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SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
w 7,6e`g 1 Mitt P. /(Q'3 9
License Number
tQ Q� sr. N0 r�,rN ro r�► Mtv 91 1(c
Address Expiration Date
fib' g, 41)
Signature r/ / Telephone
Ai
"pgistl 1pmeIr�tprovementi Gcfntr ctnr y i,ig ,by 447:, �.. .'.. ,. Not Applicable ❑
IN�
&Alitibtv e. L.Ueir lt 1 019(0
Com an Name Registration umber
Address t k ° ��O
Expiration Date
1IV k 4 D i 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 ❑
�'WI1eY' EXemn
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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House [J Addition ❑ Replacement Windows Alteration(s) Y Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [p Siding[p] Other[0]
Brief Description of Proposed A'9.,.p Q Atrae-
Work: {' i YV (J� PO V KIN ��► i`�'v[
Alteration of existing bedroom Yes X No Adding new bedroom Yes o � �
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa tf*Wft Bat=a r 4Slitt K qt r c; �t f allo lnc :
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. Dimensi•
e. Number of stories?
f. Method of heating? F -•aces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of we - ds? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or - -r floor below finished grade
k. Will building • orm to the Building and Zoning regulations? Yes No.
I. Se• • ank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, _.<\ D /' ift/I SI\'t ee.- " ,as Owner of the subject
property ��(
hereby authorize ' r` " '„ �∎GV�+T
to act on my behalf,in all matters relativ- •work authorized by this building permit application.
i ` r 2A' 2-O L
Signatur • Owner alimmummE Date
I, t i F' ` fro( e% + , as Owne Authorized
Agent ereby declare that the statements and information on the foregoing application are true and accurate,to the best o y knowle ge
and o lief.
Signed under the pains and penalties f per'ury.
w �� 1er-
Print Na ,: /
' ,
.-'u"of Owner/Agent Date
fue1/4Alk/ SI%t h-f-4VAt Ntri
1 e2,Or,'(1/41c'1 bA g(( 113 ` . .
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information ,
Existing Proposed Required by Zoning `f t'
This colump to be fil-. in by '
Building Depart.•-nt ^'
Lot Size L_. _ = I _ _ --______.. . I
Frontage
Setbacks Front r"--1
Side L:. , -- . R. .._ .1 L:;...___ .__.-_.. € 1.._
Rear '__ s'
Building Height 1---- ii- ---1
•
Bldg.Square Footage Ell
Open Space Footage
1.---1 -J
(Lot area minus bldg&paved A- .
parking)
1V
#of Parking Spa s ------ L -_3
Fill: _a_ __
. �P .__.m.ume&Location)
A. Has a Special Permit/Variance Findin• ever been issued for/on the site?
NO 0 DON'T KNOW YES
•
IF YES, date issued:L rj cJ g --1- 0 '
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW 0• YES P
1
ap
IF YES: enter Book b 5 t./.b 5 Pagel 8 and/or Document #�3tf 3
B. Does the site contain a brook, body of water or wetlands? NO ►3 DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the ConservationtCommission?
Needs to be obtained 0 Obtained ,Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location: g
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:
I
E. Will the construction activity disturb(clearing, gradinf•,exc- ation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NOS
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
i of Northampton �'
��� ilding Department r� .� 1 Parr tt ��
3 '12 Main Street ewer ' .1- ,y. ab A��
�� ec��or Ila of , t 4: , BRA
\o„�a Room 100
orthampton, MA 01060 T e oS t >
` tin .r � � �` �' � � Sou �-..�' zed
` „ one 413-587-1240 Fax 413-587-1272 '1% ^, 1 ��
`\G tt
Egg° N°
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
'' This sectiontoibe oornplettd by office
1.1 Property Address:
CC1 C� ti
1. Ma[p ��� t i l.ot � i�rttt
1v`+ ' o
b P—Oir tonne r OVerl 1 tri
dim 5t bistrici 98.ISis#nct
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED'AGENT
2—e .�� `2 o L
2.1 Owner of Record: , <J __,i,A---S'H. (-----
_ `` "T C_ b P i-- 2 �' C-N-e- eo
Name(Print) - , �n Current ili g&ddre : �.
( , ' Telephone r
J c _ .:_, I ' 7-� _
,. Signat
2.2 Au -oriz-d Agent: / Q.
P-44 . I � ` �, , i Pe4 iA l� 2r. (40 N- ( ! " ri r Irk
Name(P if ,Current Mailing Address: '`
S.c"r- Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS , ^ 3 ref 16- )c• t L ii/0 0 0 . ir II y-...--
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building j /7, — (a)Building Permit Fee
2. Electrical t l. Q. -.+ (b)Estimated Total Cost of
( 1 7 Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection Q / r/ �/ p
6. Total=(1 +2+3+4+5) I S, 3 i b 4 Check Number �S7 SO t/ �i if
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature.
Building Commissioner/lnspector of Buildings Date
%r
File#BP-2014-0253 ��l� U/`
APPLICANT/CONTACT PERSON WRIGHT BUILDERS
ADDRESS/PHONE 48 Bates St NORTHAMPTON (413)586-8287(116)
PROPERTY LOCATION 258 CRESCENT ST
MAP 31A PARCEL 056 001 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 G A
Fee Paid
Typeof Construction: RECONSTRUCT FRONT PORTICO&NEW ENTRY ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 16370 /
3 sets of Plans/Plot Plan t!eG otef'cXX.
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOAMATION 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
7-31°12
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.
258 CRESCENT ST BP-2014-0253
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A-056 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:Zoning Permit BUILDING PERMIT
Permit# BP-2014-0253
Project# JS-2014-000203
Est. Cost: $18376.00
Fee: $114.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WRIGHT BUILDERS 16370
Lot Size(sq ft.): 6490.44 Owner: STIEBER JOACHIM W&ERNESTINE
Zoning:URB(100)/ Applicant: WRIGHT BUILDERS
AT: 258 CRESCENT ST
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287(116) Workers Compensation
NORTHAMPTONMA01060 ISSUED ON:8/30/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:RECONSTRUCT FRONT PORTICO & NEW
ENTRY ROOF
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 8/30/2013 0:00:00 $114.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Louis Hasbrouck—Building Commissioner