23D-049 (7) IllikifeiTh DR BP-2003-0942
GIs#: COMMONWEALTH OF MASSACHUSETTS
Wan:Block:23D-049 : CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0942
Project# JS-2003-1510
Est. Cost: $720.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq ft.): 14157.00 Owner: DUFFY HAROLD F JR&KIM A
Zoning:URB Applicant: DUFFY HAROLD F JR & KIM A
AT: 101 RIVERSIDE DR
Applicant Address: Phone: Insurance:
101 RIVERSIDE DR (413) 584-3815 ()
FLORENCEMA01062 ISSUED ON:5/6/03 0:00:00
TO PERFORM THE FOLLOWING WORK:ERECT 16 X 10 SHED
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: Receipt No: Date Paid: Check No: Amount:
Building 5/6/03 0:00:00 1120 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2003-0942
APPLICANT/CONTACT PERSON DUFFY HAROLD F JR&KIM A
ADDRESS/PHONE 101 RIVERSIDE DR (413)584-3815 ()
PROPERTY LOCATION 101 RIVERSIDE DR
MAP 23D PARCEL 049 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid "PO e0)5—
Typeof Construction: ERECT 16 X 10 SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFpifiVIATION PRESENTED:
V 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 Stree mmission
Signature of Building Official Date
C/I°93
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.
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De"a" ept£us". my
,I I jrCity of-Northampton Status ofhPerm r k,
--�------------ -BuildingDepartment CurbCut/D�-vewa. er� lt�-
212 Main Street Sewer/,Septic A .a ab{J,ty y rt �
APR 3 0 2003 Room 100 wat"erJW�ell=Avallity. g °
Northampton, MA 01060 Two Setgtle Str e "<al a
_ :s >
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ptione 4-13-587.1240 Fax 413-587-1272 Plot/Site Plans= .�.• �� k ��
I OtherSpec,fy4 f
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING t
SECTION 1 - SITE INFORMATION
This section to,be;completed:by office,
1.1 Property Address:
101 Riverside Dr.. . Florence Map !/ Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Harold Duffy 1m1 Riverside Dr.
Name(Print) Current Mailing Address:
584-3815
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
720.00
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) 770.00 Check Number 1/el D ii;. ✓
This Section For Official Use Only
Building Permit Number: L/ __ Date Issued:
Signature:
Building Commissioner/Inspector of Buildings 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
Frontage
Setbacks Front G 27
Side L: R: L:5 ' R: Jjii J�
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO XX 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 xx 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 XX NO
IF YES, describe size, type and location: No Parking Si g.m on Fpdpra 1 St.. .
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No XX
IF YES, describe size, type and location:
•
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SECTION 5 -DESCRIPTION'OF PROPOSED WORK(checkoff applicable)
New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing ❑
Or Doors 0
Accessory Bldg. Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: Build 10 ' X 16 ' _S-t-oracge S-hcd Kit
Alteration of existing bedroom Yes xx No Adding new bedroom Yes XX No
Attached Narrative 0 Renovating unfinished basement Yes xx_ No
Plans Attached Roll 0 Sheet[XX
6a:"If7NeW fiouse an itor.:'addition to°existing housing, co"rri'plete7t he o owing:
a. Use of building : One Fa ily 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 ne construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each _
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 104 ft. of wetlands? _ Yes No. Is construction within 100 yr. floodplain Yes _No
j. Depth of basement or ellar floor below finished gr..e
k. Will building conform to the Building and Zoning regul ions? _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
, as Owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature ofOwner }pxy Date
Harold Duffy _ s Owner/ uthorized Agent
hereby declare that the statements and information on the foregoing application are true and accura , o the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Harold Duffy
Print Name
Signature of Ow er/Agent Date
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
r r ,-. grar ,Fr iT ,::- �. - :,- -etiii f`. . T-� r r77 ax r Not Applicable 0
451'Registered�.Home,�Improvement`Contractor „��, ,;• ��,, .�_�;.. x�,,ry ,;��;�,,��,• � ,�,;� �,,,�,
Company Name Registration Number
Address Expiration Date
Telephone
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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 0 No 0
11 = Hoine;Owne Exemptio
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 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 fe-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"cert. es and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances, State ocal ning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature _
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o-4., �..-9- DEPARTMENT OF BUILDING INSI'ECl'IONS
212 Main Street ' Municipal Budding '
Northampton, Mass. 01060 '/
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(hcensedpci nett:•'_)
with a principal place of btlsiness/ridene.r at
(phone
Ksrit.-- cit•i1 :i:: aip)
do hereby certily, tlll(Itr the hauls ai;u penalties of perjury, that.
( ) I am an employer providing the :oilo' :in: : worker's compensation (..,overage for m
employees working on this job:
(Polic-;Number) (Expiration )
Q1islir-ana.. Company) (Policy t:�.ltraion Date'
( ) I am a sole proprietor, general contractor c homeowner (circle one) and have hired
the contractors listed below who have the followin worker's compensation polls:es:
- (Name of Contractor) lots'.:';nc' (_�onma:, /Pohc, Number) (Ex?:rattcic Date)
-— (Name of Contractor) (insu:'fade:. Como; :1v/Pohlct Number) (Expiration Da:';.
(Name of Contractor) (Insurance Company/Policy Number) (EXi::ration Date)
(Name of Contractor) (Insu rill ice Co III;:l;y/Policy Number) (Expiratio:, Date)
(attach additional ah.ct:..._.cad ! f:Y::t a::C(:re:tni illr:'•:aI:O.G::a _-
( ) I dull a sole proprietor and have no one working for me.
) I am a home owner performinrz all the w,.):.• myself
Nom:please be atrue tha:While Ixenco••,:rss,t»c::ploy it:ac to aft::.a:::t::uncS carx.:.tim cr:cpair Wog; eri 1 dt,tJi:''.:;c!
not morn thn ttuco units in tti::d1 the fsreirsr;•.,zt<r rc::.::.t Of at t:,.:E-.S.'j ros s rutten:r.1 thcrcto as not cc-'rrally ar.::::::'':_he
r.cnployas under tlr.twa :ccrns ci:c s c aacn Ac:(Gr.152ss!(511, r;-•ti_a:ic:t by a hotacoxv i for a licnlsc cc pan:::rte•:,t- :.:r.:c::r:
legal status of en a nployec under tho Wortcn'a Co: ow...60a Act
I understand that a copy of this ttatcn cnt may he forwaraiod to tl»Ds/xi/uncut of Industrial Acidrnti'Office of In..uru*--o for the
covertgc vcrif cafioa and that f_ilure to a!ntirc eovcrn�•ur.d:r rozdou 25A of MC11.152 can'cad to the imposition ofcrcnI .I pclV.':ics
cocni.stmg of a floc of up to S 1.500.00 and'or impri.n.•1:::•t of up to co.ye ani civil puuIlia in lc fiefs of a Stop WcricOrskr and a
Piro of 5I DO.OU a city againit fir..
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DEPARTMENT OF BUILDING INSPECTIONS _`;. i`
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INSPECTOR 212 Main Street • Municipal Building o
Northampton, MA 01060
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as i.is'her construction sup..: .Hsor. 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, Harold Duffy 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 4/29/2003
Address of work
location 1 tD 1 R;veri d� Dr .
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