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43-071
• 104 DUNPHY DR BP-2005-1093 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:43-071 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2005-1093 Project# JS-2005-1483 Est.Cost: $1100.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: use Gmnn: Homeowner as Contractor Lot Size(sn. ft.): 15899.40 Owner: CHERESKI ANGELINE C Zonine: SR Applicant: CHERESKI ANGELINE C AT: 104 DUNPHY DR Applicant Address: Phone: Insurance: 203 NORTH MAIN ST 0 586-2120 0 FLORENCEMA01062 ISSUED ON:5/9/05 0:00:00 TO PERFORM THE FOLLOWING WORILSHINGLE ROOF OVER 1 LAYER 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 5/9/05 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo • -71 -City ofNortbampton Quildtng Department 212 Main Street c5 Room 100 tTkrn , ' e1�� SN&�rthampton, MA 01060 '"` , 'Iphone 413-587-1240 Fax 413-587-12721 r3, .,x,—c 3- APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION / TblssecNon%bmecodyaice / 7.1 Property Address: - wv VVV lock O V wp lro l��Z _ • tot _ rm _ poa- �. Over ayDrs?ridL #-_Ef 2Dfgttlt„4 t ._i�C67rb4tc4'",_ SECTION 2-PROPERTYOWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: - - - - v\ \ C� e -e—S(-4:\ &G3 N `n'la\�n S� �rrt-ence Name(�1 �• G n Current Mailing Address: Crl -,7\^-,O I ,�t(u Telephone U Sign. re rA 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Ii - Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building \ (a)Building Permit Fee 2. Electrical (*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 tNe' 0b497✓ This Section For Official Use Only Date. Building Permit Number. Issued: Signature: r Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Informet±bn Must Be Completed.Permit Can Be Denied Due To Incomplete Information ® Required by Zoning This column tote tilled in by Building Depmmnem Setbacks Front Side Rear — Bldg.Square ®®®TMI Open Space Footage ®®®®® Ors arre bldg&paved • Ma= MINIM A. Has a Special Permit/Variance/Finding ever been issuedf'�orr/on the site? NO 0 DONT KNOW © YES 0 IF YES, date issued,, IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW 0 YES 0 IF YES: enter Book Page: and/or Document#I,� B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES fl IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained O , Date Issued: '.r.. C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES a NO fl IF YES, describe size, type and location: '; E. Will the construction activity disturb(clearing,grading excavation,or filling)overt acre or is it part of a common plan that will disturb over 1 acre? YES 0 . NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION S.DESCRIPTION OFPROPOSEDWORK(check all-applicable) New House ❑ Addition in Replacement Windows Alteration(s) Q Roofing Or Doors Q Accessory Bldg. ❑ Demolition ❑ New Signs OD] Decks ]O Siding(ER Other[p] yrrer Descripaw of Pposed \ r .V/Work: 5` ,5 #y ra GNIT-1A% (l Y�< Cr-hsoT' SIM\ ot-eT1 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a:,IfNeW` bBsa`atnad.� "'S .cit+>`nst :..•'✓n Y7.'iE ` 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? I. Method of heating? Fireplaces or Woodstoves 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 A Will building conform to the Building and Zoning regulations? Yes Na. I. Septic Tank City Sewer - Private well City water Supply SECTION Ta-OWNER AUTHORIZATION-TODECOl0.PLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES BUILDS s.PERMIT ,as Owner of the subject property hereby authorize �..- to act on my b half,in ailmatters relative to vlprk autho ed by this building permit application. Likal" Signature or 6214 I bafe / I, 7-0\f \.\_Hc,7v�2S`-. ,as Owner/Authorized Agent hereby declare that the statemen s and information on he foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Z-C1\YTav1v rim ame e f: 6,; Signature at r/Agent Date SECTIONS-CONSTRUCTION SERVICES r S.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: License Number Address Expiration Date Signature -! Telephone ;("•tfs<'^"d.t`L�y}.iafri. su~tt�.z?:.,�ir ,,>Y.T'�; "-nw<c..< n: :L .'=s Not Applicable Company Name i— Registration Rummer — "" --- Address Expiration Date ,Telephone SECTION 10-WORKERS'COMPENSATION INSURANCEAFRDAVLT(M:Cr.L c452.425C(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 ❑ m u 51:11CO ^ilw 'fia`1 i 5-10 j.. 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.CMR 780, Sixth Edition Section 1083.5.1 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 snarhed or detached structures accessory to such use and/or farm structures.A Person who construct 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 he responsible for ail such work performed under the building perm 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,von may be liable for person(s) you hire to perform work for you under this permit. undersigned"homed er"certifies an' = sumes responsibility for compliance with the State Building Code,City of ..on Ordinances a andqing Law and State of Massachusetts General Laws Annotated. Hemeowncr Signature ia� ..... . a vu� ( lof crif�tiitiplo1 ) Gl 3gi " £ 3i'in.ry„:.Ila 17Eigi t � at��`- DEPARTMENT OP nuzwoNO INSPECTIONS 4 �(r ' 212 Main Strcct ' Municipal Building Northampton, Mast. 010G0 r` WOR1CtR'S COMTENSATION CISUTANCE .AFFIDAVIT —_.. ___._... ._ __.._. . _ _ with a principal place of businesslresidence at: - --- (p'hone#) tog- Uciritslescrap) do hereby certify, under diepains :tad penalties of perjury, Mat ( ) I :m ao employer providing the followvinu worker's cocnpceu3On covcmgc for my , employees worling on this job: Donna=Cooc:ov) (Policy Nu_-nocr) (Etpint/on Da.t) I ( ) I am a sole proprietor, general coou-aaor or homeowner(circle one) and have hired the contractors listed below cvba have the fotlowiog worker's compensadon policies: (Nam:: of Coarctctor) (IIasuranct CmnoanyPouc; :.gum!::) (F_:uimuon Dam) (Nome of Conenaor) (tnsomoac`Camoam-rPotic- Nuocer) (f=Xoiruon DaLe) , • (Name of Conrado:) (Snsuranc Cowpaus-/Potcy N9rnbcrl (EspiSoo Oak) (Name of Contractor) (tosuranc Comczpy/Policy Numb:r) (Expt2Joc Dare) (4a,a acatat..,r e,c ifac uxy aar.+,c et'0apaa.—p a.0€r-r-4111) . () I am a sole proprietor and have no oat woridng for me. I ama home owner performing all the work myself. NOTE:Pts v Is soso the .€Jc._. .Lop tots wacr'swot to do,-.:,- o - ccx,e,s-e wczv,.d fl 01 o«mos—tSv t4 La tobkt,b.b12[1:021.n -tido.m waa-,..r cIp,,.,.a..rama.,-.DX CCC 1y 4 aabc =cloy=pods the ksttoototts- 'cc P (Gu52.=IOn.oppicww by•boast wits far 1.4c^vc at N=11=1 t'M<C iS: rcg+l Kale of u wloyr lidds aw woad,r. .t Act ' I auicwe m od 0 a ry atu amt.m.y b.(a-' tda I LLw Ocp.i tlooro:.l Amdaa1 Oa.dlzv+aerl N oavanto.vifoum.ad Es macre to soots ... atovsnoI ustion 25A Mal kd of u N+impt:4=4faaioat rdia ia�ara ria.of up to SI.,NA.CO+nos cgai,r y otup'a o.yc 'odea pm.aiew ec ram af.SW wotCSc•••4• 1i o(5100A0,dy.pian e.4 Foy dy,,,aJla.[W] j I f .t „ { • Map:Parma NuIDCCY , !ti'ttij2i,Ltt " . tr-7,44k1 '� aTaP=_ —..m Lot Si rc of i v]S /permiuCc L5 e _ .) + e r..(Eif 7 tt{ Nartbantpfoit a etr! i 7i$ $iss:sehusetts (, =-SW O^.._ 2 DEPARTMENT OP BUILDING INSPECTIONS .... 7 ^' . t INSPECTOR 212 Main Street i Municipal Building � Northampton,MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supe::isor. The state defines"Homeowner"'as, "Person(s) who owns a parcel on which he/she resides or intends to be, a one or two fatiuy 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 t`egulations. 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 r 1, ' understand the above. e owner/resident's signature requesting exemption) I ill .11 to schedule all required building inspections necessary for the building permit issu>. to me. Date Address of work location