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31B-118 (3) m } a Q - BP-2006-0388 GIs#. COMMONWEALTH OF MASSACHUSETTS '� }` '"h pit CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0388 Project# JS-2006-0563 Est.Cost: $12000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Groin Homeowner as Contractor Lot Size(sq.ft.): 3049.20 Owner: HOME MARYBETH G Zoning:URC Applicant: HOME MARYBETH G AT: 15 EDWARDS SQ Applicant Address: Phone: Insurance: 15 EDWARDS SQ (413) 585-8964 () NO RTHAMPTONMA01060 ISSUED ON:10/13/2005 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT BATHROOM IN EXISTING & NEW PORCH SUPPORTS & REPLACE ROOF OVER POST TIIIS 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: FeeTvpe: Date Paid: Amount: Building 10/13/2005 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2006-0388 APPLICANT/CONTACT PERSON HOME MARYBETH G ADDRESS/PHONE 15 EDWARDS SQ NORTHAMPTON (413)585-8964 Q PROPERTY LOCATION 15 EDWARDS SQ MAP 31B PARCEL 118 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 5020 4543 Typeof Construction: CONSTRUCT BATHROOM IN EXISTING&NEW PORCH SUPPORTS&REPLACE ROOF OVER 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 INF ATION 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 f2-- Signature of Building Official 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. n Department use only Northampton Status of Permit Department Curb Cut/Driveway Permit ting d'Maln Street Sewer/Septic Availability 1 Room 100 WaterNVell Availability ortha pton, MA 01060 Two Sets of Structural Plans \\ ;\\ QC,( 3h1on 4 3-587-1 40 Fax 413-587-1272 Plot/Site Plans } Other Specify AP/17XATION CONtirfit. ETER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: J � f` S Map Lot Unit A/0 � Zone Overlay District =Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: PI a hei-4 7/0,7, e_ Name nn CuZ ? - ?71 ent Tephone 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 permit applicant 1. Building /. V() �/I (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number 07.73670 0,3"0 This Section For Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date R Section 4. ZONING All Informatibn 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 Frontage Setbacks Front i j Side L:f R:r L:' ! R:1 I L Rear i Building Height r • r-: Bldg. Square Footage ( 1 % r I Open Space Footage % (Lot area minus bldg&paved I I i__ i ' i i parking) • r- #of Parking Spaces Fill: (volume St Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page; and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? • Needs to be obtained Q Obtained © , Date Issued: C. Do any signs exist on the property? YES © NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO to 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 O , tP NO Il ) IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 1 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) 0 Roofing El Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [I= Siding[0] Other[0] Brief Descripti n of rop e - r Lo ,u , Work: Oh 0 a/A ,y.' . fi exi-s me- roe^A Weal «iC.�/'e-- / Alteration of existing bedroom Yes r/No Adding new bedroom Yes V—No FP 0 1 V k(}o . Attached Narrative Renovating unfinished basement Yes �- ki No C J� ,V/p/7r_ e iv Plans Attached Roll -Sheet l� sa^ New hauseand-oradditiQ ta-exrsfinclhousfnct;co"rpletth`e. : FOf 1�- a. Use of building:One Family np Two Family Other 1 V ` L✓ 5 u072 j b. Number of rooms in each family unit: 7 Number of Bathrooms .Z c. Is there a garage attached? / 7 L) 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 AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES F R.BUILDING:PERMIT I, a / -8/IK ,as Owner of the subject property /�,, hereby authorize v� d - � to act .• y ehalf,in all .tte -lati .� o, authorized b this building permit application. / .,...L ' ♦ / /6 /o Q Signature of owne i Date I, as Owner/Authorized Agent hereb decl raet sta em nts and inf vft atio.n on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under th pains and p nalties of perjury. et ►may b e ftiWO m� Print Nam \ / Signs re o Owner/A t Date SECTION 8-CONSTRUCTION SERVICES r 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9_Reti Stered'Homefimiii6Variienttaiii acto IIIME Not Applicable 0 Company Name Registration—Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) 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 0 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 building 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"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State Local Zoning Laws Massachusetts General Laws Annotated. Homeowner Signature , ¢rOOy /.. - �_ „4' `�4ctt..A...Ltp2,.. `;e (.±[- of '.sTarflialll3foil J 5 � E .51a31Rrlit:srtts• _ DEPARTMENT OP nuI LE)r>c INSPECTIONS it as t 212 Main Strcct ' Municipal Building 1•Torthamplon, Mass. 01060 1 _ «-OR1Q R'S COM ?ENSATION C•?SURA.NCE AFFIDAVIT • (i ccnsx./perr i tine) with a principal place of business/residence at: . (phone") (su iJcirJ/statdap) do hereby certify, under the.p2ias and penalties of perqury, h2i • ( ) I aln an employer providing the following worker's compensation coverage for my employees wor dng on this job: - (I_suranc Comp) (Polio:Ntu-nbcr) (:-pirarion Dain) ( ) I am a sole proprietor, general contractor or homeowner (cilcie one) and have hired the contractors listed below wbo have the following worker's compen_cadon policies: (Na.rnc of Co tcior) (Insuranc Colnoan}-i?o ic— Ntunixr) (Expire uon Datc) (Namc of Contrcior) (1nsw-auc CompaawPoder Ntl.mirr) (Lxoirauion Date) (Name of ConnaRor) (Insurai:c Company/Policy Number) (Expidon Datc) • . (1`a131e of Contraetar) (Insurau Compury/Policy Numb:r) ( -Minion Date) . (act.h:ddi oo1 Itt.cCif ncee.+:j to mc?v&infcc=u-oa periaioi-i to.11 ooet~_co-s) . ( ) I am a sole proprietor and have no one woridng for me. ( ) I am.a home owner performing all the work myself. NOTE:pl=se be aorue th••.,t-J:c heraeowxs wtio comp tay pa-co,:,.,to do r-,f —. crr.10e a rzcaa v.-Oft oa a d.•�..11=c of not morn tar-;t..`-o tmi'J is L icit ttx bomoo o -raid=or co the uou zop,:rten_=tbe-.c a_t not ' 11y eeeid.—ol to be ctploy - uaGr the t ui;ez cr• ,-_-/i o Ac (GUI S2^.1(5)),pplicaaoo by•bocc o0.aa fc_tis_or pant tLy ctidmoc t1:c lc-ga.!.U.S.of eo o=ploy.r under die WotIcola Cocr po ..tloo Ad. I to dcrs+nd that a copy of thi.etemool may b.focc.a,-d.d to Lb.pep.rtm.,oa of io ...rr;J Accdoard Office of Its..r•oo.for tb. eO"'-- c rctrc:Iioa'd t1'1 Csltac to scout:'covcrItze¶n-, --soaioa 23 A of MOL 152 t3a l 4 to the im2positioa of airmail p c-Iris roc,--;-cg of a fioc of up to Sl.500.00 and/or imprnocmocln of up to one ycor Lod coil pm.tio it.be room of.Stop Work Ord.end. fjnc of S 100.00 a day tezirol me For dGs.rt+= u.c only Pcrralt Numbc: • Mip-__ Lots If Sipanuirt of LiC:m_tcJPrrmittr- Dace I O¢stIAMp2 tAZtl O .art r of "az-I antptan z __'�-, _ �/, $ mvzikt 1 1835A[itl[5ett5 _ _ e - 1= J_ DEPARTMENT OF BUILDING INSPECTIONS , _ /: INSPECTOR 212 Main Street • Municipal Building ,,.�;. Northampton, MA 01060 e HOME OWNER EXEMPTION ACKNOWLEDGEMENT - The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supc: .-isor. 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 seekto 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 a ! \ understand the above. (Home o n /resident's signat re requesting exemption) I will call to s edule all required building inspections necessary for the building permit issued to me . Date /° /° Or Address of wor i � 1")� rcAS, location a. a hyp ome Matters a. 1,:.*:''71:iii.".. v. wiat, i M i . PCOrrl ,-- - - • . . ... ...--„,-4,....• . . le • _ sti 1 +- .4c,9 S44)(SG.a Marybeth Home S Nowee 15 Edwards Square ►rthampton, MA 01060 iiiii' v (413) 585-8964 <-- S'_o`r_ {" .♦ stoREcir uctu8 \meco t %S 14GW e-0 Hut. ! 8„ qua sw wac,_. Moue CASIMgr M2 . 2)QYwA"-- / ►3SuLATu eso-et lot,w4u. EKHAusr Fia&) `°'I NETE . Te 1p)TO E 1sriu:6 r Is Vt€f!. Ttt- ivJroalcisrio6 _. ._ viv . Fie. 24i-6-IT' 'Pn►,4 Zxog'• _ Lkeoe- µa-rEe14s -louteAwaa-•Teltrivrsc cam_,_ ‘u a - rn4 Ex tsTI 636 E n oe. to pits. ,A me . M A„ t w u- TOT FOE. A sours w o Y10, 310.6d) ._ . _ . .