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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' is m � x1 ct .-t Elin'S[n ,- D str ct . >,+- .�CB'Dlstpcl - • ' - 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 " . : U)1)1C PS '..i'i0A'S =� 212 Moro Si-rect. ' Municiprd lJt Iuinr = Northnmpbr.. Mess. 0106'ii NORTCER'S CO1'1YTEN5ATTQi( INS.J ANC E AvvFf r—C6-,"8-eice\`Qp{ f e p,1.11ra aatieo.'u( 37aai� ::DIC`•:+'C.':: 11'Jf •n Ua dl;; A) It' 6kc02-_7-0A,_ orsof crpariy1 tr: i . LC; a sole oropmeto _ r : . .__- --_ ha'a '^ezc 01 e n— ,�a'rD ,W., _ .. .,.. • i.tw4P�. O e O't a y;;e Lifp of Xarthamptatt .0f.^._.�ISt a ft aseacIne.ne 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