31C-018 (14) File 4 BP-2016-1080 'q
APPLICANT/CONTACT PERSON WRIGHT BUILDERS //r
gi
ADDRESS/PHONE 48 Bates St NORTHAMPTON (413)586-8287(116) Q� a(I {/
PROPERTY LOCATION 34 FORD CROSSING&87 VILLAGE HILL RD JVV ,ytt
MAP 31C PARCEL 018 001 ZONE PV(I0Q)/SGb(1OQ).
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT 1
Fee Paid
Building Permit Fitted out
Fee Paid
TvpeRfConstruction: CONSTRUCT 2 STORY DUPLEX W/DET GARAGE/PORC . partial basement build-out
for 87 Village Hill
New Construction
Non Structural interior renovations
,,,,,,,,Addition to 2xistin_
Accessory Structure
Building Plans Included:
Owner/Statement or License 106505
3 sets of Plans I Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF.c1$ 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 ANDtOR 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
De na
Signal' of I ding 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.
f~� City of Northampton
at
- 1 uiiding Department . f
% -212 Main Street
Jo' Room 100 ,' ' ,
` Northampton, MA 010 �
phone 413-587-1240 Fax 413-5874272
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 PronerNAddresst�� This section to be completed by office
LULLt p../�e TT cu- �' Map Lot Unit
cv 0 R- t !t km '4(`t MW Zone Overlay District_.
Elm St District CB District
SECTION 2•PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Regard:
Cebw �tt- y8 oAi- s-rintirfiC �11 Uben/�yCurrent Mailing Address: ptp 2.iQ 9
1y{ `
Telephone
$16ture
2.2 Authorized Anent.
6.41'vb '„ 4 t,e't ' bPrr
sr proAMPitrti
Name(Pont) r Current Mailing Address:
Lig a it C;r C�9
Signature ....._—._ Telephone ``++ Drt},^,,^, ........—
SECTION 3-ESTIMATED CONSTRUCTION COSTS GS, - M j r `t'c-"—b
Item Estimated Cost(Dollars)to be (Ada(Use Only
completed by permit applicant
1. Building t rQ b . (a)Building Peretti Fee
/r
a Electrical it
q Ota -,,,� (b)Estimated Total Cost of
R 1 t A Construction from i6)
3. Plumbing 1• Lf £f Building Permit Foe
4. Mechanical(HVAC) / tt
6.Fire Protection �,q �.,/ /jam
6. Total=(1 +2+3+4+5) d /r OIC 3 "� Check Number -J "`-�
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building CommissioneNlnspector of Buildings Date
- bt WYtvbtri &Q1.42) (46--
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due o Incomplete Information
Existing Proposed Required by Zoning
This column to be fil in by
Building Depa ,. + t
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 Parking ,.ces - - -- -
Fil • _._. • _ _. •
•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 O YES 0
IF YES: enter Book Page. and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO yor
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading, vation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteratlon(s) Roofing C
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[0] Other[0]
Brief Description of Proposed Pte-� [�E .,i,.tir p- ,1 - Pi-
Work: r Y ���'L� I D'!/ /
Alteration of existing bedroom Yes K.
No Adding new bedroom JC YesNo
Attached Narrative Renovating unfinished basement XeMiei No
Plans Attached Roll -Sheet
5a.If New house and or addition to existing housing, complete 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. Dimensions
e. Number of stories?
f. Method of heating? Fireplac:: or Woodstoves Number of each
g. Energy Conservation Compliance. •asscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of well..: . Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or • -r floor below finished grade
k. Will buildin• -•nform to the Building and Zoning regulations? Yes No.
I. ,• is Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIESQFORUBUILDING� PERMIT
r �f `
I, V Ili t tetaelp ' as Owner of the subject
property .... ^pI
hereby authorize ''WI,11 h tLL"I11 (.AGS,
to act on my behalf, in all matters relative to work au orized by this building permit application.
rq .� ` /1/7/P
Signature of er111111.11111.
r�, ,,,f Date
I, Fes' 6-11-r 41) ;UP@# , as Own Authorized
ent ereby declare that the statements and 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.
/A-' r1 (AIM Wetti
ki
Print Name A ^
` C CLIC i I / r
r
Signature •. - Agent �, Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Suuoervvisoorr/ Q� a,��p �1 ,' ( / �' ,r Not Applicable' 0
Name of License Holder: �f'f`rff7 I�VI,✓WI,T'�/AO ti c'7Ul/"_ ` S - 1047565
License Number
Vir, B Sr 1 M aVn-t-A,MPt�N , MK u/i /r7
Address \n {' I --� p��l� Expiration Date
�Cl.'w ObOGd /
K / `
Signature m Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
W P1 b�'vof /krf ti 142wt1/t---- /tic-31D
Company Name Registration Nu ber
Address An'y�/' r, Expiration Date
CI.II I' � /6 Xi/ Telephone d67
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\buiillding permit.
Signed Affidavit Attached Yes Jfl No 0
11. — Home Owner/ Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: 19 tr l (A-A- k5
The debris will be transported by:,,// WP)
'v
The debris will be received by: i CAjeA;Pi6
Building permit number: ff-. Ib- 10 g0
Name of Permit Applicant tO h UN-r 4 r(4:-WA'/Atll`l L —
iI ,� 17 0\))) ! C
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Date Signature of Permit Applicant
City of Northampton ��AP
a S cl/\ 4(/�/e l l0 77
Building Department / ✓ /./,1r-
212
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Plan Review
212 Main Review
Northampton, M 01060
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87 Village Hill Rd
R 1 Partial Basement
CATION (--,1 Build-Out
1/17/17