23A-015 (3) 'AiiK`ST BP-2004-0257
GIS#: COMMONWEALTH OF MASSACHUSETTS
} CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0257
Project# JS-2004-0379
Est. Cost: $0.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
use Group: Homeowner as Contractor
Lot Size(sq. ft.): 34717.32 Owner: FITZGERALD HAROLD R
Zoning: ORB Applicant: FITZGERALD HAROLD R
AT: 18 PARK ST
Applicant Address: Phone: Insurance:
41 MAPLE ST
FLORENCEMA01062 ISSUED ON:9/9/03 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL SHINGLES ON PORCH ROOF
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 9/9/03 0:00:00 12948 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
ss is ,e 7.1.tissfiiell'e.i.siI7inlitersr is: -
City of NorthamptoninKitlaBuilding Department ur44ariiJ' ktpCriirt -3's r
212 Main Street 3' r'raaaf`i r'rA,ilarfr _ _ -
Room 100 rrfj.Yr*f.^O1i �r� t �1R�4=
Northampton, MA 01060 fv"X'a'l3Dr�Y4�re�+.0bt�
phone 413-587-1240 Fax 413-587-1272 t .?kteti-._
D er.peojs` - ,k.
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address Thrs section Yob 6,16.1 d by afhce
�A Q S1nC-Q MaPMofelni -Dffi f `et[i k* ' itv
�` � Zon — . Overa Dlsti ,rte'" 41'
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SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
1 i �� s� •------` _ r F1c7Pr._.�
Nemec . t) i� Cs-rent t a l p a7. ess
L �.re L
(4 ,celenhone7
uthori ed Atent:
re' G
n, Sc�
Name r' - r Current Mai'Ing Address
1 -. -
Sign.ture V� _ Telephone
SECTION 3 - ESTIMATED CONSTRUCTION.COSTS.
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
.. Building (a) Building Permit Fee
rca'. (OM timated Total iClost s'
'Construction from (6)
3 Plumbing Building Permit Fee
5. r eProtection S !.
6_ Total =(1 + 2 + c + "c) I I Cneck Number /2-7 8 . I
This Section For Official Use Only 7 e>71/20c,_ _.
Building Permit Number. 1,o. ?wy—OzIS-2 Date Issued:
Signature: 9 �3
Building Commissioner/Inspector of Buildings ate
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing 7 Proposed Required by Zoning
This column m be fitted in ei
Building Department
Lot Size
Frontage
Setbacks Front
Side L. R:
Rear
Building Height
Bldg.Square Footage —.... �% ..... .—..
Open Space Footage °(Lot area minus bldg&paved
Parking) _ 1
q of Parking Spaces
Fill:
(volume&IGcat on)
A. Has a Special Permit/Variance/Finding ever been issued for/on the sdo?
NO DON'T KNOW YES .
IF YES, date issued:_,
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Toc_mer
B. Does the site contain a brook, body of water or wetlands? NO N'T KNiLDL
YES
IF YES, has a permit been or need to he obtained from the Conservaticr- ,.or.,misS Y'
Needs to be obtained Obtained , Date Issued.._. __ .. ..
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:_,,,,,,
D. Are there any proposed changes to or additions of signs intended for the oroPerp ' -._ _
No
IF YES, describe size, type and location:_
a
OsE0 mI? Re POSE•i*OR k che'k ail Ir •Yes v-
C 0 9P
---ea.a-«.. maee•,. x.^.:s^moi
New House ❑ Addition 0 Replacement Windows Alteration(s) C Roofing dC
Or Doors ❑
Accessory Bldg. 0 Demolition° New Signs [ ) Decks [ ) Siding[ ) Other (
Brief Description of Proposed Work. �- vr^r✓LI rOrr7— • / ,;.4jtt.A_rQ ) __
Alteration of existing bedroom Yes No Adding new bedroom' Yes No
Attached Narrative 0 Renovating unfinished basement Yes _
Plans Attached Roll O-Sheet 0
.€a Aeeattos a or. aibtm4taaeXisfing-hoUsiIf do ii ie#eYt/'hextdRB 7iTfa.
a. Use of building : One Family Two FamilyOther •/ ff
b. Number of rooms in each family unit- 1 Number of Bathrooms_, l _
c. Is there a garage attached'
d. Proposed Square footage of new construction. Dimensions
e. Number of stories" -- 3
i. Method of heating? Fireplaces or Woodstoves Number of ea..
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached'_ -_..
h. Type of construction
Is construction within 100 ft- of wetlands? Yes No. Is construction within 100 yr floodplar. •_.-
I- Depth of basement or cellar floor below finished grade
k Will building conform to the Building and Zoning regulations? Yes No
I. Septic Tank A City Sewer Private well _ City water Supply
;,5'ECiF o • •W14II-IERAUTHORIZATION 'TO BE COMPLETED WHEN
,'OYt Et.7"f D CDNSRrSOTOR'APP.t'I ES FOR'BUitDING PERM77'
i S 1
hereby authorize // . .... / 040ls/ /
my behalf, in 't t ers rela - toor... /� d¢ th•s building permit application_
� by
.2=- 03
Srgnature of Owner Date
as Owner/Au1-15: : . -
hereby declare that the statements and information on the foregoing application are trueand amt -am o thr
knowledge and belief.
Signed under the pains and penalties of perjury.
riot Name
Signature of Owner/Agent Date
•
SEG„2111,1 CONSTRUCTION SERVICES
8.1 Licensed Construction{,Supervisor: Not Applicable ❑
•
Name of License Holder '. r �[-/lilt '% s !Lk
� License Number
(k( drat,•-Q Ly.a Ak. ) Pit The/
Ads Expiration pate
l __ C _ 7 S
Iignatux- Telephone — / S
are: sCO':'ome n,nrowemerf- in rac o.♦[:. 2„ 5-,v 88frfki•W. r";; /I* Not Applicable 0
Company Name Registration Number
Address Expiration Date
Telephone
agilafilN(DOERS oCsOMPENSATION INSURANCE-AFFIDAVIT(M(G.L..c. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide 'his aeice'.
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes ❑ No...... ❑
.."v3 or.A B ''d-D 0.nne.JItFP�b:6IIApAtol1.
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or two(2) ranchte
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 he
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from lime 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 Ch aper 153 iltiabilier of Employers a
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated, you may be liable for perscirfs
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code. City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
"
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Northnmpbr.. Mess. 0106'ii
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DEPARTMENT OF BUILDING INSPECTIONS U `
INSPECTOR 212 Mann Street • Municipal Building
Northampton, MA 01060 —
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as Lis/her construction sup_:Hsor. 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 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