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23D-070 (4) City of Northampton •` �.,s.4 3. s�� Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 ss . � INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. 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 project until such time as the proper permits and in ctions are made understand the above. I, (Home owner/resid nt's signature requesting exemption) will call to schedule all required building inspections necessary for the building permit issued to me. Date /S Address of work location y ) dCi /'Va ✓ Ct /Q��� City of Northampton Massachusetts '- DEPARTMENT OF BUILDING INSPECTIONS R, eet • Municipal Building u .. Nor ampton, MA 01060 w DEC 2 8 2015 I G SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION FOR WOOD, COAL, PELLET,CORN,STRAW OR SIMILAR STOVES,OR FIREPLACES Check# P lease fill in all appropriate information JZ 1. Name of Applicant : i Address: l�� ii r"✓� � ��rr��i „�j -Telephoner 2. Owner of Property : Address: 7 l-6✓JVV 1V rrk'l<l'�.-L,�t Telephone: 3. Status of Applicant : Owner Contractor 4. Type or Brand of Stove-:. L� v c� ✓e l�)����lz✓,- /��s �E i 5. Estimated Cost: b U If applicant is not the homeowner:: Contractor name Construction Supervisor's License Number Expiration Date Home Improvement Contractor Registration Number Expiration Date All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit 6. Certification: I hearby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: /:2 � APPLICANT'S SIGNATURE DATE: IC HOMEOWNER'S SIGNATURE APPROVED DATE: BUILDING OFFICIAL 42 WARNER ST BP-2016-0848 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D-070 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cate�)ory: woodstove BUILDING PERMIT Permit# BP-2016-0848 Project# JS-2016-001437 Est. Cost: $1600.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sg. ft.): 20168.28 Owner: ERDT WILLSON zoning: URB(100)/ Applicant: ERDT WILLSON AT. 42 WARNER ST Applicant Address: Phone: Insurance: 42 WARNER ST (413) 387-9537 O FLORENCEMA01062 ISSUED ON.11512016 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL LIBERATOR ROCKET WOODSTOVE 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 1/5/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner