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43-067 (4)
72 DUNPHY DR BP-2007-0426 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:43-067 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2007-0426 Project# JS-2007-000634 Est. Cost: $2000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq.ft.): 17206.20 Owner: DEMERSKI JOHN&KIMBERLY A Zoning: SR Applicant: DEMERSKI JOHN & KIMBERLY A AT: 72 DUNPHY DR Applicant Address: Phone: Insurance: 72 DUNPHY DR (41) 358-2909 (6) F L O R E N C E M A01062 ISSUED ON:10/13/2006 0:00:00 TO PERFORM THE FOLLOWING WORK:ST RI P & SHINGLE ROOF 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: FeeTene: Date Paid: Amount: Building 10/13/2006 0:00:00 $25.002490 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo �:,.:Dej aCttnentueeAnty City of Northampton isnf 1,--:?&,t R _ ' Building Department Cdrv` a "3>�t ' "a ``= .- "s' 'a Y ,212 Main Street s- 1 ` ,--- a;, 'o44 Room 900 ,..-+ �', .eu " w. ` NOrihatitpton, MA 01060llfr `'p'" n' 1$r. ' phone 413-587-1240 Fax 413-587-1272 R t ,` fie, "" S? Y i1'4224. APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1A Property Address: Thissactiml toitawmPi2ted bjdThice Jr/ n riti iJ //Or 'L r � ,- IL-r '`"j4 ('jC& �` ,rZone bueelasDisklui'" --c st1 cspiswyt SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ( -cent it - Nmime- A , ars '7a .,bimphy Dr. }�kr,,nr,� Name(Prim Current Mailing Address: n /� I `//,3 ' >€5.2 - 2096 '+ Cc-- / v2'IN `- Telephone Signature 2.2 Authoed Agent ,enn i /)Y. %renec Name(Print) _ Current Mailing Address: y.-- i 1 4 Via , 9�r>/c signs Telephone SECTION 3-ESTIMATED CONSTRUCTION.COSTS Item Estimated Cost(Dollars)to be Official Use Only copleted by permit applicant I. BuildingQ V v� -(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 ,J99, yJ,,., This Section For Official Use Only _ - Digo Building Permit Number , issued: Signature: Building Commissioner/Inspector of Buildings Date 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 Building Department Lot Size Frontage • Setbacks Front Side L:_— R:'_ L:i R:i 1, Rear Building Height Bldg. Square Footage % — Open Space Footage % (Lot area minus bldg&paved _ parting) #of Parking Spaces I Fill: --- -- (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:', IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW © YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO © DONT KNOW © YES O 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 0 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: j E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. • SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing i_4 Or Doors IC Accessory Bldg. ❑ Demolition Work: ❑ New Signs [0] Decks [p Siding[C7 Other[0] Brief Description of Proposed Sh it T reshinr e enI(rt' rzyziP J Alteration of existing bedroom Yes .V7No Adding new bedroom Yes `� No Attached Narrative Renovating unfinished basement Yes i-•-•"..I.No Plans Attached Roll -Sheet Ga ff Nevatiiii dror atti r'r o e eiti a fiou firaiimpiatiaMitaiii q: 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 a Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Enemy 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 k. Wilt 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, ,as Owner of the subject property hereby authorize to act on ,y.ehalf, in all --tiers relative to work authorized by this building permit application. At 1/ Ali • Signatures er Date I, 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 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name QS Litton Hodder: _,_ License Number Address __ Expiration Date Signature Telephone it 9a3eU'fsta`fe'd'Hdm rnanlveianf*i8ctnc,w=:,, ::,..::c.°. ax"iu�,..atsas�m=-,ah Not ApPlicpble 0 Company Name i Registration Number Address Expiration Date _Telephone _ SECTION 10-WORKERS'COMPENSATION INSURANCEAFFIDAVIT(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 0 No 0 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 10&35,1. 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 cog home in a twp-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 buildin0 permit As acting Construction Supervisor your presence on the job site will be required fromtime 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 i uries not resulting in Death) Ma- Gs- 1 r a^'=Annotated,vent may be liable for Person(s) you hire to perform work for you under this permits The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State d Local Zo 'i_Laws and State of Massachusetts General Laws Annotated... __.(ip E omeowner Signature 1.•. — L A • K.o e..a.r,°n- Crim of ;artliaiii fon . IE - p N row ( gt.a..rh•u n. tc CEPA. rME14T OP BUILDING IN.SPECr10 l+s 212 Min Street ' Municipal Du Idhg Narchanapton, Mss. 01066 ti' WORKER'S CO Mir ENSA110N INSUP.ANCE A1"PIDA\1T • Qictrascripcnninec) v.d Li) a principal place of business/residence at: (phoned) • (sacc✓cltyl snip) do hereby certify, under the pains and penalties of perjury; hal • ( ) I am an employer providing the iouo',vine worker's compensation coverage for nn • emptoyecs worbicg on this job: • • Gsuranc Cocatarv) • (Policy Naraber) --.. rettpindon Dalt) ( ) I am a sole proprieror, general contractor or homeowner (circiz one) and have hired the conaaaors used below cello have the foiiolving worker's cocpencanon policies: (Dam.: of Ce=.e,:.cvr1 (Icv2 rune Co,npaiyfPolic- Near..;) ._ (E._umvon Dam) (Name of Covmcor) {Inrara= Camoaa,.vPodc; \araccr) (S»ir;soo Deft) • M=me of Caasacor) Qzaurancz Company/Poticy Nambui (Ttpindoo Dara) (?!z.c of Coat,>cier) Uosuraa Company/Policy Numbcr7 (Ex-pi'2doo Data). (,c,a: ±itC4 J e,d✓ot..7'to axuva Inra.a.a«p n 4Ins e.u....s-�:at ( ) I am a sok proprietor and have no one working for me ' 14.. I am a home owner performing all the work myself. NOTE pot ch..fvc Us P.po.smploy p: by r' =-Pr=Jco a„pa's"it m.d"w_.or not a,a tept tea.,awm e=b Dc rve,7 or ea we wvoA appLaztcoPm urn a oxon..--.1)y a souem zday-a aa -,M..ct:v+:—c::imAn(C.Lt52a1(S)?-foti,aow M.aunt n pp-mil tr-my v-x to Icbd vu..ot u.m loy.c undm d, wu'ku'a Cnuipm:LLien Ac I undctad eacopy u Cu.talacit m•y e.f d 4 to of 4.4===..1===.4===.0.5....z.`w. r w. mvczo'dein nod uu CareN ^-r'ct.<,eyv=PP-ccioo 23A of)..(CL 132 tam lad tithe iayWm ofOimvail OcaaUCi asci.:yg of a La;lug w 1000.00.M/c it wham, of up to ca Y—t"JA t m Pe tom of SI* t-tt> t+nda (ac of 7100.00 a my t iaoa ox. • For only PO- lic Mamba a 11-L )1VW/Gli Mips' - Si of Licvis&Pcrmiscc Dace ^_ Oftr1A1'tP�O , H =t_ „ ® 3,'e ( iiZr of Northampton 1= l �$.�d DEPARTMENT OF BUILDING INSPECTIONS — i/ _ = c INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 r 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:-, 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 jadeunderstand the above. ( owner/resident's signature requesting exemption) i wil cal tq schedule all t uired buildinginspections necessaryfor the W N building permit issu me Date Address of work location