03-025 (3) Rol IN (10
12'0" - - - - 10'6" - 113'6" -- -
T
0 d
I_—4'0 ' ° ON
0
6'3 8'0
110
0
11 6 r I o
6'3
5�
o
I ^� �VVI'0
2'6 ID �L7Q 2'6
� V
\2,9 3'0 rn
2'9 T6
2'6 2-0 11'6"� 3'6
ao
rn �
C2
3'0"
o 10'0"- O
J_
TO"
5'0 I o
.a
o
0
10'01, —15'0" �l
*All dimensions are approximates
_ rzf1y of Narthamptt t
$ � �Glassac}fasetfs
DEPARTMENT OF BUILDr,\TG 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(:,.s sor. T he state defines"Homeowner" as, "-Person(s)
who owns a parcel on which he/she resides or intends to be, a one or tw6 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 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, a- .11 ti L,,nderstand the above.
(Home owner/resident's signature requ sting a mption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date /o
Address of work
location_ -g
r
i '
-
F�° ���°E (riI-� of �Icrrfl��lll�Jf011 -
A - E glasakchncc[Ia' _
w`r DEPARTMENT. OP BUILDI\'C INSPECTIOI.'S
212 Main Strcct ?�Sunlupcd Building
j ?Northampton, Mass. 01060
\V()r aIt*S COilT ENSATION MSURA.NCE Al'
`fo� - - --
%VILh a prLZCipal place of businessfresidencc at: -
j n
k Ol0(00 (phone.') 1/ 4 04 -701
(Sac--Uci rfInatL12j p) C
do hereby cerdfy, under the.p?int and penalties of perjury, :hat
( ) I am an employer providing the followine!workcr's COlnpcnsz:ion cove age (or my
emplovccs working on this job:
OMSU an=COQT.`LY) (Polio:?yu--Zbccr) -- (r:'pir-ation Dz�.)
I
a sole proprietor, general contractor or homeov{Der (ci c:e one) zod have hired
the couua(nors listed below who hive the foUo%vi�Q workers cooDtnsadon policies:
I
I
(i+IlRI:
Of Co'1r^cior) (1RR!r311CC COIIlD1tI)'/PGUCi ?�IUII1=< ) (Ex, F Qn l�IIC}
l
(Name of Contractor) (lnsuranec, C.omoaa)vpolim, Nurncrr) (LxDir3tiOn Date)
I
(Name of CO=167): (Innuancz- Company[POl-q- NumbJ) (Expiraoo Datc)
I
(Name of Contractor) (LIISUfancn- Compa ly/po- Numb`r) (Ea�irtion Date).
(aaAch nccC,if ncc�1•to me-�ve�jaf ^oo pev•�b.17
O I am a sale proprietor and have no one worhdng for me.
I am..a home owner performing all the work myself.
NOTE:plesc be cw-am tf„•-U-e bom,,,-,, a to employ pcs.ona w do'--•:*-„-•••••.• cs c ao r rcpair work oa a of
tux mot th_a c: --Marx is vinch the bomoo we rcedo«oo the ffouzw:!s zppurtea:>;tbcen r:c ox Caz--Uy oeesdaod w be
aitplo)--�unCe the-- cr:cc=p---•ica An(GLl Sts 1(5)),zpPLio.6=by.bcmmaaa f=c lic5=«pamh rr:y a idmoc tL'c
of as-=Player uoder die worScda C.oaspcm,.tioo.Act
- [under-:aaad dv-a oopy o!thia mtcmei may b<foc�w tho p�gertmmt id Ac Ad Y OILoe oC 4,�tof d°
eovrz-9e veilelioa and thzl L-iltm to so-uc bovcinse undo soctioa 23 A of h(OL 152 can teal to the i=,asilioa of rimiazl Pea-+16a
oomiti%of a fiat of up to S 1}00.00 andoc ia>prbo�of up to ooc yrMr and Civil pmal-,ia is de form of a Slop work Ord--Lad a
fi=o(S 100.00 a City Lpiatl CX-
� uac only
I For d�.naL�.�
i
i permit Numtks —
/ate 06 N42p° Lot
Sisna otLi�scc/Pc ucc —ISt-
e
t
SECTION,8-CONSTRUCTION SERVICES t
81 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
o me Not Applicable ❑
Company Name Registration um er -----
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION I*[SURANCE-AFFIDAVfT'',(M G:L:c.`152,:§25C(8)
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...... ❑
F r �7� W.
