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1 EP TMENT OF BUILDDT G INSPECTIONS
2'_ ain Street e Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFjgDA.VZT
' (licenscdpermi )
with a principal place of business/residence at:
5 Sr
(street/city/stair/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)
WI am a sole proprietor, general contractor or om-eowne-cucle one) and have hired
`the contractors listed below who have the following oEr's compensation policies-
(Name of ntracwr) (Insvranc-- Company/PoGcy Number) (Expiration Date)
(Name of Contractor) (Innlrancc Compar y/Poky Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoLcy Nwnbe_r) (Fapiration Date)
(Name of Contractor) (Insurance Company/Poky Number) (Lxpimtion Date)
(ankh a6diEoc.1:hoot ifnoeeuuy to include infonnj_6, ,p�rtaiuiag to call wahnCOn)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plcrose be aware thst wElc hoarnwn-n wbo employ perzom to do i
m+*+t___n,•.,,n coas'rualon'or repair work on a dwelling of
not morn than Lbiu traiti in which the homaowncr resides o<oa Lb-0 grounds appurtcnaat thcr t me oot gcoa lly 000si dcrrd to be
employtn under tba work&x ooatpcas4oa Act(GL152,ss 1(5)),application by■bomcowncr for a license cc permit may evidcnoc the
1tV1 status of as omployec uoderthe Woclroet Compomatica Act
I uadaWAt ld thzt x copy of this eratemcof may be forwnraied to tbo D"st need of L>die!A«i&c&ofS of Iawnnoo for the
oov cra veriGcatioa and that kdt=to town eovangn under soctioa 25A of MOL 152 can tad to tba imposition of-!,a l.p-iU,_,a
*Oausu,lgofa-finc7ofuptoSl,500.00=dtcximpr6oamcntor to ono :1
uP Yar and dvr7 pcn4tia in the focm of Stop Work order and a
fum otsloo.00 a day agnias!ive
For dq=tmww nso m1y
Permit Number
Nfap# Lot 9
Signahtt t:taf Liceasee/Perruittoo
to
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Zoning
h4iscellaneous Additions,Repairs,Alterations,etc. Tel.No.5-94-3 act S Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 22 r:r Ac re,b ro o ltc -D P-%v C- Fzo 2&Jc45 /i k , Lot No.
2. Owner's name IwAl?l 4yn1 Address 2 2-"c fe bruo �N l"2 4 JCS'
3. Builder's name /ddi ,Gear Poa/s 'OL-Sna S Address `� Eae, 7: CI7 ICQ0-ta ,MA
Mass.Construction Supervisor's License No. Expiration Date 218LO /
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. Siding house
14. Estimated cost- 066 00-r
The undersigned certifies that the above statements are we to the best of his,
"(knowledge and belief..
aot-
Signature of responsible app. ant
Remarks
.-
VLAM
�. 'Nor liailt�pfail Ix
$ B �;u �{ �asartchuaclle
DEPARTWNT OF BUILDD\7G INSPECTIONS
INSPECTOR 212 A1nin Strcct ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEriPTION
( Please Print )
DATE:
JOB LOCATION:
(Map) ( Parcel ) ( Subdivision)
HOMEOWNER: MA/ft-YE) PilkOy
( Name & Address )
PIC a- 4 3-2.2
(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.
� HOMEOWNER SIGNATURE
BUILDING. PERMIT
t '
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 _ NOX_
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 $wilding Department
Required
Existing Proposed By Zoning
Lot size
J
Frontage
Setbacks frnnt
- side L: R: L: R:
- rear
Building height '1
Bldg Square footage
_ 7
%Open Space: -
1
(Lot area minus bldg
&paved parking)
# of -Parking spaces
ht '6f Loading Docks
Fill:
-(volume-& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
.1
DATE: /o?$ ���' APPLICANT's SIGNATURE
NOTE: Issuanoe of a zoning permit does not relieve an a lioa is burden to a, ply Wit4 +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.
FILE #
File Alqff
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ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 41W- tl A 61�t/'
Address:22- . FL k C� Telephone: 54" 33 Q S'
Yh e
2. Owner of Property:a de/GYN Au,er�y
Address: gazAcir"k Dyt,. FLZOEEKX� _Telephone: 674-3395'
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: Arakr /,c 'ipjQ FLorc nUCLc ,miQ, O/o6 2
Parcel Id: Zoning Map# Parcel# p District(s):_��� /2
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
01}� a,�a>"e u�rrnc.►�cl noc� ��� bccekuarc�
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/Vadance/Finding ever been issued for/on the site?
NO DON'T KNOW X 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__k _ 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)
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File#BP-1999-1144
APPLICANT/CONTACT PERSON PURDY MARILYN A
ADDRESS/PHONE 228 ACREBROOK DR 584-3395
PROPERTY LOCATION 228 ACREBROOK DR
MAP 29 PARCEL 337 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid / p
Typeof Construction: INSTALL 15'DETACHED ABOVE GROUND POOL
New Construction
Non Structural interior renovations ,
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
Tv OLLOWING 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
a
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 Comm
L..
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 a
of public works and other applicable permit granting authorities.
-0"
�4 ROOK DR BP-1999-1 144
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GIS#: COMMONWEALTH OF MASSACHUSETTS
:Block:"29 337 CITY OF NORTHAMPTON
Lot:-001
Permit: Buildina
Category:Above ground pool BUILDING PERMIT
Permit# BP-1999-1144
Proiect# JS-1999-1898
Est.Cost: $6000.00
Fee:$20.00 PERMISSION IS HEREBY GRANTED TO
Const. Class: Contractor: License:
Use Group:
Lot Size(sq.ft.): 10018.80 Owner: PURDY MARILYN A
zoo Applicant:
AT. 228 ACREBROOK DR
Applicant Address: Phone: Insurance:
ISSUED ON.71611999 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 15' DETACHED ABOVE GROUND POOL
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 7/6/1999 0:00:00 $20.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
y