23C-028 .y
SECTIOAt 8-CQNSTRUCTION SERVICES
8.1 Licensed Construction Su ervisor: / v D Not Applicable ❑
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Name of License Holder: V" C�'�+� 1 ►'` 1 Y � I 1 1,
License Number
ar I q l 1?
Address Expiration Date
Signature Telephone
W
exnep ., ; Not Applicable ❑
Company Name Registra on Number
Cf g 6 fir, A^r 3ro14 A-A- (0 1 �-* 1
Address ( Expiration Date
Telephone
S�LTIQN�Q YI��E��'CON[PENSac�f'L(��N'INS�1}?AN�EFlfi�`AIT(M�G V
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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[0] Otherk
Brief Description of Proposed p p�� • t
Work: '(�'GY A-IP-C D"(' `•7 V�l l'�-.S LEA 5A6'4-,,
6'4-,,
Alteration of existing bedroom ` Yes o Adding new bedroom Yes_ X N D
Attached Narrative Renovating unfinished basement _ _Yes No
Plans Attached Roll -Sheet
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? �'N
d. Proposed Square footage of new construction. nsions +
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 1 of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of base nt or cellar floor below finished grade _
k. Will b ' ing conform to the Building and Zoning regulations? Yes No.
I. eptic Tank City Sewer Private well City water Supply
SECTIOM� -OWI I=RA HVORT fzAT16NN Td'6b' MED EN
OW[tCEF�S AGE F1 flR COIV RACTOI�AF XU emu FORE II I"f PERIVI(�'
I, W 1J i_r P 19W-(C f as Owner of the subject
property
W
t
hereby authorize W
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
as Owner uthorized
Agen hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my ge
n elief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
4% 8E bore
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 fille by
Building Departme
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 Parking S es ----�
Fil• ��
olume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DONT KNOW 0 YES ®
IF YES: enter Book ^ Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0
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 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,a vation,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.
Y _
"h�amt of Northampton
i ing Department
2 Main Street Room 100
mpton, MA 01060
7-1240 Fax 413-587-1272
e
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTIO 1 WE I,NFWMATION
1.1 Property Address_
LL-
L R
C l /C E �
IGt a »
CT�G►N PROPERTY OWNEt�$HIPIAUTW()RIYi=D`AGENT
,SE 2.1 Owner of Record:
E Q L�> � �f� ( !�'7 3 C � tt c. �c�A PLC,ocC axf
Name(Print j„ Current Mailing Address: Z
. (✓ Telephone
Signature
2.2 Authorized Agent: `� f �� � ; ��, t�`
W a'V � - tj
Name(Print) v y ➢V_G „ Current Mailing Address:
Signature Telephone
S�CTfQN '= TIMATD Cf7�IS`fRLtGT[CTN{`Gf7STS )c
K.
Item Estimated Cost(Dollars)to be Official Use i1Y .
c leted b permit applicant _...,.
1. Building /_ {a) RP!dtng Perrrttt Fr~e.
IP I
2. _Electrical , ��A� / S� {b)Essttmated Total Gost of
SD� n trudtion-froin 6
3. Plumbing Buildtng:Permtt Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) "' Glxetc NuGnber
This Section Fear Offtcia )Se Ot l
Date
Building Permit,Number: Issued
tgrtatt3re = _
Btlding Cammissi anerltnspectarof!Buitdings .... Hate
File#BP-2016-0079
APPLICANT/CONTACT PERSON WRIGHT BUILDERS
ADDRESS/PHONE 48 Bates St NORTHAMPTON01060(413)586-8287(116)
PROPERTY LOCATION 107 BAKER HILL RD
MAP 23C PARCEL 028 001 ZONE URB(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ZONING FORM FILLED OUT ENCLOSED REQUIRED DATE
Fee Paid I 4Q
Building Permit Filled out
Fee Paid
Typeof Construction: REPAIR STUCCO SIDING&REPLACE DECKING
New Construction
Non Structural interior renovations
Addition to Existiny-
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
INF033MMON PRESENTED:
pproved 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
Demolition Dellay
Sign e 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.
107 BAKER HILL RD BP-2016-0079
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23C-028 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categry: renovation BUILDING PERMIT
Permit# BP-2016-0079
Project# JS-2016-000150
Est. Cost: $65425.00
Fee: $429.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WRIGHT BUILDERS 047146
Lot Size(sq. ft.): 146361.60 Owner: KLEPACKI EDWARD A JR
Zoning. URB(100)/ Applicant. WRIGHT BUILDERS
AT: 107 BAKER HILL RD
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 (116) Workers Compensation
NORTHAMPTON MA01 060 ISSUED ON:712312015 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIR STUCCO SIDING & REPLACE DECKING
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 7/23/2015 0:00:00 $429.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner