44-139 (2) 4/44
SECTION S: CONSTRUCTION SERVICES
5.1 Construction Snpervisor License(CSL) CS-115196 5/31/2024
Ryan J. Crandall License Number Expiration Date
Name of CSL Holder U
492 State St. UstCSLTypo(secbolow)
No.and Street Type Deacsiptien
Belchertown, MA, 01007 U Unrestricted(Buildings upto35,000 cu.ft.)
GitWrown,State,Zip R Restricted l 442 Family Dwelling
M 1 Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
802-233-9062 rcranda11@wright—buLidera.com I Insulation
Telephone Email address E D_ Demolition
5.2 Registered Home Improvement Contractor(HIC) 101536 06/25/2 02 2
wright Builders
HIC Registration Number Expiration Due
HIC Canppan7y Name or HIC Registrant Name
48 Bates St info@wright-builders.com
No.and Street Email address
Northampton, MA, 01060 413-586-8287
Ciy1Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.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..........0 No...........I]
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authotze wright Builders, Inc.
to act on my behalf in all matters relative to work authorized by this building permit application.
at 11, 4 Kelly Cfrol. i,1/2.1.
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 petjtuy that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
« wawrw � .:.�-- -- 10/29/2021
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. 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(MC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L c.142A.Other important information on the EC Program can be found at
www m;ass.gov/area Information on the Construction Supervisor License can be found at www.mass.govtdps
2. When substantial work is planned,provide the information below.
Total floor area(sq.ft.) 5.568 (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) 3,511 Habitable room count 9
Number of fireplaces 1 Number of bedrooms 4
Number of bathrooms 3 Number of haltlbaths 1
Type of heating system air/air heat pumps Number of decks/porches 4
Type of cooling system air/air heat pumps Enclosed 1 Open 3
3. "Total Project Square Footage"may be substituted for"Total Project Cost"