17C-165 b
r
411-52 High Street, Florence, MA 01062
1st floor 1st floor
52 High 50 High
Dining room Kitchen Kitchen
Dining room
Living room 4 i^
1 _. Q Living room
Front door Front door
2nd floor 2nd floor
52 High 50 High
IT
M
Bedroom 3 °o athroom G�q
Bathroo 0
Bedroom 2
cia
ai a
Bedroom 2 Bedroom 1 o '0
n Bedroom 1
1st floor 50 High street
Remove non-load carrying wall to combine kitchen and dining room.
2nd floor 50 and 52 High Street
Expand bathrooms and add hall closet by removing existing tiny bedroom.
The small bedrooms were added to accommodate expanding families.
Add sinks to both bathrooms.
4�1iAMp�,
,.Crzfy of Wart4amptan
�11ASSACltliSttt3
ms`s
DEPARTMENT OF BUILDING INSPECTIONS /
INSPECTOR `2112 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 his/her 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 fami�--
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 r'.egulations. 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
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 -F,"��
r
i
V oreesC(I- M,a 016GZ
i
o c �ti Crri� of �'To ;fljaiiip!01-1 – _—
I o DEPARTMENT OP BUILDrN'G INSPPMONS
212 Alain Street Municipal Dudding
INiorthampton, Mass. OIOGO
I
WORIa. R'S CO1IATENSA-a0N CgSURA.-NCE :'1FFMA.VIT
I, --
� (IiccnsxJprnnittcx) .-. ---- ---
%,.rith a principal place of businessfresidence at: --- — -- -
gone-')
(saz~.tici tyls=dzip)
do hereby certify, under the pauns and penalties of perjury:, hzi
( ) I am an employer providing the following�xvorkcr's colnocnsado, cove.-'se for Ind
emplovccs worong on this job:
i (irnlr��Coar ) (Pobc-,?l,'u-ter) (-pirvor, Dom:.)
i
O I am a sole proprietor, general contractor or homeow-Der (ci cae ont) aDd have hired
the contractors listed below wbo tuve the following worker's cac-2pensa6on po.!icies:
(L qm-, Of Con- Mccor) (In-,rancz Cotnoany/-Poiicr Numh-_:)
1
I (Name of Cootrctor) (LFs-waacc ComoanviPolin `uric^r) (L»iraon Date)
(Name of Coaa-aelo,) Qnsurauc:Compan y/Polio- Numbu) (Expirz600 Date)
I
j
(Name of Connaaor) (Itzsuran Comp
uy/Poticy Numbs) t'Explradoo Darr).
(aaac��unoc�t r'�ea if ncee,.y w a�c!v�iafo�ioo pertn iaia6 to.0
O I am 'a sole proprietor and have no one wort ng for me.
I am.a home owner performing all the Nvork myself.
NOTE:plea be zwut Lh, •1 .1e hemcawvcn..bo emplaX p,,,.Lo do c. �, -ciao c rgau wori on L d..ctt_Z of
a t Mott the '•re=fa in«-yeh the boa o wnc mido or oa[be pouoc.4 zpPurtcn.,=tbQ-,-n LT«x oc-=rd=ci to be
ci00yes vale the..ui eti O=PG c.Act(GUI 32-=1(5)).mpptinboa b-f a bomcoQaa fora 6-a Pemit rr y--id—tbe
IcVI naau of ea asployer uoder d,o WoAcet Compoa3.lioa Aer_
- [undc-ra.ad thrt a Dopy of lhi+mtrmcm m..y be for-+.vd.d so the Dopdrtmco¢of In�+xriJ ncedv:a�'Oir—or 4s—u —ror the
cover Zc vc•iL C=Iioe a_-td th_t L•skat to savrt'eovRx&c Sys yoaioa 23 A of MOL 132 C=Irsd to the=P.Sidoa of aimiosl P-1 i-
ooasisiag of a fiat or up to S t}00.00 anNor of up to Doc yr= aad ci it pcaJtio io tSc form or.StoP Work Ord=aad■
fun 0(:S 100.00 1 day aP!Moa WG
I' For dcp.star_,-�I u.e only -
Pctmit Numbcr
Lot n
Si
rpattur of Lic sctJPcrmittcc e j
SECTION 8-;CONSTRUCTION SERVICES t
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
Not Applicable ❑
:9_ei�is�ere�'t o�me�mmpr ee� *�
Company Name Registration Rum er _____- --
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION'lU8 IRANCE.kpA L•ViT(M.G :-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...... ❑
Irt
. Un
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" rtifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,S e d Local Zoning Law and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5-:DESCRIPTION.OF-PROPOSED WORK(check-all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[0] Other[lam]
Brief Description of Propo
Work:
Alteration of existing bedroom _Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
,vxe< , �e° .aF,nE°�.:sl�°"� `� � � ors •.- "^. :TS�S.,"
sa.[ i?tn� se' n orasexistinctiorstl�gcomDletotlo�frlu:
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. Masscheck Energy Compliance form attached?
h. Type of construction
L 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:-,OW, NE, R AUTHORIZATION ,TO BE COMPLETED WHEN
OWNERS AGENT,OR CONTRACTOR APPLIES F6'1 BUILDING-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
as Owner/Authorized
Agent 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.
Print ame
2y D
Sin re of Owner/Agent Da
Section 4. ZONING All Informatibiti 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:! I
Rear
Building Height -----
Bldg.Square Footage
9
Open Space Footage % y—(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 Q DONT KNOW 10% YES 0
IF YES, date issued:?
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW N%� YES 0
IF YES: enter Book i # Page! and/or Document C
B. Does the site contain a brook, body of water or wetlands? NO DON-r 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:
I
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location: S
i
D. Are there any proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location: ; --_—
t
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 r NO
i
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
__.flU Northampton
f� EB Department
lS 1 ain Street
i� , .
i om 100
a "
AUG 2 4 20C4 o ton; MA 01 060
1� phone 413- 87-1 40 Fax 413-587-1272
Ll
AP TER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION.1 -SITE,INFORMATION`
This section to fie compfeted by office
1.1 Property Address:
E
15 0 0 i
O Z�otla` A, OYErIaj�Dlsfrlct
�EIm��D trio
ME 4���CWDI—stE?ct_.. ,..
SECTION 2
-P I ROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: L
Name(Pri nt) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3'-ESTIMATED CONSTRUCTION:GOSTS '
Item ~ Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building L (a).Building Permit Fee
b Estimated Total Cost of
2. Electrical i Construction from 6
3. Plumbing Building Permit Fee
C>nU ---
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) O , Check Number
This'Sectieri For Official Use Onl
; Date,
Building Permi(Nurnber.` Issued:
Signature:
Building Commissioner/inspector of Buildings Date
File#BP-2005-0226
APPLICANT/CONTACT PERSON HOENER DONNA
ADDRESS/PHONE 198 STATE ST NORTHAMPTON (413)584-4003 Q
PROPERTY LOCATION 50 HIGH ST
MAP 17C PARCEL 165 001 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: REMOVE NON-BEARING WALLS EXPAND BATHRROM&ADD CLOSET
New Construction
Non Structural interior renovations
Addition to Existing
AccessoKy 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
INFO 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 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 mmission
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.
5&52 HIGH ST BP-2005-0226
GIS#: COMMONWEALTH OF MASSACHUSETTS
.llc_165 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2005-0226
Project# JS-2005-0279
Est. Cost: $5000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sa. ft.): 14766.84 Owner: HOENER DONNA
Zoning.URB Applicant: HOENER DONNA
AT. 50 & 52 HIGH ST
Applicant Address: Phone: Insurance:
198 STATE ST (413) 584-4003_()
NORTHAMPTON MAO 1060 ISSUED ON.8126104 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE NON-BEARING WALLS, EXPAND
BATHROOM &ADD CLOSET
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• Receipt No: Date Paid: Check No: Amount:
Building 8/26/04 0:00:00 730 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo