35-059 (4) DEC t 1999 '
DEFT OF 8UP 3 INS?ECTI'.
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No Alterations
NORTHAMPTON, MASS. 19 Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location '/-"7 -.' Lot No.
2. Owners name I Ile[ 1,9/,-7 /1c-' 3 42 19a-c'-) Address
3. Builders name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
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 f>`c�� ��'•�%�
11. Distance to lot lines
12. Type of roof
13. Siding house
14. timated cost:-:
i1�
The undersigned certifies that the above statements are true to the best of `
knowledge and belief.
Signature of responsible app�icant
Remarks
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DEC1 t�yy� fIasaacflasctts
DEPARTMENT OF BUILDDIG INSPECTIONS
PT
212 Main Street a Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVTr
(license&permittee)
with a principal place of business/residence at:
2,2- U�� ��� f�� 4�v=�=�L�"�� /<' < <'ic t (phone#)
(street/city/statehip)
do hereby certify, under the pains and penalties of perjury, 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 hom_eviller(circle one) and have hired
the contractors listed below who have the followin worker's compensation policies:
g P P
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
19 e✓LAS L-t c= r,c-iC
(Name of Contract/or) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insmance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach addition1 shod if necessary to include infamarion pataining to all oomractofs)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE-please be aware that while homeowa=who employ pc==to do msinteaancq construction,or repair work on a dwelling of
not more them throe units is which the homeowner resides or on the gmn ds app1daasat thereto are not Sce eralty coosidemd to be
employers under the vmd='a oompcnsatim Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the
legsl slat u of an employer under the Wa car's Compamatiom AcL
I understand that a copy of this statement may be forwarded to the Department of Industrial Accident,'Office of finursnoe for the
covaagc verification and that failure to$==cov=V under section 25A of MGL 152 can lead to the impoi oa of criminal penalties
oomisting of a fine of up to$1,500.00 srWor imprisonment of up to one year and civil penalties is the form of a Stop Wodt Order and a
firm of 5100.00 a day against me.
For depattmMW use ooty
Permit Number
Ma
p:# Lot#
Signature of LicenseelPermittce
9 r Lw t' jr
DEC IM9 ,''DEPARTMENT OF BUILDING INSPECTIONS
INSPE T
212 Mnin Strcct ' Municipal� - g
PTOF8Ut3f ,,rin��e Northampton, Mass. 01060 Buildin r• `•
fM'Od�rr' : .:. -
HOMEOWNER LICENSE EXEMPTION
( Please Print )
DATE: All?,���� ��i �9 `I
JOB LOCATION:
(Map) ( Parcel ) ( Subdivision)
HOMEOWNER: 11 1e -7 3
(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 i-s, 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 shail 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- bui-ldilio
permit.
As acting Construction Supervisor your presence on the_ j:ob site
will be required from time to time, during and upon completipn" 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 12 1.11 1164l l�--O
BUILDING. PFAZMIT �l i
10. Do any signs exist on the property? YES NO X
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO X
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This —.Luma to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L• R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&Paced Park.in31
# of -Parking Spaces
f 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.
DATE: APPLICANT's SIGNATURE
NOTE: luounnoe of a zoning permit does not relieve an applioant's burden to oomply witty all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applioable permit granting authorities.
FILE #
DEC 1 1%9 Fi 1 e No. ��1
DEPT Of 81.1111 IPEC `ONING PE=T APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: �7i'�-L �. .��
Address:
�a1�Co Telephone:
2. Owner of Property: /C c /"q r7 9 //c /-7�.�.2✓J
Address: Telephone:
3. Status of Applicant: X Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: Z -> jD
Parcel Id: Zoning Map# �S Parcel# District(s): '\
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property Ye`S
6. Description of Proposed UseMork/Project/Occupation: (Use additional sheets if necessary):
G" <_C /-/- r TI-Y 6 t c`r" c l__-)C--:77
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/Vadance/Finding ever been issued for/on the site?
NO x 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 4/c Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
File#BP-2000-0549
APPLICANT/CONTACT PERSON HUBBARD WILLIAM B&SANDRA S
ADDRESS/PHONE BOX 60166 586-2508
PROPERTY LOCATION 932 RYAN RD
MAP 35 PARCEL 059 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 0
Typeof Construction: ADD BATHROOM WITHIN EXISTING ENCLOSED PORCH
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 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
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Co fission
Signature of Building Official 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.
932 RYAN RD BP-2000-0549
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mau.Block: 35-059 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2000-0549
Proiect# JS-2000-0960
Est.Cost:$6500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED 'TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sq.ft.): 6621 1 .20 Owner: HUBBARD WILLIAM B&SANDRA S
Zoning: SR Applicant.
AT. 932 RYAN RD
Applicant Address: Phone: Insurance:
ISSUED ON.1217199 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD BATHROOM WITHIN EXISTING
ENCLOSED PORCH
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
inderground: 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 of Occupancy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
`Building 12/7/99 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo