18C-153 {
4
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not (u:/ �l Not Applicable ❑
Name of License Holder : ( r. LV �j�� 11 D
License Number
Ltif e r 6 1 e fog /1/1f(
Address Expiration Date
S - 809
gna • Telephone
9. Realstered Home Improvement Contractor Not Applicable ❑
Company Name ( 1w
Registration istration Number
• : & s / , 0( MFr) Mk i >fo
Address / ` �-�•/ Expiration Date
A, Telephone f 1 O
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 y 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 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 and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
• Y +
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) 4 Roofing ❑
Or Doors E
Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [D Siding [O] Other [0]
Brief
Work Description of Proposed D n.w f b Vk T , 4 ,,,•el J �S'�- ), f ey hittAl M (4 p j
Alteration of existing bedroom Yes X _ No Adding new bedroom Yes No "'Lc
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a If New house and or addition to existing housing, complete the following; p 6 O -
a. Use of building : One Family Two Family Other A n
1 �' `
b. Number of rooms in each family unit: Number of Bathrooms WA/04
c. Is there a garage attached? {
d. Proposed Square footage of new construction. Dimensi. •
e. Number of stories? I mo ? " 1- ° cb /cot
f. Method of heating? eplaces 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 - lands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or - - ar floor below finished grade
k. Will buildin• •. form to the Building and Zoning regulations? Yes No .
I. Se• Tank _ City Sewer Private well City water Supply
SECTION 7a OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, /14 rt t ` "t 1 A4• 0 ON , as Owner of the subject
property
hereby authorize Ut � , gelt-r relit i
to act ctjon my behalf, in all matters relative to work authorized by this building permit application.
i /4-ot dA (. ie742..a 7(0
Signature wner Date
,
I, W 6 1W - j 411 , as Owner Authorized
gent ereby declare that the statements and information on the foregoing application are true and accurate, to the best o my no dge
elief.
Signed under the pains and penalties of perjury.
•0 i, fK '• /tU6
Print Name //
L VI X / /d
Signatur- Owner /Agent Date
Wbf* "to Virnt r t )(1‘51)1141. P-1‘
it'°v;''
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 sy
Building Departme,
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 :. ces
Fi
olume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW ►'r YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T 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 f23C DON'T 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 (D , Date Issued:
C. Do any signs exist on the property? YES 0 NO Sr
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES (3 NO la—
IF YES, describe size, type and location:
E. WiII 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 41
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
t V
Department use only
City of Northampton Status of Permit:
ji I, ). i Building Department Curb Cut/Driveway. Permit
242 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 Plot/Site Plans
i 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
d' / RI e e _ Q u tzrtto A' �' Map Lot Unit
J � j b Ae , � - /, (� / M � ' Zon Overlay District
' `'
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: sir Name (Print) Current Mailing Address: t�.
/S �-- Telephone
Signature
2.2 Authorized , gent:,
U/( ' ► .,j..i ■ MAC
r /- ' t� `� �fl 9r AA) F-1 Pt N
Name (Print) / / Current Mailing Address:
I' jpri
Signature Telephone
SEC '4N 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 1 4CI 7 (P(49 °C) (a) Building Permit Fee
2. Electrical a e f . U . V (b) Estimated Total Cost of
1 Q Ip Construction from (6)
3. Plumbing I 4. 1,7. 4 6 00 Building Permit Fee
4. Mechanical (HVAC) t -_,
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) 1 5.Z' �(���" Check Number c3(Pl /5 �
This Sect For Official Use Only
Date
Building Permit Number: Issued:
Signature:'
Building Comm /Inspector of Buildings Date
File # BP- 2011 -0448
APPLICANT /CONTACT PERSON WRIGHT BUILDERS
ADDRESS/PHONE 48 Bates St NORTHAMPTON (413) 586 -8287 (116)
PROPERTY LOCATION 26 WARBURTON WAY
MAP 18C PARCEL 153 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ., / // 3/
Fee Paid �
Typeof Construction:_RENOVATE KITCHEN,2 BATHROOMS,NEW TREADS RISERS & RAILS,INSULATE
BASEMENT �-
New Construction
Fige t e6r �q e J (-
0 N M'U3 c
Non Structural interior renovations / / . r
Addition to Existing
Accessory Structure nAG v ke /C r eQ� - L 'e Building Plans Incuded: ��Kll
Owner/ Statement or License 16370
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFRATION 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 - Permit DPW Storm Water Management
Demolition Delay
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.
26' tAR URTON WAY ". • BP- 2011 -0448
GIS #: COMMONWEALTH OF MASSACHUSETTS
oe 18C tS3, 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- 2011 -0448
Project # JS- 2011- 000729
Est. Cost: $52500.00
Fee: $318.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WRIGHT BUILDERS 16370
Lot Size(sq. ft.): 0.00 Owner: OLIVO MARGARET A MAIL TO: MARGARET ANDERSON
Zoning: URB(100)/ Applicant: WRIGHT BUILDERS
AT: 26 WARBURTON WAY
Applicant Address: Phone: Insurance:
48 Bates St (413) 586 -8287 (116) Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON:11/18/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: RENOVATE KITCHEN,2 BATHROOMS,NEW
TREADS RISERS & RAILS,INSULATE BASEMENT -FIRE RATE PARTITIONS,SMOKE /CO AT
EACH LEVEL
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:
/ / // == (9 / �'
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner