13-079 O�TttlJfpyO � r►.. L
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DEPARTMENT OP t)UILDD\IC INSPECTioi,,S
212 Alain Street ' Municipal Building
.e
Northampton, Mass. 010GO
WORICE, R'S COi12P1 NSA770N, LNSURA-NCE AFIMANfIT'.`
�y � (lcrnsxlpermincx)
° oClausiner ._- ..
��t: •s.�• i�S �c't-�` ,�i'G" �r�5 3 --(phone:):, �:��'- '�/J -
(srrc-1lcity/statctzip)
do hereby certifjr, under tfic.pains and penalties of perlury, bat
O I am an employer providing the follo%ving \ti,orkcrs compenscoon covcr2gc for Iny
elupl'oyces kvorldng on this jvb.
0MSU.r---D=.Conn m•) (Polio?:u cr) {r pircion I?a }
( ) I am a sole proprietor, general contractor or homeowner(ci cie one) and have hired
the coutractors listed below wbo have the `olio viDg worker's coo. pensa6on policies-
(dame of Cont^eior) (In--uranc—c Compary/PoIUc NIu-Enr_t:) (rtiJiiJt3QP.l 1100
(Name of Cooncior) -- (Lasi-ancz� Comuanvi?olk Number) (E.i*r lon Date)
(Name of conaano.) (Insu anc: Coa pany/PoUq- Numbcj) (Ex iraooa Date)
(Name of Contacior) (Lusuranm Comraay/Policy Numbr) (Expiration Date).
(aaxcb:d:•litiocst God-irca="Xy io mc!u(k iafocma:ioc patn.ini06 w..0 wmsrO^a)
1
" f
I am a sole proprietor and have no one worldng for me.
( ) I am.a home owner performing all the work myself.
NOTE.plcsc be awzLm thu w; }o bomcawvm wbo mxploy pcs=co Sx o ciao c mPair work w a d••ctLzb of
W motz than tbrm t^ai.r in which the bomoowocr rai4=or oo the pouo6 zppu l c a=theca c r ax Uoeatty oeerdavd rn be
rurployt-s trorSc the w-tv"i==p===ioa An(GLI k.=1(5)}.=mUczaoa by a bomaow=fora Ges-or pomp rr:y-id—the
legsi etsau of ea-=ooyw under rho workwe Cooapom"r ion Act.
I undasund�+¢a O°Fy of tbir mtGtAaai m.y bo for•werd.d to tbo peq.nmoaa of Iod.cruisJ Acodmsz(01Sio.of ina+r"oa"for tb.
cov,cfT vcr' cx600 mid Ow failtac a ccaare boron v trnrScY saxioa 25A of?.IOL 112 m tc d to the impolkim of aimiost pcaattio
ooasiring of►Gx of up to S I}oo.00 acgvor 62pr�of up to ooc year znd avir pemhoo in the form of"Stop Wort Or*r"+d a
rim of 5100.00 a d--y ap.iwl me
For dcp.nrr.�-�ux ody
l� Pcrm;t NUMt=
sipoetturr f ioasscC/PCrTrtittcc e
SECTION 8-CONSTRUCTION SERVICES
Licensed Cn c n SuRtryiso r Not Applicable ❑
Name of License Holder: � i
License Number
Address ' Expiration Date
Signature s Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
Address )pirationn Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6j)
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...... ❑
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 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 buiidin¢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
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: 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 Q DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained O , Date Issued:
C. Do any signs exist on the property? YES Q NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES o NO 0
IF YES, describe size, type and location:
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 Q NO Q
IF YES,then a Northampton Stone Water Management Permit from the DPW is required.
,
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors -IV I
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[p] Other[p]
Brief Description of Proposed
Work:_ �l t s�i�f/ /it/ �r:i ✓.,..,�Ja,•+S
Alteration of existing bedroom Yes `� No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes i/ No
Plans Attached Roll -Sheet
Ga. 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 stories?
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 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.
1, 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, C m f"cx r V P t as Owner of the subject
property
hereby authorize ( 1,< r'
to act on my behalf,in all mattervIb4ative to wo authorized by this building permit anplication.
Signature of Owner Date
I, Vol � r;,P
6 ,as Owner/Authorized
Agent hereby declare th the statem nts 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.
e/lect' ,d a ..,e
Print Name
Signature of ner t Date
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
C 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability.
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PlottSite 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
Map Lot Unit
N.A Zone Overlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
C7rVP1 � ► 1C;G tvlclrtCan 1� G: AA1t:An. op-%
Name(Print) Current Mailing Address: 3 j
4 d..t c CL E'L- , ._ ✓J! .r Telephone
Signature
2.2 Authodzed A en :
L cLT
Name(Pnnt) Current Mailing Address:
Signature Telephone
SECTION 3-ES (MATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by rmit applicant
1. Building (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--/JQI& '
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
r
POW BP-2009-0441
GIs#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate ory: BUILDING PERMIT
Permit# BP-2009-0441
Project# JS-2009-000593
Est. Cost: $5000.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CRAIG MARNEY 102112
Lot Size(sq. ft.): 14897.52 Owner: MARVELLI CLAUDETTE M
Zoning: SR(100)//RI Applicant: CRAIG MARNEY
AT: 100 MARIAN ST
Applicant Address: Phone: Insurance:
P O Box 128 (413) 586-5512
LEEDSMA01053 ISSUED ON:1012112008 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS
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: Date Paid: Amount:
Building 10/21/2008 0:00:00 $35.001076
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo