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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
1. Location /Y f? cT�Pf c .4-SS Lot No.
2. Owner's name - Address S.9
3. Builder's name f Address S'g,-r
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished? V
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
14. Estimated cost `/�O Q
The undersigned certifies that the above statements are true to the best of his, her
knowled e d belief.
Signature of responsible app icant
Remarks
Y .$ Crz#� of wort 1raliiptoil
s. DEPARTMENT OF BUILDING INSPECTIONS
INSPECTO A 2 4 212 Main Street ' Municipal Building
Northampton, Mass. 01060
DEPT OF
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION:
(Map)...�(Par e 1) , (Subdivision)
HOMEOWNER:
'L� f,r�' .� J[Jf3w. �rg.?'f�.b�9
(Name & Address )' - 6 Svc C!
(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 109. 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 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
BUILDING PERMIT # .� A-
O4�t ! �.
JUL 2 4119% Crx laf WOrt4al"PtOn
1?
9 6 Masa itch nsctts
PT OF f7'
DEPARTMENT OF BUILDING INSPECTIONS l
212 Main Street e Municipal Building '
Northampton, Mass. 01060
WORKER'S CON2ENSATION INSURANCE Ali=AVIT
(111 censerJpermi ttee}
with a principal place of business/residence at:
ele6e) (phone#)
(stre�tici ty/stalrJn p)
do hereby certify, under the pains and penalties of pegu y, that:
O I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Ins-u=ce 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 Numbcr) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml shed ifn6oeasary to include infwwition pertaining to all coaznaors)
( ) I am a sole proprietor and have no one working for me.
(t.1`am a home owner performing all the work myself.
NOTE:please be aware that whilo homeo%;-D=who employ persom to do m inl�coastnution of repair work on s dwciling of
not more than three units is which the homoowncr resides or on the grounds appurtenant thereto are not gwcrally 000sidered to be
employers under the worker's compensation Act(G1,152,ss 1(5)),application by a homeowner for a liocaso oc Pa"t may evidence tbo
legal status of an employer under the Workeez Compemaiion AcL
I understand that a copy of this sutcmcat may be forwurded to tho Dcpertmrat of lndustrW A=dea&Of500 of 1ma¢s000 for the
coverage verification and that failure to secure ooverngo under socUon 25A of MOL 152 can lead to tba imposition of criminal PeanW-
comistmg of a fine of up to S1,500.00 sndlor imprisot>mni of up to one y3r and civil pa=Wcs in the fort of a Stop Work Order and a
Sne o(5100.00 a day against tee.
For dep l—only
Permit Number -
Lot#
Signa4ue' fLiccnseelPermittx
10. Do any signs exist on the property? YES NO 6/'
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 INFORMATION.
This colwa to be filled in
by the Bmild=q Department
Required I
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
e of Loading Docks
Fill:
(vol-ume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowl e.
DATE: APPLICANT's SIGNATURE
NOTE: 104kuarfoa of a zoning permit does not relieve a applioan burden to oom wit
zoning requirements and obtain all required P1Y tp .411
q permits from the oard of Health. Conservation
commission. Department of Publio Works and other applioable permit granting authorities.
FILE #
JUL 2 CO Fi 1 e Nc
�
BONING PERMIT APPLICATION ( 10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:�iL'tS/7
Address: 6/t Ae _Telephone: �`�3 -J~�6
2. Owner of Property: L�'Address: , G' Telephone: —.S�1(— `��6 s
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: �_ ® �✓/'iG �� 11Ll
Parcel Id: Zoning Map# 7( 2 Parcel# District(s): _
(TO BE FILLED IN BY THE BUILDING DEPARTME T)
5. Existing Use of Structure/Property S 1FI54
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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 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 1--' YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO_1,,-' 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)
" *4 Reference No: B,P-1999-0107
I'0 *0epartment: ...................................
Building,Electrical & Mechanical Permits
Fee Type: Receipt No:
Roofing
... ..................................................................................... REC-1999-000177
PaidBy: ......................................
I Iomer Darada Paid in Full On-
......................................................................................... Fri Jul 24,1998
Received By.- 'dh-e-c-k'...Na........................
Linda Lapointe
......................................................................................... MONEY ORDER
......................................
DEPARTMENT'S COPY Amount: $20.00
....................
DEIPARTMENTFILE COPY 350 ACREBROOK DR
CITY OF NORTHAMPTON
BUILDING PERMIT
Owner's pulling their own permits or dealing with unregistered contractors for applicable work do
not have access to Guaranty Fund(MGL 142A)
Issued: Permit No: Inspector: Tracking No.: Fee:
28 Jul, 1998 BP-1999-0107 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
5035 29 311 001 350 ACREBROOK DR URA 15899.4
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
City: State: Zip Code: Phone:
Proiect No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0148 roofing $1,500,00
Description of Work:
ROOF OVER I LAYER
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: