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36-299 g �i9,6g I 4 U tr ,a� i 6 � f �g,.lid vbO2� t N iV Q 0 -( N � N r 1 � ------------ - 5'-11" —20'-1" 6'-0'x 6'-8'OHD 3 x 6'7j9*9Lt T. x 6�9%t i-----------------------i 3'-0"x 4'-8" 6'-0"x 6'-8"SD T-O"x W-I 1 47 2' 15,_O- Open) I.- Z-4-4 �- DECK Proposed Deck For Jill Mendez 15'-O"(Open) 865 Burts Pitt Rd. Northampton, MA 01060 15�-O"(Open) (413) 585-0143 ECK of Framming: 2x8PT 12"O.C. for "Trex 11'-7"(Rail) --- Rails 36"H ("Trex) .-;I- rn 6 6 x a x /5 00'r 'Se-'.�'Oq 7v34.;- -/6 " x I/ Submitted by. Robert H. Dunn, Jr. CS #085846 HIC # 133318 II O¢�{t1AAlp�O (rztp of Norf4alnptnn - $ � �irlassacltusctts ' m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building INSPECTOR 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 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, --6s It,)FA M 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 s6S r1____3 J �TitAHhTO RC 11 Lis ctIs m L)EP!'u2T?iL1\rT OF EUILDmG INSPECTIONS 212 Main Street ' Municipal BulUjig Northampton, Mass. 01060 WORKER'S COMTENSAUON INSURANCE A + t A IT %vlth a prlrlcIp d place of buslIicsshtsidcIlc�c is do I1Creby CCrialti: lla;' 1 dl -mains :'.ild peal:it1Cs Oi pcgllry, iha; f I am an enlployei- pFovl(hn- the iollovviI1L '':OI'r:Cr$ collinc 1saUon COVCI2vC for Illy eil?ployces working on Lhls job: - (Ins =c_-: Company) ( clic.Number) ----- (F�pir.:wen Datc) ! ) I am a sole proprietor, general c-on1a-.c7_o; !jr hor-,trowou (cUEcic one` and 11a`,'e `aired the contractors listed beiow .. t, the ollc� . e .'ohc o t:- :1 y "OF!Ke s com-o ns`�on .e.s: (Na-mc of rro lLMCior) (Name of Contr:cto:) (7ltsur nc° Coy ra n/PG!ic; Nt rl fir, C1- ailo:. Late) (Name of Contractor) Coe zn.;iPolic Nusnlr r) =x.:rr:i.on Date) — (Name of C.Ontm. ctGr) —— (Insulallc-Z Comr v},Policy Numba_r) (F :-:tior Date) 1 well ti SOIC pl-O*Pil(:CJi "r:i:1 havc no oI c OC .ii`' for -nnc. t• I am a Ilome OwIIC. i)Ci?il`1?�11'!� all ?•10.11`:please In at arc tl: .�•ilc tx<ua zre a:ro c_, ic,+ r .^ '� , ;.�:'.�:ra��::anc�a:.=z:r",:�_:m cr:c^yair.c•,;._,� .�«cLi^s c not UK-cc th-n throe uui''s in%Nett the rc:,:,j a-a; :Z)t� e-,.to under t}r:vc:f;ea': t t n-. •_ - ? Y� cc:x•_•--:cr.��.c. (3t..5Si),r.l:r by a hortm:«rr`cr a Gccu cr F'-'::::r 'tin:c legal ctatuc of an c=VIOyec uud tLo wockee.Cozl_ _. GDn:`.ct_ I un,c_ztand tea:a ropy of thin data t: _t n:ay tp fOf�A'Rltla,I LD the 1>jM tnY_ty of lr'iui;fl_l Allvj:Y&OfflJ Of 1:J,LT FOi lj1 covcsxfle va-Iftealioc and thaw f_ilure to t- c coy r ,un3-r:ZctiOc 25A of MGt.152 can lead to the impositio:t of c•:.^r"1 pcts*:cs coal-istmg of n rtnc of up to 51.500.00 n:rd'rr i7t-pr:.r, ::p to Cn:} r.-.i evil Ixzult a in 94 fimn c•f a S!n,`;Jnz.O u a:d a Ltic Of SI00.0t1 t day ig-izrt m:. Fcn iq a t:,zeal u.c c�:ty 1 t .,a; .� Llt17tC1)1-1..ICL.i'�^JF!r. tYlitCc' - ,• � 7;1,,.- i Sf_CTON 8 ;GONSTRUCTf;ON SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : 'T 14 , �in� _ OJ Q "--5 License Number � 2 T -515 IC 7 Address 7`f L7 Expfratln Date S3 Signature Telephone Re a-e - ,A:ff rn Vernen. . n 'ra6to - Not Applicable ❑ 10 ck 1-3 Company Name Registration Number 9,5 _a L., 61416 S� Address ExpihticA Date Telephone 7y � SECTION 10 y�VORKERS' COMPENSATION INSURA NCExAFFIDAVIT(M�G.L.-,c 152, §'25G(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 acecptable 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 a Local Zoning L s and State of Massachusetts General Laws Annotated. Homeowner Signature SECT�OTI5l 52A7" OFFROP SED�IVORKM1checkaflya Idle .O` ; fi`.3 .aS�'*"?�� " «>,,.,.pz: �?a.4Y„a?:k �.v: a� :__ .s, .; �:�"3"�°" ,�:.�.:: M'”is*TM..rv�"'�-....+;„�-•n+cr#`� New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ . Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks Siding[ ) Other[ ] Brief Description of Proposed Work: -D Alteration of existing bedroom Yes�o Adding new bedroom Yes ✓ No __Z No Narrative D Renovating unfinished basement Yes ✓No Plans Attached Roll 0 • Sheet cl tRon to eX�sting;h 0 ueng pE Ti fAl.lowrng: 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? 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.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. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SEGTI 1NNER�AU�HORIZATION TO BE COMPLETED WHEN OWNERS ADEN O` CONTRACTORi_ LIES-FOR BUILDING PER I, C£11' as Owner of the subject property hereby authorize ���12-'� v'�r� to ac.: on my Vehalf, in all ma s relative to work authorized by this building permit application. SignatLffe of Owner Date f, OL '1- ` .` tl Nle-1 as Owner/.Authorized Agent hereby declare that the statements and information n the foregoing application are true and accurate, to the best of my knowledge and belief. Signed,unthe pains and enalties of perjury. vY,r anat(jr�eof Owner/Agent e i 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 i r Lot Size i Frontage h Setbacks Front r Side L: ,�O R: fi L: R: �U 7�©/ Rear 5/Q Building Height op t ! it 2-j 1( 3C ! Bldg. Square Footage `t % a70 SQr d�v Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume'&Location) A. Has a Special Permit/Variance/Finding ever n issued for/on the site? NO DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT 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 re any proposed changes to or additions of signs intended for the property?YES_ No IF YES, describe size, type and location: �► - rthampton epartment in Street 0 100 Atha , MA 01060 ? phone 413-58 -124 Fax 413-587-1272 „ ,, A6.111 64` CO -T NSTIIUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION sechon�to a cot- '61" b' affce 1.1 Property Address: Bo n 44 y �h►ertay`1pI5ti7Ct^-" � �a :w"app ?. s SECTION.2-PROPERTY-OWNERSHIP/AUTHORIZED AGENT. 2.1 Owner of Record: E !#JR ;rim a 2--- g -Z cy-, S Name tint) Current Mailing Addre 'A -�/ Telephone Signatur 2.2 Authorized Agent: r—yrT pay--T- Current Mailing Address: 3 t Telephone SE ON 3-E. MATE .CONSTRUCTION°COSTS Item Estimated Cost(Dollars)to be Official-Use Only com leted by ermit applicant 1. Building C' {a)`Building Permit t=ee 2. Electrical (b),Es mated_Total,Cost of Construction from 6 3. Plumbing Building Permit'-ee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 +3+4+ 5) 'S C3 Check Number This Section,For'Official Use,Onl Building Permit Number: Date Issued: i Signature: Building Commissioner/Inspector of Buildings Date File#BP-2004-1340 APPLICANT/CONTACT PERSON ROBERT H DUNN ADDRESS/PHONE 43 BURT RD WESTHAMPTON (413)527-2953 PROPERTY LOCATION 865 BURTS PIT RD MAP 36 PARCEL 299 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out _ Fee Paid 722V �m Typeof Construction: CONSTRUCT DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 085846 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9MATION 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 Street Commission Zz, Signature of Building Official 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. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. 865 BURTs PIT RD BP-2004-1340 GIs#: COMMONWEALTH OF MASSACHUSETTS hbgMh0k 36-299 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-2004-1340 Proiect# IS-2004-2016 Est.Cost: $4575.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const, Class: Contractor: License: Use Group: ROBERT H DUNN 085846 Lot Size(sq. ft.): Owner: MENDEZ REGINA M Zoning: SR Applicant. ROBERT H DUNN AT: 865 BURTS PIT RD Applicant Address: Phone: Insurance: 43 BURT RD (413) 527-2953 WESTHAMPTON MAO 1027 ISSUED ON.712104 0.00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 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: 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 7/2/04 0:00:00 104 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 865 BURTS PIT RD BP-2004-1340 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-299 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-2004-1340 Project# JS-2004-2016 Est.Cost: $4575.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROBERT H DUNN 085846 Lot Size(sq. ft.): Owner: ME`NDEZ REGINA M Zoning s nnB>=pT H DUNK AT.• 865 BURTS PIT RD Applicant Address: Phone: Insurance: 43 BURT RD (413) 527-2953 WESTHAMPTONMA01027 ISSUED ON:712104 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 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: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Oil:, Insulation: Final: Smoke: Final: (9 k 7 O, Q q 7 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. _ /�/ Certificate of Occupantt Signature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 7/2/04 0:00:00 104 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Conunissioner-Anthony Patillo