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GOMEZ-THOMAS HOUSE
11 Verona Street, Florence MA
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GOMEZ-THOMAS HOI.'t,{ U5E ,gyp,,: Li
iZ Verona Street, Flone',arence MA ���n1dM`•eata�m'itd Living
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GOMEZ-THOMAS HOUSE
11 Verona Street, Florence MA
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GOMEZ-THOMAS HOUSE
11 Verona Street, Florence IVA
LOOR PLAN
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GOMEZ-THOMAS HOL,ti DOSE ,,,t,t Li
11 Verona Street Flor1�:'!Orence MA „� „t..=.�.t
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DEPARTMENT OF BUDDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building '
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CNIR 108.3.4 to
act as l;is/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 accessary 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 tg 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
R CrZf of '.�n�-f12��It}�tflil
1 Q •E gZ l3 Inch accl la' -
DEPNtTMEN-T OP £3UILDr7\C INSPECTION'S -
212 Main Strcet iKunicipal Building '
Nort.hampton, Hass. 010G0
i
WO1UCER'S CON'fPENSA-17ON GPISURA.NCE AI'I'II)AVIT
1
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(Ii ccnsexjpermj tfcc)
%Vith a principal place of business/residence at:
ha k_ ._5:b 5kel vLt}o rrc S (phone') L113 �
� (str�tici ty/st,al.da p
do hereby certify, under dic-pp_ins and penalties of per3ury, -hat
( ) I am an employer providing the follovvinL worker's colnDCf]s_:jon cove2ge for Iny
etuplovecs worlang on diis job:
(Imstinncc Coizp7m,) (Policy Nu-mixr) -- (r:•pit[ion Dam)
( ) I am a sole proprietor, geoeral contractor or homeow-oer (c cie one) and hive hired
the contractors listed below wbo hive the following worker's comptnszaon policies:
('Name Oi Contnctor) (Insurance. Compai)-Pi obc; Date)
(N LMc of Contretor) (lnsurznc ComoaavfPo!ie; \�nesr) (E\'plm6on Date)
(Name of Coaaacto,) (In.surancz- Company[PoL-q- Number) (Expimtios Datc)
(N2me of Contractor) (Insuranct- Compary/PoLcy Number) (Expimtioo Date) .
(atiac�:d'Ji:;ocaJ dcct iraoca�r}•to¢�ctucl;iaforta.0 oa pertasai.ag to 111 ooa7-_c.o:�)
I am a sole ro rietor and bave n
P P o one orl;3.ng for me.
( } I am.a home owner performing all Lbe work myself.
NOTE:plcsc be eorarc t i +{ }e 6emco.%acn vbo emplaY P<=sooa w Lb m•=--r rrrav
Wori on.d..xb of
Got moon thr- throe t -J is myth the bomoo.wcr rtzidc cc oo the pvunr3 zppuflr�rl tb. c_ cr aoc C=h:_Uy==&---d to L-
citploycs
' ( ( )),:{�plinDOn lry a 6otneowve fcr:��--a permit n_y cvid—11:c
jIcga.1 nave of Ia a Ployec under dao Work^o &compom&6oa Act
[uDdc•ri...ad that a Dopy of t1sil mltm sst m,.y b.f—urded w the Dopef,mc o¢or lodutril!Accde ly OM oC Irnurlom ra tb.
oovo ISc vaireslioa,ud Qtu C iltat w soaun tov�yt�under soction 25A of MGL 152 na led to the i=p ssaioa of a=ic i pcbtW=
ooa%is of a fiat orup to S I}00.00 andfor oCup to oac yr=r end 6%-J pmlltio io tSc focal of s Stop Work Orde Ind a
fim of S 100.00 a day LpjrA me
For dcq.�u.c Doty
S/' ✓ ` 7 V'Xi /YaGi (�.
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S+�naiun of Lic=Ls(.-JPctzniucc �� F
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor. Not Applicable ❑
Name of License Holder: J d N {'n- /D 1 e°10 111 0
License Number
q7 LV)U I a wl 561 S,(e,&A—hZ 1-61 J 5 d,1370
Address Expiratio bate
S' ature Telephone
ciisterecl- m e inp ro�iement Contractors
11 I�e Flo
Pp
�M,n f12 P-1e QV f2 y-
Company Name Registration Number
,�k7 Iaok Sf 57*kc°_)�ygHP r-kf'1LJ 1144- NJ?0 ;-1--Og
Address Expiration Date
Telephon ZS= b
SECTION 10-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...... ❑
omen. one ME i r�
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 ill 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 buildigg 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 Slate of Massachusetts General Laws Annotated.
Homeowner Signature
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 [p Siding[0] Other[CI]
Brief Descriptiong wPr`oposed F
Work: �d l4,*— CtAL Al'tl �t\i14�,Yt,Ck" -
Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes ✓ No �� k
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
g0f'hlernr�hoase a cNora d for o exls#inu o lslnp �car�m a e .a awriap:
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—OWNERAUTHORIZATIOW-TO BE COMPLETED:WHEN
OWNERS AGENT OR"GONRACTOR=APPLIES FOR".BUICJNG PERMIT
as Owner of the subject
property
hereby authorize
to act o y beha , in all matters relative to wok authorized by this building permit application.
Signatufe of Owner Date
ep y L as Owner/Authorized
Age reby declare that the statdments 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.
Jokh M. pie u
Print Name
SjoKature of Owner/Agent Date
or
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 --- % —�-
i
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 a 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 Paged and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Date Issued:
C. Do any signs exist on the property? YES 0 NO
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 Qr
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excav tion,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
l � � G -
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eta S�Sa. T �
City of Northampton s
I. building Department
x12 Main Street n
1' Room 100
Norttfa mpton, MA 01060
phone 41 -58711240 Fax 413-587-1272
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APPLICATION
ICATION Ti520NSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
Tfi s secttan fo be ycomplefed by office
1.1 Property Address
��ne � OvertayOtsftct
k µf x n
Elie`S DistrJCt CB ►stnct a
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
C,o�vfLitJ 'caou S M �AAa► 1. Caor Z l U�a�S 571 ,I �y�++ti TD� �lA otOC�
Name(Print) Current Mailing Address:
4►3 sas s�
Telephone
ure
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION;13-ESTIMATED CONSTRUCTION COSTS-
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building /a �� -(a)Building Permit Fee
2. Electrical "I (b).Estimated Total Cost of
Construdfion from 6
3. Plumbing Building Permit Fee:
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) CV Check Number d.
This Section For Official Use Only
-D"ate
Building Permit Number. Issued:
Signature:
Building Commissioner/InspectorofBuildings Date
File#BP-2007-0069
APPLICANT/CONTACT PERSON JOHN M PIEPUL
ADDRESS/PHONE 47 WILLIAMS ST SHELBURNE FALLS (413)625-6667
PROPERTY LOCATION 11 VERONA ST
MAP 17D PARCEL 015 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out At CA'
Fee Paid
Typeof Construction:_RAISE LIV RM/KITCH CEILING&ADD SKYLIGHTS,REMOVE KNEE WALL&
EXTEND KNEE WALL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 071381
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFPRMATION 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 Co on
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.
BP-2007-0069
GIs#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category_ BUILDING PERMIT
Permit# BP-2007-0069
Project# JS-2007-0113
Est.Cost: $9000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOHN M PIEPUL 071381
Lot Size(sq.ft.): 12888.84 OWner: THOMAS CAITLIN&DANIEL GOMEZ
Zoning_URB Applicant: JOHN M PIEPUL
AT: 11 VERONA ST
Applicant Address: Phone: Insurance:
47 WILLIAMS ST (413)625-6667
SHELBURNE FALLSMA01370ISSUED ON:712712006 0:00:00
TO PERFORM THE FOLLOWING WORK.-RAISE LIV RM/KITCH CEILING & ADD
SKYLIGHTS, REMOVE KNEE WALL & EXTEND KNEE WALL
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 7/27/2006 0:00:00 $50.002655
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo