36-349 (3) rm
SECTION 8 ;CONSTRUCTION SERVICES'
8.1 Licensed Construction Superviso : l Not Applicable ❑
Name of License Holder : /<e2 i // �GICA. i
License Number
— _..0 . _.e. gam ' Ai 11i (%.,„„ 4
Address ` Expiration Date
/ i •Kiir
yi
Si: :t 1 67 /7 " WW1" Telephone 011 ,51 - 9- .5
-e_ ''ee- ®f, .Ome: on eat o . Not Applicable Ci
Company Name Registration Number
Address Expiration Date
Telephone
SECT 10 WORKERS' COMPENSATION INSURANCEsAFFIDAVIT (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 ❑
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.
Homeowner Signature
`SECt'IONnS. ttti tPS.ION O it , P08EDWORK(check alt
,.: ;ate _x ,
f. i, mss - -_s .. ,•
New House Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: A % t . S/1136 4T _ 1 ) y
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0 - Sheet 0
s;a f e hot sEaand o ad"d'itionito.,.ezistii Fi'ititit C;7cOlWi e. a i fo i ing:
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? __ i
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? <
f. Method of heating? F HA Fireplaces or Woodstoves ye J Number of each 1 •
g. Energy Conservation Compliance. yea Mascheck Energy Compliance form attached? e S
an �'f
h. Type of construction 51- )61k—
i. Is construction within 100 ft. of wetlands? Yes v No. Is construction within 100 yr. floodplain Yes t"
.7 a
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 A
SECTION `teR NKR AUTHORIZATION TO BE COMPLETED: WHEN
OW NERS AGENTOR A FOR B UILDING PER
I, sus /4 n /Jilne_ /Ph PLC /1 r ` re ,- C..—
, LG , as Owner of the subject property
here yy a . i' oriz- /y4_ () 4v x _ to act on
my be.. , in , • m. -... relative to work authorized by this building permit application.
ii..,.. // 4 --/" "
y '.ture of Owner Date
_' c - --
I, 1 > 1;,_'. ` , as Owner /.Authorized Agent
heresy declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signer ,n.er tthh� s an..enalties of 'ury, ..,e.,,,,---.
Pri nt ame �
i�
Signature • • ner /•gent
. 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
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
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 v 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 DONT 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 there any proposed changes to or additions of signs intended for the property ?YES _
No
IF YES, describe size, type and location:
1 '
' a�� a ana? -- =®r.
City of Northampton
Building Department . 1 ' ' i ' 4 1
212 Main Street r
Room 100 e s � �
7
Northampton, MA 01060 7 -1272 1 • . t i� ,
phone 413 - 587 -1240 Fax 413 - 58 ° • .`
' ... t40.•a , at^ '. . ' - .'
APPLICATION TO CONSTRUCT, ALTER, F E AIll to A ONE OR TWO FAMILY DWELLING
, - ________________ )
y
11 i JUN 10 2CO4 '
SECTI 1 — SITE INFORMATION
1----- ,, Fns ction to be c o m pleted by office
1.1 Properly Address: �
�i. Jr /�p� j'J �✓e' ` L Uni 7.
Zone .Overla Distri
EIm 5t. District i `' CB Distri -'-'--
SECTION 2•- PROPERTY OWNERSHIPjAUTIIORIZED AGENT'
2.1 Owner of Record: .-�- / l
Mari , qY «r !�'Ci' 61.E )5 r i Aide /1
Name V t) v ::: d ss
•nature
2.2 Authorized A. ent: �jf /� ��J/� Imo! +i
/1 �L ? /�/ ��!' �st� sY /11J�
Name (Print Current Mailing Address: 2
n. �'� %� t� Telephone
SECTION -L MATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be ., Official Use Only
completed by permit applicant
1. Building C� D (a) Building Permit Fee
2. Electrical — (b) Fstimated,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 6c, J --- is Section For Official Use Only
Building Permit Number: ('/ / 2t Co l Date Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
, --- �► OVEREI G N
,f,„4
UILDERS 4
135 Southampton Road, Westhampton MA 01027
413.527.8001 FAX 413.529.9988
July 7, 2004
Building Commissioner
City Hall
212 Main Street
Northampton, MA 01060
Re: Dunphy Drive
To Whom It May Concern:
We would like to transfer our building application on Dunphy Drive. We are not on the job and
have transferred ownership of property and building plans to Robert G. O'Bear.
Sincerely,
PIA
Todd Cellura
IIIIINP
O .TNAMP2 Q
� � 01,ifx of Northampton I L • = °_ _ i
ii '�"" DEPARTMENT OF BUILDI7'G INSPECTIONS f ' 4 _ ' _ _ �= ,_____-
f _
INSPECTOR 212 Main Street • Municipal Building
Northampton, MA 01060 5
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as Lis /her construction sups:.. sor. 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
I, understand the above.
(Home 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
t MIN ,
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fill‘
4 0_,,„„ of Nartilainpfoil
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4.1 E..a.
.;c:c• ••• DEPARTMENT OF BUILDING INSPECTIONS - M - 1,1 i =
—
212 Main Street • hfunicipal Building
• ,,_
Northampton, Mass. 01060 to
WORKER'S COMPENSA'llON INSURANCE AFFIDAVIT
(licr-_nstclr..crtn:tt:-..!:)
with a pan cipal place of business/residence at:
(phone)///5
(strecticIty,':;:atf:Pi-Jp)
cio hereby der under r_hc pans and penaltics or perjlin, ;hat -
( I am an employer providing the follov:ini: '.vorker compensation covera:2,e for my
employees working on this job:
( 4 jAKiirlhve;.c Gfp/7/7 re 4/ ' .7i—a-C '
/ (Insaranai Coraparly) (Pclic: umber) (Expiration D.-ate) ,..
( ) 1 am a sole proprietor, o.entral Cl-01,1: CT. 0 F C_.■ F homeowner (circle one) and have hired
the contractors listed below - ,ho have, the folic workers compen&atzion policles:
(Name of Contractor) an.suranco Colm NumbT) (T- Date)
(Name of Contracor) (Lasuranc, CorrioaT:y(PoNcy Number) (Expiration Date)
___ --.------
(Name of Contr ( Ins rruic,-... Coz3T,a1JyiPolicy NIIJIli'plr ) ,,xr,:rat Date.)
.
(Name of Contractor) (losuranco: Comt:ar.y/Polic. Numbes) (Expiration Date)
( if :1 1.7 ..., :: tr..: 7 a: 7 • - - 7 ' : , 1 i ,,<:::',... :'
( ) 1 Z un a sole propne:.oi a:Li 'nave no one •.. for me.
( ) 1 am a home ovvner DerfoTminc all td e -,,,,',-.-;:-.... ir: - ,..sclf
NOTE.: picasc be as ',.1...v. •. 1-, - , ,', - .-3 ern-ploy p- to eo :. co,.'n Cr ' "'"' ' ' ` c:-
not more th...tn throe tiniti in is • t. 7,t. ro c,r oc :Ss:: gro..n. . thccto are nc< cc o
cz1ploya-3 ury,Sor the vrorl .-::-.7......qc Act (C31...152.;:si (5)), nr..;,.1:. by a homeowner for a Lc =sc cc prim:: nif.:. c. ths:
k rt
gal atia; of an cemploy 1 / the Woricor's Coroperea.tion :`..ci._
1 u-nd •,. of .e. •.; of .; e cr,.."..f. re.ny be fro-3 to IL, Depart-mull of lociautrial Arcie......,-rr? Oftio- of 1, -''''.7 1 ' for 1-1 '` .:
C°v • • • • • fi• that f toQtrt covcrt.g,s ur‘...'cr scctioci 25 of l'.{01- 152 oni3 lcui to thc imposition oi cs--naL__1 pci-ali.os
cormisti o f ,, , ,,, , . 1 S _300 ,,,n"rr iol--rv:1i of up to cr..: yi:zir ?: civil pctultics in •i,c form of ri Sio-,, ',corr. Or' ,c. end a
firr. of ' 1 00. • i i i.s.....ii . rr.c..
/ ■••.'
' f 004410 For cic-4-ix.:smesrl ti.c only
Pcrrnit Numbe_r _ _ j
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_i gna t.0 r 4 V 111 "lcc , r;.(..:•.11 ) r r i 1 :1 tr.:. . - --- Ti 1:• !. i
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•
File # BP- 2004 -1266
APPLICANT /CONTACT PERSON ROBERT OBEAR
ADDRESS/PHONE P 0 BOX 951 MONTAGUE (413) 367 -2424 0
PROPERTY LOCATION 135 DUNPHY DR - LOT #4
MAP 36 PARCEL 349 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /- / 2
Fee Paid CC�L�J ,3v —
Typeof Construction: CONSTRUCT 2 STORY SFH W /ATT GARAGE /DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 086260
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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 S et Commission
____ Signature of Building Official Dat
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.
p y.y,0 5c,
i cviv")
135 DUNPHY DR - LOT #4 BP -2004 -1266
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36 - 349 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: New Single Family House BUILDING PERMIT
Permit # BP- 2004 -1266
Project # JS -2004 -0781
Est. Cost: $240500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT OBEAR 086260
Lot Size(sq. ft.): Owner: SOVEREIGN BUILDERS 1NC
Zoning: SR Applicant: ROBERT OBEAR
AT. 1'5DUNPHY DP -;OT 4
Applicant Address: Phone: Insurance:
P 0 BOX 951 (413) 367 -2424 O
MONTAGUEMA01351 ISSUED ON: 7/8/04
TO PERFORM THE FOLLOWING WORK: CONSTRUCT 2 STORY SFH W/ATT GARAGE /DECK
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
i ,/ / Footin gs:
h l q Roug (1S ' ,, - Rough: V ( House # Foundation: c f ( 6 - G • e '1' � Driveway Final:
n Loi)6 `'
Final: /l/ , — R/ "1j Final: p/P277 iJ Wi,} / d
06
77_- / RoughFrameK2k 3 - 6
j `?.ei4 /iG Zisr
Gas: Fire Department Fireplace /Chimney:
�
Rough: ' --j K � j Oil:
1 Insulation• (',' K �j ` /7 G ,
� �
Final: )1' - AL:_s Smoke „, at, x,"_"'
Final: elf 67 ` / -4 ••ire�'� -�
THIS PERMIT MAY BE REVOKED B HE CITY OF NORTHAMPTON UPON VIOLAT OF
ANY OF ITS RULES AND REGULATIONS. --°
-- . ;,
Certificate of Occupancy ,e signatu
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 7/8/04 0:00:00 663 $50.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patiilo