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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 9 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
V-11. Location U "i its t, t L b T -v w i, ,, L r- Lot No.
ST' i J, ,.•,S
Owner's name c u r Address
3. Builder's 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
11. Distance to lot lines
12. Type of roof
13.hiding house
4/. Estimated cost:- � ?�� �� u
e undersigned certifies that the above statements are true to the best of his.
knowledge and belief.
Signature of responsible app.icant
Remarks
IM
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„ D TA TMENT OF BUILDINIG INSPL'CTIONS
INSPECTOR DEPT OF SU1L41NG i `2 2nin Strect Municipal Building
N0R' f' ' 701 °°' 'N+orthnmpton, Mass. 01060
HOKEOWNER LICENSE EXEMPTION
. (Please Print )
` 1ATE;
/JOB LOCATION: 36 16 It —S'4
(Map) ( Parcel ) ( Subdivision)
* OMEOWNER: y �� i z n
(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 reside.S 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; bui-ldihq
permit.
As acting Construction Supervisor your presence on the. job 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 responsibi=lity
for compliance with the State Building Code , City of .Northampton
Ordinances, State and Local Zoning Laws , and State of Massachusetts
General Laws Annotated.
\LX6'MEOWNER SIGNATURE
BUILDING. PEt MIT ��
e e t (rik of 'W.nx#4amptan
$ 6
Qc/�. ,�tasacfittsctts
Z 61999
,. DEPARTMENT OF BUILDDIG INSPECTIONS
DEPT OF 8Uh01NG l ,, r 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(lipermittee)
with a principal place of business/residence at:
(phone#) 5�- � S
(strewcity/stat.e/ap)
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 o homeowner( cle one) and have hired
the contractors listed below who have the foll owin compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compaay/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (E)piration Date)
(attach ad&tioml sheet if neeemm y to iaclurle informadon pertaining to all ooatrot4on)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing alI the work myself.
NOTE:please be aware that while homeowner who employ pesos:to do makdenzwe,cvnouction or repair work on a dwelling of
not more than three units is which the homeowner resides or on the grounds apptttuenwA tb=to am Dot generally omsklcr><d to be
employers under the vmrkc`s oompens4m Ad(GL152,ss 1(5)),application by a homeow=for a license ere permit may evidence the
legal status of an employer under the Walcces C.ompamdion Act
I understand that a copy of this uatemmt may be forwarded to the Deputmecs of IadusbW Aocida&Offioe of Iaxawoe for the
coverage verification and that failure to soatre coverage under section 25A of MOL 152 can lad to the impaskion of criminal peualticn
consisting of a fine atf'up to$1,500.00 anNoc imprbomnat of up to one year and dvil peaaltia in the form of a Stop Work orbs and a
fine of 5100.00 achy agaimt me.
For depaatmrrtal use oily
Permit Number
G/L-(.�`:�i— '�- � x 4�cC Iifapl{ _Lot#
Signa13M of LicenseelPermittee Date
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.
Tbis cols 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
&Paved par kingi
# 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.
LICANT's SIGNATURE
NOTE: lesuanoe of a zoning permit does not relieve an applioanYs burden to comply wltla all
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Publio Works and other applicable permit granting authorities.
FILE #
File No.
DEFT OF SURD i
=� F1TN ERMI T APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
�1. Name of Applicant: L_ 1- )C- IC- r, 1"
ddress: 5- o 62 It� 4- Iti D r L- Telephone: 1s �r S
2. Owner of Property: !/��
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
Job Location:
Parcel Id: Zoning Map# C 3 S Parcel# <v
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
Description of Proposed Us or roject/Occupation: (Use additional sheets if necessary): ___.�_....
fi L 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.
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOkti' ✓ 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 D9cument#
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)
M �
809 RYAN RD BP-2000-0441
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35- 164 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:woodstove BUILDING PERMIT
Permit# BP-2000-0441
Project# JS-2000-0764
Est. Cost: $3500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group:
Lot Size(sq.8.): 46173.60 Owner: KENNEDY SCOTT&STRAUSS SUZANNE
Zoning: SR Applicant:_
AT: 809 RYAN RD
Applicant Address: Phone: Insurance:
ISSUED ON:1012611999 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL WOODSTOVE
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 of Occupancy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 10/26/1999 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo