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37-004 (4) -o tri rn !II 3 L J F ` ' � j r -t H 4 C; rc n 5 Z C O I n Zoning Miscellaneous Additions, Repairs, Alterations, etc. Tel. No. :.5d' -5:66 16 Alterations 44 NORTHAMPTON, MASS. 19 Additions 111 APPLICATION FOR PERMIT TO ALTER Repair / �r Garage, 1. Location .5 7 f Hi re�e_ d Aid r/`I1i. p/ Lot No. 2. Owner's name Ani1CA. fn( L T j P C -t ki Address .11'3 l O r e t JTe 4/. 11) 'i - 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 Q yVICi /d Si t r'Y; re,s h i /e„ 13. Siding house 14. Estimated cost_- /2_0 dT) The undersigned certifies that the above statements are true to the best of his, her knowledge and belief. aro a) ( A ) OrU.mw Signature of responsible annicant Remarks 9 ��`" 'jr, ft :..., c" t Qf Nar*i ant tart ► _ #_ � a � -, ,� , - , SEP 3 0199 , = :' ►— y4 t x�4 xssxr asrtis re m '' = V 1►JSP !..A O1 G`f,t� r�i'S D ARTMENT OF BUILDING INSPECTIONS , p�RtHAM P t dN 212 Main Street 'Municipal Building_ Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AI'NmAVIT ()et re (licenser/permittee) with a principal place of business/residence at: .5 9 d /Trice _ ei Ah 4/rill/pi-Of) M4 (phone #) ,i7.5" (street/city /state/rip) J7O,64) 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) ( ) 1 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) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance CompanyiPolicy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Nnmtrr) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (shade addit oval sled. ifnoccssu) to include infonnafion pertaining to all ooaradors) ( ) 1 am a sole proprietor and have no one working for me. (1. am a home owner performing all the work myself. NOTE: please be aware that while homeowners who employ parson: to do m , construction or repair work on a dwelling of not mom than throe units in with the homeowner resides or cc the grounds appurtenant theccto are not generally considered to be employers under the worker oompeas anon Act (GL152,s3 1(5)), application by a homeowner for a license cc permit may evidence the legal etatus of an employee under the Wonders Compensation Act I understand tad a Dopy of this aatemer t raw bo forwarded to tbo Depar t:owl of Industrial ,a-3& Oflioe of Irrarrtoce for the coverage verification sad that failure to seatre coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties consisting of a fine of up to 51,500.00 andlor imprisonment of up to one year and civil penalties in the form of it Stop Work Order and a fine of 5100.00 a day against me. Signed this day of , 1997 For depadmcotal use only Permit Number '`W... (Y1 , il_.. sL4 Map# Lot # Signature of Liccnsee//Permittce 1 j 11 G IJ X I u�'i $ sEP 3 0 1997 ' 0z r`f Nort � alll p ton . ii' ` .. ('` a �ASOAclittortlz = F �`, �NORTHAMPTON T OF SU.... O IOF G INSPEG#� R MENT OF BUILDING INSPECTIONS :_� =�_ :: MA ' INSPECTOR °1 a Street ' Municipal Building No rtham P ton, Mass. 01060 \tttr air' f HOMEOWNER LICENSE EXEMPTION (� (Please Print) DATE: --q a. 30 i qQ 7 JOB LOCATION: 7 - 4 - SiT /� (Map) (Parcel) (Subdivision) HOMEOWNER: / 1,14 - ,. rn (DeLu.2 rF'ouL'er. (N"ame & Address) / , c!0 '58 7 * st. �h (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. 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. ,,, (444--) 0 HOMEOWNER SIGNATURE /PA /1 , ✓ISZVe BUILDING PERMIT # 10. Do any signs exist on the property? YES NO L/ 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 Pilled in by the Building Department Required Existing Proposed By Zoning Lot size Frontage Setbacks - frnpt - side L: R: L: R: - rear Building height Bldg Square footage %Open Space: (Lot area minus bldg &pa ged parking) # of `parking Spaces it of Loading Docks Fill: vo1 -ume -& location) 13. Certification: I hereby certify that the information contained herein G is true and accurate to the best of my knowledge. DATE : � �� i qq 7 APPLICANT 's SIGNATURE 6LnAlct 0'1 04. ' ?i l,2) NOTE: lassuaricie of air zoning permit does not relieve an a ~ pplioant's burden to oomph/ witty , all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Department of Public, Works and other applicable permit granting authorities. FILE if s�UJS Fr, :51 I , R I; SEP 3 0 1997 DEPT OF BUILDING INSPECTIONS File No. ?, &GQ NORTHAMPTON, WA 01060 ZONING PERMIT APPLICATION ( §10.2 ) PLEASE TYPE OR .PRINT ALL INFORMATION '( Name of Applicant: 14 h✓? /J De L # Address: / lcj i &ic % Nekk n-► jelephone: S <S UcJ /(- 2. Owner of Property: S /9/ Address: `SYrm E Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain): Q 4. Job Location: 79 �z %x ,'"` Parcel Id: Zoning Map# (- Parcel# District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property c,t 6. Description of Proposed Use/Work/Project /Occupation: (Use additional sheets if necessary): • A-64-4( 7 /1/e-k 5 .0,64, 5 „, 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 PermitNariance/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 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) T lJ LS ' lJ U ;.. Lii SEP 3 01997 FILE # 962848 G i l l r l APPLICANT /CO T CT PERSON: __E i 5175 6, D . 'Tr )7'f. WI; VG illi : E NORTHAMPTON, MA OIG' ___ . ,_ PROPERTY LOCATION: '2 9 9 %-4 P al MAP h' PARCEL: s� ZONE 'm IS SECTION FOR - OFFICIAL USE ONLY: . PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FT(INT) MIT t.----- Fee Pair! Building Permit Filler! not `'''-' Fee Pair! ii._ Remodeling Interior A -t,,- CL.ci 41 -/V .1 Addition to FYicting , - -e % ry�� . .•t-11O Accessory Structure Bnildin • ' nc Tnclrrde& • i• .I •.s . •u•1 a • • II •: 3 Sets of Plans / Plot Plan TBE LOWING ACTION HAS BEEN TAKEN ON THIS AP' ICATION: !! //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 -Bd of Health Well Water Potability -Bd Health Permit from Conservatio om r.i / / Signature of Building Insp or Date NOTE: Issuanoe of a zoning permit does not relieve an applioant's burden to oompty with all _ zoning requirements and obtain ail required permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioable permit granting authorities. g City of Northampton REQUIRED ,'� �`'^' a 1. Footings and Walls v : ; / -. BUILDING DEPARTMENT 2. Structural Components in Place* • 3. Complete Building* No. 947 Office of the Building Inspector Zoning Form No. 962848 Date 10/2/97 Fee$ Check # 185 Page, 37 Parcel 4 , Zone SR Section 127 ❑ Yes ® No BUILDING PERMIT * Plumbing and Electrical Inspections required THIS CERTIFIES THAT Anna DeLue Powers before Building Inspections has permission to '6trip & shingle house, garage & sunporch Inspection on Site — Foundations situated on 579 Florence Road Inspection of Plumbing —Rough provided that the person accepting this permit shall in every respect Inspection of Plumbing— Finish conform to the terms of the application on file in this office, and to the Gas Inspection provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring —Rough Maintenance and Inspection of Buildings in the City of Northampton. Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring— Finish of this permit. Expires six months from date of issuance, if not started. Building Inspection —Rough Note: A certificate of occupancy will be issued by this office upon return Insulation Inspection of this card signed by the Plumbing, Wiring and Building Inspectors. Building Inspection— Finish ** Install per Manufacturer's information: windows, vinyl siding, roofs Smoke Detectors (Fire Department) and woodstoves Other THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON TI,PREMISES Certificate of Occupancy ''' - a „� j Building Inspector