38A-111 (6) \ A
er-7
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4
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: 1 0 Not Applicable ❑
fi Name of License Holder : V� ' " rl • )ww� �� T` �2Z 'fv(- - 0 Yair
License Numbe
L I it'M s � . � o 1 �C jig
Addres Expiration Date
�
7761/
Signature Telephone
9. Registered Home Improvement Contractor Not Applicable ❑
�N
PiTni< AA 0 12-0 Ca -- - yz 1 / 30
Company Name Registration Number
'4 (k sf frp a .pm1 /
Address / Expiration Date
�� r Telephone
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 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
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SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
�
Or Doors
Accessory Bldg. ❑ Demolition El New Signs [O] Decks [Q Siding [0] Other [0]
Brief Description of Proposed ( A `_ I e � � � �
Work: jTt Kt l S
Alteration of existing bedroom Yes X 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 housinci. 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. ensions
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 • . of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of baseme• or cellar floor below finished grade
k. Will buildi. • conform to the Building and Zoning regulations? Yes No .
I. S- : is Tank City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, K—e1A44 .S l" , as Owner of the subject
property ,p 8/014e1-5
hereby authorize VV �,
to act on y behalf, in all matters relative to work authorized by this building permit applic. tion.
'a ..
Signa re of • T -r Date
j uDGI s 6 6s4 A/ Z )eui , as Owner Authorize.
A. ent ereby declare that the statements and infor ation on the foregoing application are true and accurate, to the best o my now edge
and belief.
Signed under the pains and penalties of perjury.
D h"4 P'vv2 A
Print Na ) / /7/ // /
Signature of �wner /A ent Date
Ammommummainar
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ivrw -tv t.Dpre- 6ci (-.:Perorfott4Tikir
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information M ( I��.
Existing Proposed Required by Zoning y
This column to be filled • by
Building Department
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 :. ces
Fi .
olume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DON'T KNOW 0 YES
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 lt!® DON'T KNOW 0 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 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, ex . ation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 4 •
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Sck
• Department use only
- I of Northampton Status of Permit:
R 1 Buil• in Department Curb Cut/Driveway Permit
2 2 Main Street Sewer /Septic Availability
l 4 ZO%I ! Room 100 Water/Well Availability
1272
No mpton, MA 01060 Two Sets of Structural Plans
. � ����. 58 -1240 Fax 413- 587 - Plot/Site Plans
oar , , , • ;1 � • uu+o,oso Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR O FAMILY DWELLING
RECEIVED
SECTION 1 - SITE INFORMATION
1.1 Property Address: ggisr t o pleted by office
I� Ma
N1 L ot Unit
o pE PL o BUILDING INSPECTIONS
Zo N o oN MAta Q r ay strict
N o Pr)t ►^,P M
Elm St. District ' CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 O n: of L -cord:
A l( iv M 4Stie. Cr. N 012- 1)t )
, Q7Q
Name (P • t) Current Mailing A ddress: ��► " 1
�i Aga Telephone
Sign -ture •
2.2 Authorized Agent:
I ii r $M
W cibeY-A me (Pri -151)2'11 � nt Si. �/1J a -A► N , l►ll�r
Current Mailing Address:
igrature Telephone n p' —
el
SECTION 3 - ESTIMATED CONSTRUCTION COSTS 4 13 F' 1Q tit froo , • 4 / 0 • —'
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building i(09/b- �. (a) Building Permit Fee
2. Electrical j / ` .. - - (b) Estimated Total Cost of
Construction from (6)
3. Plumbing I yam Building Permit Fee
4. Mechanical (HVAC) tq )- -
5. Fire Protection /
�7 l
6. Total = (1 + 2 + 3 + 4 + 5) � '� � • Check Number j}�
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
7
File # BP- 2012 -0477
APPLICANT /CONTACT PERSON WRIGHT BUILDERS
ADDRESS/PHONE 48 Bates St NORTHAMPTON (413) 586 -8287 (116)
PROPERTY LOCATION 14 MOSER ST
MAP 38A PARCEL 111 001 ZONE PV(100) / /SG b
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid •� jS jl?
LJ /C 7
Typeof Construction: FINISH PARTIAL BASEMENT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 84280
3 sets of Plans / Plot Plan
THE FOLLOWING 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 Commission _ Permit DPW Storm Water Management
Demolition Delay
it 112111
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.
Ifs
14 MOSER ST BP- 2012 -0477
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38A - 111 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2012 -0477
Project # JS- 2012- 000802
Est. Cost: $12756.00
Fee: $78.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WRIGHT BUILDERS 84280
Lot Size(sq. ft.): 33759.00 Owner: SNELL KELLY A
Zoning: PV(100) / /SG b Applicant: WRIGHT BUILDERS
AT: 14 MOSER ST
Applicant Address: Phone: Insurance:
48 Bates St (413) 586 -8287 (116) Workers Compensation
NORTHAMPTONMA01060 ISSUED ON :11/28/2011 0 :00 :00
TO PERFORM THE FOLLOWING WORK: FINISH PARTIAL BASEMENT
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 11/28/2011 0:00:00 $78.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner