32A-168 (9) SECTIONS-CONSTRUCTION SERVICES
1 Licensed Construction SuQpeerrvissoor::,/ All r� �,Q�y� •�•� Not Applicable ❑
Name of License Holder: ` `�'' Rl M'' �/C"IJ�r'`' ' 1;36
License Number
Ads Expiration Date
Sig,nature Telephone
Not Applicable ❑
b �91Y__�
Company Name c� Registration um er
Z
Add r ss „ l/ Expiration Date
Telephone D
SECTION'10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT 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
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
7CTION 5- DESCRIPTION OF PROPOSED WORK(check ill applicablg)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolitiony( New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: 0 octgqmml, fl�►D -
0 4s
S r'W G6 ND M w-
Alteration of existing bedroom Yes c Adding new be i o Yes o
Attached Narrative o Renovating un�ffi ished basement Yes No
Plans Attached Roll ❑. Sheet❑ n?�' e,I k EN-0
IVN O om dd a1 "CHO N• M 0 S 1✓Gr' i' ;
a. Use of building: One Family Two Family OtherM
b. Number of rooms in each family unit: Number of Bathrooms 6'N b�f C�j(�,��1 0
c. Is there a garage attached? j � S
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? bem 0 I N t"IvN 6 f-
_),14 twL (-T El bt
f. Method of heating? Fireplac or Woodstoves Number of each
(� ROM. ff-0Nr)
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
Type of construction 1� (T 'b SET, Srt-Poc�U�
wm(-e PIS-EVE a us �Dm and
i. Is construction within 100 ft. of ands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or ar floor below finished grade V)A -A IT"
MAN 61JI vbi N&
k. Will buildin nform to the Building and Zoning regulations? Yes No .
I. Se Tank City Sewer Private well City water Supply
SECTION' 'a QVIIfVERlU FHORiZATlaN '1 Q3E GMPLE71tD WHEN
OWNERS)AGENT�OR CONTRACTOR PPLIES FO�t�lJIL I PERMIT
., . _.: ..
I Vs U N as Owner of the subject property
hereby uthorize *4� �' G`" to act on
my be , in all m t elative to work authorized by this building permit application.
0. A-3 Ib
Signature o wner Date
0¢46W kl,cbe INC- I'DW — as Owner AWees 45yyE_)Agent
hereby declare that the statements and information on he foregoing application are true and accurate, to
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
ig ture of Owner/Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
ENIE�D�DiJ� TO LACK F INFOR�A�O�1 c,�,
a N
f:b e . or Existing Proposed Required by Zoning
�1 t' This column to be fill" by
•t f/� Building Depanme
Lot Size
Frontage
Setbacks Front
Side L: R: L:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Se s
Fill:
�Ydume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW _ YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location:
f
(` City of Northampton
' B'uiJdIng Department
21� Main Street
Room 100
-'Northampton, MA 01060
phone 4131587'1240 Fax 413-587.1272
w
APPLLCki6k b', TRUC4,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: f
gl SI�I�x1tr/C l B i hC 'F'".•. /4' _> "��',<ia 5.,.
SECTION 2-'PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: MO
Name Pr Current Mailing Address:
Telephone �JpbJJ�� f Tb
Sign—at ur C�
2.2 Authorized Agent: �/l TI !'f^ �L
e(Print)• �^ , I Current Mailing Address:
�'j 2��
Signature Telephone
SECTION 3=ESTIMATELI CONSTRUCTION COSTS K o
Item Estimated Cost(Dollars)to be Official Use On
Y
completed by ermit applicant
1. Building (a)Bulls Ing�Perml,
2. Electrical (b)Estimated Total Cost di Fez
construction"from O
3. Plumbing Building Permit IFee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 +2 + 3 +4+5) 0 d 0 Check number
This Section For Official Use Onl
Building Permit Number Date lssued
V
x -
Signature
Builct�rfgC Cnrrt�ssioh r/l6spector of Buildings bate
File#BP-2004-0440
APPLICANT/CONTACT PERSON Wright Builders
ADDRESS/PHONE 48 Bates St (413) 586-8287
PROPERTY LOCATION 50 HAWLEY ST
MAP 32A PARCEL 168 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid '-
r
Typeof Construction:_REPAIRS&NON-STRUCTURAL DEMOLITION TO EXPOSE CONDITIONS FOR
REMODELING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 047146
3 sets of Plans/Plot Plan
THE F9LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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 Co ion
o0
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-2004-0440
GIS#: COMMONWEALTH OF MASSACHUSETTS
vo, CITY OF NORTHAMPTON
Lot: -001
Permit Building
Category: BUILDING PERMIT
Permit# BP-2004-0440
Project# JS-2004-0637
Est. Cost: $10000.00
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Wright Builders 047146
Lot Size(sg.ft.): 17598.24 Owner: VERSON ALAN
Zoning:URC A-pplicant: Wright Builders
AT. 50 HAWLEY ST
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 Workers Compensation
NORTHAMPTON MAO 1060 ISSUED ON.10123103 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIRS & NON-STRUCTURAL DEMOLITION TO
EXPOSE CONDITIONS FOR REMODELING
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• Receipt No: Date Paid: Check No: Amount:
Building 10/23/03 0:00:00 16812 $50.00
212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo