25C-180 SECTION 8-CONSTRUCTION SERVICES
I Licensed Construction/Supervisor: ,,,) Not Applicablee^❑
Name of License Holder:- 1" 1Cti & 1T6t w PI l CC) ozi-114 `''
License Number
Address Expiratiolh Da e
4
Signature Telephone
Not Applicable ❑
ul evs KWIC I D 13 S-
Company N e Registration Number
Address Expiration Date
Telephone��'��' (7���'�
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G L.c.152,
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...... ❑
i
o W e Uwne NERS . o `
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
resoonsible 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
7CTION 5•DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ,
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work:' Q A ----
Oe_in E Cx� Yne-U a. bV1
Alteration of existing bedroom x Yes__ No i Adding new bedroom Yes No
Attached Narrative o 5 shcs. li_: Renovating unfinished basem No
Plans Attached Roll ❑ . Sheet5K checa�cc��
L OVt i L S 1�-q i7 Vl IF
rtiouse n ; di ion o x s si -co to e- Fte�oi w n
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. Dimensions
e. Number of stories?
f. Method of heating? Firepla or Woodstoves Number of each
g. Energy Conservation Compliance. ` �Mascheck Energy Compliance form attached?
Type of construction
i
i. Is construction within 100 ft. o lands? Yes No. Is construction within 100 yr. floodplain Yes No
' j. Depth of basement o ellar floor below finished grade
k. Will b onform to the Building and Zoning regulations? Yes No .
Tank City Sewer Private well City water Supply
SECTION 7a 'OWNER AUTHORIZATION=TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
V1 V1 G n as Owner of the subject property
hereby authorize I" 1� ��i�W�l I I ylj yl, A Vl� w Otte to act on
my behalf, in all matters relative to work authorized by t is building permit application.
Signature of Owner a Date
I, QV kk( '��YS as Owner/, 1`horized A ent
hereby declare that the state nts an information on the foregoing application are true and accurate,to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury. .
Print Name
Signature of Owner/Agent Date
r•
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFO TION
e. .
- . « �vui ldi� o+ nnF
Existing Proposed J Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parkin S06-es
Fill•
ume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
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—
No
IF YES, describe size, type and location:
X
Y
City of Northampton t
Building Department .` `
212 Main Street e
Room 100
Northampton, MA 01060 e
phone 413.587.1240 Fax 413-587.1272 0
APPLICATION TO CONSTRUCT,ALTS , N E10R#E H A ONE OR TWO FAMILY DWELLING
I � ii p nt�
L)
SECTION 1-SITE INFORMATION
(y( This section to be completed b office
1.1 Property Address: rT� ,r)K. ; ;M--`� b P zy
.._.,. ftF s Unit
�w
OA Z d
one
~Overiay Qlstrict
Elm St'District CBDistrtcf
SECTION 2—PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
_ �,1'I wslb,0 e- �W(1b-0 _ vi] f4py-h'1 �t'n P tZ�Vt 1 M
Name(Print) l/ Current Mailing Address:
��f7r r s Telephone �]
Signature �I
2.2 Authorized went:
Name(Print) Current Mailing Address:
Signature Telephone �O
SECTION 3 ESTIMATED CONSTRUCTION COSTS J Q
Item Estimated Cost(Dollars) to be Official Use Only
cc cleted by permit acolicant
i. Building / (a) Building Permit Fee
ct b
2. Electrical (b)Estimated Total Cost-of
Construction fram''6
3. Plumbing 7� Building Permit Fee <°
n � i
4. Mechanical (HVAC)
Z3 5.
5. Fire Protection ,%.-
6. Total =(1 +2 +3 +4+5) 3 r��. Check Number - •�'
�.
�..Thls`Section For Official Use'Onl �`t. Aw•xhc
�
Building-Permit Number M,� '�� ''�*�`' r Date Issue
"' % 'ti4h�, a.:,r T y r ,, r• .,.' ., =.`J�r"yls ddeTYC�'t� •k4',1 7♦ .^w: �.+ ,�1t-•""b s "[,7i'hy( y•,1iv r �.'ia "7+ y<y" •w+`_?., W �c�,7.
,.7-"Kn
.e`
."t:.rJ'.41$��r" "�.k. ,�. �'W rt�`!t'�Si. ♦':E.�a'�S"�,,r„ 6 a'S.:�.'1 J � Sv +2l' 1� � (N„�n' ...
1f Signature. } 'lk�v.4 Y T. vx::k, i w, i ,�r•T v �c "t.. :R.'Y-r.1” �i o'"s4'? k. �
File#BP-2004-0033
APPLICANT/CONTACT PERSON Wright Builders
ADDRESS/PHONE 48 Bates St (413)586-8287
PROPERTY LOCATION 97 NORTH ST
MAP 25C PARCEL 180 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out &dQ 44 061�i 4?�9
Fee Paid
Typeof Construction: DRYWALL,REINFORCE ROOF,INSULATION,SKYLIGHTS&BATH REMODEL
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/Statement or License 047146
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9hdftATION 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 Commissi
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.
BP-2004-0033
r.
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0033
Project# IS-2004-0055
Est. Cost: $39420.00
Fee: $150.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Wright Builders 047146
Lot Size(sq.ft.): 11107.80 Owner: HANNON CHRISTINE G
Zoning_URC Applicant: Wright Builders
AT. 97 NORTH ST
Applicant Address: Phone: Insurance:
48 Bates St (413)586-8287 Workers Compensation
NORTHAMPTON MAO 1060 ISSUED ON:719103 0:00:00
TO PERFORM THE FOLLOWING WORK.-DRYWALL, REINFORCE ROOF, INSULATION,
SKYLIGHTS & BATH REMODEL
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• Receipt No: Date Paid: Check No: Amount:
Building 7/9/03 0:00:00 16006 $150.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
L'Lez T�l wL /v`q/
97 NORTH ST BP-2004-0033
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25C- 180 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2004-0033
Project# JS-2004-0055
Est.Cost: $39420.00
Fee: $150.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Wright Builders 047146
Lot Size(sq.ft.): 11107.80 Owner: HANNON CHRISTINE G
Zoning. URC Applicant: Wri ht Builders
.'1A,F.- w4r+RTi
t. 7! IVI.!:C� 1'i JI
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 Workers Compensation
NORTHAMPTON MAO 1060 ISSUED ON.719103 0:00:00
TO PERFORM THE FOLLOWING WORK.DRYWALL, REINFORCE ROOF, INSULATION,
SKYLIGHTS & BATH REMODEL
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: j()1j/a3 Rough: Pj}7Qf1gL 1U�4/aj House# Foundation:
Driveway Final:
1 l�12" � 5�� 3
FFinal: /KFin al:
Rough Frame: ��Lh r�
Gas: Fire De artmen Fireplace/Chimney:
Final: Smoke: ! I Final: It,
THIS PERMIT MAY BE REVOKED Bl' IE ITY OF NORTHAMPTON UPON VIOL OF
ANY OF ITS RULES AND REGULATIONS
Certificate of Occu anc - si°nature'
Feel e: Receipt No: Date Paid: Check No: Amount:
Building 7/9/03 0:00:00 16006 $150.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo