Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
17A-219
Gu?boaa-aS nv�l Ll(o tkT F►x'��'-E (GE1L�N6) to � ^D uR�N� '7t �v�.►otr►-n�tits �s i 8�� <0 Jtl Li L I" ou-F tlo4 N . w�.k-P� sT C—Laiz L=iJ G G, I\A A — NOT Tu SG,NLe — A CEIt..tN6 F t>cTUR� QEF216EV.�F'ro OUTt� r CE►t_�N� r—�.t�l L1.loN-T SW 1TLk1' 6nep�a(.6 F � I�NDE�Z GPc�>>N ET Llfo#i-Tl R.1�- WfYN F::A,� LO IT+F ® O O bN IL. w �. Og�t1AA1P�O L ifl Y anz#4aln}z#art $ � �lassacl�usrffs r� DEPARTMENT OF BUILDING INSPECTIONS / INSPECTOR 212 Main Street • Municipal Building '>o Northampton, MA 01060 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 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 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 proj ct 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 � y) I O�G`c��Oaf, — �- r IIf �iCILfl�cilll�If011 - _ fit ' E tjlcsanchrtsclla' — " DEPARTMEN7 OF BUILDfI\'G INSPECTIONS 212 Alain Strcct Municipal Building Northompton, Mass. 010G0 `YOP-KERBS CON[PENSA.TION `MSURA-NC'F' Al=AVI-S v"Ith a principal place of business/residence at: (Sffcc t/C�ty/sta.tcfn p) do hereby cerdi ,, under t})c.paim and penalties of pcgufy., hzt ( ) I am an employer providing the following worker's comocns-ndo, cove agc for my etnplovees worlang on tliis job: (Iniut-mac Conner,) (Polio: Nu-Mr) -- (r:-pinion Dzi--) ( I am a sole proprietor, general coon-acror or homeowner (ci:c:e one) and have hired the cono-actors listed below rgbo have the folio%vino worker's comptiasanon policies: 6WOW,C-6 I.y 313110-7 P lO�I��{� TLtJ6 (In2ranr : Cornoa� fT'ouc; ?�`um c:) (D:)iivjnn bate) %� �iiMoN CCPWQ -SOLE PROPki-C z- NCH (Name of Contramor) (Ins-aranec: ComoanyfPolim. tune^'r) (Limp ,:oon Date) (game of Com-aelo:) (Imsurane:_ Compan)-/Polic)- Number) (Expiraoo Datc) I (Name of Contractor) (irisZtrance Comcany/PoUcy Numbs) (Expiration Date)- (ans.�-d;ifocal cSca lacoa��-w me iafocm�oo p��•;�; o .L Co=- o') ? f t { ) I am a sole proprietor and have no one wor��Dg for me. ( ) I am.a home owner perforraing all Lbe work myself. NOTE:pi==c be awzrc it---L:j} bca,=. era-,00 employ pc'sona to�¢.�.¢sca ^^* �=-.:.camp c tau work oa.d.•c11_Z of noc mocc Ih tt7m is wjzcb tb.bocnoovla=raid.« oa tb.c prouac r a9�Ls-- : ox C==--Uy m=.d.-rtd to t� catployc-�unr'c the..at;¢crsp�m Aa(GLt S7_s3 l(5)�=.�plintiov by n 6om�wvcr fv c Gcmv_oc pc7xnit try c�-idea[�c Icgrl n,_.,,,of=-=;)Iayo under trio Wori,,e,CoO. .tion A,.t- I uzz— d the x ooQy or tai, my be row...,-d<d b�pcpo%c cca of 1�wild ncedr OMo or I=om for the cova-xbc�aiC'cstioa aad th:.t L-iltac soatrc to�crasc mac soctioo 25 A of h{oL 1 S2 m led to the io'of ta-imiasl prnaltio oomixixtg of a Gx orup to S I X00. anwcx,i=Pri-'0=,= or up to ooc yr=r and aviJ pm>_Jtia in 11x form of n Stop Wor{;Ord=n d a rim o(S J .00,day t trio For dcp.rtu+��u.c only Permit Numb= Sipa�z of Lic=iscc/Pcrmiucc e SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ ,Name of License Holder License Number Address Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date ,Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(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...... Ck 11. - Home Owner Exemption 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 Sion 108.3 51 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 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 i eath)of the Massachusetts Ge 1 Laws Annotated,you may be liable for person(s) you hire to perform work for you un this permit. The undersigned"homeowner"certi and assumes res risibility fo co pliance with the State Building Code,City of Northampton Ordinances State and 1 Zoriing Laws d to of husetts General Laws Annotated. Homeowner Signature !` / SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacementjll(indows Alterations) Roofing ❑ Or Doors PQ Accessory Bldg. ❑ Demolition ❑ New Signs [CO] Decks In Siding[1:3] Other[p] Brief Description of Propo Work: Alteration of existing bedroom Yes X No Adding new bedroom Yes 1C No A rrative Renovating unfinished basement Yes No ans Attach Roll Sheet $a.If New house and or addMoon to existin+a housing, complete the following: Q/A a. Use of building:One Family ( Two Family Other b. Number of rooms in each family unit: of Bathrooms AE c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? I. 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. 1. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 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 l 1 E '&IM.�( NACDeo'i v l�'--ti— as Owner/Authorized Agent hereby declare that the staterneifts 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. Av\A\j cam# /s--�V> atJ plc c> y�L-+- Signature o r/Agent Date Section 4. ZONING All Information 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 Side L: R: L:_ R: Rear Building Height Bldg.Square Footage Open Space Footage % (Lot area minus bldg&paved Arkin #of Parking Spaces Fill: _ volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES 0 IF YES: enter Book Page and/or Document#" B. Does the site contain a brook, body of water or wetlands? NO l DONT KNOW © YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , 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: 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 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. - Doar it ,only , 1 of Northampton �cif rrt* ' "ding Department 12 Main Street , . 2 p 2006 �� `� Room 100v QCT orth mpton, MA 01060 Twr9f: rat r 3-587-1240 Fax 413-587-1272 Phis 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 I(V4 NC)4ZT1A MAPl-s ST Map Lot Unit E-t�j�Eh1C E, Ac C7 l C7(v 1.- Zone Overlay District Elm St District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: /-\ � i I~ , 7o t,Cou)&A- AP L e S 1- E-LO MA Na ,� Current Mailing Address: Telephone Signature 2.2 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 -2, U G U (a)Building Permit Fee 2. Electrical ; ,6 06 (b)Estimated Total Cost of Construction from 6 3. Plumbing -2-, 1 Z Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/inspector of Buildings Date File#BP-2007-0459 APPLICANT/CONTACT PERSON MCDONOUGH AMY&STEVEN ADDRESS/PHONE 164 NORTH MAPLE ST FLORENCE (413)214-4762 Q PROPERTY LOCATION 164 NORTH MAPLE ST MAP 17A PARCEL 219 001 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: RENOVATE KITCHEN 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: c.- 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 Street Commission l0 J2,r10 6 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. 164 NORTH MAPLE ST BP-2007-0459 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-219 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2007-0459 Project# JS-2007-000674 Est. Cost: $6625.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 19035.72 Owner: MCDONOUGH AMY&STEVEN Zoning. URB Applicant: MCDONOUGH AMY & STEVEN AT: 164 NORTH MAPLE ST Applicant Address: Phone: Insurance: 164 NORTH MAPLE ST (413) 214-4762 O FLORENCEMA01062 ISSUED ON:1012512006 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE KITCHEN 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 10/25/2006 0:00:00 $50.00110 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo /S kill cig ... . ` taw !� a7 ,�. e 164 NORTH MAPLE ST BP-2007-0459 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-219 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2007-0459 Project# JS-2007-000674 Est. Cost: $6625.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. tt.): 19035.72 Owner: MCDONOUGH AMY&STEVEN 7.0 upi g,:_i fRB Applicant: MCDONOUGH AMY & STEVEN AT: 164 NORTH MAPLE ST Applicant Address: Phone: Insurance: 164 NORTH MAPLE ST (413) 214-4762 O FLORENCEMA01062 ISSUED 011:1012512006 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATE KITCHEN 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: / +I LI o 4 (,d Rough Frame: d i{ 1�i s uy)(�4 AC'GH Lek fr I 37TO? X } �1 c Gas: Fire De a' tme Fireplace/Chimney: Rough: Oil: Insulation: C Final: Smoke: Final: Q -'a Q�p-7 —Y� THIS PERMIT MAY BE REVOKED BY THE ITY OF NORTHAMPTON UPON VIOLATION OF J ANY OF ITS RULES AND REGULA ON ,,. • R Certificate of Occupancy sienatnre: FeeTyue: Date Paid: Amount: Building 10/25/2006 0:00:00 a 50.00110 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo