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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS.- 114 19_s Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 13- 11 mi(C t4cLAkQ &y16 Lot No.
2. Owner's name MACZ. S• MPvF►r,-(Z Address 1 C.rheL "A , N bCZT�-1AMPT'01J
3. Builder's name N 1GV-k-0L-PCS 'SDN'E S Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration 1K4-e A1R [-VWFrZ- 1. Vet.-. TL6P� ►moo( �
6. New Porch
7. Is existing building to be demolished? O
S. 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 cost 2� 000
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief.
zrto
S nay a of.poresibfe appicant
Remarks
JUN 2 5 ,g98 ❑ '
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e JUN 2 5 ,1998 $lasaaraDSrlls
DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(licenscrJpermittee)
with a principal place of business/residence at:
N0C 4> �, (phone4)4135eLt I J-3
(stm,..t/ci ty/staLeln p)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the follovyil]g Nvorker's compensation coverage for my
employees working on this job:
(Easurana� Cody) (Policy Number) (Expiration Date)
(fain a sole proprietor, general contractor or omeowner (circle one) and have hired
the contractors listed below who have the follow'Dg wor ens compensation policies-
1 L T►jles ��c-_ � 968 j Y
WA
(Name of Contractor) (Expiration Date)
(Flame of Contractor) (ln-nuianc: Company/Policy Number) (Expiration Date)
A 4
(Name of Contractor) (Insurance Con parry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (E)piration Date)
(attach addidoml*tact ifnoo..ry to inch>dc infocmatioo pcxtaining to all ooatradon)
( ) X am a sole proprietor and have no one worlang for me.
( ) X am a home owner performing all the work myself.
NOTE please be aurae tilt wtnlo homoowocrs who employ perzoa=to do mxk_c___•,,• ooasuuctioa.or rcpa it work on i dwelling of
not mwe them three tzar[=is wbxh the bomoowncr resides a m the DVU06 appartea Xd tbacto are Dot generally coondered to be
etnploycra larder tbo wockces oompcasaiioa Act(GL152,a 1(5))�,application by a homcovm&for a Gecwe a permd may evidcaoe rho
legal gad=of as employer trader tho Wockees compoomtion Act
I uadergst xd that a copy of thin rtat=cat Dray be forwarded to tl a Dgwtmco2 of Inda34ial Aocideohi Ofso0 of lawmaca for the
cover ago va ifladioa aid tbit failure to soatre eoventgo under soctioa 23A of MGL 15Z cm lcad to the imposition of a imiDA pcualtiea
00ausimg Of a-Sae of up to S1,500.00 and(or is aprisoamwt of tip to ow ycw and civil pcaattits in the form of a Stop Work Order aid a
lino of$100.00 a day ag dml tae.
For iqttft=3t1l uao aaly
Pcrmit Number
jot#
2 'ocnsec�Permium I Care
_
'►� .�ASfA[1�11ft��D u J
JUN 2 5 11998 DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 21q Main Street ' Municipal Building
Torthampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION:
(Map) (Parcel) (Subdivision)
HOMEOWNER:- 0AXPA M tC*k4E�L4AA1,J kJG. N OR�1'�1�h 10JJ�t'l�.bt06�
(Name & Address ) '
31� W 4Nr SS4 l000 _..
(Home Phone) (Work Phone)
The current exemption for "homdowners" 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: Persons) 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.�z
HOMEOWNER SIGNATURE
BUILDING PERMIT #
4_
10. Do any signs exist 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 colt 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 parking)
# of -Parking Spaces
#
of Loading Docks
Fill:
-(volume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE:----�1 APPLICANT's SIGNATURE
NOTE: Issuanoe o a zoning permit does not relieve an a i n burden to oompty with 4111
zoning requirements and obtain all required permits from t e 13 and of Health. Conservation
Commission. Department of Publio Works and other applicable permit granting authorities.
FILE #
JUN 2 5 1
998 File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 6yzF'o,
Address: lot EuOvkO • Telephone:
2. Owner of Property: H kfLF''t 6AAEIZ
Address: L lcAt!,—t--NAA.�J AJC— Telephone:
3. Status of Applicant: V Owner _Contract Purchaser Lessee
Other(explain):
4. Job Location: l�h'E
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE UILDING DEPARTMENT)
5, Existing Use of Structure/Property 1 wo �Ly'1i �LM E
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
tZeTzn2. s..-o� TuGee_ i-farzx-j.A
`l. Attached Plans: 540� 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.
S. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO_ DON'T KNOW V" 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)
1 FILF_ # 903 1
JUN 2 5 MB mac.
APPLICAVTIJCONTACT PERSON:
ADDFTS ` >'HONE:
PROPERTY LOCATION: /� J/, ;�.�� ` ?�L
MAP PARCEL: Z5— ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING EORM FH,T,F-T) OUT
1Riyilffin2 Permit Fillerl nut
Remodelinc, Tnterinr
Tnrlyidefi-
Arrrcenr-v �trnrtrrrr
I�11111
THE LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIW
_IZApproved 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
,fir iy, 40 f'
nth Well Water Potability-Bd Health
Per 't from Conservati oinmissio
Signature of Building - ector Date
NOTE:issuance of as zoning permit does not relieve an applioant's burden to comply with all
_ zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Pubiio Works and other applicable permit granting authorities.
4 +
Department: Reference No: BP-1998-0089
----------------------- ..........
Building, Electrical & Mechanical Permits
.-• .................•--...........---•--------...............---•-•-•------------.......
Fee Type: Receipt No:
Building-Renovation REC-1998-000097
Paid By: Paid in Full On:
Marpa Eager Mon Jun 29,1998
.................•-•••-•-----....-•-•--..•••...................-••-•----...............--
--------------••----........----------
Received By: Check No:
Linda Lapointe 440
..........................................•--............................................
......................................
DEPARTMENT'S COPY Amount: $40.00
...........................
DEPARTMENT FILE COPY 17 MICHELMAN AVE
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: m3 Inspector: Tracking No.: Fee:
29 Jun, 1998 BP-1998-0089 J 963717 $40.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
6617 32C 146 001 17 MICHELMAN AVE URC 6403.32
Contractor: License Type: Insurance:
Homeowner as Contractor
Address: License No.: Insurance No.:
City: State: Zip Code: Phone:
Pro*ect No: Category of Work: Const. Class: Cost Estimate:
JS-1998-0093 $2,000.00
Description of Work:
repair lower level of rear porch
GenTMS40 1997 Des Lauriers&Associates.Inc_ Cian�fi.rn•