29-377 (3) ^f ' Q ,1998
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a rNORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location '� 6rcclI ,l,-,occ1 ��`�V � C�V"Fv Lot No.
2. Owner'sname W� UL;'c,t i, Address . �f'c=c� � tXC� 4�Io,C i--)c.
3. Builder's name heY ,,v r;i.fa^ Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration ►'e P3 4Gi✓ �-
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 I /
11. Distance to lot lines (I�r a 4 '111:4, i t
12. Type of roof -X C,I e-
13. Siding house
14. Estimated cost:- cC1
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
Signature of responsible app,icant
Remarks
r.
� �nssKCitnsrtla
T
s. j998DEPARTMENT OF BUILDING INSPECTIONS -
Pa
AUC �
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION•
(Map) (Parcel) (Subdivision)
HOMEOWNER:
(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 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.
t
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. A
HOMEOWNER SIGNATURE ��
BUILDING PERMIT #
4�tiAMp�, r� f i
�o oI;
>af chart allipto11
A UG4 19-98 �asaxrflasrlls 4
m DEPARTMENT OF BUILDrNG INSPECTIONS
W. .. 212 Main Street ' Municipal Building 'a
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AF MAVIT
I,
(IicenserJpeTmittce)
with a principal place of business/residence at:
(phoney#)
(street/ci ty/statP/a p)
do hereby certify, under the pains and penalties of pemily, that:
( ) I 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) (Insurancc Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Pokv Number) (Expiration Date)
(Name of Contractor) (lnstlrancz- Company/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach add?doail sheet ifnexxuuy to inchsde inform tioa pertaining to all ern om)
( ) I am a sole proprietor and have no one working for me.
( I am a home owner performing alt the work myself.
NOTE:please be aware that while homcoAi-m wbo cmplay pazow to do maadc*»ace,construction or repair work on a dwelling of
not more than throe traits is wluch the homoowncr stela or on the uouads appurtenarrt thacto arc not generally ooasidercd to be
employers under tbo worker's oompessation Act(GL157,s 1(5)),application by a homeowner for a liauso or permit may evidcnoe the
1eg21 etalus of an employer under the Workeet Compeosation Ace.
I undersund that a copy of this etatemcxd may be farw�to tho DcQerm of Jo&utrial A 64ca 3 Off oc of 1n%uvnoo for the
coverage verification and that failure to secure eoverago under soction 25A of MOL 152 can lead to tbo imposition of aiminal pean -
oomisting of a&ate of up to S 1,500.00 and/or kapr6omnent of up to One year and Civil pem lutes in the form of a Stop W otk Order and a
fim of 5100.00 a day agaiml ma.
For dgmt=%W uuo only
CPermit Number
Mapy Lot#
Signahtre of Licensec/Permittee
10. Do any signs ebst 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 INFORMATION.
This column to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size /Z'Z7 �c C,
7� ll
Frontage f d�
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height O j
Bldg Square,footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of -Parking Spaces
#` 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 knowledge.
DXTE: ��' APPLICANT's SIGNATURE
NO Issuan a of a zoning permit does not relieve an ap I�oanYs burden tts comply wittA .all
zoning requirements and obtain all required permits from the Board of Health, Cons:ri ation
Commission. Department of Public Works and other applicable permit granting authorities.
FILE #
File No. /
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: [/&r4,)c,,Telephone:
2. Owner of Property:
Address: Telephoner
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): n
4. Job Location: � ' ice/
Parcel Id: Zoning Map# Parcel#`9 7 7 District(s): Z�Izm llv:�q�'
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. Existing Use of Structure/Property ) 4trllr
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
tD
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 Departrnent 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 YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO ll 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)
s •
File#BP-1999-0149
APPLICANT/CONTACT PERSON Manuel Santos
ADDRESS/PHONE 5 Brookwood Dr (413)586-1958 O
PROPERTY LOCATION 5 BROOKWOOD DR
MAP 29 PARCEL 377 ZONE URA/WSP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building,Permit Filled out
Fee Paid s —'
hpe of Construction:
New Construction
Non Structural interior renovations 77 25 72
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License#
3 sets of Plans/Plot Plan
THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Well Water Potability Board of Health
on
C i
Signature ofmiulld 0
Note: Iss, of a Zoning permit does pqt F0iPy-e��applicant's burden to comply with all zoning
requirenii diYr '*"IKW i�f s° # s and of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
Department: Reference No: BP-1999-0149
............••.•........•.•.....•..
Building, Electrical & Mechanical Permits
.........................................................................................
Fee Type: Receipt No:
shed REC-1999-000269
• Paid By: Paid in Full 0 n
Manuel Santos Tue Aug 04 1998
........................................................................................ ......................................
Received By: Check No:
Linda Lapointe 4088
.........................................................................................
......................................
DEPARTMENT'S COPY Amount: $20.00
............ ..............
DEPARTMEN"I' VILE COPY 5 BROOKWOOD 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:
BP-1999-0149 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
5100 29 377 001 5 BROOKWOOD DR URA 14897.52
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
LkE State: Zip Code: Phone:
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0219 shed $600.00
Description of Work:
18' X 12" SHED
GeoTMS@ 1997 Des Lauriers&Associates,Inc. Signature: