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17C-176 (2)
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Rio o�E 6It7 4f ';arf11alllp1011 , 4 t - fttsaacllasctta• DEPARTMENT OF BUILDt7\C INSPECTIONS 212 Main Street ' Municipal- Building 'Northampton, Nfass. 01060 - WC Rja-R'S CONE et1`tSATIO.IU GSUR hC1✓ . , .vl-I': .(liccastxlpernsit(ec) _._...:._-----.- - .--------- - V-11th 2 primc ipal place of ' essfresid at: A4 (ph o o ao. dOA- Jo(sa=clei rj�staidzi p) do hereby cerdi -. under the.pains and peualties of perjury, that ( ) I am an employer providing the Following 4%orkces comnensa6on cover-'se for my L employees worlaug on tll s job: (Losvran=Coady) (folic;NtL• cr) (�--xpiroon Date) ( ) I am a sole proprietor, general contractor or bomeo�raer(cir c:e one) and have hired the contractors listed below wbo have the ioDowm' S woritees corm)--ns2;ion.policies (Name o:Con!.:accor) (lasvran Cotnoazy/ cticj -Numsr-r) (F� iaseon natty (Nrmc of C000-actor) Onssran=Comoan /Po4icz tuae:r) (izpim6do Disc) (Name of Cooaaczor) ([nsuran=CompanytPobcy Nambac ) f- iMdon Datc)' (Name of Coaoaaor) (mu-anm CompanylPotscy Number) (1r-Vhdon Date): _.__.._. (.aa/l,seasS« J 6cct'ir-rr w 6du&id«mA;oo pau;Aiae to.tI 00=M _o a) (V 1 am-a sole PFOP etor and bave'no one working for me. ( ) I asn..a home owner performing all cbe work myself. NOM ptese be caram&C c b=,,N0]-to-=*OY Pa%an to do r'-:w•• ••' a==-=*W C RgaR-wk aQ a d-%Uig of as matt th:a t'.=W c=-;d'aad,be eraploycs ttoGe the waekd's -•' pet{Crl$52�s 1(s�l.a0Pb7 a boaoao+raa fts a use oc pawn=Y evidwce tke legs,days of as as,iey a mdar dm wwk.-s Compeaa.tpn Aw- l.�adeaaaad&A a am"of obis mtomm a y b.feeward.d to for DVPUAe 06 of lodwarid Modaa&OBia*erlaa+�fW ih. O°"tj+Se rei[xmiw and[Mai Ghse to ranee bm,,,.ge sadder saaiaa 25A orb(QL, 52 on led to he itQ Of Pa *=i.iz%of a fine crap to S 1 a10-oo atdor imprsoaeai of uP to ooc yes tad ct7 et p=.b;o id 6C farm d a$tap Wart Or+ and• o r=*of Sloo.Oo a dtr'Pica Or- For d-w.rtt ,W u+e only •v ti DEPARTMENT OF AWLDD(G INSPECTIONS INSPECTOR 712 Main Street • Municipal Building ;e�y Ntrthawpk-A MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT . The State of Massachusetts allows the homeowner the right under 780CU R 108.3.4 to act as-his/her-construction super sor. The state defines"Homeowner"as,"Ter-son(s)who owns a=-cel on which he/she resides or intends to-be,;-a ogle or riW dwelling; attached or detached structures accessory to such use and/or farm structures. A person who construes more than one home in a two-year period shall not be considered a home owner." The g ep ent or a CizofNo-rthatnpton-wants-anylrcxmiksjrwho-seek-to use the home owner exemption, to act as their own construction supervisor,to-be aware that by doing so yon become responsible for compliance with state-buNding codes and tsegulations.The inspection process-requires that the building department be called to inspect work at various stages,.which include foandation/footinas(Wore backfill), sonotube holes(before pour),a rough building-inuxx—fion(before work is concraled)_insulation inspection (if rea$iredi and a final building insoection:.The building department regWres these inspections before the work is concealed,failure-to secure these inspections can result in failure to obtain a certificate of occuvancy 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 ofthe individual trades to segue the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made 1, 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: - Bate Address of work location "(� ��_ (./�PLe) ✓ l e, 1- SEGLION.8'-CONS1RUgM S R1/tGE fit' 8.1 U Construction Supervisor: Not Apps ❑, Now of t.iceese Hotder License Number Address Er os Dais Sigrnabue Telephone Not Applicable 0 Camoarn Name 0") Aub u t3oN PD L � /"(A o cos T l _3�J'- Ems—'' _ f =rig SEC'�i©N�1ti� v Workers Compwaam hssurrrtce affidavit must be contpleled and subrnilted with itas applceftL Fame to provide tas anklaw vrfil result in the derM of the isstm m of the pears[. WMW Affidavit AttadW Yes.. ... No.,.... 13 p.. The currerrt exemption for"homeowne was extended to include Qw,w-occeoied Hof one(1) or two(2)fam lies and to allow stKAJio noowner to engage an individual for hire who does not possess a license,gravideAthat the o�w r�r act - as snoervtsor.CMR 788. SbA�ZdiHon Seedioa I&W. Den of Homenwner:Person(s)who own a parcel of land ai which he/she resides or intends to reside,on which there is,or is to be,a one or two family dwetiing,ached or.dainched si newres accessorIy to such use and/or farm shuctures.A person who gpa WnM nigre than One hone in a tens-year oeAW siaili wt be coaddend a hen�eowtacer Soeh"homeowner"shall submit to the Building Official,on a form acceptable to the Bwldmg OTkiaIftJMWdd be mmsibk Sgr aff snch Md performed MUNdw ft °=& As acting Construction Sn mvbw your presem on tyre job site will be required from time to tune,during and Won' completion of the work for which this permit is issued Also be advised that with re*reace to MVter 152(Workers'Co ion) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachimetts General Laws Amtotatcd,yon um be liable for persons) You hire to perform work for you under this pemait. The undersigned"homeowner"certifies and asnanes respowaWlity►for Compliance with the State Building Code,City of Nordnampto n Ordinances,State and Local Zoning Laws and State of Massacknotts General Laws Annotated. Homeowner Signature r SEcnoN5--DES9R"QtWPROPO$EQVIfbRK(tlMectr. b�e1 New House [] Addiidon 0 Or�C� moo`$) Q R � Accessary Bldg. ❑ Demormon C7 New suns x3i Docks um SkSM M Otlw tdj Brief Description of Proposed Work- Alteration of wasting bedroom Yes ''a- No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes ° Plans Attached Roil -Sheet a. Dsa w b:siio�.g:^: c Twn F ;r Other . b. Number of rams in each family unit Number of Bathrooms c. Is there a garage attactred?,.f� d. Proposed Square footage of new construction. Dions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form aged? h. Type of construction I. Is construction within 100 ff.of wetlands? Yes No. Is construction within 100 yr. fioodplain Yes No j. Depth of basement or cellar 111"bekrN finished grade k. Will building conform to the Building and Zoning regulations? Yes No_ I. Septic Tank _City Sewer Private well car water Supply SECTION ft t)M1flM �•ONYNi�'tSAG�l�1't"O�t' 0 .� i,_ l 1 i L�4/e`e/ .as Owner of the subject property I .�.L _ hereby authorize _-7—/rn O l /LL/ �,I . Lu G E _ to behaff,in aN matters relative to od�v r c b5►tl>ss budding p��. Signawre of Owner Dabs 1, Ti m o L y .as OwnedAuthorQed Agent hereby declare the s mmoft and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pairs and penalties of perjury. 1/ MDR J LuC.E _ Mint Name C .3 2_9 , .. _. ,) Signadae of OwnedAg t Section 4. ZONING MI i o&mtkit Must Be Completed.Permit Can Be Denied Due To ku=Wete krtormation Exisft Proposed Required by Zaniag - Ibis cobum to be MW in by BuilftDgwun u :r Lot Size I r ► ; t r Frontage Setbacks Front Side L•= R:f Rear C �^ Building Height --- Bldg.Square Footage ( % Open Space F~Q.M am n� X mi #of Parking Spaces —� —� Fill: ; (volmea Lo 7 A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES Q IF YES: enter Book �_— I Page�i,� t and/or Document#S B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW Q YES Q 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 0 IF YES, describe size, type and location: D. Are there an proposed changes to or additions of signs Intended for the property? YES 0 NO Q IF YES, describe size, type and location: l E. Will the construction activity disturb( 9radkng,excavation,or filling)over 1 acre or is it part of a cortlmon plan that will disturb over 1 acre? YES NO Q IF YES,then a Northampton Storm Water Management Pemlit from the DPW is required. L City of NortpOmpton Building Department 212 Main Street Room 100 Northampton;-MA 01060 phone 413-587-1240 Fax 413-587-1272 APPUCATION TO CONSTRUCT,ALTER.REPAIR.RENOVATE OR DEMOLISH,A ONE OR MO,FAMILY MUM NG �SEC1701�C1 S1T,EgiFK?RMA'FIOld - 1.1 Property Address: `�Y ti �- d r S PawkRTY _ E 2.1 Owner of Record. Craned Meft f' Uri M'�c - C' Cc 09' Telephone signatw+e 22 Authorized Anent —rl T. L U C-E -? 0 >oX l FE� � 610S,3 Nerve — Cwwt Melling Adams: / ®--- 41 - 387- g8od soiakme Telephone :.$EGr10N43 EtMATHkE30NSTTF7EMOtV t.Q: Kam'- Estes Cost(Dobers)to be officM Use 0* 1. Building / / otildurg Pearl Fbe 2 Eledrtcai J Costsrf 3. Plumbing P 4. Mechanical(WAC) 5.Fire Protection 6. Total=0+2+3+4+�,) Q*&Number . -"TirisSecti�mhE> flse - Buirdng Pemut lVtirnber _" Signature: F B&ftC*wft ionwfiwpector_of' Date VE BP-2006-1034 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-1034 Project# JS-2006-1536 Est.Cost: $2650.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin TIMOTHY J LUCE 149288 Lot Size(sq.ft.): 5880.60 Owner. DURKEE MARY A Zoning: URB Applicant: TIMOTHY J LUCE AT. 30 FAIRFIELD AVE Applicant Address: Phone: Insurance: P O BOX 14 (413) 387-9800 LEEDSMA01053 ISSUED ON.41412006 0:00:00 TO PERFORM THE FOLLOWING WORK.-SHINGLE ROOF OVER 1 LAYER 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 4/4/2006 0:00:00 $25.00369 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo