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36-349 (3) rm SECTION 8 ;CONSTRUCTION SERVICES' 8.1 Licensed Construction Superviso : l Not Applicable ❑ Name of License Holder : /<e2 i // �GICA. i License Number — _..0 . _.e. gam ' Ai 11i (%.,„„ 4 Address ` Expiration Date / i •Kiir yi Si: :t 1 67 /7 " WW1" Telephone 011 ,51 - 9- .5 -e_ ''ee- ®f, .Ome: on eat o . Not Applicable Ci Company Name Registration Number Address Expiration Date Telephone SECT 10 WORKERS' COMPENSATION INSURANCEsAFFIDAVIT (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 (/ 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 `SECt'IONnS. ttti tPS.ION O it , P08EDWORK(check alt ,.: ;ate _x , f. i, mss - -_s .. ,• New House Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: A % t . S/1136 4T _ 1 ) y Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet 0 s;a f e hot sEaand o ad"d'itionito.,.ezistii Fi'ititit C;7cOlWi e. a i fo i ing: 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? __ i d. Proposed Square footage of new construction. Dimensions e. Number of stories? < f. Method of heating? F HA Fireplaces or Woodstoves ye J Number of each 1 • g. Energy Conservation Compliance. yea Mascheck Energy Compliance form attached? e S an �'f h. Type of construction 51- )61k— i. Is construction within 100 ft. of wetlands? Yes v No. Is construction within 100 yr. floodplain Yes t" .7 a j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? / Yes No . I. Septic Tank /' City Sewer Private well City water Supply A SECTION `teR NKR AUTHORIZATION TO BE COMPLETED: WHEN OW NERS AGENTOR A FOR B UILDING PER I, sus /4 n /Jilne_ /Ph PLC /1 r ` re ,- C..— , LG , as Owner of the subject property here yy a . i' oriz- /y4_ () 4v x _ to act on my be.. , in , • m. -... relative to work authorized by this building permit application. ii..,.. // 4 --/" " y '.ture of Owner Date _' c - -- I, 1 > 1;,_'. ` , as Owner /.Authorized Agent heresy declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signer ,n.er tthh� s an..enalties of 'ury, ..,e.,,,,---. Pri nt ame � i� Signature • • ner /•gent . 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 Side L: R: L: R: 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 DONT KNOW v 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 DONT 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: 1 ' ' a�� a ana? -- =®r. City of Northampton Building Department . 1 ' ' i ' 4 1 212 Main Street r Room 100 e s � � 7 Northampton, MA 01060 7 -1272 1 • . t i� , phone 413 - 587 -1240 Fax 413 - 58 ° • .` ' ... t40.•a , at^ '. . ' - .' APPLICATION TO CONSTRUCT, ALTER, F E AIll to A ONE OR TWO FAMILY DWELLING , - ________________ ) y 11 i JUN 10 2CO4 ' SECTI 1 — SITE INFORMATION 1----- ,, Fns ction to be c o m pleted by office 1.1 Properly Address: � �i. Jr /�p� j'J �✓e' ` L Uni 7. Zone .Overla Distri EIm 5t. District i `' CB Distri -'-'-- SECTION 2•- PROPERTY OWNERSHIPjAUTIIORIZED AGENT' 2.1 Owner of Record: .-�- / l Mari , qY «r !�'Ci' 61.E )5 r i Aide /1 Name V t) v ::: d ss •nature 2.2 Authorized A. ent: �jf /� ��J/� Imo! +i /1 �L ? /�/ ��!' �st� sY /11J� Name (Print Current Mailing Address: 2 n. �'� %� t� Telephone SECTION -L MATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be ., Official Use Only completed by permit applicant 1. Building C� D (a) Building Permit Fee 2. Electrical — (b) Fstimated,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 6c, J --- is Section For Official Use Only Building Permit Number: ('/ / 2t Co l Date Issued: Signature: Building Commissioner /Inspector of Buildings Date , --- �► OVEREI G N ,f,„4 UILDERS 4 135 Southampton Road, Westhampton MA 01027 413.527.8001 FAX 413.529.9988 July 7, 2004 Building Commissioner City Hall 212 Main Street Northampton, MA 01060 Re: Dunphy Drive To Whom It May Concern: We would like to transfer our building application on Dunphy Drive. We are not on the job and have transferred ownership of property and building plans to Robert G. O'Bear. Sincerely, PIA Todd Cellura IIIIINP O .TNAMP2 Q � � 01,ifx of Northampton I L • = °_ _ i ii '�"" DEPARTMENT OF BUILDI7'G INSPECTIONS f ' 4 _ ' _ _ �= ,_____- f _ INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 5 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as Lis /her construction sups:.. 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 made I, 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 t MIN , • - -c Itidi P2, • ‘1.1., .,\... .. . 0 1:1; fill‘ 4 0_,,„„ of Nartilainpfoil ,--, - ,, 4.1 E..a. .;c:c• ••• DEPARTMENT OF BUILDING INSPECTIONS - M - 1,1 i = — 212 Main Street • hfunicipal Building • ,,_ Northampton, Mass. 01060 to WORKER'S COMPENSA'llON INSURANCE AFFIDAVIT (licr-_nstclr..crtn:tt:-..!:) with a pan cipal place of business/residence at: (phone)///5 (strecticIty,':;:atf:Pi-Jp) cio hereby der under r_hc pans and penaltics or perjlin, ;hat - ( I am an employer providing the follov:ini: '.vorker compensation covera:2,e for my employees working on this job: ( 4 jAKiirlhve;.c Gfp/7/7 re 4/ ' .7i—a-C ' / (Insaranai Coraparly) (Pclic: umber) (Expiration D.-ate) ,.. ( ) 1 am a sole proprietor, o.entral Cl-01,1: CT. 0 F C_.■ F homeowner (circle one) and have hired the contractors listed below - ,ho have, the folic workers compen&atzion policles: (Name of Contractor) an.suranco Colm NumbT) (T- Date) (Name of Contracor) (Lasuranc, CorrioaT:y(PoNcy Number) (Expiration Date) ___ --.------ (Name of Contr ( Ins rruic,-... Coz3T,a1JyiPolicy NIIJIli'plr ) ,,xr,:rat Date.) . (Name of Contractor) (losuranco: Comt:ar.y/Polic. Numbes) (Expiration Date) ( if :1 1.7 ..., :: tr..: 7 a: 7 • - - 7 ' : , 1 i ,,<:::',... :' ( ) 1 Z un a sole propne:.oi a:Li 'nave no one •.. for me. ( ) 1 am a home ovvner DerfoTminc all td e -,,,,',-.-;:-.... ir: - ,..sclf NOTE.: picasc be as ',.1...v. •. 1-, - , ,', - .-3 ern-ploy p- to eo :. co,.'n Cr ' "'"' ' ' ` c:- not more th...tn throe tiniti in is • t. 7,t. ro c,r oc :Ss:: gro..n. . thccto are nc< cc o cz1ploya-3 ury,Sor the vrorl .-::-.7......qc Act (C31...152.;:si (5)), nr..;,.1:. by a homeowner for a Lc =sc cc prim:: nif.:. c. ths: k rt gal atia; of an cemploy 1 / the Woricor's Coroperea.tion :`..ci._ 1 u-nd •,. of .e. •.; of .; e cr,.."..f. re.ny be fro-3 to IL, Depart-mull of lociautrial Arcie......,-rr? Oftio- of 1, -''''.7 1 ' for 1-1 '` .: C°v • • • • • fi• that f toQtrt covcrt.g,s ur‘...'cr scctioci 25 of l'.{01- 152 oni3 lcui to thc imposition oi cs--naL__1 pci-ali.os cormisti o f ,, , ,,, , . 1 S _300 ,,,n"rr iol--rv:1i of up to cr..: yi:zir ?: civil pctultics in •i,c form of ri Sio-,, ',corr. Or' ,c. end a firr. of ' 1 00. • i i i.s.....ii . rr.c.. / ■••.' ' f 004410 For cic-4-ix.:smesrl ti.c only Pcrrnit Numbe_r _ _ j - -- -- - • -- -- 7 -- d r , 'f:tpfl 1,0t .. — i _i gna t.0 r 4 V 111 "lcc , r;.(..:•.11 ) r r i 1 :1 tr.:. . - --- Ti 1:• !. i ' ' - ' ' " -. • File # BP- 2004 -1266 APPLICANT /CONTACT PERSON ROBERT OBEAR ADDRESS/PHONE P 0 BOX 951 MONTAGUE (413) 367 -2424 0 PROPERTY LOCATION 135 DUNPHY DR - LOT #4 MAP 36 PARCEL 349 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out /- / 2 Fee Paid CC�L�J ,3v — Typeof Construction: CONSTRUCT 2 STORY SFH W /ATT GARAGE /DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 086260 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: 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 S et Commission ____ Signature of Building Official Dat 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. p y.y,0 5c, i cviv") 135 DUNPHY DR - LOT #4 BP -2004 -1266 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 349 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: New Single Family House BUILDING PERMIT Permit # BP- 2004 -1266 Project # JS -2004 -0781 Est. Cost: $240500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROBERT OBEAR 086260 Lot Size(sq. ft.): Owner: SOVEREIGN BUILDERS 1NC Zoning: SR Applicant: ROBERT OBEAR AT. 1'5DUNPHY DP -;OT 4 Applicant Address: Phone: Insurance: P 0 BOX 951 (413) 367 -2424 O MONTAGUEMA01351 ISSUED ON: 7/8/04 TO PERFORM THE FOLLOWING WORK: CONSTRUCT 2 STORY SFH W/ATT GARAGE /DECK POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: i ,/ / Footin gs: h l q Roug (1S ' ,, - Rough: V ( House # Foundation: c f ( 6 - G • e '1' � Driveway Final: n Loi)6 `' Final: /l/ , — R/ "1j Final: p/P277 iJ Wi,} / d 06 77_- / RoughFrameK2k 3 - 6 j `?.ei4 /iG Zisr Gas: Fire Department Fireplace /Chimney: � Rough: ' --j K � j Oil: 1 Insulation• (',' K �j ` /7 G , � � Final: )1' - AL:_s Smoke „, at, x,"_"' Final: elf 67 ` / -4 ••ire�'� -� THIS PERMIT MAY BE REVOKED B HE CITY OF NORTHAMPTON UPON VIOLAT OF ANY OF ITS RULES AND REGULATIONS. --° -- . ;, Certificate of Occupancy ,e signatu FeeType: Receipt No: Date Paid: Check No: Amount: Building 7/8/04 0:00:00 663 $50.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patiilo