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WRIGHTZ..\.> BUILDERS
I N C O R P O R A T E D
48 BATES STREET
NORTHAMPTON,MASSACHUSETTS 01060
413.586-8287 FAX 413-587-9276
U Wughl BuilJrn,Inc.
Prepared fur ihr r.cfusivc•uae of WRI(,1IT liUll l)ERS,INC.al.ul,xtK unlra.I.rn,au.i sul4rhen
All aher u—probdmavl.
N
SECTION 8-"CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: Not Applicable ❑
ab
Name of License Holder: �� I i 1 'r j �S y`� C5 0-PE5
License Number
Ck t z N1 P1 -7 11 C5 1 cf
Address �� Expiration DA
Signature c` Telephone Q
HE
Not Applicable ❑
n I w+ -JSW la-t!'.v� s 01 r5l F0
Company N e I Registration Number
Address �Q( Expiration Date
Telephone
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 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.
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
7CTION 5--DESCRIP1I0N 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:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement — Yes No
Plans Attached Roll ❑ • Sheet
cSYI s 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 f`
e. Number of stories? -
r
f. Method of heating? Fireplace Woodstoves Number of each
g. Energy Conservation Compliance. 1Nascheck Energy Compliance form attached?
Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or ce1l�af floor below finished grade
k. Will building co m to the Building and Zoning regulations? Yes No .
I. Se ank City Sewer Private well City water Supply
SECTION��fra` OWNER AUTHORIZATION �TO,�E CO�IAPLETED WHEN
OWNERS dGEN'��R,CONTRACTOR IlPPL1E5 F'OR�Ut1.D1�VG!PERMIT
I, 1_6YrC�aV-\ Vl r , as Owner of the subject property
hereby a o z � O �/l kl `(Lt✓ S to act on
my beha in II atters five to work authoriz d by this'Wilding permit application.
-
Signa ure r Date
I, ' l 1- V��S�l T �j �� , as Owner uthorized Agent
��
hereby declare that the statements and info ation on the foregoing application are true and accurate, tz7the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
1E,11,oft MOur
Print Name �-
Signature of Owner/Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
11 um -ff'qiy'l 2 S �Ki 11V*k �J f
Existing Proposed Required by Zoning
This column to be filled in 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 Parkin aces
Fi .
olume&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. Doe 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 X 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:
City of Northampton
Building Department
2'12 Main Street
iRoom 100
Nortliah�pton, MA 01060
L.,]pkbneA-t! -5871240 Fax 413.587.1272
APPLICATION'TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-,SITE INFORMATION
�s se tTTR
1.1 Property Address: , �j,
RrN
z r
�x
ptt@ `0 er a #CiC � 1 yz s
Dlsrrlct -�
SECTION'2 PROPERTY OWNERSHIP/AUTHORIZED AGENT,
2.1 Owner of Recor r
TO YA evvd'VA
Name(Print) Current Mailing Address:
)</ Telephone - 1 � ��j� ( j.-7
Signa re Y� L� `
2.2 Authori A ent:
k Y1 P,LA i l dt v 4 g) vate irr f ry lk
Name(Print)• Current
�Mailing Address: 2�0
-5r-_ C4 . A& .Signature Telephone
SECTION'3=tSTIMATEb CONSTRUCTION COST5 I X , = (,;(}
Item Estimated Cost(Dollars)to be Official Usei Only
completed by ermit applicant
1. Building (a g,� (a}Bull ing Permit Fee
_t
2. Electrical Estimated Total Cost of
CanstNction'frorri 6
3. Plumbing Builsling-Permitfee
4. Mechanical (HVAC) I�`
5. Fire Protection (0
6. Total =(1 +2 +3 +4+5) Check Number �!? "
This'Section For Official Us'e Onl
Building Permit Number: Date issued
s<
Signature
Rulltl�ng Goriinissloner/lnspecor of�Su�ldtngs Date
File#BP-2004-0773
APPLICANT/CONTACT PERSON Wright Builders
ADDRESS/PHONE 48 Bates St NORTHAMPTON (413)586-8287
PROPERTY LOCATION 642 NORTH FARMS RD
MAP 02 PARCEL 028 001 ZONE RR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid 12 AoO --
Typeof Construction: FINISH BASEMENT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 045075
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 Co ssion
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.
642 NORTH FARMS RD BP-2004-0773
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 02-028 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0773
Project# JS-2004-1142
Est. Cost: $11474.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Wright Builders 045075
Lot Size(sgi_ Owner: NEW HARMONY PROPERTIES LLC
Zonine:RR Applicant: Wright Builders
AT 642 N0RTi-i FA M':i K.Q
Applicant Address: Phone: Insurance:
48 Bates St (_413) 586-8287 Workers Compensation
NORTHAMPTON MAO 1060 ISSUED ON:215104 0:00:00
TO PERFORM THE FOLLOWING WORK:FINISH 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:
D
J �` /a Driveway Final:
Final: Final:
Rough Frame: e9 rt3
C1
Gas: re emittment Fireplace/Chimney:
Rough: Oil: Insulation:etc, 5-g"O y jM
Final: Smoke- � Final:
THIS PERMIT MAY BE VOKE BY THE CITY OF NORTHAMPTON UPON VIOLATI OF
ANY OF ITS RULES AND REGU ATI NS
Certificate of Occupancy Signature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 2/5/04 0:00:00 17689 $60.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo