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Zoning _
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
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NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location e ,�/i/ � Lot No.
2. Owner's name 'S ��_� Address g 6(-D GUd
3. Builder's name 0 Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition R Q .;
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
14. Estimated cosL-
The undersigned certifies that the above statements are we to the best of his, hc:
knowledge and belief.
L/ Signature responsible app,icani
Remarks
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DEP TMENT OP BUILDING INSPECTIONS
(DEPT OF SMI- !? G INSPECTIONS
INSPECTO NO THAIVI Tsi� MA 01060 2 Main Street • Municipal Building a
Northampton, MA 01060
Applicant Information
Name ,e- —5-� �OLe ---------- —
Location �-'�� _ _-----------
City 4- .0. _Q i bo_ ---------
I am a homeowner performing all work myself
❑ 1 am a sole proprietor and have no one working in any capacity
077-MMT
❑ I am an employer providing workers' compensation for my employees working on this job.
Company Name ------------------- --
Address
City
---- ---------- Phone#--------
Insurance Co.------------_—Policy#------ ---
Company Name
Address % `a
City Phone#
Insurance Co. Policy#
Failure to secure coverage as required under Section 25 A of IvIGL 152 can lead to the imposition of criminal
penalties of a fine up to$1500.00andfor one years'imprisonment as well as civil penalties in the form of a STOP
WORK ORDER and a fine of$100.00 a day against me. 1 understand that a copy of this statement maybe
forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby cert under the pairs and penalties of perjury that the information provided above is true and correct.
Signat ? Date
Print Name C" P�__=✓tl�P ��°C�' Y Phone
Official Use Only Do not write in this area to be completed by city or town ofcial
City or Town PermiVLicense3P ❑ B-iidi:tc Dert
❑Lie
zuint Bond
Check K immediate response is required
Contact Person Phone#. ❑SekcIz—'Der►.
Health Dept.
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$ J3 �� 31999 � r !
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DUARTMENT OF BUILDING INSPECTIONS _
-
INSPECT _ 212 A1nin Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
( Please Print )
DATE:
JOB LOCATION:(
(Map), Parcel) ( Su�bhi O2on) �
HOMEOWNER
(Name & Address) �
0
(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: Persons) 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
conside.red 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 SIGNA
BUILDING PERMIT # A
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File Nob ��_ n1 tl
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LNG PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant
f
Address: , �f " ' k 7"_• ; y.,' Telephoner )
I
2. Owner of Property:
Address: . 6,4 .. L -1-v �::.. Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s): Q
(TO BE FILLED IN BY THE BUILDI G DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/WorkJProject/Occupation: (Use additional sheets if necessary):
v
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.
S. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO y 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 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)
File#BP-1999-1024
APPLICANT/CONTACT PERSON SPENCER STEVEN G&MICHELE V
ADDRESS/PHONE 28 BROOKWOOD DR 584-3885
PROPERTY LOCATION 28 BROOKWOOD DR
MAP 29 PARCEL 384 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 6
Typeof Construction: CONSTRUCT 10 X 12 SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
THE LOWING 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:
4
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Co is ' n
Signature f ding Officia 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.
BP-1999-1024
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Bloc ` 194 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Catego :shed BUILDING PERMIT
Permit# BP-1999-1024
Project# JS-1999-1735
Est. Cost:$1000.00
Fee:$20.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Sizes .ft. : 15986.52 Owner: SPENCER STEVEN G&MICHELE V
Zonin , �-; Applicant:_
AT• 28 BROOKWOOD DR
Applicant Address: Phone: Insurance:
ISSUED ON:6/7/1999 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 10 X 12 SHED
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:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate f Occupancy Si nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 6/7/1999 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo