17C-165 (2) l
M-52 High Street, Florence, MA 01062
1st floor 1st floor
52 High 50 High
Dining room Kitchen Kitchen
Dining room
Living room 4
Living room
Front door Front door
2nd floor �;o,� till* 2nd floor
52 High f L> ;`' 50 High
v M
E E
Bedroom 3 00 rathroom Bathroo L
Bedroom 2
m
Bedroom 2 Bedroom 1 , 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.
���iAMpl,
�ASSACliliSttt4 n '
IF Tify of Worthainpton
�-, DEPARTMENT OF BUILDING 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 has/her construction sup .:l sor. T he state defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be,a die or two fit X
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 buildinz 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
�a-r 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.
Daze
Address of work _
location
r
Lo 10 c_- /`2 o%06,2
F{ 6� (rii of �,Tcrrf1la11ip!011
I =
�Zsssit chnrefla'
i w•`
o DEPARTME1dT OP DUILDD�G INSPECTIot''s
212 Main Strcct Municipal Building
?Northampton, Mass. 01060
`N'ORKCIt'S CGIMTENSA'MN CgSURA-NCE AT,MA.VIT
(Ir CC:IIS.^.Cf(X:ri11J IICC)
principal place of businessfresidence at: — -- -
(phone:')
ry/a.Ltc/a p)
do hereby certify, under the pains and penalties of pcgusy, hal
I am an employer providing idle following Iworl:cr's cofnocas oo, covemse for lny
I etnplovccs wor�orlg on Ulis job:
1
j (tcsuran=Corer m') (Pabc-,Numbcr) -- (r:-pirz or, D24.)
I
( ) I am a sole proprietor, general cooa-accor or homeowner(ci c:e one) aid lizve hued
the contractors Gsted below c-rbo have the folio%vino workers compentzaon policies:
I
(,Namc Of Contncior) (InR rancc-Compare)-P1P1 OUC-, NLLMiC)
1
(Name of Coofraor) (inssrznec.Compan-vrpo!.im, NUmbr ) (%ipir-don Date)
(Name of coaina .) (tnstuane Compa.n}/PoUq- N:=kj) (Expimdon Date)
(Name of Contmmor) ansuraac-c Comrazy/PoUcy Numb-r) (Etpiradoa Datc).
(na1G}3 sdiitoc�!rSc�.if acccurr•w c>GU�-taforma;oa pcnri�w..tl axa-r..o:-a)
I
O I am'a sole proprietor and have no one working for me.
I am.a home oNvner perforraing all the work myself.
NOTE:pl=se be cwsn to"•t le 6emcoµocrs vto c=pjay pc,O,=to do x-.=00 Cr tgair work oa t d-M-U--Z of
mot Mott th_n is wh;ch tfae bomoawne rta=da a oo the IIouac's zppurtea.=rs the rl L e we Ca Jty oeerd=cd to tY
eaploy— the-- rs'Z c=np ---+�cc Aa(GUI Sts+1(5)),applteaooc by s b n.%-ocr fv c Gczr-_cc Pcmit rosy n46—LL-
lc-gal ct=u of sa c=Ployx uodcr d> Wohdc C.omy«u.Ziou ACL
!
I uadcsraad dad a oopy of dais mt ww==ov y be focwurd.d w rbo Dopnrtmtar of Acddz%Y Ofroa of fa.y+noo roc tbo
oovcra&t veil c 31ioo and tau fihac to:ovrc lovermVe undo socsioa 23A or MOL 151 m Imd to the impasitioa of criminal pcuslsics
ooasi�in of a fiat orup to S Q00.00 arfdto[6mpri of up to ooc y=,and civil pmihuc i-d-form 0"Stop W-A Ordc acrd a
fim 0(:S I OO.DO s day Lplx%51 me
� fa dcq.rca+�ux ail7 -
i
Pc.Tt$tt j`Iumbc-r
OKr LOf.°.
Sil,oaturc of Lio=iscc/Pctzniucs e l
SECTION.8-CONSTRUCTION.SERUICES t
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
PP
Not Applicable ❑
.9 '2eas�eie�i�one ii�orovemen�°ontracto ..i ��� ' �"
Company Name Regisfration Num er ----- --
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT
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 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' ertifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,S to/ d Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature /
r
SECTION;5-DESCRIPTION'-OF-PROPOSED WORK(check altanblicable)
New House ❑ Addition ❑:; Replacement Windows Alteration(s) F_� Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[E-3] Other[E:]
Brief Description of Proposed r
Work:. O ?7`s--- _` _c tY � Re",4 - �0
Alteration of existing bedroom 1t Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
tia.- ty�W 10175�'an. tiltl�D t�QeX1S#!!][t 10) SliLq: onaptetethe folta lnrt:
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
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,OWNER At JTHORIZATION.-,TO,,BE.COMPLETED WHEN.
w ,
OWNERS AGENT;OR CONTRACTOR`APPL tES'`FOR BtJ1LDING.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
4pe y)(= ,as Owner/Authorized
Agent hereby declare that the statements an information on the foregoing application are true and accurate,to the best of my knowledge
and belt
Sign un er the pains and pe e f perjury.
Print Name
Signature of Owner/Agent Date
Section 4. ZONING All Informati6h 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 I i
Frontage
Setbacks Front
Side R: L=R: I
r.� 3
Rear
Building Height '
Bldg.Square Footage ; % � --I -
,
Open Space Footage �j %
(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 0 DON'T KNOW (D YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 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 ( DONT KNOW Q YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued: E
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location: 1
D. Are there any proposed changes to or additions of signs intended for the property? YES 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 r NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
r w
City of Nortf;lampton
Building Department
212 Main Street
Room 100
Northampton; MA 01060
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1.-SITE INFORMATION
This section to be comp%ted by office
1.1 Property Address:
x �'
tlAap r Lot I into
Cn Z Zone: OverlaD�sfrict
�>dmD�$tr►ct � ' := �� GCB Distract. ,
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
►�jL,i 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):Building Permit Fee
2. Electrical '-,(b).Estimated Total Cost of
Construction from 6
3. Plumbing C00 i Building.Permit Fee
d _.
4. Mechanical(HVAC)
5.Fire Protection
6. Total=0 +2+3+4+5) Q 7 Check Number
This Secfion For Official Use Onl
g .. � Issued:
Building Permit Numbe
Signature:
i
Building Commissionedlnspectorof'Buildings Date
File#BP-2005-0227
APPLICANT/CONTACT PERSON HOENER DONNA
ADDRESS/PHONE 198 STATE ST NORTHAMPTON (413)584-4003 Q
PROPERTY LOCATION 50&52 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
Buildin Permit Filled out
Fee Paid
Typeof Construction: REMOVE N N-BEARING WALLS,EXPAND BATHRROM&ADD CLOSET
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:
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 Co ssion
It
9 1 G
Signature of Building Officia 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.
50&52 HIGH ST BP-2005-0227
GIS#: COMMONWEALTH OF MASSACHUSETTS
MamJk: 17C- 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-2005-0227
Project# IS-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 Shmature:
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