31A-273 (4) 21 DRYADS GREEN ST BP-2017-1134
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:3IA-273 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-1134
Project# JS-2017-001924
Est.Cost: $1649.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN PERRIER 173021
Lot Size(sq. ft.): 24175.80 Owner: ALAM MOHAMMED.'
Zoning: URA(100)/ Applicant: JOHN PERRIER
AT: 21 DRYADS GREEN ST
Applicant Address: Phone: Insurance:
18 BROADWAY POND RD (860) 930-7794 WC
STAFFORD SPRINGSCT06076 ISSUED ON:4/10/20170:00:00
TO PERFORM THE FOLLOWING WORK ADD R-48 CELLULOSE INSULATION IN ATTIC
FOR WEATHERIZATION PURPOSES
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:
FeeTvpe: Date Paid: Amount:
Building 4/10/2017 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File k BP-2017-1134
APPLICANT/CONTACT PERSON JOHN PERRIER
ADDRESS/PHONE: 18 BROADWAY POND RD STAFFORD SPRINGS (860)930-7794
PROPERTY LOCATION 21 DRYADS GREEN ST
MAP 3IA PARCEL,273 001 ZONE URA( 09g
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT _
Fee Paid jJ
Building Permit Filled out J(
Fee Paid
llygq.,8fConstruction; ADD R-48 CELLULOSE INSULATION IN ATTIC FOR WEATHERIZATION
PURPOSES
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 173021
3 sets of Plans;Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO MATION PRESENTED:
Approved _ Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Proiect: 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
Demo ".n Delay
y' /
// � ," O /)
S : . ure of Bui di g O 'ci. 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.
_—-- Se The Commonwealth of Massachusetts FOR
---�^ y jlr p Board of Building Regulations and Standards MUNICIPALITYiQl�i1 Massachusetts State Building Code,780 CMR USE
I Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
I ' -I This Section For Official Use Only
CG '�
* Building Permit Number: Date Applied:
I
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
Lt ,opo o ddress: • Il� 1.2 Assesses 1r&Parcel Nomben42 7_3
1.1a Is this an accepted street?yes_ no _ Map M_"my� $ fj- Panel Number
£3 Zoning Information: 1.4 Property Dinrnsioa^.:
Zoning District Proposed Use Lot Area(sq0) Frontage(8)
1.5 Building Setbacks(ft)
From Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c,40,§54) 1.7 Flood Zone Information 1.8 Sewage Disposal System:
Public 0 Private❑ Zone: _ Outside flood Zone? Monicipei O On site dispuatti system 0
Check if yesO
SECTION{ , 2: PROPERTY OWNERSHIP' p/(� °)666
/L X
2,i,O.wgyr' .9lecord: l ' S , a/,_�4 'i�/ l/.. /' / f`` ' " °/ 6CJ
Name(Print) SS Z
,7 I� /) s r tt - 41 -5y1 -3(e6
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building O Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
To Add R-48 Cellulose Insulation in Attic for weatherization purposes
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official U Onlyam (Labor and Materials)
1.Building $ I. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
_ ..... 0 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $__ —
4.Mechanical (HVAC) $ List
5.Mechanical (Fire $
Suppression) Total All F $ / )))
Check No. � Check Amount:
'B Cash Amount:
6.Total Project Cost: $ l/n I c 0 Paid in Pull Outstanding Balance Due:
NEGH
28 Spellman rd
Please Submit Stafford Springs,Ct
Permits to: 06076
SECTIONS: CONSTRUCTION SERVICES
LI Construction Supervisor License(CSL)
John Perrier 103319 12-12.2017
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)_I_„_^
18 Bradway Pond rd
Type Description
No.and Street U Unrestricted(Buildings up to 35,060 cu.fl;)_
Restricted 1882 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
Stafford Springs Ct 06076 WS Window end Siding
SP Solid Fuel Burning Appliances
1 Insulation
860.930-7794_ Iperrier06076(®yahoo.eomTelephone Email address D Demolition
Si Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name (73021 &27-2018
HIC Registration Number Expiration Date
John Perrier
No.and Street jperrier060764o.eom
18 Bradway Pond rd
Statlord Springs,Cl.06076 Email address
City/Town,State,ZIP Telephone 860-930-7794
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G.L.c.152.1E 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 ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
t,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
03/x/2017
Print Names Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,f 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
03/11j2017
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. 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 not have access to the arbitration
program or guaranty fluid under M.G.L.o. 142A.Other important information on the HIC Program can be found at
www.mass.govtoca Information on the Construction Supervisor License can be found at www,mas3.Rov/dps
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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JOHN A PERRIER
NI BROADWAY POND ROAD
STAFFORD SPRINGS CT 06076
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d-:Registration: 173021 ,,,, ,T
Expiration 8E276010 , , individtraf r,•,?;,-r,
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City of Northampton
wMassachusetts
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k DEPARTMENT OF BUILDING INSPECTIONS •S\
212 Main Street a Municipal Building •C.
p
Northampton, MA 01060 ,_- 1^
Property Address: (9 / A"/ S 61 s4)
Contractor John
o h n ��'I JJJ�I
Name: `/ ] /� � �/
Address: ' (J 8M(VI • J /96W` �//•'��7/q
City, State: ��f%)2� SE '/pip / a �b `
Phone: �1J 0- y- 13
Property Owner ,( Ja j^ ,, ` / {�/��
Name: /% kg_ -H
Address: iQ / C{O& 67✓
City, State: L// h ,'Y/ 0l t1 ,j
I, /i A n Prny�k C _ (contractor) attest and affirm that the building I intend to
insula e oes not have any open air (knob and tube)wiring in the spaces to be insulated and that I have
provided the property owner with a coil of this affidavit.
Contractor signature OAF .0.-Aillie
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Date ))'�l/