36-262 (3) SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Suo I e rvisor: Not Applicable ❑
Name of License Holder: FDD" (� w6i — 6
�� � ��. � License Number
�� M a-I9l aq
Address Expiration Date
�-
Signature Telephone
9.Re"istered Home I' rove_ment Contra tor. Not Applicable ❑
UJk 6n+�s &V 1 /ink f; w 1 o 10
Company NaUge Regist atioJ' Number
�
Y$ T SE. M�> P IJ b I>r,/11)
Address Expiration Date
'67J��l 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....... P6 No...... ❑
11. Home,Owner Exernvtion
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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all appligablel
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors E]
Accessory Bldg. ❑ Demolition ❑ New Signs [[I] Decks [C] Siding[❑] Other[❑]
Brief Description of Proposed
Work: M Pkm PM, "b�
Alteration of existing bedroom Yes No Adding new bedroom Yes _�No
Attached Narrative Renovating unfinished basement Yes �c No
Plans Attached Roll -Sheet
6a.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. Dime . s
e. Number of stories?
f. Method of heating? ireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. o etlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement Ilar floor below finished grade
k. Will buildi 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 APPLIES FOR BUILDING PERMIT
I, 1' r 64!-�J / 70V as Owner of the subject
property
hereby authorize V + ►• �•�'G rte'
to pct on m alf, in all matters relative to Work authorized by this buildg y rmit application.
3 1,12e
9=re of Owner Date
I , �N G • as Owne Authorized
Welief.hereby declare that the statements and information on the foregoing application are true and accurate,to the best o my knowledge
Signed under the pains and penalties of perjury.
M&#+- !:Im
Print Name
Lo '9
Sig natur f Owner Agent Date
o? j.,Jj "jf4r—•
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required b�bcd
This column ty
Building D e
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:'
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&pave
parking)
#of Parkin aces
Fi
olume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES
IF YES, date issued:'.
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT 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 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 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,gradin ex avation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of i*ermit:
?_ Building Department Ctarb.Gut/Driveway Permit
� '212 Main Street S wefj e'pticAuailabilit
r Room 100 Water l Availability
rNgrthton, MA 01060 Twp Sits°of Structural Plans
phone 4 h,3 Fax 413-587-1272 Plotlsite.r?ians '
Other Specify
A,QPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1
This section to be completed by office
Property Address: �Q�
I I3 IV`s 4/s,� ! "�,p(Y,�- Map Lot Unit
�p uCi / Mk- 000-- Zone Overlay District
Elm St.District ' CB District
SECTION 2-'PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
8A- N5f 44D e0 e,61 V fLC (1)K 1-t-, frU J'trw. MIS
Nam,#,(Pri Current Mailing Address:AT
Telephone
gna'ture
2.2 Authorized Acie .
Name(Print) Current Mailing Address:
0 - �
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS`
Item Estimated Cost(Dollars)to be " Official Use Only
completed by ermit applicant
1. Building 1 !�q (a)Building Permit Fee
2. Electrical , (b)Estimated Total Cost of
t Construction from 6
3. Plumbing ' g �y pr Building Permit Fee
l d �
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number: Date
.Issued:
Signature:
Building Commissioner/inspector of Buildings Cate
File#BP-2009-0588
APPLICANT/CONTACT PERSON WRIGHT BUILDERS
ADDRESS/PHONE 48 Bates St NORTHAMPTON (413)586-8287
PROPERTY LOCATION 173 MAPLE RIDGE RD
MAP 36 PARCEL 262 001 ZONE SR(100)/
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 MASTER BATH
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)tMATION 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 Street Commission Permit DPW Storm Water Management
Demolition Delay
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.
BP-2009-0588
GIs#: COMMONWEALTH OF MASSACHUSETTS
mul
"T CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2009-0588
Project# JS-2009-000843
Est.Cost: $21747.00
Fee: $132.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WRIGHT BUILDERS 047146
Lot Size(sq. ft.): 69696.00 Owner: PUCCI JOHN P&MARY E BATES
Zoning: SR(100)/ Applicant: WRIGHT BUILDERS
AT. 173 MAPLE RIDGE RD
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 Workers Compensation
NORTHAMPTON MAO 1060 ISSUED ON:1211112008 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL MASTER 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: 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 12/11/2008 0:00:00 $132.0030848
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
173 MAPLE RIDGE RD BP-2009-0588
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map.-Block: 36-262 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Perrnit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2009-0588
Project# JS-2009-000843
Est.Cost: $21747.00
Fee: $132.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WRIGHT BUILDERS 047146
Lot Size(sq. ft.): 69696.00 Owner: PUCCI JOHN P&MARY E BATES
Zonine_SR(l00)/ Applicant: WRIGHT BUILDERS
AT. 173 MAF`L`
11 i LJ'v t K i1
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 Workers Compensation
NORTHAMPTONMA01060 ISSUED ON:1211112008 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL MASTER 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: Rough?�1018 House# Foundation:
j Driveway Final:
Final: Final: Z
1� -> Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: ai:a:: y'i r j�tw �*ry ✓�
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy ( Si nature:
FeeType: h7aYe Paid: Amount:
Building 12/11/2008 0:00:00 $132.0030848
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Conunissioner-Anthony Patillo