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36-183 (3) of 'Naz#ljailip#alt � � � �laesadtusctls ja DEPARTMENT OF BUILDING INSPECTIONS 6 INSPECTOR 212 Main Street Municipal Building 5� Noi-thamplon, MA 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to act as construction sup I :,_or. The stage defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or nvo family dfvelling, 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 backtill), 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 1, 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 Cl,ifll Of an Inv(lt, 0!' FMlj)P G, 212 Main Skeet * blunitApA Budding Northaillptoll, Mass. 01060 WOP-M(AR11S COMPY'N'SAIJON IN'SURANCY, AFFIDAVIT + 0 M S T C! A� %vitll pI ill(-ipli 40V A.)OP-T-ft Fvzms p'-n:.- FLO12-EWCC, 0�p6 do 'ani 311 t:lllpr._�vi,: c o 1 11 1,i: I Nom..il1Y 1 an' a SOW YMIZIU01, yunt!A cromraclor nF the colltmctol-s !):o havc the f0powin mWevs CWMS=A-. pm pOw-.: (AMC of (Namz of (4pnnb .' ASIA 1 A—.10 (Name of Cunwwt,,-�,-) Da 16 Taw of Connnw(),) llfll ill ;Mlc ?1,i llavc Im ( il, (6,1,1 52,:l 1 uz dr.�und th.!a -yy oftllv.niter—t ut".y I- of 1-4, vcIificzlion rr-f"that f r to 25A of 152 an lc--d to :npos if i c ct comblog of a fix of up to S 1—"01),C0 up to(-r,-)-7 r P.ni civil!Krulti cl in dr.Irma of a cite I' U)o SECTION 8 -':CONSTRUCTION SERVICES 8.1 Licensed ConstructionSupervisor: Not Applicable El Name of License Holder : I ) o A4 s?0 A O3 / 2 4 19 License Number c73 P--n-t FAR-ms R3�! • — 9 3 0 /©3 - Address Expiration Date FLo 2eNCE tvl A- 5 19194 9-S! Signature Telephone n " f �, f Not Applicable El 9Re>�istereii Homlmtiroverriert'Contractor mar:,.� m �s ,�_, �� _,._„ .�, .,.. _. Company Name Registration Number l 3 2 Z4, Z Address Expiration Date �f0 Q � 12- // 0 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....... UK' No...... ❑ � .., �x 1x11 - 'Ome ®wne �gemp,non 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 fc-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 LocalLoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5 DESCRIPTION OF.PROPOSED WORK(che&all applicable) New House ❑ Addition K Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work:_ Vr--> R{oOm 4 -JVT2Y ( O(Z CH Alteration of existing bedroom Yes No Adding new bedroom Yes t-` No Attached Narrative 0 Renovating unfinished basement Yes t/ No Plans Attached Roll 0 • Sheet IV`- 6a,'=. f NdW,Jf use.;ancl"'1or addition to existing hous`ing,'complete�the"following: a. Use of building : One Family ✓ Two Family Other b. Number of rooms in each family unit:_ -7 _,__ Number of Bathrooms Z. c. Is there a garage attached? uO MvAJ2oorv/ � d. Proposed Square footage of new construction._ 4 S. F. — Dimensions g k Z ►►�+ ZzY Z - 5. F. EN ftY AEC-K. -- - e. Number of stories? ACb0iT10K � Z SroQt. "0 aster f. Method of heating? HOT OA 7-" BA-._5E Fireplaces or Woodstoves NO Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction L0oo!:� Eta ok-*-nC i. Is construction within 100 ft. of wetlands?_ _ Yes _X No. Is construction within 100 yr. floodplain ___.__Yes j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? _ )C Yes No . 1. Septic Tank i✓ City Sewer Private well City water Supply X SECTION 7a;"OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT pR,GONTRACTOR APPLIES,FOR BUILDING PERMIT as Owner of the subject property hereby authorize Gm _ _ to acr on my behalf, in matt rs elative to work horized by this building permit application. dy0 — Signatu e of Owne 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. Print Name Signature of Owner/Agent 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 I $,D O J�Q�T ?U aro Frontage /29 o Setbacks Front .3e go Side L: 3 R: FAO ' L: l3' R: 5 2 i Rear &7 , ?' 6,-3 '- I�/ Building Height 25 t 14 , Bldg. Square Footage i +'R % CM -9 -sr S,317& Open Space Footage (Lot area minus bldg&paved 13 ,j 3(pM 7j Z- 13,45Z S 747/'6 parking) #of Parking Spaces Z- Z Fill: volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO V"' DON'T 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 there any proposed changes to or additions of signs intended for the property ?YES No IF-YES, describe size, type and location: City of Northampton Statusot rtt- _�� � �_ �,- Building Department Curb Cutl,DrVewa �rft 212 Main Street Sewer/Sepie o Room 100 1NaterJWe I Avat ab�l Northampton, MA 01060 T o Setsof S,fir c ra a pholae 413-587- 240 Fax 413-587-1272 Plot%Site Pan .. El � . Other Spec APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Proper Address: This,section m `to be copleted 4' office J Z 7 �t)Nit►�tf `r 1�4Z . Map Co# Unit NORTf{�cM('7 d N. Zone OverlayflDistrict Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(P ) Current P ailing Ad res3l I elephone Signature _ -L l - _ ( — - 2.2 Authorized Agent: NE-IL Hor�sTE�t� - -- 4o8 IVDp-TH FAams Rn 1-t..02EuGc_/'f A Name(Print) / Current Mailing Address: C7 - S V14 -0415 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by permit applicant 1. Building # g, pOO °�� (a) Building Permit Fee 2. Eie—rical �.50. m — (b) �timated Total Cost of _ Construction from 6 3. Plumbing Building Permit Fee 4 Mechanical (HVAC) 4 1000• 5. Fire Protection — __ _ 6. Total = (1 + 2 + 3 + 4 + 5) 9 06 0. "'� Check Number 7(p D= This Section For Official Use Only Building Permit Number: U �� Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2003-0917 APPLICANT/CONTACT PERSON NEIL HOMSTEAD ADDRESS/PHONE 408 NORTH FARMS RD (413)584-0458 PROPERTY LOCATION 127 DUNPHY DR MAP 36 PARCEL 183 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid T_ypeof Construction: CONSTRUCT 8 X 12 MUDROOM/ENTRY PORCH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 031249 3 sets of Plans/Plot Plan THE F LL OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Perot 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 ion Signature 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. 127 DUNPHY DR BP-2003-0917 GIS#: COMMONWEALTH OF MASSACHUSETTS MM:Block: 36- 183 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-0917 Project# 35-2003-1463 Est.Cost: $9050.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groun: NEIL HOMSTEAD 031249 Lot Size(sa.ft.): 17380.44 Owner: MEYER VIVIAN D Zoning: SR Applicant: NEIL HOMSTEAD AT. 127 DUNPHY DR Applicant Address: Phone: Insurance: 408 NORTH FARMS RD (413) 584-0458 FLORENCEMA01062-4513 ISSUED ON:511103 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 8 X 12 MUDROOM/ENTRY PORCH 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 Sisnature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 5/1/03 0:00:00 876 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo , x l `'^ y' '�" � .` 5. r'' E t _. n � '' ` .' � 1 a t 11 gxc. `�, x;, a ± x'?„ ,� ''3 .1`�r dr a a , �S-^r , 'l 11,4 r 1 x�4`,Y, s" a ss � 3 s 11 - 11`axe A: rx ;r 'w j s, `'� y„J` sr'5` E �rfx?" 5 ,' '`' y= s> r i z i X s` s,' ,� z.*` 4�`"b. r*`'•"'n,� :a °4 9,, d r�� � c r-,�,.,*si. ti' "r�5`�` y `� �",Y �,e 5,% s '': F .�"Y' x�, x k are I r '`3, f ¢ z t ,11 _.s���r �xya, F 5"''.' - a � , A -k e 'x 7+ n rv: Y r o aAz r,}y° "'k�r,sr `�" I , e �`": ''y'`. ,*,�*" ate.; 4,�y a' .,r.-.- s ' a'�<y` s.d snz q ,( a,.,'s 'v ,I 's ,� F �r 1 0 I"'A&W,Z _�",,llol,""Itl;� 0 I Z,14�, �",_�,�"��,� '�z,, , -� ,,,,� , ,, , , ,, I �, , ';, ,,,�,,, I 1-1,1p, I" , -.r r s ,� - ` a>m # , � sz R 5? k v x �,i a ' .. _ �- F ,� a 4r v y�k. 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QwAen MEYER yIVIAN D zoning: SR Ag04kgnt: NEIL HOMSTEAD Anpicant Address: Phone: Insurance: 408 NORTH FARMS RD (413)584-0458 FLORENCEMA01062-4513 SSUQ QN_.•.S/i 103 A-00:od TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 8'X 12 MUDROOM/ENTRY PORCH POST THIS CARD SO EE IBS ya$IBLE FROM-THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: r1.� House# Foundation: L• Q Cd Driveway Fin C — Final: Final: 71311o� Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: t. $*./3 •Q 3�d THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. or of Feel e• &ecpjgt Na. Date Paid: Check No: o nt: Building 5/1/03 0:00:00 876 $50.00 212 Main Street,Phone(413)587-1240,Fax.(413)587-1272 " a a xnt. "rs`g" . r& r. & msd[