17C-131 SECTION 8 -CONSTRUCTION SERVICES s
8.1 Licensed Construction Supervisor: • t Not Applicable ❑
Name of License Holder: MAf+-- �i_a� T�JV� CS 041 �4�19
License Number
4$ S1-. 14*tl:&M PTo N, VIA- 2191 D 7
Address Expiration Itate
413-�✓S�—�z��
Signature Telephone
'Z2�.�2_ �;�,
9. RealsteriiA Home'Imurovemerit Contractor. �, �, Not Applicable ❑
W�IG�tt' l�V� �D�R►s �pl
Company Name Registration Number
ma S4: wDe-abWeON , MX l01 Zb 10(P
Address Expiration Date
Te1SeS5%b^13257
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...... ❑
11. '_ Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occuloied 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-vear 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. I . '
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 thisfpermit.
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
t
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Audition ❑ Replacement Windows Altdration(s) *W Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks[M Siding[f=] Other[=
Brief Description of Prop o ed
Work: (N113511A0 Q- (,EMoD1:.L . NEW lO r""N (,d'Lt9MR,S.
Alteration of existing bedroom Yes_&No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -"Sheet
6a f New hou �e anQ or addl�ion to exi'"s�i'n'q flousng, complete t e0fro1 owl q
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. Di sions
e. Number of stories?
f. Method of heating? fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. >constructon ruction
i. n within 100 ft.of ands? Yes No. Is construction within 100 yr. floodplain Yes No
j. ment or ar floor below finished grade
k. orm to the Building and Zoning regulations? Yes No .
I. City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO,BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, E D15 '5 61-I"f as Owner of the subject
Property
here y authorize
t�
to
el5alf,,in,all afters relative to work authorized by this building permi application.
ner to
I as Owner uthorize
ereby declare that the statem nts and information on the foregoing application are true and accurate,to the best o my know e e
and belief.
Signed under the pains and penalties of perjury.
M L Lep vv G W
Print ame
Signat of Owner/Agent Date
Prw/ W0fPL*- V�—V PVt4e- VVITYnN 65Y,15-nt-J& VvOVP4�
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning,---,
This column to b3fire-d in by
Building=cnt
Lot Size
...............
Frontage .........................
Setbacks Front
Side L. R: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg& ed ......
parking)
#of P g Spaces
Fill:
(volume&Location) ...........
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
DON7 KNOW , YES 0,
NO 0
IF YES, date issued:
of Deeds?
'Registry
IF YES: Was the permit recorded at the
NO 0 DON7 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, DON7 KNOW 0 YES (D
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 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading, excavation,or filling)over I 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.
� ,, Department use only
City of Northampton Status of Permits ; _ n
Building Department Curbu/DrrPermit t " � � �_� '
212 Main Street S&ddS ptld Ava lability
Room 100 „ ��ill A a
1NaterNVellAvaila611rty
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240. Fax 413-587-1272 Plot/Si. ns
71 71'11�111
APPLICATION TO CONSTRUCT,ALTER,REPA ENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I.-SITE INFORMATION
This section to be completed byoftice
1.1 Property Address: f `'
PMap Lot Unit
Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERS 11P1AUTHORIZ ;11`.,t`�
2.1 Owner of Record:
YiWA "Vl�A11) 4;T-. Rx6vkz-
Narpe(P'n9, . Current Mailing Address:
Telephone
SWture X13 —S 9
2.2 Authorized Agent:
M 1/0Wk_W w u 4b 14z e-T}tA�PO N
Name(Print) Current Mailing Address:
4A3-5 e)(o-`32c6 7
SignaturOr Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS 1-7 V- V- = $6
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building I ZL" .Ot (a)Building Permit Fee
2. Electrical 3 3 1 (b)Estimated Total Cost of
Construction from 6
3. Plumbing S Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) 2 Check Number
This Section For Official Use Only
Building Permit Number. te
r.
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2006-0402
APPLICANT/CONTACT PERSON Wright Builders
ADDRESS/PHONE 48 Bates St NORTHAMPTON (413)586-8287
PROPERTY LOCATION 109 HIGH ST
MAP 17C PARCEL 131 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REMODEL INTERIOR&NEW KITCH COUNTERS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory 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
INFO ATION PRESENTED:
p�prroved 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 on
QUO
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.
109 HIGH ST BP-2006-0402
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C- 131 CITY OF NORTHAMPTON
Lot: -001
Permit: Buildinq
Cate oiji- BUILDING PERMIT
Permit# BP-2006-0402
Project# JS-2006-0584
Est. Cost: $21250.00
Fee: $85.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Wright Builders 047146
Lot Size(sq. ft.): 17075.52 Owner: PAPADEMETRION ELISABETH
Zoning:URB Applicant: Wright Builders
AT. 109 HIGH ST
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 Workers Compensation
NORTHAMPTONMA01060 ISSUED ON:1011312005 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL INTERIOR & NEW KITCH
COUNTERS
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 10/13/2005 0:00:00 $85.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
109 HIGH ST BP-2006-0402
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C- 131 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0402
Project# JS-2006-0584
Est. Cost: $21250.00
Fee: $85.00 PERMISSION IS HEREB Y GRANTED TO:
Const. Class: Contractor: License:
Use Group: Wright Builders 047146
Lot Size(sq. ft.): 17075.52 Owner: PAPADEMETRION ELISABETH
Zoning.URB Applicant: Wright Builders
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 Workers Compensation
NORTHAMPTONMA01060 ISSUED ON.1011312005 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL INTERIOR & NEW KITCH
COUNTERS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
/ Footings:
Rough: Rough: �//e�pa„ /Jj House# Foundation:
Driveway Final:
Final:,(—/'06 CA-2 Final:0/�/�$� .
/ /// Rough Frame: 6lC I2I22-�o5 Lo�tS
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation: o bC 4ZltigQ5 L-61-k* o
Final: Smoke: Final: 61e- 6 b 1'G 6 Lb u.l S
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAT�,I N OF
ANY OF ITS RULES AND REGULATI S.
Certificate of Occu anc si nature:
FeeType• Date Paid: Amount:
Building 10/13/2005 0:00:00 $85.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo