25C-207 (3) SECTION 8 CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder:
License Numb pr
4 4/11 0,0
Address expiration Date
Signature Telephone
9.Registered Home'Improvement Contractor: Not Applicable ❑
yJ P-( 4- t' k t, C4 ��'C/ti-Efif l b 1 5 3
Company Name _ Registration Numbe
Q ST, o lJ 4 x�7fl 6
Addres Expiration Date
Telephone �O
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...... ❑
11. - Home Owner Exemption
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
Accessory Bldg. ❑ Demolition New Signs [O] Decks [0 Siding [0] Other[O]
Brief Description of Proposed'V'AA DL' ,t �s..��'�1
Work: I
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes _X 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. Dimensions
e. Number of stories?
f. Method of heating? Firepl s or Woodstoves Number of.each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of we s? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or r floor below finished grade
k. Will buildin form to the Building and Zoning regulations? Yes No.
I. S c 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, S-M I �� as Owner of the subject
property
hereby authorize
to act on my beh f in all ma er trela4ive towork authorized by this building permit application.
,
Signature of Owh4r Date
ti c-- as Owner uthorized
ent ereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
an elief.
Signed under the pains and penalties of perjury.
Print Name
Sig natu wner/Agent Date
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 filled in by
Building Department
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 Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW NY YES Q
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 a 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 Q NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,ex(;Pvation,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 Permit:.
Building Department Curb Cut/DrivewayPermit
212 Main Street Sewer/Septic Availability
Room 100
_ Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone'413- 87-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
1� 1,.;Nm-N ST. Map Lot Unit
V O�, P—�N f Imp( Zone Overlay District
'`� Elm St.District CB District
SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
S-Me ST.z No PMA,/ e—T%0
Name(Print) Current Mailing Address: A--W/
OD
Telephone
Signature
2.2 Authorized Aclien :
At (sw� l I& f 41 �Al X o POtAl^P fi nl
Name(Pri Current Mailing Address:
�0-.e)
Sig r Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building $/ / O (a)Building Permit Fee
T� O-
2. Electrical �o o• (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) • Check Number
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings', Date
09/26/2005 14:35 4135879276 WRIGHT BUILDERS PAGE 01
MEMQ
To: Tony Patillo
Northampton Building Dept.
Date:. 9/26/05
From: Linda
Re: Demo Permit for work at:
17 Linden Street
Northampton, MA
SEP 2 n HOC ,
Hi Tony,
A Demo Permit for work at 17 Linden Street was submitted and approved
4/13/05) (expires 10/13/05). The seller recinded the P& S,for a time due to
personal health reasons, but now the project appears to be moving forward
again.
We respectfully request a 90 day extension on this Permit. New expiration
date to be 1/13/06.
We understand that official issuance of this Permit is pending all shut off
letters.
Please contact us with your decision. Please call if you have any questions
or need additional information.
Thank you.
WRIGHT BUILDERS, INC.
48 Bates Street
Northampton, MA 01060
Tel: 1-413-586-8287
Fax: 1-413-587-9276
File#BP-2005-0988
APPLICANT/CONTACT PERSON Wright Builders
ADDRESS/PHONE 48 Bates St NORTHAMPTON (413)586-8287
w EN ST
000&�Wfii
URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid
Typeof Construction: DEMOLISH SFH
New Construction
Non Structural interior renovations
Addition to Existinp-
Accessoa Structure
Building Plans Included:
Owner/Statement or License 068185
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOPMATION PRESENTED:
Lo'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 mmission
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.
SAY
*
Variances are ranted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Varian g y
Planning&Development for more information.