\T OF BUILDING INSPECTIONS �s \n INSPECTOR 212 Main Street * Municipal Building Nordminpton, MA 01060 .r' MUST INCLUDI Site Plan%Plot Plan showing all buildings with square footage and Distance to property lines. Residential 2 sets of framing plans (with smoke detectors marked) If adding a bedroom, floor plan of existing house with With updated smoke detectors Commercial 3 sets of plans with fire narrative Filing deadline is Wednesday by noon Reviewed every Thursdati 05 1 Af q��Irp4f-.s K e : oq 01 w tj I 751 31 his h VXY File#BP-2003-0940 APPLICANT/CONTACT PERSON NORMAN ZALESKY ADDRESS/PHONE P O BOX 53 (413)268-3553 PROPERTY LOCATION 144 BRIDGE RD MAP 17A PARCEL 050 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid T_ypeof Construction:_CONSTRUCT 14'6"X 24 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 034841 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF94WATION 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 Stree ommission 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. 144 BRIDGE RD BP-2003-0940 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-050 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-0940 Project# JS-2003-1508 Est.Cost: $4400.00 Fee:$50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NORMAN ZALESKY 034841 Lot Size(sq.ft.): 11935.44 Owner: HARDER JASON C&STEPHANIE Zoning:URA Applicant: NORMAN ZALESKY AT. 144 BRIDGE RD Applicant Address: Phone: Insurance: P O BOX 53 (413) 268-3553 WILLIAMSBURGMA01096-0535 ISSUED ON:518103 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 14'6" X 24 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: 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: Receipt No: Date Paid: Check No: Amount: Building 5/8/03 0:00:00 865 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo