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17A-137 O¢�►1AlypJO Gx#y of Xart4a ptan z � � �Tassatl�nsrtfs m DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton,MA 01060 5 r 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 .• 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 fancily 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 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 4�ILAMP lS-If h1 Llf l7�" (��Z7ll�l Lill ♦ �1�iSSAClj iib[ii� . m DEPARTMENT Of' BUILDING INSPECTIONS 212 Alain Street ' Municipal I3uiicling Northaml}toil, Mass. 01060 WOP.-TCER'S COM ENI SA770N INSURANCE A.T+'FMAVIT 1 %,ri III a principal place of busiresslrc:-jiccnce at. -"---�- do hercby Cer—ujy, LI];1 r die l)i ii1J i?iid OCil?1t1CS C)i 7ef�lll�r ( ) I am as employer proviciin- the follo`vint colnnensation covcrr: e or Iny erllployces worbr]g on dus job-. (Las-,=cc ('onp.mv) tr`t 11>cr) ( ) I a -i a sole proonetor, ze"'ItTLI homcowoer ;circle one) and, t]a,re tureu t_lic contractors listed below-] to l-, „ the Polo ,Na-mc of'"'ontmc-Lor) (InSUaI1C Col IGi1Cr T1L1Sn i) T.?'; DatC) (Name of Contr<.c nr) /Po?ier UM, (E. r tinD Date) (NIame of Contractor) Inns�s}ce C. - - -, 1 _-.. � 'oL•�. NuJirer) :.�,. �t.oc ;ate) -- (Name of Contactor) --- Jos-1 ra ��omr_--y r o—licy-`---�-- -�_ —Date/ - l.`..C1•"�I:1 CY:1I i::_iS...._-_... _ .n.-._. .._.":Y-..a..,n ,--....... rli.�:t:'_..-...•-) l V6 Lll is mole pl Oj?r]CtJi ii:11 ilave 1 oilt, . ' ;! i]e' ( ) � � i O for ills. i11 a home ?d0'TIi:please be ntva:c Lst•.ti�:i)c]x<rco.�ir_r;t,-o c �L.^-,;r—,::;n::�..—�c:�,�.ac�a.: n:���m cr:r,^air t.,':i:�-:_d�rc!!i::�c. not umce L'Lp thrvo uni±i ir:«-!:dt;he 1,:.-.:ti� a��_re::.��or oc;•�><.�;•_.-.���*utter�rS LhcRO c,-c rr�{�-rsall.i o:�::::::c:;:a t�: eatployc�uti!er t}r tvc;i:cr s cc x- cc Ac (C3L!f3 c!(51;.n<=,•._;:ic;:by a hoc tco r `cr e Gccx cc pcz;:i:: n e _c lcgzl rtztuc of an amploy♦r undo tL•o Workcx�c COM,>m_- 6,3,n;A.cL I undeztand the a copy of thi rtatG,_�r_uy bo for---d-3 to tl»IYtL L ua of Oir—of for t1x covcngc vcriGciioa and tlht f iltuc to:-z -'coti r;ut cC.iM 25A of MC-L.152 ctn lc--,d to tl>c impozitiat misting of a fur_of up to S I S .00 zn:'re of up to nn:)-,-.r-.:er.j civil perulUa in dK;c-,nn of a S!r, f r> of S l i}n.pp a iy�raina mc. -- Fo,6q—' f-ll u.c c�lly I I � SECTION SCONSTRUGTION:SERVICES .............. .. .. 8.1 Licensed Construction S,ul2ervisor: L Not/A�ppl/icayble ❑ Name of License Holder License Number EaW' laiq JP yu HAS 'z7--6 Address �j Expiration Date Sign e Telephone ve en Ton'tr:'acto - Not Applicable ❑ i?26-00 00 I N( Sl -br 6c, Com any Name Registration Number Address Expiration Date Telephone sSECTIDN U WOI §R' MPEN ATI 1 htSLIRANCE.AFFI DAVIT;'(M G:L .c. 152, § 25C(5)) 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 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 SEC p l w B. PST O OF ROPbSED NORI( check�aif a Ilica: � t New House ❑ Addition 0 Replacement Windows Alteration(s) ❑ Roofing I/. Or Doors ❑ Accessory Bldg. ❑ Demolition[] New Signs [ j Decks [ ] Siding[ Other [ ) 7 Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll D• Sheet 0 dTUGH5,17 sfing h.ou Ong,.c m� a=e he ilow.i:ng: 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 . f. Septic Tank City Sewer Private well City water Supply m SECT®N ERTORIZATION TO BE COMPLETED WHEN 0 PCEftSA�� O�OvN�RACTOR'APPL{ES FOR SIfILDING PERIVIiT ': I, SS aK,� as Owner of the subject property hereby authorize -�,�� CJ ( �(1 b to ac;. on my b�half, in all tters relative to work authorized by this building permit application. t<tf . Signatu of Own DateO I, j 1 1 l uti as Owner/Authorized Agent-3 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. :V-) 16 D0 - Print Name Date Signature of Owner/Agent w 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 Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces 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 # B. Does the site contain 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 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: City.of Northampton 9wilding Department ~' 212 Main Street Room 100 U - 1 L005 Northampton, MA 01060 hone 41 .587-1240 Fax 413-587.1272 t APPLICATION TO C T, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1- SITE INFORMATION This secti:ontolicom ate"Ybyo face 1.1 Property Address: ^• �x " Zon Overta; D�stxt SECTION 2- PROPERTY OWNERSHIP/AUTHORIZEDAGENT 2.1 Owner of Record: Jess Ica, ,(-a�j IV,' Cl es �4 2�S71 arr_12&, Name(Print) Current Mailing Address* A Telephone Signature 2.2 Authorized Agent: Nam Tint) Current Mailing Address: Signature Telephone SECT10N.3 ESTIMATED'CONSTRUCTION'COSTS4''' Item Estimated Cost(Dollars) to be Official Use'Orily completed by ermit applican t 1. Building i,� (a) Building Permit Fee 6i 2. Electrical (b) Estimated Total Cost of j Construction.from 6 5 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 + 4 + 5) , Check number This Section For Official Use Onl Building Permit Nu mber> Date Issued: Slgnature`' Date Building Commissioner/Inspector of Buildings T 229 CHESTNUT ST BP-2006-0118 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A- 137 CITY OF NORTHAMPTON Lot: -001 Permit: Building Caterv: BUILDING PERMIT Permit# BP-2006-0118 Project# JS-2006-0177 Est. Cost: $6500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Robert Thibodo 118441 Lot Size(sq.ft.): 35457.84 Owner: LAPINSKI JOHN&JESSICA Zoning:URA Applicant: Robert Thibodo AT. 229 CHESTNUT ST Applicant Address: Phone: Insurance: P O Box 201 (413) 586-0391 NORTHAMPTON MAO 1061 ISSUED ON:811105 0:00:00 TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE ROOF 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 8/1/05 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo