36-209 (8) 13 BIRCH LN BP-2017-1157
GIS SI: COMMONWEALTH OF MASSACHUSETTS
Map:Block:36-209 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGLLcc.1144/2�A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-1157
Project# JS-2017-001958
Est.Cost: $1647.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN PERRIER 105319
Lot Size(sq. ft.): 56192.40 Owner: HAMELIN MATT
Zoning: Applicant: JOHN PERRIER
AT: 13 BIRCH LN
Applicant Address: Phone: Insurance:
18 BROADWAY POND RD (860) 930-7794 WC
STAFFORD SPRINGSCT06076 ISSUED ON:4/14/2017 0:00:00
TO PERFORM THE FOLLOWING WORK ADD R-48 CELLULOSE INSULATION IN ATTIC
FOR WEATHERIZATION PURPOSES
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 ti 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 4/14/2017 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Filer BP-2017-1157
APPLICANT/CONTACT PERSON JOHN PERRIER
ADDRESS/PHONE 18 BROADWAY POND RD STAFFORD SPRINGS (860)930-7794
PROPERTY LOCATION 13 BIRCH LN
MAP 36 PARCEL 209 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
pERmrr APPLICATION CHECKLIST
EN . I r REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid /Q
Building Permit Filled out (tJY",
Fee Paid �
Tvpeof Constructiont ADD R-48 CELLULOSE INSULA ; N XfTIC FOR WEATHERIZATION
PURPOSES
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 105319
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
!/Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: She 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 Cm 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
D.. Iel.y
Signa ure 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.
r__
The Commonwealth of Massachusetts
CD Board of Building Regulations and Standards FOR
U Massachusetts State Building Code,780 CMR MUSE CIPALITY
1.; Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
I.' n One-or Two-Family Dwelling
This Section For Official Use Only
�—-- B 'ding Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.I l oper{yiAdyress:i ,,, a 1.2 Assessors Map&Parcel Numbers
Ha Ia Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private❑ Zone: _ Outride Flood Zone? Municipal LI On site disposal system ❑
Check if yes0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owne 'of rd:
/�an
rn ) a�i� ,ZIP ee rvt nCIIPZ
I
Name(Print) Ci te,ZIP
/3 ,g rchz`ni. /3 - 7017 -03 ?
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) ❑ Addition 0
Demolition ❑ Accessory Bldg.0 Number of Units_ Other 0 Specify:
Brief Description of Proposed Worlr2:
To Add R-48 Cellulose Insulation in Attic for weatberization purposes
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ I. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Cost'(Item 6)x multiplier z
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fr$ ,IID 'sc
Check No.'61�i Check Amoug (P Cash Amount
6.Total Project Cost: $ /te, q 7 0 Paid in Full 0 Outstanding Balance Due:. •
NEGH
28 Spellman rd
Please Submit Stafford Springs,Ct
Permits to: 06076
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
John Perrier 105319 12-12-2017
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)_I
18 Bradway Pond rd
Type Description
No.and Street U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
Stafford springs Ct 06076 WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
860-930-7794_ jperrier06076®yaboo.com
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name 173021 8-27-2018
FDC Registration Number Expiration Date
John Perrier
No.and Street • Jperrler06076Qyahoo.eom
18 Bradway Pond rd Email address
Stafford Springs,Ct 06076
City(Town,State,ZIP Telephone 860-930-7794
SECTION 6: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 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize New England Green Homes to act on my behalf,in all matters
relative to work authorized by this building permit application.
John Perrier
03/ /2017
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that ail of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Lynn Ford
03/ /2017
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program Or guaranty fund under M.G.L.c. 142k Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
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18 BROADWAY POND ROAD
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STAFFORD SPRINGS Cl 06078
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