12C-080 (5) > o
70 'v
-s
00
hl 7p o '7 Z
o
v o �
Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. a G 19 'It Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1.
a 1 ( fQ rL Urdy Lot No.
2. Owner's nameja t�t V;111'am �U Gt Cztt✓I+ 9`� �J�Adress t l e2 C4 cc, C1, r-c e II
3. Builder's namefro nV, _��( J�° Address_ H IVO. c
Mass.Construction Supervisor's License No. Expiration Date �-
4. Addition Ali l t�rd��� rn r e rVt u 00W t_> �0 co
5. Alteration 'ci-
0 n t"r o•'1�'�t'�U
6. New Porch N i�
7. Is existing building to be demolished? Ab
8. Repair after the fire IAN
9. Garage Aj D No.of cars Size
10. Method of heating t J
11. Distance to lot lines
12. Type of roof A)
13. Siding house
14. Estimated coscr 1��
The undersigned certifies that the above statements are we to the best of his, her
knowled P and belief.
i nature of res o� ible app,ica 1 /
Remarks- .i�'1i e- aw n .� &J J
3 0
ION MA
17f
• s. k �858AtI)IIStt)4 �
Izi
2 S DEPARTMENT OF BUILDING INSPECTIONS
INSPEC OR'' 212 Main Street ' Municipal Building '
n T j Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION:
(Map) (Parcel) (Subdivision)
HOMEOWNER
IN (Name & Address )
(Home Phone) (Work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or two (2) fami lies. 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.
HOMEOWNER SIGNATURE �� -
BUILDING PEIMIT #
f �
1
g �X�7 la� �LxZ'���11Y�1fIIli ..
Lee
9 Off 2 8 1 Aa sit itch ttsctte
DEPARTMENT OF BUILDING INSPECTIONS
n°'R1 $ 212 Main Street ' Municipal Building '
_._ Northampton, Mass. 01060
WORICER'S COAITENSATION IN"D RA.NCE + + AVIT
(licensecJpermi ite_c}
vnth a principal place of business/residence i_t:
(phonei�)
(stTC—_Uci ty/stald7a p)
do hereby certify, under the pains and penalties of penury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(IIlsi=ce Company) (Polic; Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeostiLer (Cucle one) and have hired
the contractors listed below who have the following worker's compensation policies:
G`11.inC n C011 OC) i,1`.1 i2_''.C:: COi.i7�3nj'�1�011�� ''a'i11CC;1 ��'.ti??lti]Lni1 D2le)
(Mine 0t Cont. ct0r) fll"L""ranc C'orn��li1�iPo�_c; ,�titn�er) (L>piranonD2[e)
---(Name of Contractor) - --(Inairance. Company/PoLicy Numbes) (Expl-.bon Dale)
(Name of Contractor) J==, cn Comoauy/Policy Number) (Expiration Date)
(attach_-_M6cn�l to incluc-_infvmatic�perta:mrc to a!! xdradon)
( ) I am a sole proprietor and have no one worldng for me.
( ) I am a home owner performing all the work myself.
NOTE:please be atruc that vrhilo 1K "ncra wbo a-play pcx_o to do m_xia�0,rx bucYion or rcpaa worst oo a d«clling of
not morn thnn throo units in tv',rich the homoouvcr resian or oa the grounds'PWrten_ni thccto Arc oe(ecacralty ooatickrrd to be
cmployrrs under tho wocl(ct s.compcacaiion Act(GL152-s 1(5)�application by A homeowner fora license cc permit may cvidcocc tho
legal aatua of an employoc under thn Woriccet Compcn 60a AcL
I underhand that a copy of thu ctatcmcnt may bo to the DVut-c of Indium al Atti&--f OfOO of Irzwranoo for th'
coverage verification and that failure to scxttre ccva ii go under section 23A of MIL 152 can lcId to tbn'imposition of criminal penalties
ooaustmg of a-fine'of uP to S1,500.00 an&oc impraotrmcnt of tip to one year And civil pcoillia in the form of a Stop W ork Orda and a .,...
�»of 5100.00.dAy asA�t
For
2vfad�Iqmz
aty
Perot#P L .
SiLGoZhut o' ;.iccnscclPcrmitLcc
10. Do any signs ebst on the property? YES QD—'AP 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 7/'
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This columm to be filled in
by the Building Department
Required I
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 parking)
# of Parking Spaces Z
f of Loading Docks
Fill:
{vol-ume--& location) A.) Aj Ili-
13 . Certification: Thereby certify that the information contained herein
is true and accurate to the best of my k wledge. �- G
DW"E: /� 7/if APPLICANT's SIGNATU , -
NOTE: lssuanoe of a
zoning ?t�
permit does not relieve irn app oan s burden to, mply wit .all
zoning requirements and obtain all required permits from the Board of Health, Conservation
)Commission. Department of Publio works and other applionble permit granting authorities.
FILE if
LS lV Ls i.:
28 f
DEPT. Fi 1 e No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant;�o n +- i l)i6LM .1 lL AL hQQY\ i f l QCC of r- L,U S10-e-
Address: 1I MA rc Telephone: Sky-90 ycl I
2. Owne , f Property_ Inn P QLA 4c4rel
Addre r Ur e -eF =� iic it Chts��i�t ►�1� Telephone. 2� Z
um r)n1c-t �
3. Status of Applicant: �^Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 1A rn6/'C C� j.e
Parcel Id: Zoning Map#� Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property :d-'S ,'d 1?%] ( -t
6. Descri lion of Proposed Use/Work/Project/Occu ation: (Use additional sheets if necessary):
In Pub ��, A C c ,16cl �
\wo ny ok:)`; --
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 P ermit/Variance/Finding ever been issued for/on the site?
NO L,-/ 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-1999-0461
APPLICANT/CONTACT PERSON John LaSelle
ADDRESS/PHONE l I Chestnut St - Chris Duggan 268-9358
PROPERTY LOCATION 11 MARC CIR
MAP 12C PARCEL 080 ZONE URA/WSP
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(a4u
Type of Construction:
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License# t�
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
04— Well Water Potability Board of Health
i # Y
Permit Tr6rn Conservation ommission
Signature of BuildinoOfficial 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.
Department Reference No, BP-1999-0461
Department: ...................................
Building, Electrical & Mechanical Permits
.......................................................................................
Fee Type: Receipt No:
Building - Renovation REC-1999-001263
.........................................................................................
................................
Paid By: Paid in Full On-
.John Laselle Thu Nov 05,1998
............... .........................................................................
......................................
Received By: Check No:
Linda Lapointe 6228
.........................................................................................
......................................
DEPARTMENT'S COPY Amount- S40.00
----------- - -----------
DE.PARTNIFINTFUX, C011Y 11 MARC CIR
CITY OF NORTHAMPTON
BUILDING PERMIT
Owner's pulling their own permits or dealing with unregistered contractors for applicable work do
not have access to Guaranty Fund(MGL 142A)
Issued: Permit No: Inspector: Tracking No.: Fee:
BP-1999-0461 $40.00
GIS Map Block: Lot: Address: Zoning: Use Group:, Lot Size:
869 12C 080 001 11 MARC CIR URA 11499.84
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
Li!li State: Zip Code: Phone:
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0897 alteration-addition $1,130.00
Description of Work:
CONSTRUCT ACCESS RAMP
GeoTIVIS@ 1997 Des Lauriers&Associates, Inc. Signature: