22B-013 (2) 04" O
G'ifp of Wartl amptan
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DEPARTMENT OF BUILDIJG INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
Norduvnpton, MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CNlR 108.3.4 to
act aS has/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
in ections. Failure of the individual trades to secure the permits and inspections as
re7uired can DELAY the project until such time as the proper permits and inspections are
ade
I understand the above.
(Home owner/residen s signature requesting exemption)
tt n t t t n L__•t�'�� r X4-1. 1.,.:t r7 nn Hermit
1 will call to schedule all lcqulCcu uuiluill� irl5pc�tivnS i1cCcSSai j Zvi Me
v.........b Y
issued to me.
Date
Address of work
location
c�
� ,�O��l�•c�,lic�iTOy (r r_
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DEPARTMEI-T OP BUILDr),�G INSPECTIOIds —
212 Main Strcct ' Municipal Building
Northampton, Mnss. 01060
«rOMCER'S COi` PENSA'aON C SURANCE AI I MAVIT
�y I
{Ii ccn5�lperm�ttcc}
with a principal place of bus1Oess/reSidence at:
V� A 3. Ss -7- z'zcF
(stsc-t/ciry! atrlEjp)
do hereby certify, under the.pa_ins and penalties of perjury; --hat
( ) I am an employer providing the following worker's colnpens�:Ja, cove age for my
etnplovices �>,�or-lang on this}ob.
f ,
(Insane Comr, y) (PcLi c-,Nvu_ r) --- FIxpirvor, Dztr)
O I am a sole propretor, general contractor or homeowner (side one) and have hirea
the contractors listed below cgbo have the fok iDg worker's compnsa6on pc!icies:
(i+8lll: Oi COD- r^Ci0") fl[1Rr7n(^ COITID7n)'hob -, !,,Iuff1C<:)
I -
(N.me of Contmcror) (Iris--- .ncc Comt)Z-vpolic" Numbrr) (%.%-L:.% Die)
(-lame of Connacto;) (Lusurancn— Compan)-Roticy tvumbzr) (Expirdoo Datc)
n•'��e c.Ccauaciar) (Lnsucanc—c Coma ylPolicy i Iumbcr} (Expirtion Date).
(attsch^addiz'onJ thed.ilncoas._�w ate? utrcrmiioe pey isms to.1I cc+xr-sun)
O I am a sole proprietor and have no one wori�ng for me.
(—)-I am.a home owner performing all the work myself.
NOTE:plcx be aw-Arc if,g u1^.Ic bccca ,3 wto caplcy pc;o w d0 ^. -. csraoo r rgair work oa.d%. U1 Z of
aoc most tb_a ttxo i s is ubicfs the bomoowocr raids a oa the jjouacS zppurtcn•n c ocg�:ty osdi to k co c z
--PI-Y--oars lbc-=kcr's o=P=r-�ca Au(GLI 52.n t(S)} rppLicn,on by a bamco -oa fcr c!ice oc p=mh r=y c iders tlrc
legal wsc or an c: loyx under dt Workze-C.o=pom4ioa AcL
l uadazryad tba>oopy of 0h-cal® m.y i.fon urdud to the Dcpnrtmmd of l-a.,"id Accdcoa'O(G-of bu.�rvr tb.
eova'+.se vaiG—ion and ttu L i um to coauc)COvcMS under'-e on 23A of MOL 152=Ied to the itlrcpcsi ioa of oimiail pen-+16o
cooaiamg of a fine of up to s 1_�o0.00.ndicr impr-jyo orup w one yar e.od oil pasaliia to tSe rocm of s Stop Work Order and a
rrm of 5100.00 a d_y LVInst mL
- J `` For dcp.rta+=�uK oa;y
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SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
7 . Not Applicable .❑
9 'Reuiste�edt�ome�innrouemen�ton�ra�for* ,�. � � x pp
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 1'0-WORKERS'COMPENSATION%INSURANCE AFFIDAVIT(M.GL.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
i_� r..L_a,r,,,,,.,,,,t...�e.-t,.ro.—] i mvc Annntntp.d you may be liable for person(s)
Employees for injuries not resulting in Deau,�o1 u1Q�.,� �a... ��••�.»--»••--
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-arrd 7rs and State of Massachusetts General Laws Annotated.
omeowner Signat re
SECTION 5 DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[O] Other[m]
of Description of Proposed g
Ork: V'C, 0(t( S,G�� , � ,?� C� ;✓4�{�e�L.S , ,^4 — t. 1,
J
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
'L'.,, "= ."„".s?•ra's eu'gn r .'.",'w"' P' " r •». ?+�.:5:r'?*`�c..r'?'n?.ic .s, ^"`A�= 5"fk > `" 'mow..°'3";'.•
6a 1f New ha�se°and.or- clitiot>I to;exlGStin.4 6t1sliaa..compfiete t e olto�cing:
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.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER'AUTHORIZATION:-TO BE COMPLETED,-WHEN
OWNERS AGENT OR-CONTRACTOR APPLIES`FOR 6UILDING 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.
ISignature of Owner Date
I, -- ' .s r•� fn - l as Owner/Authorized
Agent hereby declare that t e 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.
Print Name
Signature otOwner/Agent Date
y
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 r
Bldg.Square Footage %
� , s
Open Space Footage %
(Lot area minus bldg&paved E I I
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 0 YES 0
IF YES, date issued:!
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page,; and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q Date Issued:
C. Do any signs exist on the property? YES 0 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 0 NO Q
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 0 NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
ti
DepartrAett useAnty
City of Northampton Status oferrtt
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nn 22 Tiding Department Eur> GvttDrta+e `Pep�t, � ,
l� L� M r�L� I(` 12 Main Street SnrerltccatlatrtF
Room 100 i _ a �
ah
No mpton MA 01060e � ,
,
I ph`t}4 41$ -1240 Fax 413-587-1272
APPLICATIQi��,j �A%TRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
Tht ss6q#ontobe.completedbyoffrce
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t" e V- erCayD
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-E�tli$t'�IStrICt `:.. _ 'Cwt]IS�I'IGt
'SECTION"2-PROPERTY OWNERSHIP/AUTHORIZEDfAGENT
2.1 Owner of Record:. 'n t
"le
Name(Print) Current Mailing Address:
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 ermit applicant
1. Building 4 (a)Buildin Permit Fee
2. Electrical ',(b),,Estimated T-ptal Cost of
Constructionftom 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire.Protection
6. Total=(1 +2+3+4+5) C g,n<<, Check Number d--
This'Section For Official Use Only
.. _.
Building Permit Number.' -:-Date'
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2006-1087
APPLICANT/CONTACT PERSON MARVELLI CHRISTOPHER
ADDRESS/PHONE 45 MEADOW ST FLORENCE (413)587-9284 Q
PROPERTY LOCATION 45 MEADOW ST
MAP 22B PARCEL 013 001 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
Typeof Construction: REPLACE SIDING WINDOWS&INSULATE WALLS
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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 Commis * /
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.
. t
45 My r BP-2006-1087
GIS#: COMMONWEALTH OF MASSACHUSETTS
Ivf�p,,
CITY OF NORTHAMPTON
Lot: -001
Permit: Buildinq
Category BUILDING PERMIT
Permit# BP-2006-1087
Project# JS-2006-1603
Est. Cost: $15000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 8712.00 Owner: MARVELLI CHRISTOPHER
Zoning:URB Applicant: MARVELLI CHRISTOPHER
AT: 45 MEADOW ST
Applicant Address: Phone: Insurance:
45 MEADOW ST (413) 587-9284 ()
FLORENCEMA01062 ISSUED ON:411312006 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE SIDING, WINDOWS & INSULATE
WALLS
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 4/13/2006 0:00:00 $50.001221
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo