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Zoning
Miscellaneous Additions, Repairs, Alterations. etc. Tel. No. Alterations
e NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
ton d 7 i. w ) 1 L Lot No.
Owner's name , `) CA ,e .� �. c L t e " Address 6 0 !1 Fie e ./7 - f f. )et t iii Q, e
3. Builder's name L1 \� Address ._J ,1
Mass. Construction Supervisor's License No. Expiration Date
Addition i n" . G z 1 :! /t e 4 ' • , �� , • G 44
5. Alteration �.
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage No. of cars
Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. ,Siding house
4. Estimated cost:- 7 0 l)ti can
undersigned certifies that the above statements are true to the best of ■
knowl ge and ief.
( zii 6 t- )/' ?
Signatuslot`
Remarks `// responsebls app.icant
•
s t : Ci.if of Nox#i1ant4ton _
$ i **
`� „�% (j B T ' 9 1 T xssxcllnsctts _ ` _
"'W ::`- DEPARTMENT OF BUILDIT(G INSPECTION = '°````—
• 0` 212 Main Street ' Municipal Building __ �=
Northampton, Mass. 01060 ~ � '�
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
,/L' ,5-q-At. y (v.rit)(.1m y
(licensee/permittee)
with a principal place of business/residence
� at:
l/ t / /�1 /'CPI . V / L_L A 6 (phone #) .51 0 s5
A j , /xi- (street/city /state/zip) Q / j
do hereby c e , u nder the pains and penalties of perjury, t a
( ) 1 am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
¢ I am a sole proprietor, general contractor or homeowner (circle one) and have hired
/the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) - (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company /Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sleet if necessary to include information pertaining to all contractors)
( ) I am a sole proprietor and have no one working for me.
( ) lam a home owner performing all the work myself.
NOTE: please be aware that while homeowners who employ persons to do maintenance, construction or repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thereto are not geoeraily considertd to be
employers under the wotket's compensation Act (GL152 ss 1(5)), application by a homeowner for a license cc permit may evidence the
legal statue of an employee under the Worker's Compensation Act.
I understand that a copy of this statement may be forwarded to the Department of Industrial Accidents' Offioe of Insureoee for the
coverage verification and that failure to secure coverage tattler section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1, 500.00 and/or imprisonment of up to one year and civil pemitics in the form of a Stop Wodr Or and a
fee of 3100.00 a day against me. •
For depsctmrztal use only
' ' . 4 , . Permit Number
�� Map# Lot#
ignature of LitxnseefPermittee DD
,: r .:-i .,„ Lil . 1"; ' \ ii :' 1 sCk il 1 4 ( rif 3 2 B JXle��achnrrtl� -�" � ,
� 5. ! s„ ,'' ., D EMJ MENT OF BUILDING INSPECTIONS Q� INSPECTOR j _ 12 t nin Street ' Municipal Building
orthampton, Mass. 01060 ow
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE :, /o-1 q —Cirirl
JOB LOCATION:
(Map) (Parcel) , Subdiv'sion) L
HOMEO�TNER: ' /..,,t_ / . 4 )A 0 r % . ' ( ' - __
( Name & Address)
(Home Phone) (Work Phone)
. 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. CMR780 Section W9.1.1
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 t� 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
permit: .
As acting Construction Supervisor your presence on the, j.ob 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./
r / 4' .
HOMEOWNER SIGNATURE �� _ _ ✓', ' C ( . •
BUILDING. PERMIT 4 - :N
1
,l,l
.
10. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF NFORMATION.
This co.L to be filled in
by the Building Department
Required
C O r,,,,-„PAINA--t--
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt .
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of - Parking Spaces
it of Loading Docks
Fill:
(volume -& location)
i
13. Certification: I hereby certify that the information contained herein
is true and accurate to the best of my know edge.
C a
\''E: /c q 0 0 APP 'CANT i s SIGNATU t b (,a !--"
NOTE: Issuanoe of a zonin - - - rmit does not relieve a a l i - ant's burden oom
PP ply wltlp all
zoning requirements and obtain all required permits from the Board of He Ith, Conse
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
•
OCT + 9X999 File No . ae l iG®
DFP
`'' '' EONIIsl r G ' PERMIT APPLICATION (§'10.2 )
PLEASE TYPE OR PRINT ALL INFORMATION
L Name of Applicant: 7 r L C )(4) 1./0/4
Address: c?O S T`T 1 K /'t" N ti Telephone: .112_ ` ( 7 Z 3
Owner of Property: >Cp -cry G?- /J ? )4
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other (explain): ,Q /
L Job Location: 6 O t l: /J / / U V V I L- L24-(9-E_
Parcel Id: Zoning Map# 1‘/9"
10 Parcel# 1% T '8� �istrict(s T) �� ��" / 1
(TO BE FILLED IN BY THE BUILDING DEPARTMEN
5. Existing Use of Structure/Property
6. Description of Pro o Use/Work/Project /Occupation: (Use additional sheets if necessary):
/ / Pt elt,57 /or 7"-
* s
Ai t a-t al( J
7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special PermitNariance/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 ocument #
9. 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:
(FORM CONTINUES ON OTHER SIDE)
608 FAIRWAY VILLAGE BP- 2000 -0400
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 16A - 020 CITY OF NORTHAMPTON
Lot: -083
Permit: Building
Category: woodstove BUILDING PERMIT
Permit # BP- 2000 -0400
Project # JS- 2000 -0691
Est. Cost: $300.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group:
Lot Size(sq. ft): Owner: CONWAY SALLY
Zoning: URA/WSP/WP Applicant:_
AT: 608 FAIRWAY VILLAGE
Applicant Address: Phone: Insurance:
ISSUED ON:
TO PERFORM THE FOLLOWING WORK: INSTALL WOOD PELLET STOVE & LINE EXISTING
CHIMNEY
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace /Chimney :,
Rough: Oil: Insulation:
Final: Smoke: Final:O _ r r i D 4
l 1
THIS PERMIT MAY BE REVOKED BY THE C % OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULA ON /9-41ril
.ter
Certificate of Occupanc si. nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo