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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 Lot No.
2. Owner's name Address
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
\ 4. Addition S c o X v C,A S -�"), X \`-i I
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-
1 The undersigned certifies that the above statements are we to the best of his
knowl ge and beli f.
X
OF . k / ignoturc of responsible appican!
Remarks
a� ��'a C1LZ�' 1�rf ��z#ljttnt�#utt
a e
�assacbtrsctts
m DEPARTMENT OF BUILDDT G INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. ' 01060
WORKER'S COMPENSATION INSURANCE AFMAVIT
with a principal place of business/residence at:
(strtet/city/a gip)
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 following worker's compensation policies:
(Name of Contractor) (I.nsurancc Compauy/Policy Number) (Expirntion Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(anadt additional sheer ifnaocnary to include infucmirioa pertainiag to all matracwn)
( ) I am a sole proprietor and have no one working for me.
r I am a home owner performing all the work myself.
NOTE:please be amt=that tvhilo bomcowo=wtuo amplay pasoas to do ma�o=s:ruC owor r pir work on a dwd&g of
not moce than throe units is which the homoowocr r=ides or oa tho groun&appurten=t tb=w arc not generally oea-datd to be
employers under the wockc`s ooa>Vcr=4oa Act(GL152,ss 1(5)).application by a homeowner for a 6ccax or permit maY cvidcaoe the
legal a— of as employer under the Worl=ds Caoo ansatioa Act_
I understand that a copy of this shtemesrt may be forwwrded to the Dopertoamt of Lxkmtrid AodAux&OiGoe of 1nxxome for the
nova age verification and that failure to swtru covcrngo under snctroa 23A of MOL 152 as tad to the bnpositioa of criminal p-d6a
comisting of a Sme urup to S1,5po.00 and/or icapr6omncot of tip to ow-yew and avt7 pear Wes in the form of a Stop Work Order and a '
Sao of 5100.00 a day against tnc.
For dcput6xdd uaeQM1Y
Permit.Number
a� !• � t ., - I Crif� Jaf Pay fl allyptolY
$ SEP � ' $ a=encl�utttle =
DI.'�jPARTMENT OF BUILDI\1G INSPECTIONS
INSPECTO ptP 212 Mnin Strcct ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEI.IPTION
a ( Please Print )
DATE; 1 �I,
JOB LOCATION: Y)X\11 awl 63 0 c�
(Map) ( Parcel ) ( Subdivision )
HOMEOWNER:
(Name & Address )
ivV7,\u C13
( 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 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 Annot'at 4
HOMEOWNER SIGNATURE `,'q�
BUILDING. PFAzMIT . is
.....=cam� .. _ .�-'-- . °�:�ij%��••
2 4 lqQ
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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 cols W be filled in
by. i.he Pufldin!+ Depart—n?
Required
Existing Proposed By Zoning
Lot size
J
Frontage
Setbacks - i R o
- side L:@.o
' R: 10 D L: R: 1 a-t' '
O
- rear
Building height `a � o70
Bldg Square footage 01 7 LJCD 0 51. 4�' dy4o vP0 len
%Open Space: • o J
(Lot area minus bldg
&paved parkingi
O
# 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.
D7�TE: APPLICANT's SIGNATURE
NOTE: Issua o® f a zoning permit does not relieve an appli n b6rdeA to oomph► W11:4 at1
zoning requirements and obtain all required permits from th Board of Health, Conservation
Commission, Department of Publio Works and other applioa permit granting authorities.
FILE #
Lr►
SEP 2 4199q
r. File No. J✓�
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: \ n
Address: Telephone: I �3 l` (ILL-
2. Owner of Prope ►�
Address: Telephone:
3. Status of Applicant: V/ Crwner Contract Purchaser Lessee
Other(explain):
4. Job Location: ,� vn
Parcel Id: Zoning Map# `—� Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. Existing Use of Structure/Property _ r
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
d
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 Spacial Permi'u^/a,-;a..ce/Firidi,-,g ever been issued for/ors the siie?
NO DON'T KNOWS ✓ 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 V 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)
r
File#BP-2000-0337
APPLICANT/CONTACT PERSON HALE SUSAN&JAMES
ADDRESS/PHONE 27 BAYBERRY LN JIM(W)667-8711 EXT 39
PROPERTY LOCATION 27 BAYBERRY LANE
MAP 35 PARCEL 232 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 , C 9( �"-
Typeof Construction: ERECT 10 X14 STORAGE 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:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commi o
�d
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.
27 BAYBERRY LANE BP-2000-0337
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:35-232 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: shed BUILDING PERMIT
Permit# BP-2000-0337
Project# JS-2000-0551
Est. Cost: $3000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group:
Lot Size(sa.ft.): 48787.20 Owner: HALE SUSAN&JAMES
Zoning: SR Applicant:_
AT: 27 BAYBERRY LANE
Applicant Address: Phone: Insurance:
ISSUED ON:0913011999 0:00:00
TO PERFORM THE FOLLOWING WORK.-ERECT 10 X14 STORAGE 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 of Occupancy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 09/30/1999 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo