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31A-218
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A • Prepared for the exclusive use of WRIGHT BUILDERS, INC. staff, subcontractors, and suppliers; ni All other uses prohibited. . , ...-. ,. . , • • ,- . v 1. • (.3 ,..,,, . . , _. 0 ---, - '0 6 ; •,, •_.__ • • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : A r itu f CS' License Number e, S4- l Nor- ki∎awt p lGv1 61 01 O C 4- 1//q/a0 C Address Expiration Date q /3- 5‘) `F28 signature T phone dinO We;t tt a.ci, :. . en Co fracto Y V t Not Applicable ❑ 6uilA€rs f 1ToCe JO/ 36 CompantdName Registration Number � I f3(f 5 54 6 /26 // Address Expiration Date • i '1 Q VIAL p T" 0 r or , O Telephone S&6. . -Ea 3 7 SECTIO;C� 10� {IIIORKERS' CON[PENS1ATlON INSL��ANGE$Al=t=l�?A'V�,ITS � � c '152,;15, ,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 12 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 Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be Iiable 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 • r . SECTION 5 .DESCRIPTION•OF PROPOSED WORK (check all applicable) New House n Addition n Replacement Windows Alteration(s) I Roofing n Or Doors L,6 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding [p] Other [p] Brief De cription of P. oposed , ./.V75/ (lctH) A 0 Work: Sty. G. k uc- i -u' r co of e-kist;✓►,c Les( stc; - p orc:k� 1 -P(aor /eve I widows , 4& F' too l- ie ((GS. Alteration of existing bedroom Yes V No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes V No Plans Attached Roll - Sheet `: V i M < O i lq lOtlS'txltl iii hn . 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. Dimension.- - e. Number of stories? f. Method of heating? Fplaces or Woodstoves- Number of each f g. Energy Conservation Compliance. , °' Masscheck Energy Compliance form attached? h. Type of construction /' i. Is construction within 100 ft. of w nds? Yes No. Is construction within 100 yr. floodplain Yes _ No j. Depth of basement or - ar floor below finished grade k. Will buildin• - .nform to the Building and Zoning regulations? Yes No . I. is Tank City Sewer Private well City water Supply SECTION 7ra „ iOWNER AUTHORIZATION TO BE COIVtP WH 'OWNEft.S AGENT O.dost AGTOR`APPLIES FO;R. BUILDII G'PERIitHT 1b` 1, t cIL c 6corook 5 as Owner of the subject property f(� hereby authorize Lk) c t k- r)U I kcke 5 1 C to actn1'y in all matOrs relative to work authorized by this building permit application. d ip - / • Sign. -8 `� a' r ..- Bate 1 � . , , )r-i• , ■A ; 4 u i l c ' 4 k(. , 'IA. 1 £ , as Owner6uthorize • gent i ereb , declare that the statements and inf. mation on the foregoing application are true and accurate, to the best of my k) nowledge an. •elief. Signed under the pains and penalties of perjury. #r+itur- Qi ..iA . Print Name ° -- " --, , t, ,„ '-/ . ------ 1 r - .,,-- thilo Signature of wner/Agent Date 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 fille • by Building Departure Lot Size 1 1 1 1 7 1 Frontage L _ 11. ....._... Setbacks Front .,- L.= Side L:r 1 R: = L:I .• 1 r Rear E / im Building Height 1 1 = 1 1 Bldg. Square Footage F % 1 1 Open Space Footage (Lot area minus bldg & paved parking) # of Parking S . es 1 1 1 Fil . plume & Location) l A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 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 IF YES: enter Book ..:. Page and /or Document # 1 d I B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 a IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? ' YES NO er 1 IF YES, describe size, type and location: 1 r D. Are there any proposed changes to or additions of signs intended for the property ? YES. 0 NO f lF YES, describe size, type and location: i E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan t that will disturb over 1 acre'? YES 0 NO Cr IF YES, then a Northampton Storm Water Management Permit from the DPW is required. $ 4 I h File # BP- 2010 -0703 APPLICANT /CONTACT PERSON WRIGHT BUILDERS ADDRESS/PHONE 48 Bates St NORTHAMPTON (413) 586 -8287 PROPERTY LOCATION 81 HARRISON AVE MAP 31A PARCEL 218 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin l Permit Filled out r t Fee Paid Typeof Construction: REPAIR WEST SIDE 1ST FLR PORCH & INSTALL WINDOWS ON 2ND FLR PORCH New Construction Non Structural interior renovations Addition to Existing Accessory Structure_ Building Plans Included: Owner/ Statement or License 068185 3 sets of Plans / Plot Plan T HE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INATION PRESENTED: Appr oved 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 , __________ / p . _ 2 ® 6 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. 5.81. HARRISON AVE 0,4° BP-2010-0703 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) Category: BUILDING PERMIT Permit # BP-2010-0703 Project # JS- 2010- 001045 Est. Cost: $9654.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WRIGHT BUILDERS 068185 Lot Size(sq. ft.): 8537.76 Owner: BARONDES BLAIR D & JANET BOWDAN Zoning: URB(100)/ Applicant: WRIGHT BUILDERS AT: 81 HARRISON AVE Applicant Address: Phone: Insurance: 48 Bates St (413) 586 -8287 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:2/4/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: REPAIR WEST SIDE 1ST FLR PORCH & INSTALL WINDOWS ON 2ND FLR PORCH 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 2/4/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo The Commonwealth of Massachusetts _ - Department of Industrial Accidents ` !..- - -4 _r' Office of Investigations - =? 600 Washington Street . t Boston, MA 02111 =�'' www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information ,�/1 Please Print Legibly Name ( Business /Organizacioe/Individuai>: l (I-CCU— k . I M PA D V t. p.•1(( J Address: f&4 ), (30\1 1C__ CitylStatelZi c: l:r''t i 1 � h 01 1Y) Phone #: 41 S 8103 Are you an employer? Check the appropriate box: Type project p j of ro 1. i!1 I am a employer with Z 4. 0 I am a general contractor and I f mired): employees (full and/or part-time).* have hired the sub - contractors 6. ❑ New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.; 9. ❑Building addition required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. to workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13.0 Other employees. [No workers' comp. insurance required] *Any applicant that checks box #1 must also fin out the section below showing their workers' compensatim policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-cantractors 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 htformatia n. Insurance Company Name: I� 41 / Policy # or Self -ins. Lic. #: qi �-/ .'7 Expiration Date: l 1 'i 7/ - c IO Job Site Address: 15 / Y V>`X f rlS C'1 are_ City/Statel24A fig A!'7 Old 6D 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 'u under the , k and penalties ofperjuty that the infonon provided above is true and correct Signature: c►' "wt ..-- I /2 Y'r S. Date: (A / Phone #: // !:C^3 : /v22 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 #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction S pervisor. Not Applicable ❑ Name of License Holder : a Yl\ Q ( ( I t S 61 t License Number 1*a, vSoik. m A 10110(0-6(c) Address ) t Expiration Date ( Telephone SigtSature • �} c. 8. istered Home Improvement Contractor: Not Applicable ❑ C ` 4-h t"► ■ M v O 1-- -N k,l� t . I r i C_... t 4.0 Company Name j Registration Number Address ' t Expiration Date Telephone e tlD j-;�1 )-t SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be competed 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 Dwellines 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 1083.5.1. 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 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 buildiue 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 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House [J Addition 0 Replacement Windows Alteration(s) 0 Roofing El Or Doors 0 Accessory Bldg. El Demolition EJ New Signs [o] Decks ([l Siding [C7] Other Brief Description of Proposed 0, w fah _ Q "calf) Work: ! /,{, , 1 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - 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 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 BUILDING PERMIT l i3 I ai r 6(1(0 ncl S , as Owner of the subject property M� her y" authoriz-� ° ar nes (i'1i S to act on b • - matters relative to work authorized by this building permit appli tion. _ ►. A -- Date C( rn,QS 'i 1(S , as Owner /Authorized Agent hereby dedare 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. i ?S Ft it Prinj me Cr; Si • atu • of Owner /Agent Date 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 0 DONT KNOW ' ° 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 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained (3 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO E° ,, 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 11 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 4E) IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 4 . Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit r&�Q 212 Main Street Sewer /Septic Availability r ,- Room 100 WaterIWeil Availability N orthampton, MA 01060 Two Sets of Structural Plans phone 413-58 Fax 413 -587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELUNG SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office py / Jf,? (�i /] V c_ Map Lot Unit Zone Overlay District /11 0 r 44Zica i p M4 0 /Cho Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Reco ( Name (Pri Curygrit {�tai)ing �, 4,,, M (� gi O / / l .�� %! T e lephone r l F r (!J V Signat � �� O "' q I 5 O - or/ 5 2.2 Authorized Aaent: ( me eI I S 14 , do ,,k_ lel. CiIl MA 013?;` Print) Current Wiring Add £ � ) 4 3(23 - j)47 gnat re Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 5,131 C,1 - 0 (a) Building Permit Fee 2. Electrical 1 (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) 3 1 , " t //�� , v Check Number j&77 055 This Section For Official Use Only Date - Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0717 APPLICANT /CONTACT PERSON IDEAL HOME IMPROVEMENT INC ADDRESS/PHONE 142 BOYLE RD GILL (413) 863 -2128 PROPERTY LOCATION 81 HARRISON AVE MAP 31A PARCEL 218 001 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 rr Fee Paid J 7 7 §7 s' Typeof Construction: INSTALL WALL INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 091207 3 sets of Plans / Plot Plan THE FOLLOWING 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 Commission Permit DPW Storm Water Management Demolition Delay � Z dr ii 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. 81 HARRISON AVE BP- 2010 -0717 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) Categorv: INSULATION BUILDING PERMIT Permit # BP- 2010 -0717 Project # JS- 2010 - 001045 Est. Cost: $3232.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: IDEAL HOME IMPROVEMENT INC 091207 Lot Size(sq. ft.): 8537.76 Owner: BARONDES BLAIR D & JANET BOWDAN Zoning: URB(100)/ Applicant: IDEAL HOME IMPROVEMENT INC AT: 81 HARRISON AVE Applicant Address: Phone: Insurance: 142 BOYLE RD (413) 863 -2128 GILLMA01354 ISSUED ON:2/11/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL WALL INSULATION 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 2/11/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo