31A-173 (2) 40 MAYNARD RD BP-2016-1236
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 A- 173 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv: INSULATION BUILDING PERMIT
Permit# BP-2016-1236
Project# JS-2016-002124
Est. Cost: $1482.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN PERRIER_ 105319
Lot Size(sq.ft.): 7492.32 Owner: SMITH STEPHEN E&JOLIE B
Zoning: URB000)/ Applicant: JOHN PERRIER
AT. 40 MAYNARD RD
Applicant Address: Phone: Insurance:
18 BROADWAY POND RD (860) 930-7794 WC
STAFFORD SPRINGSCT06076 ISSUED ON:4/29/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL ATTIC 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:
FeeTyne: Date Paid: Amount:
Building 4/29/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1236
APPLICANT/CONTACT PERSON JOHN PERRIER
ADDRESS/PHONE 18 BROADWAY POND RD STAFFORD SPRINGS06076(860)930-7794
PROPERTY LOCATION 40 MAYNARD RD
MAP 31A PARCEL 173 001 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
Fee Paid
Typeof Construction: INSTALL ATTIC INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 105319
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION 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
f
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.
R Z 1 2.016
The Commonwealth of Massachusetts
eels oard of Building Regulations and Standards FOR
MUNICIPALITY
z„tomos,r+,ti is;� assachusetts State Building Code, 780 CMA
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Famdy Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Priat Name) Signature Date
SECTION 1:SITE INFORMATION.
1.1 Property Address: 1.2 Assessors Map&ParceI Numbers
1.1a Is this an accepted streetY yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L a 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: Outside Flood Zone? Municipal Q On site disposal system ❑
Check if yesO
SECTION 2: PROPERTY OWNERSHIP'
2.1 0Pvner,1ofRe rd P/,r
Name(Print) ZIP
C,� t , ,?v ...��
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK(eheck all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s} ❑ Alteration(s) 13 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other Cl Specify:
Brief Description of Proposed Work2:
To Add R-38 Insulation too en attic
SECTION 4:ESTIMATED.CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Fee:$ Indicate hove fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:-
5.Mechanical (Fire $ Total All
suppression)
Check N�16_Check AmoCash Amount:
6.Total Project Cost: $ U L` ❑Paid in Full ❑Outstanding Balance Due:
NEGH
28 Spellman rd
Please Submit Stafford Springs,Ct
Permits to: 06076
r SEiCTION'5: CONSTRUCTIONSERVXCEIx;
51 Construction Supervisor License(CSL)
John Perrier 105319 12.12-2415
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) I
18 Bradway Pond rd
:.Type I7esptnon
No,and Street U Unrestricted&uildings up to 35,000 cu.ft.
R Restricted M2 family Dwelling
City/Town,State,ZIP M Masonry
RC I RooSn Coverin
Stafford Springs Ct 06076 WS I Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
860-930-7794 jperrier06o76@yahoo.com
T cle^hone Email address D Demolition
5.2 Registered Home Improvement Contractor(111C)
HIC Company Name or HIC Registrant Name 173021 8-27-2016
HIC Registration Number Expiration Date
Bohn Perrier
No.and Street jperrier06076Qyahoo.com
18 Bradway Pond rd Email address
Stafford Springs,Ct.06076
Ci /Town State ZIP Telephone 860-930-7794
"S)u0" 6t QI Rs'COMPENSATION INSURANCE AFFIDAtj11T t :G 1✓ .�I52: 25Q
77
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...........13
SI +C�'1;ON 7a QVS?NERAUTHORIZATION TO BE COMPf; D !✓�N
AGEN'T.OR.CONTRACTOR APPLIES F-m' MMNGI'ERMIT:
I,as Owner of the subject property,hereby authorize New England Green Homes to act on my behalf,in all matters
relative to work authorized by this building permit application.
John Perrier
4//-(/2016
Print Owner's Name Electronic Si ature Date
G�`IbN 71):<OW.NER'OR'AUt4ORIZED AGENT:AEC
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Lynn Ford
4/ d/2,016
Print Owner's or Authorized Agent's Name(Electronic Signature) c
NODate
77
I �Te �
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will nog have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.Roy/oca Information on the Construction Supervisor License can be found at www.mass.eovldps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) _(including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
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City of Northampton
Massachusetts
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DEPARD&W OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 14
Northampton, MA 01664
Property Address:
Contractor
Name: 1 f_1
Address: 7
City, State: I � 4!�
Phone: ,A?
NProperty ame:
Owned
Address:
City, State:
(contractor)attest and affirm that the building t intend to
I4pridted
doe ave any open air(knob and tube)wiring in the spaces to be insulated and that i have
t roperty owner with a copy of this affidavit
Contractor signature
+�-----
Date
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