680890417_ City o f Northampton
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1. 1 inn serking a building permit Pursuant to the homemorwrs' exemption m the permit requirements f the
Massachusetts Smw Building Code, rod�d at 780 CMR 110.R5.13.1, in connection unth a Aect or
wark on a parcel of land m which I hold legal atle.
2 1 am sot rngaged in, and Ore project or work Jor which 1 am seeking the aJoremrntlorwd Immemniwn'
exemption, does not inwlce the field erection f marmfactured buildings mnstruded in accordance with
780 CA4R IIO.R3.
3. 1 qual]y under Ou State Building Code's deftion f,homeowner" as defined at 780 CMR I1O.R5.1.2:
Persons) who owns a parcel of land on which he/she r sides or intends to reside, on which
there la, or is intended to be, a one-or'wo-favtily dwelling, attached or detached structures
essoey to such use and/or farm smoct n A person who constructs mom than one home in
a two-year period shall not be considered a home owner.
4. 1 do sot holdnd unu"'diMaw t sa husetFs Stact-te Bui ding Code's rem exrept to theme sump n'sio t f
q�'ly/O1Q quiremen for
Ow project or work on my parcel, I am sot engaged in m�sbucnon superoision in' ; cno demoliany
tion
pried m wcrk ince ng omstruction, reconstruction, alteration, repair, r or o
innoloing any actimty regulated by any provision of the Massachusetts Suite Building Code.
5, IJI engage t or
any other person or persons hve in connection with t em upennsarfor d jcetm work
my parcel, I acknmoledge that 1 am re d m anddwnill act as the s
gu the pains Z:;Z�!
day of20
(Signature)