43-063 (6) -941 )t1NPHY DR ' BP-20020443
GIS#: COMMONWEALTH OF MASSACHUSETTS
,,x:43-063 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Gategorv: shed BUILDING PERMIT
Permit BP-2002-0443
Project# JS-20020675
Est.Cost:$1900.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group:
Lot Size(se.ft.): 15115.32 Owner: MCELROY PATRICIA L
Zoning: SR Applicant: MCELROY PATRICIA L
AT: 40 DUNPHY DR
Applicant Address: Phone: Insurance:
40 DUNPHY DR (413) 586-1541 O
FLORENCEMA01062 ISSUED ON10/15/01 0:00:00
TO PERFORM THE FOLLOWING WORK:E R ECT 12 X 10 SHED
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 Sienature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 10/25/01 0:00:00 6007 $25.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2002-0443
APPLICANT/CONTACT PERSON MCELROY PATRICIA
ADDRESS/PHONE 40 DUNPHY DR (413)586-1541 O
PROPERTY LOCATION 40 DUNPHY DR
MAP 43 PARCEL 003 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled oca// .,,,, ,p, ,�
Fee Paid t tOP 7
Typeof Construction: ERECT 12 X 10 SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans r Plot Plan
THE F, LLOWINC: ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFFRMATION PRESENTED:
Approved Denied
PLANNING BOARD PERMIT REQUIRED UNDER:§_ _
Intermediate Project: Site Plan OR _ Special Permit and Site Plan
Major Project: _Site Plan OR _ Special Permit and 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 ion
HCl „S�
Signature of Building 0 sial 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.
City of Northampton
Building Department
212 Main Street rILIEwiE3, -;t4Fs.
Room 100 rlr r-tottlap; _ _
Northampton, MA 01060 .ieire- eil
phone 413-5871240 Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
s T s sect i o-becomplet d' / d +"
n n of Y -
Zo ez,.-ms's a d�rlaY.Distr`�e
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Na •- Print) (� Current Mailing Address: 5-1 /�//
• J \tom" C11h- ((pp U `t"
.- Telephone
.ignature
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
o. Building 4 (a) Building Permit Fee
db0. d O
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection 't
6. Total =(1 + 2 + 3 + 4 + 5) Check Number jj�� p�
I7 1L This Section For Official Use Only
Building Permit,Number: 3Paa 1t17� :. Date Issued:
SignatU(e .,.5. '
BuildingCommissioner/Insp'ector of Buildings Date..
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION_
Existing \ Proposed) Required by Zoning
This column to be filled in by
S
�(q/Q�j �/�Is Building Department
Lot Size /3-(/ JO / .V.
Frontage
Setbacks Front /5--- 1/43 ACt-
Side L: R: L: R:
Rear / O
Building Height
Bldg.Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT 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 Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
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 ere any proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location: eS
� a x'I il •lti•a• EDif✓O•6.'0r6
cv ' [Braille E.:40 urc,..
��..e_ ...,.e. ..
New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing 0
Or Doors 0
Ace- • .. .- 9emolition0 New Signs [ ] Decks [ ] Siding[ I Other[ ]
Brief Description of Proposed Work: J u e. \ ` ,-
Alteration of existing bedioom Yes No Adding new bedroom Yes No
I Attached Narrative U Renovating unfinished basement Yes No
Plans Attached Roll U- Sheet U
i 6 l tlditlffl eligtfi h iiYgtcorF re falbletg:
a. Use of building:One Family Two Family Other
I b. Number of rooms in each family unit: Number of Bathrooms
i
c. Is there a garage attached?
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. Mascheck 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
OWNE'RS.AGENT:OR CONTRACTOR APPLIES FOR.BUILDING PERMIT
I, , 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, , 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.
.PPrriintt^NNaalme ry \\,is p
nature of Owner/Agent b Date
S di` �� _ 1 S'6RlYCTION.SERVIGES*
8.1 Licensed Construction Supervisor: ' Not Applicable 0
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
'ai;YP6:daA'Xli, 11611 R•-,r TIVIR7.1 ;. ;rsMTS-.`.+T:.X.:- S ;:' TT",:''.: Not Applicable 0
Company Name Registration Number
Address Expiration Date
Telephone
SECTION•10;;WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MAL 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
s . ; o
I -died dem• ®<;tee PA'CM n 1;
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 and Local Zoning Laws� and State of Massachusetts General Laws Annotated.
4lomeowner Signature �7 A t:Asia-5x p( LXkof
I.
•
ay 'Pro ' ''\
BAo ' .• Uifg of Norfliattpfnn t e
'7".1%;-1:44,,C14 044•rxssacynstits' _
z DEPARTMENT OP BUILDING INSPPCI'IONS •—s$
212 Main Street ' Municipal Building
Northampton, Mass. 01060 " i'••`
WORICER...,'SCOMPENSSATION INSURA.NCK, APID)AVTT
. Y,/ \ x-s 9i� 22s-_w- Q�(lio '[triffLx}
'with a principal place of business/residence at:
pailleat a e .. V • gn.,. . KW (phone) 5 5l �>- I id )
(6rectfcitylsrtetrip) dt443.- U.,1;SC.a�
do hereby certify, under the pains and penalties of perjury, that:
O I am an employer providing the following worker's compensation coverage for my
employees working on this job:
._ -- n Date)
- (insurnucc Company) (Policy Number) (ExpirationDate)
4,4 I am a sole proprietor, general contractor o tomeowner t lick one) and have hired
fille contractors listed below who have the folio rim ••. . compensation policies: APhci 1 H i va—
1
f". 6M. U1373 )31\ 9 ? t - tr — o- 1 Tow o--t. G•z( .
•t ii e of Con(. ur (Insurance Compavy/Poticy Number) (Expiration Date)
ti-i 6-0..4../.. ,.s�0orA•
Oa—. V"..r a. `no, 01142,.
(game or Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (lx s nano Company/Policy Number) CF-gindon Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(sarh..ddice.'%mil Tn.:cc:any to°dude inf utioa ptimng to all m>ae.on)
( ) I am a sole proprietor and have no one working for me.
O I am a home owner performing all the work myself.
•
NOTE:ptcvw be aware that wlrilo heczcwven v6o«kf rwi+nm to M m:vtaw:cat atsuciao or tap a wutk an adwtJting of
:wtmore thea tam max in which Si' m naiads or on-tnw+hryPwtenc'4:! to arc act gnaw}ceandle be
cmploym under tha wmitta capcmnim Ada(O1152.=10)).IWPIirariro by a bornmwwvcim a Bare or permit may ctidmathe
leg3°Anti of an eaglayer under Mu Woha's Cvmpm.tion&4
r uadcn,ed Cuter copy of tb'u atstmsm may be forw.ardad to tba LApanmcat afted&trial&mean°OMw oflcamss.afbr SI
oasaagcvaiticnim aid lbs faikrc to tm ,wwcmg.wdszcaion 2SAIMOL.152 ma Inds,iSa inyoshea of Stiad pralsics
awvngq of It Gm of up toS1,300,00 tette(irapthecancat ofup tooce yes aativa pmarim in It°f of a Step Work Odd nod
Gm a(S100.00 a day aphis(me.
/( F«emits t'l`u°`'dY �._
y// p Pamir xumlmc'
Dc 3u /; d - ctALso Idaho-.1 t aPi_.—_Let p
'Signaturenrti� «pem e Q s. —.—
i,
'• •xYV-."4.Y.
JELu OCT 2 e 20C1
DEPT RFAMPIN.G INSPECTIONS
0:CE0
NOd?HAMPTON.MA 0:0'0
Tr
n r, TT
-
, s1µ
Ali
if
1
THE
Wit LIS EON
NORtNANNPTON
SCHOOL
".
k
(t
1 •
0
_ r '
1
a •
•
•
•
•/
�
�
y
_ra
•19 Payson Avenue Easthampton,Massachusetts 01027 413/527-1520
•
xx i
SZ x ,ZT � 1
�' Ilf
10'x 12'
1