36-292 (6) SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: ,�/�► '/�/� Not Applicable ❑r
Name of License Holder: �V�1 .61)I �b G ��L(:=' �W611t 6 tf 9 •
License Numbqr
N Bps s--.. Ni pi)k ►rr� )-( 7/09
Address Expiration Date
Signature Teleph e '
9.Registered Home Im rovement Contractor Not Applicable ❑
R'I' &W-1- MA-�ik W�lc� /6 15'3
Company Name Registration Number
4f 6 /"140 6
Ad re Expiration Dat
Telephone �b �" �
SECTION,10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GL.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 buil 'ng permit.
Signed Affidavit Attached Yes....... No...... ❑
11. - Home Owrier 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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacemenf Windows Alteration(s) �❑ Roofing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [[J] Decks [p Siding,[[3.] Other
Brief Description of Proposed t r PA
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes N
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.if New house and or addition to existing housing,: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. Dimensi
e. Number of stories?
f. Method of heating? eplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. etlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement ellar floor below finished grade
k. Will buildi onform to the Building and Zoning regulations? Yes No .
1. is Tank City Sewer Private well City water Supply
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
WV as Owner of the subject
property p�� ' �� -r
hereby authorize I
R' (f ►1"fi (yV VDeg I '1"to act on my behalf, in all matters relative to work authorized by this building permit application.
Signatur of er Date
I V V r 9,1111 VVVV_ as Owne AuthPnowlaedge
A ent hereby declare that the statements and information on the foregoing application are true and accurate,to the best o my
a—n-dMlief.
Signed under the pains and penalties of perjury.
Print me>_\_� X61 Lo v o�
SignatWKof Owner/Agent Date
1 .
kU-,, New 6' WJV KT N OIIrT --
�
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled' y
Building Depart
m
Lot Size
Frontage _. ...,., ___..... ......_._. .. ..____.
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&pave
parking)
#of Parking aces
Fi
olume&Location
A. Has a Special Permit/Variance/Findin ever been issued for/on the site?
N0. 0 DONT KNOW YES
IF YES, date issued:'
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, 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 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading exc ation,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.
ae
A
~Department use only'
City of Northampton ,_ SlatusofPerniit
u
Building Department Curb CutlDnveway Permit
212 Main Street Sewert$epticAvailability
Room 100 Water/VYell Availability"
R; _ r, u Northampton, MA 01060 Two Sets of Structural Plans
Iv0`/ ,phone 413-587-1240. Fax 413-587-1272 PIoUSitePtans
I
0, e ecify
APPLICATION*6 C'ONGTRdCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I.-SITE INFORMATION
1.1 PropertV Address: Thls section to be completed byoffice
u-'0±q Map Lot Unit
?"�sl ��.A(� �� 0` bb�• Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
02,0 o K-o(�o f�N`'��-!�W yt `f �ye,�-e►16-0 WA-vi, e-G7Nd,,iG-
Name(Print) Current Mailing Address: (��
Telephone 7 •'Tp
Signatur
2.2 Auth zed Aaent:
Name( rint) Current Mailing Address: 1—fl , e>'Tq
Signat Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS M!r
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
2. Electrical " " (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total= (1 +2+3+4+5) " Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2006-0513
APPLICANT/CONTACT PERSON Wright Builders
ADDRESS/PHONE 48 Bates St NORTHAMPTON (413)586-8287
PROPERTY LOCATION 74 SOVEREIGN WAY
MAP 36 PARCEL 292 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
T_ypeof Construction: EXTERIOR TRIM REPAIR
New Construction
Non Structural interior renovations
Addition to Existing
Accessoy Structure
Building Plans Included:
Owner/Statement or License 047146
3 sets of Plans/Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION PRESENTED:
THE
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 mmission
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.
P.
74 SOVEREIGN WAY BP-2006-0513
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-292 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0513
Project# JS-2006-0761
Est. Cost: $2500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Wright Builders 047146
Lot Size(sq. ft.): 60504.84 Owner: OKOROANYANWN UZO
Zoning: SR Applicant: Wright Builders
AT. 74 SOVEREIGN WAY
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 Workers Compensation
NORTHAM PTONMA01 060 ISSUED ON:111912005 0:00:00
TO PERFORM THE FOLLOWING WORK.-EXTERIOR TRIM REPAIR
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 11/9/2005 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo