43-069 (9) BP-2006-1299
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-1299
Project# JS-2006-1917
Est.Cost: $13000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Coast. Class: Contractor: License:
Use Groao: Homeowner as Contractor
Lot Size(se.i): 15768.72 Owner: THEROUX ANN ELIZABETH ROCK&
Zoning: SR Applicant: THEROUX ANN ELIZABETH ROCK &
AT: 88 DUNPHY DR
Applicant Address: Phone: Insurance:
88 DUNPHY DR
F L O R E N C E M A 010 6 2 ISSUED ON:6/2/2 006 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 24'ABOVE GROUND POOL
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 Occu.anc Si!nature:
FeeType: Date Paid: Amount:
Building 6/2/2006 0:00:00 $25.002629
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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File ft BP-2006-1299
APPLICANT/CONTACT PERSON THEROUX ANN ELIZABETH ROCK&
ADDRESS/PHONE ELIZABETH ANN ROCK ACKERMAN FLORENCE
PROPERTY LOCATION 88 DUNPHY DR
MAP 43 PARCEL 069 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ol�orf sed
Fee Paid G(
Typeof Construction: INSTALL 24'ABOVE GROUND POOL
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
INFQirMATION PRESENTED:
f 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
_cite°
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.
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City of Northamptonv '� .;:a'
Ilding Department a 'r A
L �` � 12 Main Street , "
1 Room 100 .S'u'r "' y ; 4'a'• '
N ampton, MA 01060
MA'l ° up1404- 41 87-1240 Fax 413-587-1272
04uea5 eC
‘it
APPUCA7i0T3 Td Q{JIVSTRUCk,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
Property Address: (r�Tiussectioreto tie compfoteQ fi roffiee
31/0(e n pjtl��qq' r'
go-tr3 (sty /`!( fr Oiilb L Lone Oversi tzftt
+E4uSCDls4i4 r. - C6t1atdct; . .
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner p1 Record: /Cal
Nit ifJC.'r�r>c+rt��.
Nun t) /J
Current Maiing Address:
/✓ / �� r�vxl���t
Telephone ........
gnatureLure
g.2 Authorized Agent:
Name(Pont) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1.. Budding 11/3,coo 1L.. ta)Btatding Remit Fee
2. Electrical (b)Estimated Total Costal
Constmutionfrom(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) ..-_
5, Fire Protection /,
6. Total=(1 +2 +3+4+5) Check Number _4;246d27 /015-C' —
This Section For Official Use Only
Date
Building Permit Number_ Issued:
Signature:
Building Commissioner/Inspector at Buildings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed ' Required by Zoning
This column to be filled in by
✓�'�Q Building DepDepartmentm
Lot Size _ _— -- -T-6\ 1 b
Frontage : /0° •
Setbacks Front • ire 73"
- ,,�
Sidi. L: R:— L.-y� R:3Lit /D'.
Rear I2 0
Building Height
Bldg.Square Footage • %
Open Space Footage
(Lot area minusbldg&paved ' _ — ;
packing)
#of Parking Spaces
Fill: I _
(volume&Location) I
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW O YES O
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 Pageand/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained (3 , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
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 NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ri
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[O] Other[CII
Brief Description of Proposed
Work: d7*'b/ i /
T - ��45 c[-c`O' rroav�a
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ea.If NeW'iioua.iii tiirgatTi`iaigezi'stinahiit #h"sv°.com` eratiMlaiiiti:
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. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstcves 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 Ta-OWNER AUTHORIZATION—TO BE.COMPLETED WHEN
OWNERS AGENTOR CONTRACTORAPPUES FOR BUILDING PERMIT
,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
I• ,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.
Print '
riot of Owner/Agent ate
SECTION S-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: I Not Applicable ❑
Same of License Holder'_ .__..
License Number
Address Expvabon Date
Signature Telephone
LRei'ttera`a)'HomeitiWPo�amonitoi111acfas: ,,,,t =:f;,t sx' :s .P� _-,.--';j Not Applicable
Company Name Registration Number
Address J 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 0 No O
Dirt" 0t at:4s��i 9s i3:tt.
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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,CMA 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 borne 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 fromtime 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 Zo 'ng Laws and State o Massachusetts General Laws Annotated.
-IC /
/Homeowner Signature � � L ,
op'(ItMIP}Qy�
til of Patii)ainptau A
Af gi .rhac.ua'
DEPPATMEN-I' OP OUrWIFG INSPECr10NS "
- 212 Maio Street ' Municipal E iid:nc
Northampton, Mass. O10G0r
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WORKER'S COMJ'ENSA IION GvSURA.N(.h AFFIDAVIT
•
to
(bwALLtit )
vwith a plincipai place of business/residence at:
(phoneO •
•
(rtUcity/stafrfrip)
•
• do hereby certify, under the pains and penalties of perjury; Ulu
( ) I am an employer providing the follosvine worker's compensation coverage for u»•
employees worCdng on this job.
•
(1 -.nc Cornc_ov) (Polio Nvcab=q --_ (E,pinuon Dv:.) .
Y" I am a sole proprietor, geueral cocQactor orA eow-oes cie one) and have hired
the coaracgrs Gst^ei below wbe have the foiiotvamg workzompensadon pcbcies
(Nuke of Conroe;o (Insurance CempanyRciie; Nuuecl Capl:aeoc Dmcl
U'tame of Cezeaoor) (inutance ComoacyPotiw Nurarbcr) - ( splrnaon Drat)
(Name of Contractor) (Inswance Compzay(Pobq' Nmntcrl (Expiration Daft)
•
Mame of Contractor) (Insi+ran CompawtPoticy Number) (Expiation Dice).
(44.2.=, A';D:CC2d too VDans&-y to:1U•4 iaf''apc.04.ix0o.E to 01eery0
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( ) I am a sole proprietor and have no one woridng forme.
() I am a home owner performing all the work myself-
NOTE:plcv.bc temp:t^v_,..t j avca von esGtuY PatOLLA uta _ a'Pact",0'44.2.a..cll_C or
am w00, :S3 u'-ucvr w which 0.c .. 00 raid=a m ur Cvaoc,ap,+ru fair tri wt tm0apy said-'ax
0=010:00 ur".--0e"zkua .,,....gym Ac(Ci_na.n I(s)).. pUmw by ahommwer fa aO' r<a path may c00caccbc
toil caa,a of u actors 404.r Wa wukya r py
I w4au.od Cv a copy a tai.chum'm.y b lo-.....y4 to N.DW amrm arbS .J,v„vdamf.CPC"of
Iftaacr.w,.
hn
• aca"rmGcum'r Nar'i-Pcaamvcm.aTay colawin ISA.of'CL i3cu taew 04=1,...,0003°0 dnitao
amav5 of a floc of„o to SIy00,00.rrdot h ion rao(up to cx<rain.td dV3 pcoatto u Cc fa,a o(.Sup wo-t Qda cd.
r e(Sloo.oa imy Lpisca sc
w.0w+tuc ail, •-
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For d
�/ permit Number
. / _ AQ / .41 /If It _.. ,� 1" bfaF"_ Lac: y
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DEPARTMENT OF BUILDING INSPECTIONS �%F
212 Main Street • Municipal Building
INSPECTOR
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 his/her construction sups.:-.1son The state defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two fluidly
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
1C � understand the above.
(H e 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
N 100.03'
PROPOSED
LEACH FIELD
oi (SEE DETAIL & NOTES)
SHED o
a
4 /1,00
-- 20' / I— 2�
‘9,9
N EXISTING FAILED
LEACH PIT
f- -1I 11 (SEE NOTES)
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— TOP OF SEPTIC
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un
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DWELLING
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