44-103 (2) 1
n �v
0
In A
th
t16
ii iw FLr%l w wmi 11-w , ,.v,r,
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
NOTE:
SUBJECT TO EASEMENTS AND >y
RIGHTS OF WAYS OF RECORD.
BOOK 9618, AGE 303
PLAN BK. 12 PG. 6
LOT #
rn
io
rn
,/ FF
f-3
CJ?
�C
1V -j G"
of G}
�=• � ti rt 1
1
L=11
ROCKY HILL ROAD ROUTE 66
TO: PEOPLESBANK AND
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #250167
-NOTE-
SURVEYOR:�� �.
AND DOES NOT A PURPOSES
CONSTITUTE APROPERTYSURVEY
OF -MORTGAGE LOAN INSPECTION PLAT-
NORTHAMPTON, MASSACHUSETTS
RAE ALL PREPARED FOR
IZER y DOMINICK LASAPONARO
!35032 SCALE: 1"=60' MARCH 8, 2013
- HAROLD L. EATON AND ASSOCIATES, INC.
SURV REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSETTS
- 4
4
CITY OF NORTHAMPTON
Cons' tructlon Debris Affidavit
In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work.
-- =: - -covered.by-a-Building Permii shalt be disposed-of-in a-properly licensed.disposal facility,
as defined by M.G.L: c.•111- § 150A. .
Address of Work: yS/ ,E?oelc,4 9, c f tore r r; 114 o 6 Z
the-debris_wfll.be-trans_po.rted by:
The ddbris.will be received:a#:. ' Ca4 c/.h
- Signature of Permit A'p11&ant
'Date 15�
Ruiidin" g Permit Number:
- r
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS r.1
y " 212 Main Street • Municipal Building yJt .b
Northampton, MA 01060
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 inspections are made
�tls pp d �&o understand the above.
(Home owner/resident'h 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
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/organization/Individual): Dom io I6 LQ<ct pay is r,5
Address: 14 31 PR p e k,l a a c
City/State/Zip: F1 d ce , M N Phone M /�/3 s8� Z S' 7
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. F-1 New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. F-1 We are a corporation and its 10.❑ Electrical repairs or additions
3., I am a homeowner doing all work officers have exercised their 11.F-1 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic. M Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the p ins and penalties of perjury that the information provided above is true and correct.
Signature: y Date:
Phone# 13 �g� `t(Z 5"7
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable £
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9._Registered Home.Im prove metit Contractor Not Applicable £
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...... £
11.'-.Home Owner,,Exemption
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 buildine 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 and Local Zoning La and State of Massachusetts General Laws Annotated.
Homeowner Signature. 0
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition EQ Replacement Windows Alteration(s) Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding [O] Other[O]
Brief Description of Pro osed ss d` 1 11 � i
Work: Keyn&a;& l XrS�iV =s ckect� ar-J 'Ad A (vt/r14 T�O�In ;n A-kt- ��� "�� ��` �6 i h� i2 X (�
Alteration of existing bedroom Yes No Adding new bedroom Yes ✓' No
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Roll -Sheet
sa:If New house and or-'addifon to"existing housing, complete the follownd:
a. Use of building: One Family ✓ Two Family Other
b. Number of rooms in each family unit: �(�_ Number of Bathrooms
c. Is there a garage attached? _
d. Proposed Square footage of new construction. ��Z Dimensions
e. Number of stories? / , �_
f. Method of heating? el,P c'�� /�6f /to4Jer �C�ctf Fireplaces or Woodstoves�_Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction i'VG'4 7t-4n11_--'t 4 n11_--'
i. Is construction within 100 ft. of wetlands? Yes V, No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade Z-/"C -
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 FOR.BUILDING PERMIT
1 as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
1, O Vh tN tC L0.SAP d r p. as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
D D V11 i Yl L-•,
k Gt5 ck S(A . d N a(\r)
Print Name
A� 51/0 )
Signature of Owner/Agent Date
^ ^
Section 4. ZONING AR Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
'nis column to be filled in by
Building Department
Frontage
Setbacks Front
LL�L RE
Rear
Building Height
Bldg.Square Footage 9/0
Open Space Footage r7. %
(Lot area minus bldg&paved I
#of Parking Spaces
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
xDl �~� �~�
NO ��' DON7KNOVY �~� YES �~�
|F YES, date issued:| |
IF YES: Was the permit recorded at the Registry of Deeds?
NO K J DUNlKNU 'ES
�� YY
IF YES: enter Book Page and/or Document#
��
D. Does the site contain a brook, body of water orwetlands? NO o�� DONT KNOW �=� YES
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs tnbeobtained v,� Obtained «—� Date Issued:
��� «_� '
C. Do any d ��signs YES �~/ NO
IF YES, describe size, type and location:
D. Are there any proposed changes toor additions nf signs intended for the pmpert 0 y� YES NO .�Km�
IF YES, describe size, type and location: ( |
E. Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre orisd part ofa common plan
that acre? YES K 3 NO K��
. x~� "�~
IF YEG,then u Northampton Storm Water Management Permit from the DPW ia required.
w'.'. pepartrteht use ortlx
V�ctr,- City of Northam pton 'Status;ofPer�� Building Department 92014 p 212 Main Street erl5e ticRoom 100 :W a te--- -- foras Northampton, MA 01060 Twa Sets ot5tructritai Plans Php 13-587-1240 Fax 413-587-1272 Plof/Site Plans . a
�- i r k f
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
1.1 Property Address: This section to be'completed by office
Map Lot Unit
Zone : Overlay D►strrct
Ibrt?v►ce , M N.
i
Elm St Distract C8 DiStnct
SECTION 2. PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
DOMIy1iC11 I.-ascapc 11urC2 -43
Name(Print) Current Mailing Addres :
p Telephone
Signature �1-3
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 ermit applicant
1. Building (a)Building Permit Fee
2. Electrical i i n G (b)Estimated Total Cost of
Construction from 6
3. Plumbing C7 Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection ) Z GC2
6. Total=0 +2+3+d +5) ' a Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2014-1182a
APPLICANT/CONTACT PERSON LASAPONARO DOMINICK
ADDRESS/PHONE 431 ROCKY HILL RD FLORENCE (413)586-4257
PROPERTY LOCATION 431 ROCKY HILL RD
MAP 44 PARCEL 103 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out /L!/I IS
Fee Paid
Typeof Construction: REPLACE DECK W/12 X 16 DINING RM ADDITION
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
INFQRMATION 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 Commission Permit DPW Storm Water Management
Demolitio Delay /
4Signa 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.
431 ROCKY HILL RD BP-2014-1182
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:44- 103 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Permit# BP-2014-1182
Project# JS-2014-001999
Est.Cost: $10300.00
Fee: $96.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 59241.60 Owner: LASAPONARO DOMINICK
Zoning: Applicant: LASAPONARO DOMINICK
AT: 431 ROCKY HILL RD
Applicant Address: Phone: Insurance:
431 ROCKY HILL RD (413) 586-4257 ()
FLORENCEMA01062 ISSUED ON.511612014 0:00:00
TO PERFORM THE FOLLOWING WORK.REPLACE DECK W/12 X 16 DINING RM
ADDITION
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:
FeeTyne: Date Paid: Amount:
Building 5/16/2014 0:00:00 $96.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner