24C-061 SECTION 8-CONSTRUCTION SERVICES`
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: ° " V- k, hp Yfi U li [
License Number
Address Expiration Date
Signature Te ephone
9.RialstercidHome Improve ment Contractor. Not Applicable ❑
1a I X 3 6
Company Name Registrat' n Number
Address Expiration Date
� Telephone �� �Ody
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,5 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...... ❑
11. - Home Owner Exem Lion
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 sball 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 S-DESCRIPTION OF PROPOSED WORK(check''al)applicable)
New House [-1 Addition ❑ Replacement Windows Alteration(sj Roofing ❑
Or Doors E-1 K I
Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks [0 Siding[0] Other[[I]
Brief Description of Proposed Q �O V p�[i ,(Q/ �f'0` r B `
Work: ("G 1� �.'` l�
Alteration of existing bedroom Yes No Adding new bedroom Yes � No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa. If New house and or addition to eAsting housing, colinpfete 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. Dimensio
e. Number of stories?
f. Method of heating? F laces 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 ce oor below finished grade
k. Will building c rm to the Building and Zoning regulations? Yes No.
I. Sep ank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 S ►�-j _ as Owner of the subject
property
hereby authorize
to act n my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner ate
c
I )(� as Owner Authorized
qAgeantereby declare that the statements and information on the foregoing application are true and accurate,to the best o ef.
Signed under the pains and penalties of perjury.
Q
Print Name / Lao L-
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Income ete Information
t�'Existing Proposed Required by Zonin
This column to be ed in by
Building De ent
Lot Size
Frontage
77777777- r
Setbacks Front 3
Side L.w . R. Ul'
Rear
Building Height
Bldg.Square Footage -- %
Open Space Footage ;..,. .,-_.
(Lot area minus bldg&paved
parking)
of Parking ces
Fit • _ ��
olume&Location '__.._
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:,
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0... YES T®
IF YES: enter Book Page and/or Document#I _.
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q 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:
E. Will the construction activity disturb(clearing,gradin ,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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City of Northampton Sttatus ofPtt X
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Building Department Curti Ctrrvey Petltt
212 Main Street Se4rerlSe''WA iiii
0302015 ,,? Room 100 Vat AV6,II A t�btr y
Northampton, MA 01060 T)"A6" is o'8 is uEal l ra `k K
mac.Plumbing&Chas 3-587-1240 Fax 413-587-1272 Ptottite Plats
Northampton,MA G1060
Other Spy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 =SITE INFORMATION
This section to be completed by office
1.1 Property Address:
tj �/ ' Map ' Lot Unit
N O /f n„P�� j &4� Zone Overlay District _
�`^ i"` Elm St District CS Dlstrict
SECTION 2`-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Pico 14
Name Print) Current Mailing Address:
n
_ J/ ! TD
LA►�1 �J�fa07r✓ Telephone
Signature El
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS x dO�
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building �„�t a. (a)Building Permit Fee
2. Electrical 0 /9 �. (b)Estimated Total Cost of
Construction from 6
3. Plumbing a �, Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) Check Number 1
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Co*ty►ssionerllnspector of Widings Date
File#BP-2015-0769
APPLICANT/CONTACT PERSON WRIGHT BUILDERS
ADDRESS/PHONE 48 Bates St NORTHAMPTON01060(413)586-8287(116)
PROPERTY LOCATION 95 WOODLAWN AVE
MAP 24C PARCEL 061 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid go Q
Building Permit Filled out
Fee Paid
npeof Construction: RENOVATE 1 ST&2ND FLR BATHROOMS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 84280
3 sets of Plans/Plot PlaneG��ol'r�
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
roved 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
Demo " De
Si ure of uildin O icial 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.
95 WOODLAWN AVE BP-2015-0769
GIs#: COMMONWEALTH OF MASSACHUSETTS
MU:Block: 24C-061 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2015-0769
Project# JS-2015-001492
Est. Cost: $28810.00
Fee: $174.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: WRIGHT BUILDERS 84280
Lot Size(sq. ft.): 10672.20 Owner: BRADBURY SCOTT A&NANCY M
Zoning.URA(100)/ Applicant: WRIGHT BUILDERS
AT. 95 WOODLAWN AVE
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 (116) Workers Compensation
NORTHAMPTONMA01060 ISSUED ON:21412015 0:00:00
TO PERFORM THE FOLLOWING WORK:RENOVATE 1 ST & 2ND FLR BATHROOMS
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 2/4/2015 0:00:00 $174.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner