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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. Defmition 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 4 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House n Addition ❑ Replacement Windows Alteration(s). x , . Roofing ri Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [D Siding [0] Other [0] C. Brief Description of Proposed r E - �� p A' 9i C' kepeDo0. A bu� �� NILgf �' rb P I �t"Q-. Work: Alteration of existing bedroom Yes - t ° No Adding new bedroom Yes No , i� .G—Ks Attached Narrative Renovating unfinished basement Yes No ^� Plans Attached Roll - Sheet G` .� ,� v � � r �� ��� ,r. e• !fie .. � ., t t _,^' 'a5�e'" i ' „ 1 8 .. 6 _ s ®s s ' s , d � . s . ® i i : . . .� , s till a. Use of building One Family Two Family Other. t ibV . , , s b. Number of rooms in each family unit: Number of Bathrooms OA 0 V., 7C4)' S ■ 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. .r cellar floor below finished grade k. Will buil•' • conform to the Building and Zoning regulations? Yes No . I. • •tic Tank City Sewer Private well City water Supply SEdt.rA ?N 7a 0140 =R AUT TO. 4: C :MPL WHEN OIdfIN R 14.1 T f3R ddi;ei CTrOR A CIO FCft '§140506:0ERIVII 1, P.(51 er . ! ?2-3 � � � , as Owner of the subject property nA hereby authorize V V PI 6 1-1-3( Iw N Lbe to ac on my behalf, in all matters relative to work authorized by this building permit application. / /3/2 0 /3 E . I(� �l S -- 585 — 853 6 S igna t ure of Owner hate 1 W fr 64 I lI D tl-.a , as Owner�Authorizedi gent hereby declare that the statements and information on the foregoing application are true and accurate, to the best o my knowledge i ,e ief. Signed under the pains and penalties of perjury. 1 4) f & ' ( V 112/04 . Print Na — Z GJl/ / /(11/ Signature of Owner /Agent D ate • Pte' ltitv (A/1W +° jk 4o r'6 IA/ l . t 1 tsi sbt l`IG" -kraktir 6 1N,s' gevo 6 " • ‘ Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zonin. '' !';c i; , , This column to be f . in by Building Dep. v. ent Lot Size �. .° 11._______ Frontage Setbacks Front I= = LL Side L:— R:T LT R: l 1 1 1 �_ Rear 1 I J �° Building Height Bldg. Square Footage I I 1% = 1 1 L._,.... Open Space Footage , [ (Lot area minus bldg & paved r ! _ t�: 1, 1 parking) # of Parking :. ces - 1 "' Ell Fill .lume & Location) t . A. Has a Special Permit /Variance /Finding ever been issued for /on the site? ` NO 0 • DON'T KNOW IN YES 0 . IF YES, date issued:I 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 C4, DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 Date Issued: C. Do any signs exist on the property? ' YES 0 NO �4 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 V IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, avation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO • IF YES, then a Northampton Storm Water Management Permit from the DPW is required. File # BP- 2013 -0693 APPLICANT /CONTACT PERSON WRIGHT BUILDERS ADDRESS/PHONE 48 Bates St NORTHAMPTON (413) 586 -8287 (116) PROPERTY LOCATION 16 VERNON ST MAP 31A PARCEL 087 001 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 z,‘,93 01 9 b Fee Paid Typeof Construction: REPAIR DUCT CHASES, FIRESTOPPING 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 INFORM N PRESENTED: proved 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 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. 16 VERNON ST BP- 2013 -0693 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A - 087 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Pellaut: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2013 -0693 Project # JS- 2013- 001144 Est. Cost: $10000.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WRIGHT BUILDERS 84280 Lot Size(sq. ft.): 5009.40 Owner: BARBER ROBERT E & CAROL J EDELSTEIN Zoning: URB(100)/ Applicant: WRIGHT BUILDERS AT: 16 VERNON ST Applicant Address: Phone: Insurance: 48 Bates St (413) 586 -8287 (116) Workers Compensation NORTHAMPTONMA01060 ISSUED ON:1/10/2013 0:00:00 TO PERFORM THE FOLLOWING WORK: REPAI R DUCT CHASES, FIRESTOPPING 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 1/10/2013 0:00:00 $60.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner