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O � 9� °$ Crzt� Of &Xart4alllvtoil n'" a B �lxsaacf<srsctts' m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 ' WORKER'S COMPENSATTON INSURANCE A,FMAVrr I, IV�1L 7-lo�ST��� (Lcensee/permlttee) with a principal place of business/residence at: 40-ke OoP-T-Ft- Ek 4en1.s R-r;>. j roe gx7c MA (phone#) 56-•O 45—F (streeticity/stafrlrip) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: r KrZ's r, C"5f*A'A-'0 _ Am fi72rr�7 S7-57 JW- s Co , A PP O I C73© ) ! 03 (Insurance Company) (Policy Number) (Expiration Date) I am a sole proplieto eneral contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: .SctF�tlEila� ��j1 C� l l zQ c� /,Uc �"ASi?ooa2►on (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) f�R/�Lnvx ,�c �ScT�IL �/2, �'�St1i3-757 IJ9gl�'f} b ©Y (Name of Contractor) (Insurance Company/Policy Number) (Expiration ate) 2-RAJ 90 CK ��2cHk�r��y�G�sxP �gcNA127g557f 7 / Z(Name of Contractor) (Insurance Company/policy Number) (Expiratio D (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shed if neorssary to inchtide information pertaining to all ooatmci ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing alt the work myself. NOTE:pleaso be aware that wbilo homeowners wbo employ per oas to do maintcamce,a=shuctioa or repair work on a dwelling of not more than throe units is which the hoamwner nsidcy or on the gecwnds appurtenant thereto arc not gcoaally oonsidacd to be employers under the work&x coaT ass4on Act(GL152,m 1(5)),application by a homeowni fora license or permit may evideaoe the legal ctat- of an employer under the Worlceet Compemation Ace. I underhand that a copy of this uatemeat may be forwarded to the Dep&ruwc2 of I.&,,t<ial A.,,dm&Off oc of iasuranoe for the covaxge verification and that failure to segue coverW under sectioa 25A of MGL 152 can lead to tbd impos—of-mi-1 penalties oomisting of a fine of up to$1,500.00 andlor of up to one year and civil penalties in the form of a Stop Work Order and a fim 0(5100.00 a day against me. For l use only permit Number T&p#— Si of icensee/Permiitee ECTION 8-CONSTRUCTION SERVICES .1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: k)E/L. �WVP S TZ��ZL� i-2,/ Z 4- License Number o1277+ &&m$ ?D Lo2ooc6 A A- O(OG 2 '76o% l Address Expiration D to Signature Telephone -� SS'4 -0 4 S � `A^<", -:; s, , E• 4� 1`EI d,E E E EE I E •',E EE mill.E.. •` Not Applicable ❑ ? Company Name Registration Number fog &L27--e J�em s 2p. (�r_ye acs A Oro(- ? i 2/�8, o Z Address — Exp tar ii on Date 4 Telephone .S74- 04'-5-9 L�� 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. igned Affidavit Attached Yes....... %e 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 CT�ON 5- aESCRIP ION 01 PROPOS ORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: RG JOVA-Q )4 ()iyF��lSN�T� f3/kSEJ�Ls�7- .34�'SF Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative❑ Renovating unfinished basement —!54--Yes No Plans Attached Roll ❑ - Sheet K a. Use of building : One Family 1/ Two Family Other b. Number of rooms in each family unit: Number of Bathrooms Z c. Is there a garage attached? �1 d. Proposed Square footage of new construction. 3 `1 Dimensions 25 !x / 2 e. Number of stories? f. Method of heating? i0a H,,-- "-7-5R Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? Type of construction (AIF / i. Is construction within 100 ft. of wetlands? Yes //'No. Is construction within 100 yr. floodplain Yes V No j. Depth of basement or cellar floor below finished grade 1_5L 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 I, V1 JAA) e,(6'2- as Owner of the subject property hereby authorize i ' to act on my behalf, in ers relative tc ork auth2oLrized.by this building permit ap lication. C7 ' Signature of Owner D to I, IVE((_ f{o/rsr a*-� CoA) ry as Owner/Authorized Agent hereby declare that the statements 6nd information on the foregoing application are true and accurate, to the best of my knowledge and belief. ned under the pains and penalties of perjury. /JEfCr '(",OAAS7-Z�A Print Name / !/ 2 t AZ Signature of wn /Agen D to 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 & l ed D U o 5 S l= Frontage Z A-'I'+ Setbacks Front Side L: 13- R: (p(v L: R: r Rear 7�� Building Height 20 r 5/�vti L:- Bldg. Square Footage 14#6;j" % 1776 Open Space Footage 5 3 0 q $� % sA (Lot area minus bldg&paved L parking) #of Parking Spaces Z Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 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: A it Northampton f � i g Department Main Street r algN w. 3 �"/ � z oom 100 DEPT OF DIN a pton, MA 01060 ')7- 240 Fax 413-587-1272 �s APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property Address: This section to comre3oftl 127 l7yrr1 (�K-( Die . Map, Lot (frttt.' )L)0P-rkA"1PT0A-) MA 010&Z Zone Overlay District a Elm St.Distrilp't i SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: V I v e 127 -L->,7m Poi- R . A 0,eTRAKff , 1�i4 Name(Print) �.' Current Mailing Address: aliq&Z r' Telephone S-9-f - 03 7 7 Signatu 2.2 Authorized Agent: 4osl 00477f FAIegf.s Pea- Name(Print) Current Mailing Address: .5'FS-+-045.8 Sig ature Telephone SECTION 3'M ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building s' 0 Q 0 (a)Building Permit Fee 2. Electrical O ©O (b) Estimated Total Cost of Construction from 6 3. Plumbing O Building Permit Fee 4. Mechanical (HVAC) �f S0p =a 5. Fire Protection /p 6. Total = (1 +2 + 3 +4+ 5) / 0C . °G Check Number This Section For Official Use Only Building Permit Number: `- Date Issued: Signature: Building Commissioner/inspector of Buildings Date File#BP-2001-0608 APPLICANT/CONTACT PERSON NEIL HOMSTEAD ADDRESS/PHONE 408 NORTH FARMS RD (413)584-0458 PROPERTY LOCATION 127 DUNPHY DR MAP 36 PARCEL 183 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid it75- 040' T_ypeof Construction: RENOVATE UNFINISHED BASEMENT(348 SO FT) New Construction Non Structural interior renovations Addition to Existing Accesso_U Structure Building Plans Included• Owner/Statement or License 031249 3 sets of Plans/Plot Plan THE LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presentedibased on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § —w/ZONING.BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § w/ZONING BOARD OF APPEALS 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 • Z Signature of Building OMAI 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. 127 DUNPHY DR BP-2001-0608 ,1S#: COMMONWEALTH OF MASSACHUSETTS dap.Block: 36- 183 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category Non structural interior renovations BUILDING PERMIT Permit# BP-2001-0608 Project# JS-2001-1088 Est.Cost: $8100.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NEIL HOMSTEAD 031249 Lot Size(sg.ft.): 17380.44 Owner: MEYER VIVIAN D Zoninp,: SR Applicant: NEIL HOMSTEAD AT. 127 DUNPHY DR Applicant Address: Phone: Insurance: 408 NORTH FARMS RD (413) 584-0458 FLORENCEMA01062-4513 ISSUED ON:1181010:00:00 TOPERFORM THE FOLLOWING WORK.-RENOVATE UNFINISHED BASEMENT (348 SQ FT) POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 1/8/010:00:00 475 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo I r x »�./F 9 w �.� ,yam � ....:_�x--"'�r�.�`��„�.,,,F,•- -..._...��...c.-, � i..�.....+a.�...,,�.,.,rau»F"�.�.:sq..�-�,,...�,�,..�. ^- ._ ._ �_ ", - _ _ _ '-- _ -: TV zoo's P� min MP W. k 127 DUNPHY DR BP-2001-0608 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:36- 183 CITY OF NORTHAMPTON Lot:-001 Permit: Buildinq Category:Non structural interior renovations BUILDING PERMIT Permit# BP-.2001-0608 Project# JS-2001-1088 Est.Cost:$8100.00 Fee:$50.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group: NEIL HOMSTEAD 031249 Lot size(sq.ft.): 17380.44 Owner., MEYER VIVIAN D zoning.SR Applicant: NEIL H O M ST EA D AT: 127 DUNPHY DR Applicant Address: Phone: Insurance: 408 NORTH FARMS RD (413) 584-0458 FLORENCEMA01062-4513 ISSUED ON.•1 18101 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE UNFINISHED BASEMENT (348 SQ FT) POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: 1 I*1°( CR19- House# Foundation: Final: Final: O Frame: �Rough l t -a Gas Fire Department Fireplace/Chimney: Rough: Oil: insulation: © !Z Final: Smoke: Final: Off 3-3-,61-4600 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPT UPON A N O ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: Fee Tvve: Receipt No: Date Paid: Check No: Amount: Building I/8/010:00:00 475 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo