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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.S�Q Q1 Alterations
a NORTHAMPTON, MASS._ It) " G' 1 9 9 Additions
APPLICATION FOR PERMIT TO ALTER Repair
r
Garage
Location S(10 ��1:5\ �.t'(' �-1 �L.�GZ �C- ' . ('�\ Ci bc-�, Lot No.
-'2. Owner's name!D C f\,)ft-�t-� Address 't% Q,i Ike L L�21 �N
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
�2. Type of roof!� ��
13. Siding house
Estimated cosF Q Q a
J
The undersigned certifies that the above statements are we to the best of his,
knowledge and belief.
Signature of responsible app.icont
Remarks
4�11ANP�0
� � s 3 was:dtasctts
vV, s EPARTMENT OF BUILDDZC INSPECTIONS
212 Main Street ' Municipal Building .
DEPT OF SUftDIMG INS ' +, `
NORTHAMPT C JNS Northampton, Mass. 01060
ON ARA 010,0
WORKER'S COII?ENSAITON INSURANCE AFFIDAVIT
(li 1Pcrmitt=)
with a principal place of business/residence. at:
✓ , �L11+tU_(1���(}LF FLbfZ1� = 1 • C�)VEa�(pbone#) - �U �
(strt^.t/ci ty/stalrJa p)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the folloNv'ing worker's compensation coverage for my
employees working on this job:
(�nc-- Cody) (Policy Number) (Expiration Date)
( ) I atn a sole proprietor, general contrac�tor or homeowner (circle one) and have hired
the contractors listed below c-rho have the following worker's compensation policies:
(Name of Contractor) (lasuranc—_ Company/PoUcy Numb--:) (Expiration Date)
(Name of Contractor) (Insumn� Company/Policv Numter) (Expiration Due)
(Name of Contractor) (Insurance Comp:ury[PoUcf Numb-r) (Expiration Date)
(Name of Contractor) (Insura icc Comparry/Policy Numb-s) (Expiration Date)
(anich 3ddit3oo2l iSoct if noc=&iry to irfc<a oo perta.iain&to a 000!.C.on)
( ) I and a sole proprietor and have no one worEng for me.
�I am a home owner performing all the work myself.
NOTE plcuc be awa=thdvtiZdo bomco.Avcrs Nbo alloy persom to do ;rd ,,o= cowmscuca•or rcpairwo����d-dliag of
not mmv than throe units is�the boa m ncr rails cc oa tbo grounds apPUex „A tbacty am cot b�Y be
employers uodce tho wocicrr's oompc=dicn Ad(GL152.=1(5)),applir3Don by a bomcowaa fat a liaax a permQ may cvidcnoc the
ievi dxuu of as employee undar the Wocirees compeosu"AcL
I undastiad d%A a copy*[this stdcmmt m.y be focwwd.d to the Dep.rt--A of Ia&uni"Aoodm&Of oe of Lw-c-*-fa d-
oovaage vaiGed 00 sad that failure to toaue covcrvV uadcr section 25A of MOL 152 can lad to tbd imp0d—of aimiaal pmalaa
o(a Mme Df to S1 00 aad�or' of tip to one yex sad eava P®'Iti°iu the form of a stop Wade Ocdcr sad a '
E up.0 ..
fim 0(3100.00 a day qga..iast ma
Fordcyatata�'I"'°°°1X .
Permit Nttmber
,_: . .. sivnant>;-arugmsc Cunt tie
� file:.acharrtt. .t:
Off s
TMENT OP BUILDING INSPECTIONS
INSPECTOR Tain Strect Municipal Building
- Northampton, Mass. 01060 •' `
DEPT OF BUILDING INS' ,,"j&
_ NORTHAMPTON MA 01060
HOi•fEOWNER LICENSE EhE2,1PTION
n ( Please Print )
DATE: U L �1
JOB LOCATION:
(Map) ( Parcel ) ( subdivision)
HO
hiE04,TNER: `�E1�3�?\ S c-,_ z �R.
(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 1 ies 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 Ls, 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
coftstruc,ts more than 'one home in a two-year period shall not be
considered a homeowner. Such "homeowner" shall submit to e'he Building
Official , on a form acceptable to the Building Official, that he/she :
shall. be responsible for all such work performed under: the bui-ldiriq
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 'cam
BUILDING. PFAZMIT #
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 c02u= to be fi22ad i.ri
by tha Dmi2dimg Department
Required
Existing Proposed By Zoning
Lot siz
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&Pac•ed parking%
# 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.
DATE: j '(C,- 1 APPLICANT's SIGNATURE - �
NOTE: Issuanoe of a zoning permit does not relieve an applioant's burden to oompty wlt4 Vali
zoning requirements and obtain all required permits from the Board of Health. Conservation
Commission, Department of Publio Works and other appiloabie permit granting authorities.
FILE #
Fi 1 e No. -emD D 3-7/
DEPT OF$UItDING INSFECI!
NORTHAMPTON, MAOt21MING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:` 1\Jr0!l\ Q— E 5�
Address-S(0 1:%ISM N C rC L r—_ C 1�Telephone: L A I 3
2. Owner of Property:4--)--)l�>'� i
Address: SA 0--sit, __ Telephone:
3. Status of Applicant:—""� Owner Contract Purchaser Lessee
Other(explain):
` t— ► bC��
4. Job Location: �5(o AVt.ST tA} Cir2°t_Li`
Parcel Id: Zoning Map#42 Parcel#_ 7� District(s):_
(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):
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/Vahance/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)
56 AUSTIN CIR BP-2000-0379
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-349 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2000-0379
Project# JS-2000-0617
Est.Cost: $1000.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sa. ft.): 14157.00 Owner: LAKE DIANNE
Zoning.URA Applicant:_
AT: 56 AUSTIN CIR
Applicant Address: Phone: Insurance:
ISSUED ON.•10/06/1999 0:00:00
TO PERFORM THE FOLLOWING WORK.-SHINGLE ROOF OVER EXISTING 1 LAYER
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 10/06/1999 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo