36-178 87 DUNPHY DR BP-2017-0559
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36- 178 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BASEMENT RENOVATION BUILDING PERMIT
Permit# BP-2017-0559
Project# JS-2017-000901
Est. Cost: $12500.00
Fee: $81.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
La: Homeowner as Contractor
Lot Sizelsq. ft.): 14984.64 Owner: ECKERT LESLEY
zoning: Applicant: ECKERT LESLEY
AT: 87 DUNPHY DR
Applicant Address: Phone: Insurance:
87 DUNPHY DR (413) 695-3168 O
NORTHAMPTONMA01060 ISSUED ON:10/25/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:BASEMENT ALTERATIONS - REPLACE
WINDOWS, NEW EGRESS WINDOW, INSULATIONNVALLS AND BATHROOM
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:
FeeTepe: Date Paid: Amount:
Building 10/25/2016 0:00:00 $81.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-3017-0559
APPLICANT/CONTACT PERSON ECKERT LESLEY
ADDRESS/PHONE 87 DUNPHY DR NORTHAMPTON (413)695-3168 Q
PROPERTY LOCATION 87 DUNPHY DR
MAP 36 PARCEL 178 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
NCLOSED REQUIRED DATE
ZONING FORM FILLED OUT ��
Fee Paid
Building Permit Filled out ik
Fee Paid
Tvneof Construction: BASEMENT ALTERA . -REPLACE WINDOWS,NEW EGRESS WINDOW.
INSULATION/WALLS AND BATHROOM
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
INFOFMTION PRESENTED:
.. pproved 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 Permit DPW Storm Water Management
Demolition Delay
sise" �� ini /1 y/G
S ature of Biilding 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.
Deparanent use only
RECG[�l eL` . City of Northampton Status of Permit
IICI
Building Department Curb Cut/Driveway Permit
I�It 2 L.i 0 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Daae oveuun:uo iNsrrcnoNs orthampton, MA 01060 Two Sets of Structural Plans
NORTHAMPTON MA�tjrine 4 3-587-1240 Fax 413-587-1272 PM/Ste Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
87 Dunphy Drive Map Lot Unit
Florence,MA 01062 Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Lesley(Eckert)Milligan 87 Dunphy Drive,Florence,MA 01062
Name(Print) Current Mailing Address:
(413)695-3168
u..)A. (1 0 U uLt LC/LC/vv... Telephone
Signature
2.2 Authorized Aaent:
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 $6000 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
$1500 Construction from(6)
3 Plumbing $5000Building Permit Fee -67 I
4. Mechanical(HVAC) F BD
5. Fire Protection
6 Total=(1 +2+3+4+5) $12500 Check Number y?9
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings
Date
$ction 4. ZONING Nl Information Mist 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 0.344 acres 0.344 acres
Frontage 100 ft 100 ft
Setbacks Front 24 ft 24 ft
Side L:23 ft R:45 ft L:23 ft R_45 ft
Rear. 98 ft 98 ft
Building Height 15 ft 15 ft
Bldg. Square Footage 938 6 % 938 6
Open Space Footage
(Lot area minus bldg&paved 12860 86 12860 86
parking)
#of Parking Spaces 2 2
Fill: not applicable not applicable
(volume&Location)
A Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT mow O YES O
IF YES, date issued:
IF YES Was the permit recorded at the FLagistry of Deeds?
NIO O DONT mow O YES O
IF YES enter Book Page and/or Document #
a Does he site contain a brook, body of water or wetlands? NO O Darr KNOW O Y6 O
IF YES has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Cb any signs exist on the property? YES O NO O
IF describe size, type and location:
D. Are there any proposed changes to or addit ions of signs intended for the property ? YES0 NO O
IF YES describe size, type and location:
E W II the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is d part of a common plan
that will disturb over 1 acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoolicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[o] Other[DI
Brief Description of Proposed
Work: Basement alterations(replacement windows,new egress window,insulation/walls,new bathroom)
Alteration of existing bedroomYes X No Adding new bedroom Yes X No
Attached Narrative Yes Renovating unfinished basement X Yes No
Plans Attached Roll 1-Sheet
6a.If New house and or addition to existing housing. complete the following:
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 stones?
f. 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 t 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
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 my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, Lesley(Eckert)Milligan , 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.
Lesley(Eckert)Milligan
Print Name
/ U � lc)zo/i(G
Signature of nor/Agent v Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9. Registered Home ImorovemeM Contractor: Not Applicable 0
Company Name Registration Number
Address Expiration Date
Telephone
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. - Home Owner Exemption
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 10835.1.
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 Codc,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature (-4.',1H �k ithA(AA.
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: 87 Dunphy Drive,Florence,MA 01062
The debris will be transported by: Homeowners
Valley Regional Recycling&Transfer Facility,234 Easthampton Rd,
The debris will be received by: Northampton,MA
Building permit number:
Name of Permit Applicant Lesley(Eckert)Milligan
•
102(116, de .A„ki.k tvv,..
Date Signature of Permit Applicant
City of Northampton
SS S%C
Massachusetts e= e
I�
\d 4E;- � 3 DEPARTMENT OF BUILDING INSPECTIONS
� — 212 Main Street • municipal Building
{ 0,c,jav" _° Northampton, AM 01060 J'y'-. `�aC
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. 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 Dour). 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 ins
pections are made
I, NC r, u.lt ,�w understand the above.
(Home own r/residelit's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date ICI 2c(I(e
Address of work location 87 Dunphy Drive,Florence,MA 01062
The Commonwealth of Massachusetts
=_ Department oflndustrialAccidents LS
it-a-Fit. 1 OgceofInvestigations
C nicht_ 1 Congress Street, Suite 100
_J:— Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organiretion/Individual): t-G51C' (Eck e'-1 ,k1'Ilk) 50 il
_
Address: S7 Dunpn' 'Qr1ve
City/State/Zip: FlCrnnce/ MA ICIC Cr . Phone#: 1113– ( c15 -3 iLt8
Are you an employer? Check the appropriate box: Type of project(required):
I.❑ I am a employer with 4. ❑ I am a general contractor and 1
employees (full and/or part-time).* have hired the sub-contractors 6. ill New construction
listed on the attached sheet. 7. ® Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have g_ ❑ Demolition
workingfor me in anycapacity. employees and have workers'
F n' t 9. El Building addition
[No workers' comp. insurance comp. insurance.
� required.] 5. ❑ We are a corporation and its 10.® Electrical repairs or additions
3.IIN N I am a homeowner doing all work officers have exercised their 11.N Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] ' c. 152.§I(4),and we have no
employees. [No workers' 1341 Other
comp. insurance required.]
*Any applicant that checks box/41 must also fill out the section below showing their workers'compensation policy information_
'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a newaffidavltindicating such.
teontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp_policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: itttk.L C Lk.xllrC�v Date: IC! 0,C11(r
Phone III 3- (9C1S - 31(c
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
Project Narrative — Basement Alterations
87 Dunphy Drive, Florence, MA 01062
The project includes the following work:
▪ Replacement of all five existing basement windows
▪ Installation of one new egress window in basement
• Insulation of interior basement perimeter walls
• Framing and drywall of eastern 2/3 (+/-) of basement
• Addition of closets in basement
• Addition of one new full bathroom in basement
• Installation of new lighting, electrical outlets, and electric baseboard heaters in
basement
1 tSi
Basement Alterations Plan Masc.>
87 Dunphy Drive, Florence, MA 01062 i LAW( Et , m1Et";
N
'It.q }; .,.;,K@a. ,,,,4&'xirx; ... t5'i New Egress. dtitle ' '.' t•.
w
20" 60 — 2' 0" :2,0..
J
Closet R )" k tl
. irt/e/e ..5" 4,,,fit CjAd/P/0 Kr/
0' 1"
City of Northampton
Building Department
Plan Review
212 Main Street Utility Area
Northampton, MA 01060 4i 2" 24'2
X 120' i 2'8"—X X 4'8" .
Half Wall
X 12' 0" —s> -
0
3' 5" Stairs 3'5''
,.1 �,
12' 0"
Bathroom .' „41/4-114'6"—\ I O
--- 11 2"-_.____--_.__.. _ 3 •
Clos4et
3 7P Washer and Dryer 3' 7" 3' 7 # I .
4"- 12' 0" X— 11'2"
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