32C-201 (3) SECTION 8-CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: i��� Not Applicable ❑
Name of License Holder: MA-F+ UC U/ CS o4,10-
License Number g lo
Addre s Expiration Date
Z
ignature Telephone
r.,. ;, Not Applicable ❑
VJ415R it lt,� S 1m53(p
Company Name Registration Number
,e* sfi "6�Ti-WFrnO MA cP 12(0 IV
A dr s 1
//��-- I p Q Expiration ate
Telephone+[;
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...... ❑
o weer - e>Ill� o
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 buildine 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
ACTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ]
nef Description of Proposed Work:"b mI -Tw V wTIA wTuf-" t "-w NW
Alteration of existing bedroom Yes _No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes _ No
Plans Attached Roll ❑ • Sheet 0
VWJ p 12-� 'Tb 6 I�t
6as1 a `Ei se n d'drtron o ex s n o rn co e e he o Cowin
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? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-70 BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT `
. as Owner of the subject property
hereby authorize Mftti � �v -1(� �1NS to act on
behalf, in all-matters relative to work authlorized by this building permit application.
Signa re of Owner - Date
l� . as Owner/ 1wthorized A e
hereby 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. .
P int me
LIJ4,r'
Signature of Owner/Agent Date
Section 4.
ALL INFORMATION MIDST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Aw w ?I>J I)W-5 egt' -
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontase
Setbacks Front
Side L: R: L: R`
Rear
Building Height
Bldg.Square Footage %
Open Space Footage °'o
(Lot area minus bldg&paved
parking)
#of Parking S aces
Fill:
vol e&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the, Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO _ DON'T KNOW
YES
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_
No
IF YES, describe size, type and location:
4 d
City of Northampton S a & t
Building Department t
212 Main Street
Room 100 .
Northampton, MA 01060 e
phone 413-587.1240 Fax 413-587-1272 o t
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENgV T R EioLiSIVA t VE TWO FAMILY DWELLING
JUN 1 6 2005 ;
SECTION 1-SITE INFORMATION
1 �r is section o be ompleted by office
1.1 Property Address: f s '; "�
� j/�� ///JJJ �//ry�� `/mil C M ny }'dk'in
V• ✓ "'a• �I.(lL
�M Zone �Overlay District` + �
Elm St Distrkt •;CB District
SECTION 2- PROPERTY OWNERS HIVAUTHORIZED AGENT
2.1 Owner of Record:
p p
F�1r.
Na rint) � Current Mailing Address:
Telephone ,�l
2.2 Authorized Agent:
M
Name(Print) Current Mailing Address:
Signa are Telephone ��^^
SECTION 3 ESTIMATED CONSTRUCTION COSTS IG_ ► J. "' =
Item Estimated Cost(Dollars) to be Official Use Only
comoleted by ermit applicant y'
i. Building
(a) Building Permit Fee
^ /'J' �.(�. —� __
2. Electrical d' lnJ (b)Estimated Total Cost of .
a-� /o Construction from..6
3. Plumbing / 9�n� Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 +3 +4+5) 5`'
Check Nurziber
This Section For Official Use a
S
-;.J• ."� '
Building P erms it Numb _ `* :l -. t N a D.a.te r :•. -gt}w,v, ;t ff..}'u S F",»�.R:lh S Y'a5,�-`^ti��i�'�`v.4 C' `kj�'J�L�+- �ki r ''"`N�s -.
Issue u ,
}� ++ fix •y: °.� :q� P !. i. P •�`1r's�,w x; h P .'+,A�r��.', t�.e o"'S3 }+1., "'�` ' ,w LC .l.s 1^v •`R�:. s
Y -
�r..M
�� a�C'- ��+t: {' +� P �r�i� y �'� � %��A4� 'GKS•,,� i `0t t�rA t3r4•a,J
File#BP-2005-1285
APPLICANT/CONTACT PERSON Wright Builders
ADDRESSIPHONE 48 Bates St NORTHAMPTON (413)586-8287
PROPERTY LOCATION 89 WILLIAMS ST
MAP 32C PARCEL 201 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 030 �40 01
Fee Paid
Typeof Construction: CONSTRUCT NEW MSTR BATH&REMODEL EXISTING BATH
New Construction
Non Structural interior renovations
Addition to Existing
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
INF RMATION 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 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 S et Commission
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.
89 WILLIAMS ST BP-2005-1285
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-201 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2005-1285
Project# JS-2005-1715
Est. Cost:$32442.00
Fee: $130.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Wright Builders
Lot Size(sq.ft.): 3789.72 Owner: LAMONDE KIRSTFNI UNGER&
Zoning:URC Applicant: Wright Builders
AT. 89 WILLIAMS ST
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 Workers Compensation
NORTHAMPTON MAO 1060 ISSUED ON:6123105 0:00:00
TO PLRFORM THE FOLLOWING WORK.-CONSTRUCT NEW MSTR BATH & REMODEL
EXISTING BATH
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:4 Rough: , House# Foundation:
Driveway Final:
� f
Final: ,/ vFinal: / r p� /� r% /
l��'`"/ ! / Rough Frame: 6)�rl_ S !
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: - Insulation:
/J
Final:
��
Smoke: � G I - -��- Final: �
f O
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION,OF
ANY OF ITS RULES AND REGULATIONS. ,M
�r
Certificate of Occupancy_ si nature: _
FeeType. Date Paid: Amount:
Building 6/23/05 0:00:00 $130.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo