36-349 (4) s
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�... �_.'"' ,—� DEPARTMENT OF BUILDING INSPECTIONS _ _ _ /7
INSPECTOR 212 Main Street • Municipal Building ' �!•
Northampton, MA 01060 o,~ 5 �`'
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 sup< :.. 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
. .
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' VAPIAirCtt, '
V"- DEPARTMENT OP BUILDING INSPECTIONS
...-- —
212 Main Street - Municipal Build;ng
Northampton, Mass. 01060
WORICE,R'S COMPENSATION C\ISURANCE AFFIDAVIT"
•
I, __ _._ .__
(liceas.X/pc
with a principal place of businessfresidenc,e at:
(phonel:)
(scr=t/c ty/statcfrip)
do hereby certify, under dic pains and penalties of perjury, '1121
. - .
• •
( ) 1 arn an employer providing the followinc, v..orker's conioensadon covera,ge for my
employees worng on this job:
,
(las Corr') • (PoLicy Numbcr) (axpirztion Date) .
• ,
( ) I am a sole proprietor, general contractor or hotneoW (tistie one) and have hired
the contractors listed below who have the following worker's coo.Den....sa6on policies:
•
(Name of ContrzIctor) (Insurantx. Compii Nurribcr) (Expirauon Datc)
_
_
_ -
(Name of Coticrzcior) (Lasur2_noc. Company/Policy N1.10621) (Ex D2_te) ,
- -
. .-. .
(Name of Contractor) (Insiirance compan /Polic Numbe.r) (Expiration Daic)
' . .
•
(Name of Gontrac (Insuran= Company/Policy Number) (Ex Die).
(.a...ch z.thdit..: ccal clInc if occa,-^y to 'c)cks& inform...ion pc to ...11 oontroc-ors)
( ) I an a sole- proprietor and have no one working for me.
p< I am.a home owner performun g all the work myself.
NOTE: PI bc " thot wt.i.lo bccpcowoon wbo =tap lay pcsokit to do r-,;,--,--,,,, =r = ropair work oa a dwt.1112i., of
Cla COOCC lb= 1 •■•= . =its ja , ‘ - 'acidt thc botWeveocf maid.= 0( 00 (Jac p-ouccla tcportosz= ttco-oo ....-c Doc ca,-.--lty co:rid-- to bc
crixployc the 'o occapc..oa Act (G052.3=1(5)1. , toplic:u6cro by . boo e lc: t Lics.--c cc permit tr_ty eviOcooc the
lossl rto.o.ic of on &splay«. erodes tio Woricor'. Cocapoco.o..lon Act-
I crow:Sort:Loyd thot a copy of (lair carom.= cowyb. fora-orri.c1 to tbo Dopartotoort of Inoto.nriol nonictoord OfGo . of l000r‘oco for th .
coverage verificstion and thot Ctilto to socure'coverne undo ection 25A of btOL 152 C1.0 1=4 to the Lempositioa of a p.
coacciatirca of a fox ally to 51.500.00 cctprboacc.=r1 of op to ooc year d civil pcoxltict . 113 CSC form of a Stop Work Ord= inyd a ,
fun a S100.00 a dty Lexixist co.
.04r
r.-6" ...ft.-4
_ ____.
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Signature of Liccasce/1 & te
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SECTION 8 - CONSTRUCTION SERVICES i
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
g. ReasfececTio telitpraveriierrontracfo€ „ _ Not Applicable ❑
Company Name Registration er
Address Expiration Date
Telephone
SECTION 10 WORKERS COMPENSATION INSURANCE AFFIDAVIT (M G:L. c152.: §; 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 /7/4
v
t.:
SECTION 5- DESCRIPTION OF PROPOSED WORK (checkall >applicable)
New House ❑ Addition ❑: Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [p Siding [D] Other (kr
Brief Description of Proposed D J C / G
Work: l /v 1 /� T /1� �J111Z14
Alteration of existing bedroom Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa -ifNN`e rhouiseand o dttra'i ex nq=hra tFii c OSi et the o fo
a. Use of building : One Family Two Family Other Je
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. 30 be. 30 Dimensions / do
e. Number of stories?
? Fireplaces or Wo st v
f. Method of heating? od s Number of each o e
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction _
i. Is construction within 100 ft. of wetlands? Yes x 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 FOR BUILDING PERMIT
1, -1 1 / , ' ' "3' , as Owner of the subject
property A
hereby authorize ./1/47/ C�
Ail? /
to act on my behalf in all matters relative to work autho dis building permit application.
Signature of Owner
1 ' ' Da� 1 2i
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.
Print Name
Signature of Owner /Agent Date
or
t
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
f R , e /` V- 4L ., e Building Department
Lot Size ___ �' ' fi s ! y i7 I
Frontage /??.02 1 1 4? - as ` i
Setbacks Front YA sue) i 36 I /5
Side L:1.> R L:. ZQ a R:' PO
O
Rear ' ' s
Building Height i i
I a ?i E
Bldg. Square Footage t po0 f i 9 1% I7Tc) 1
Open Space Footage / %
(Lot area minus bldg & paved Id i W-1° 1 ? 2-o
parking) -
i
# of Parking Spaces ' / `
Fill: D v Sj I Dot/ g/ ' I ;
(volume & Location)
A. Ha_ s a Special Permit/Variance /Fin ing ever been issued for /on the site?
NO 0 DON'T KNOW YES 0
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW WSC YES 0
IF YES: enter Book Page'; and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission? '
Needs to be obtained Obtained Q , Date Issued: i
C. Do any signs exist on the property? YES 0 NO I
IF YES, describe size, type and location: j
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, ex - vation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O r NO ► +®
I
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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City of Northampton � "
Building Department _5
212 Main Street � + a r
Room 100 r et ,:
a
Northampton; MA 01060 _
phone 413 - 587 -1240 Fax 413-587-1272
c8 a ecl a
APPLICATION TO CONSTRUCT, ALTER, REPAIR; RENOVATgD O( Hr '"ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION APR 2 9 2flr75 s s
hi eefr4n to be completed byofce � .
1.1 Property Address: [_ t
Zr e 47;211
k ®�
La+ `f ne
Zone ;`7 "-- OverlayDi
EImSt Dwtrict CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZEDAGENT
2.1 Owner of Record:
& .. ckiLs +Nv-- H71 1 v+
Name (Print) Current Mailing Address:
40#
Telephone 3 +s , r a- y°-r
Signature
2.2 Authorized Agent:
4
/tfilf //n f 4 �,�-�- // 4/Rv
Name (Print) Current Mailing Address:
2 4 oz6 777
Signature 11LC Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item - Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building /‘5261-0 (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 (
This- Section For Official Use Only
Date: .
Building Permit Number: Issued:
Signature: r
Building Commissioner /Inspector of Buildings Date
File # BP- 2005 -1061
APPLICANT /CONTACT PERSON MATT MURPHY
ADDRESS/PHONE 110 PETTICOAT HILL WILLIAMSBURG (413) 268 -7892
PROPERTY LOCATION 135 DUNPHY DR
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 r �
Fee Paid ,d$
Typeof Construction: CONSTRUCT 30 X 30 DET GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 066916
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION 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 Str et Commission
//2 -/Cttr —
Signature of Building fficial 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.
V ovi4 6 g F e-- 135 DUNPHY DR BP- 2005 -1061
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36 - 349 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit # BP- 2005-1061
Project # JS- 2005 -1448
Est. Cost: $15000.00
Fee: $135.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MATT MURPHY 066916
Lot Size(sq. ft.): Owner: ROBERT OBEAR
Zoning: SR Applicant: MATT MURPHY
AT: 135 DUNPHY DR
Applicant Address: Phone: Insurance:
110 PETTICOAT HILL (413) 268 -7892
WILLIAMSBURGMA01096 ISSUED ON: 5 /16/05 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT 30 X 30 DET GARAGE
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:
FeeType: Date Paid: Amount:
Building 5/16/05 0:00:00 $135.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
-ovotor
BOARD OF HEALTH OFFICE OF THE v� 3 �d .�° 4 "'�
MEMBERS l al, 041
ROSEMARIE KARPARIS, R.N., MPH BOARD O HEALTH - . �� = , , •
XANTHI SCRIMGEOUR, MHEd, CHES
JAY FLEITMAN, M.D. m;
STAFF 212 MAIN STREET
Ernest J. Mathieu, R.S., M.S., C.H.O. CITY O F NORTHAMPTON NORTHAMPTON, MA 01060
Director of Public Health
Richard Meczywor, R.S., Sanitary Inspector
Patricia Abbott, R.N., Public Health Nurse MASSACHUSETTS 01060 (413) 587 -1214
FAX (413) 587 -1221
i
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July 13, 2006 ■
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Dionne Management Team JUL i 3 2006
ATTN: Justin Dionne
P.O. Box 355 LG
Northampton, MA 01060
Re: Dunphy Drive - Lot # 2- Septic System Permit
Dear Mr. Dionne:
Please be advised that your septic system permit issued on July 20, 2004 is valid for only two years and will
expire on July 20, 2006. Since the wetland boundaries on the lot have been re- defined since the issuance of this
permit and the proposed location for the system on this lot is now in the wetlands which results in this plan
being invalid.
Therefore, The Board is Health is requiring that new deep observation holes and percolation test be performed.
Also, a new septic system design will have to be submitted for approval.
If you have any questions, please contact me at 587 -1213. Thank you for your attention in this matter.
Sincerely,
Ernest J. Mathieu, R.S., M.S., C.H.O.
Director of Public Health
cc: Conservation Commission
Timothy McGinnis, R.S.