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 buildine 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 S of Massachusetts General Laws Annotated.
Homeowner Signature
r
r.:
SECTION 5-DESCRIPTION OF'PROPOSED`W.ORK(check-all-applicable)
New House Addition ❑:;. Replacement Windows Alteration(s) Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [❑ Siding[0] Other[ED]
Brief Descrip on of Proposed N O S''f t2A�t(TU 124'1_
Work: 4 4:;rJtSFlrb aaoLt /.✓ BA-S'Eyk — N E D(Le�Vvl S r
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
MV
.:
sa virouse a d2ols- n sii ,co a .01ou�ul
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms 3•s/
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: 0WNERAUTHORIZA1 ON TO BE COMI?tETED WHEN
OWNERS-AGENT AFt CONTRACTOE2 APPLIES Fp[2-&dILbh4d PERMIT-
I, 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�.�✓ �asCp�r/
thori zed
Agent hereby declare that th statements and information on the foregoing application are true and accurate,to f my knowledge
and belief.
Sig�need-under the pains and enalties of perjury.
Print Name
Signature of O er/Agent Date
Section 4. ZONING All Informatibit 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 2.49 c t i
Frontage if I
Setbacks Front
Side L:—1 R:7-71
L:� ! R:f
Rear I
Building Height
Bldg. Square Footage } —(
Open Space Footage --� %
(Lot area minus bldg&paved I
azkin �--
#of Parking Spaces
Fill: i
i I
(volume,&Location
A. Has a Spe ial Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DONT KNOW 0 YES 0
IF YES: enter Book Paget and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO , DONT KNOW 0 YES 0
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 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location: t
E. Will the construction activity disturb(clearing,grading,ex vation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES n ,- NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton
Building Department
212 Main Street
Room 100 {
Northampton; MA 01060
phone 41�1-587-1240 Fax 413-587-1272 ,
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -,SITE.INFORMATION
Th�ssectton to be cotnteted bboftce`
1.1 Property Address: �
C�r�
„W M
t
. x 'cqo
tc
Etti` Dist[ � aCBpisti�ct �
SECTION"2-PROPERTY OW NEkSHIPIAUTHORIZE D'AGENT
2.n1 Owner of Record: ,/
/ I4y f_ �j /Sow FkR /V. St>,� $�'� �C E 1kVf0vw
Name(Print) Currentpgilin Address:
3 Sd',G,-�_
M�--_ Telep
k2.2 ignature
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
�OUO
2. Electrical � -(b)Estimated'�Total.Cost of
Construction"from`6
3. Plumbing Building Permit Fee,
4. Mechanical(HVAC)
5.Fire Protection Soy
6. Total=(1 +2+3+4+5) $oao.oD Check Number
This Section For'O.fficial'Use Only
Building Permit'Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2007-0411
APPLICANT/CONTACT PERSON HARRISON MARK D&SHARA
ADDRESS/PHONE 579 COLES MEADOW RD NORTHAMPTON (413)586-9019 Q
PROPERTY LOCATION 579 COLES MEADOW RD
MAP 03 PARCEL 025 001 ZONE RR
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: FINISH BASEMENT
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
INF 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 Pen-nit 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 Commi o
2
240 (v
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.
579 COLES MEADOW RD BP-2007-0411
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 03 -025 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A1
Category: BUILDING PERMIT
Permit# BP-2007-0411
Project# JS-2007-000605
Est.Cost: $8000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sg. ft.): Owner: HARRISON MARK D&SHARA
Zoning: RR Applicant: HARRISON MARK D & SHARA
AT. 579 COLES MEADOW RD
Applicant Address: Phone: Insurance:
579 COLES MEADOW RD (413) 586-9019 O
NORTHAMPTONMA01060 ISSUED ON:1011812006 0:00:00
TO PERFORM THE FOLLOWING WORK.-FINISH BASEMENT
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 si nature:
FeeType• Date Paid: Amount:
Building 10/18/2006 0:00:00 $50.002342
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo